med surge nursing cardio prep u ch 25 questions wi
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Med-Surge Nursing Cardio Prep U ch 25
Which term describes the amount of blood ejected per heartbeat? - ✅✅-stroke
volume
Stroke volume is determined by preload, afterload, and contractility of the heart.
Cardiac output is the amount of blood pumped by each ventricle during a given
period and is computed by multiplying the stroke volume of the heart by the heart
rate. Ejection fraction is the percentage of the end-diastolic volume that is ejected
with each stroke, measured at 42% to 50% in the normal heart. Afterload is defined
as the pressure that the ventricular myocardium must overcome to eject blood during
systole and is one of the determinants of stroke volume.
A client is being scheduled for a stress test. The client is unable to exercise during
✅✅
the test. The nurse would include information about which medication used for
pharmacologic stress testing? - -Dipyridamole
If the patient is unable to exercise, a pharmacologic stress test is performed by
injecting a vasodilating agent, dipyridamole or adenosine, to mimic the physiologic
effects of exercise. The stress test may be combined with an echocardiogram or
radionuclide imaging techniques to examine myocardial function during exercise and
rest. Digoxin would not be used for stress testing. Thallium 201 and Cardiolite are
radioisotopes used in myocardial perfusion scanning.
The nurse is preparing a client for a transesophageal echocardiography. What will be
✅✅
an indication for the client to have a transesophageal echocardiography? -
-Determination of atrial thrombi
The TEE is an important diagnostic tool for determining if atrial or ventricular thrombi
are present in patients with heart failure, valvular heart disease, and dysrhythmias.
The electrocardiogram (ECG) is a graphic recording of the electrical activity of the
heart to determine dysrhthmias. Stress testing is used to evaluate the response of
the cardiovascular system to increased demands for oxygen and nutrients. Thallium
is used with exercise or pharmacologic stress testing to assess changes in
myocardial perfusion at rest and after exercise.
A client with a history of right-sided heart failure lives in a long-term care facility. In
✅✅
the daily assessment, the nurse is required to record the level of this client's
peripheral edema. Which would be the main area for examination? - -feet and
ankles
Edema occurs when blood is not pumped efficiently or plasma protein levels are
inadequate to maintain osmotic pressure. When blood has nowhere else to go, the
extra fluid enters the tissues. Particular areas for examination are the dependent
,parts of the body, such as the feet and ankles. The area over, not below, the sacrum
is another area prone to edema.
The nurse is caring for a client who is diagnosed with an infarction of the posterior
✅✅
wall of the right atrium. Which assessment finding would the nurse anticipate relating
to the infarction location? - -Irregular heart rate
The posterior wall of the right atrium is the location of the sinoatrial node (SA node),
which is the pacemaker of the heart. Damage to this location may result in an
irregular heart rate due to a disturbance of electrical pulse initiation. Depending on
muscle damage, the client may have respiratory compromise, chest pain, and/or
cyanosis.
The balloon on the distal tip of a pulmonary artery catheter is inflated and the
✅✅
pressure is measured. What is the term for the measurement obtained? -
-pulmonary artery wedge pressure
When the balloon is inflated, the tip of the catheter floats into smaller branches of the
pulmonary artery until it can no longer be passed. The pressure is recorded,
reflecting left-atrial pressure and left-ventricular end-diastolic pressure. Central
venous pressure is measured in the right atrium. Pulmonary artery pressure is
measured when the balloon tip is not inflated. Cardiac output is determined through
thermodilution, which involves injection of fluid into the pulmonary artery catheter.
✅✅
A student nurse prepares to assess a client for postural blood pressure changes.
Which action indicates the student nurse needs further education? - -letting 30
seconds elapse after each position change before measuring BP and HR
The following steps are recommended when assessing clients for postural
hypotension:
(1) Position the client supine for 10 minutes before taking the initial BP and HR
measurements;
(2) reposition the client to a sitting position with legs in the dependent position, and
wait 2 minutes to reassess both BP and HR measurements;
(3) if the client is symptom free or has no significant decreases in systolic or diastolic
BP, assist the client into a standing position, obtain measurements immediately and
recheck in 2 minutes;
(4) continue measurements every 2 minutes for a total of 10 minutes to rule out
postural hypotension. Return the client to supine position if postural hypotension is
detected or if the client becomes symptomatic. Document HR and BP measured in
each position (e.g., supine, sitting, and standing) and any signs or symptoms that
accompanied the postural changes.
, A client is experiencing an irregular heartbeat. The client asks the nurse how a
heartbeat occurs. The nurse explains the conduction system of the heart beginning
✅✅
with the sinoatrial node (SA node). Place the conduction sequence of the heart in
order beginning with the SA node. Use all options. - -1. Atrial cell stimulation
2. AV node
3. Bundle of His
4. Bundle branches
5. Purkinje fibers
In the normal sequence, the impulse starts in the SA node. The waves of stimulation
spread through the atria to the AV node. The impulse then travels from the AV node
to the bundle of His, then to the right and left bundle branches, and eventually to the
Purkinje fibers.
The nurse is caring for a client in the cardiac intensive care unit (CICU) after a
✅✅
myocardial infarction (MI). Which drug will the nurse administer that will decrease
contractility? - -Metoprolol
Contractility is depressed by beta-adrenergic blocking medications. The other
choices all enhance contractility.
The nurse is administering an Amiodarone drip for a client that develops a ventricular
✅✅
dysrhythmia after having a myocardial infarction (MI). What is the best indication that
the medication is having the desired effect? - -electrocardiogram (ECG)
Lidocaine is an antiarrhythmic and is given for the treatment of cardiac irritability and
ventricular arrhythmias. The best indicator of its effectiveness is a reduction in or
disappearance of ventricular arrhythmias as seen on an ECG. Urine output is an
indicator of pump effectiveness; CK and troponin levels monitor myocardial damage.
Blood pressure and heart rate measurements are too nonspecific to help determine
the effectiveness of parenteral lidocaine.
✅✅
A nurse is preparing a client for an exercise stress test the following morning. Which
client statement indicates a need for additional teaching? - -"I won't eat or drink
anything after midnight tonight."
The client requires additional teaching if he states that he'll fast from midnight until
the test. Clients need to abstain from eating and drinking for only 4 hours before the
test. The client should refrain from smoking for several hours before the test.
Although the physician may direct the client to avoid certain medications, it's more
likely that the physician will direct the client to take all his normal medications. The
client must sign a consent form before the test.
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