Cardiac MI and HF

1)
Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of
coronary artery disease?

1.
2.
3.
4.
2)

Decrease anxiety
Enhance myocardial oxygenation
Administer sublingual nitroglycerin
Educate the client about his symptoms
Medical treatment of coronary artery disease includes which of the following procedures?

1.
2.
3.
4.
3)

Cardiac catherization
Coronary artery bypass surgery
Oral medication therapy
Percutaneous transluminal coronary angioplasty
Which of the following is the most common symptom of myocardial infarction (MI)?

1. Chest pain
2. Dyspnea
3. Edema
4. Palpitations
4)
Which of the following symptoms is the most likely origin of pain the client described as knifelike chest
pain that increases in intensity with inspiration?

1.
2.
3.
4.
5)

Cardiac
Gastrointestinal
Musculoskeletal
Pulmonary
Which of the following blood tests is most indicative of cardiac damage?

1.
2.
3.
4.
6)

Lactate dehydrogenase
Complete blood count (CBC)
Troponin I
Creatine kinase (CK)
What is the primary reason for administering morphine to a client with an MI?

1.
2.
3.
4.
7)

To sedate the client

To decrease the clients pain
To decrease the clients anxiety
To decrease oxygen demand on the clients heart
Which of the following conditions is most commonly responsible for myocardial infarction?

1.
2.
3.
4.
8)

Aneurysm
Heart failure
Coronary artery thrombosis
Renal failure
Which of the following complications is indicated by a third heart sound (S3)?

1. Ventricular dilation
2. Systemic hypertension
3. Aortic valve malfunction
4. Increased atrial contractions
9)
After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation
of crackles in the lungs?

1. Left-sided heart failure

2. Pulmonic valve malfunction
3. Right-sided heart failure
4. Tricupsid valve malfunction
10) What is the first intervention for a client experiencing MI?

1. Administer morphine
2. Administer oxygen
3. Administer sublingual nitroglycerin
4. Obtain an ECG
11) Which of the following classes of medications protects the ischemic myocardium by blocking
catecholamines and sympathetic nerve stimulation?

1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Narcotics
4. Nitrates
12) What is the most common complication of an MI?

1. Cardiogenic shock
2. Heart failure
3. arrhythmias
4. Pericarditis
13) With which of the following disorders is jugular vein distention most prominent?

1. Abdominal aortic aneurysm

2. Heart failure
3. MI
4. Pneumothorax
14) Toxicity from which of the following medications may cause a client to see a green-yellow halo around
lights?

1. Digoxin
2. Furosemide (Lasix)
3. Metoprolol (Lopressor)
4. Enalapril (Vasotec)
15) Which of the following symptoms is most commonly associated with left-sided heart failure?

1. Crackles
2. Arrhythmias
3. Hepatic engorgement
4. Hypotension
16) In which of the following disorders would the nurse expect to assess sacral edema in a bedridden client?

1. Diabetes
2. Pulmonary emboli
3. Renal failure
4. Right-sided heart failure
17) Which of the following symptoms might a client with right-sided heart failure exhibit?

1.
2.
3.
4.

Adequate urine output

Polyuria
Oliguria
Polydipsia

18) Which of the following classes of medications maximizes cardiac performance in clients with heart failure
by increasing ventricular contractibility?

1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Diuretics
4. Inotropic agents
19) Stimulation of the sympathetic nervous system produces which of the following responses?

1. Bradycardia
2. Tachycardia
3. Hypotension
4. Decreased myocardial contractility
20) Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in
urine output?

1. Angina pectoris
2. Cardiomyopathy
3. Left-sided heart failure
4. Right-sided heart failure
21) Which of the following heart muscle diseases is unrelated to other cardiovascular disease?

1. Cardiomyopathy
2. Coronary artery disease
3. Myocardial infarction
4. Pericardial effusion
22) Which of the following types of cardiomyopathy can be associated with childbirth?

1. Dilated
2. Hypertrophic
3. Myocarditis
4. Restrictive
23) Septal involvement occurs in which type of cardiomyopathy?

1. Congestive
2. Dilated
3. Hypertrophic
4. Restrictive
24) Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?

1. Heart failure
2. Diabetes
3. MI
4. Pericardial effusion
25) Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the
following conditions?

1. Pericarditis
2. Hypertension
3. MI
4. Heart failure
26) In which of the following types of cardiomyopathy does cardiac output remain normal?

1. Dilated
2. Hypertrophic
3. Obliterative
4. Restrictive
27) Which of the following cardiac conditions does a fourth heart sound (S4) indicate?

1. Dilated aorta
2. Normally functioning heart
3. Decreased myocardial contractility
4. Failure of the ventricle to eject all of the blood during systole
28) Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?

1. Antihypertensives
2. Beta-adrenergic blockers
3. Calcium channel blockers
4. Nitrates
29) If medical treatments fail, which of the following invasive procedures is necessary for treating
cariomyopathy?

1. Cardiac catherization
2. Coronary artery bypass graft (CABG)
3. Heart transplantation
4. Intra-aortic balloon pump (IABP)
30) Which of the following conditions is associated with a predictable level of pain that occurs as a result of
physical or emotional stress?

1. Anxiety
2. Stable angina
3. Unstable angina
4. Variant angina
31) Which of the following types of angina is most closely related with an impending MI?

1. Angina decubitus
2. Chronic stable angina
3. Noctural angina
4. Unstable angina
32) Which of the following conditions is the predominant cause of angina?

1. Increased preload
2. Decreased afterload
3. Coronary artery spasm
4. Inadequate oxygen supply to the myocardium
33) Which of the following tests is used most often to diagnose angina?

1. Chest x-ray
2. Echocardiogram
3. Cardiac catherization
4. 12-lead electrocardiogram (ECG)
34) Which of the following results is the primary treatment goal for angina?

1.
2.
3.
4.

Reversal of ischemia
Reversal of infarction
Reduction of stress and anxiety
Reduction of associated risk factors

35) Which of the following interventions should be the first priority when treating a client experiencing chest
pain while walking?

1. Sit the client down

2. Get the client back to bed
3. Obtain an ECG
4. Administer sublingual nitroglycerin
36) Myocardial oxygen consumption increases as which of the following parameters increase?

1. Preload, afterload, and cerebral blood flow

2. Preload, afterload, and renal blood flow
3. Preload, afterload, contractility, and heart rate.
4. Preload, afterload, cerebral blood flow, and heart rate.
37) Which of the following positions would best aid breathing for a client with acute pulmonary edema?

1. Lying flat in bed

2. Left side-lying
3. In high Fowlers position
4. In semi-Fowlers position
38) Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema?

1. Anoxia
2. Hypercapnia
3. Hyperoxygenation
4. Hypocapnia
39) Which of the following is a compensatory response to decreased cardiac output?

1. Decreased BP
2. Alteration in LOC
3. Decreased BP and diuresis
4. Increased BP and fluid retention
40) Which of the following actions is the appropriate initial response to a client coughing up pink, frothy
sputum?

1. Call for help

2. Call the physician
3. Start an I.V. line
4. Suction the client
41) Which of the following terms describes the force against which the ventricle must expel blood?

1. Afterload
2. Cardiac output
3. Overload
4. Preload
42) Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following
areas of the heart?

1. Left atrium
2. Right atrium
3. Left ventricle
4. Right ventricle
43) An 18-year-old client who recently had an URI is admitted with suspected rheumatic fever. Which
assessment findings confirm this diagnosis?

1. Erythema marginatum, subcutaneous nodules, and fever

2. Tachycardia, finger clubbing, and a load S3
3. Dyspnea, cough, and palpitations
4. Dyspnea, fatigue, and synocope
44) A client admitted with angina compains of severe chest pain and suddenly becomes unresponsive. After
establishing unresponsiveness, which of the following actions should the nurse take first?

1. Activate the resuscitation team

2. Open the clients airway
3. Check for breathing
4. Check for signs of circulation
45) A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission
interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better.
Which of the following nursing diagnoses takes priority for this client?

1. Anxiety
2. Ineffective tissue perfusion; cardiopulmonary
3. Acute pain
4. Ineffective therapeutic regimen management
46) A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy sputum.
Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of
38 breaths/minute. The clients medical history included DM, HTN, and heart failure. Which of the following
disorders should the nurse suspect?

1. Pulmonary edema
2. Pneumothorax
3. Cardiac tamponade
4. Pulmonary embolus
47) The nurse coming on duty receives the report from the nurse going off duty. Which of the following clients
should the on-duty nurse assess first?

1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a respiratory rate of
21 breaths a minute.
2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order.
3. The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV heparin.
4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV
diltiazem (Cardizem).
48) When developing a teaching plan for a client with endocarditis, which of the following points is most
essential for the nurse to include?

1. Report fever, anorexia, and night sweats to the physician.

2. Take prophylactic antibiotics after dental work and invasive procedures.
3. Include potassium rich foods in your diet.
4. Monitor your pulse regularly.
49) A nurse is conducting a health history with a client with a primary diagnosis of heart failure. Which of the
following disorders reported by the client is unlikely to play a role in exacerbating the heart failure?

1. Recent URI
2. Nutritional anemia
3. Peptic ulcer disease
4. A-Fib
50) A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital
from the physicians office. The nurse would plan on having which of the following medications readily
available for use?

1. Diltiazem (Cardizem)
2. Digoxin (Lanoxin)
3. Propranolol (Inderal)
4. Metoprolol (Lopressor)
51) A nurse caring for a client in one room is told by another nurse that a second client has developed severe
pulmonary edema. On entering the 2nd clients room, the nurse would expect the client to be:

1. Slightly anxious
2. Mildly anxious
3. Moderately anxious
4. Extremely anxious
52) A client with pulmonary edema has been on diuretic therapy. The client has an order for additional
furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin
(Lanoxin), a nurse checks the clients most recent:

1. Digoxin level
2. Sodium level
3. Potassium level
4. Creatinine level
53) A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client
received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory
results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the
client is at risk for:

1. Hypovolemia
2. UTI
3. Glomerulonephritis
4. Acute renal failure
54) A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do
which of the following to enable the client to best tolerate the ambulation?

1. Encourage the client to cough and deep breathe

2. Premedicate the client with an analgesic
3. Provide the client with a walker
4. Remove telemetry equipment because it weighs down the hospital gown.
55) A clients electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR
interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is:

1. Normal sinus rhythm

2. Sinus bradycardia
3. Sinus tachycardia
4. Sinus dysrhythmia
56) A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned
with this dysrhythmia because:

1. It is uncomfortable for the client, giving a sense of impending doom.

2. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.
3. It is almost impossible to convert to a normal sinus rhythm.
4. It can develop into ventricular fibrillation at any time.
57) A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the treatment of heart
failure. The nurse would particularly assess the client for:

1. Thrombocytopenia and weight gain

2. Anorexia, nausea, and visual disturbances
3. Diarrhea and hypotension

4. Fatigue and muscle twitching

58) A client with angina complains that the angina pain is prolonged and severe and occurs at the same time
each day, most often in the morning, On further assessment a nurse notes that the pain occurs in the absence
of precipitating factors. This type of anginal pain is best described as:

1. Stable angina
2. Unstable angina
3. Variant angina
4. Nonanginal pain
59) The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing
actions include which of the following?

1. Obtaining an infusion pump for the medication

2. Monitoring BP q4h
3. Monitoring urine output hourly
4. Obtaining serum potassium levels daily
60) Aspirin is administered to the client experiencing an MI because of its:

1. Antipyrectic action
2. Antithrombotic action
3. Antiplatelet action
4. Analgesic action
61) Which of the following is an expected outcome for a client on the second day of hospitalization after an
MI?

1. Has severe chest pain

2. Can identify risks factors for MI
3. Agrees to participate in a cardiac rehabilitation walking program
4. Can perform personal self-care activities without pain
62) Which of the following reflects the principle on which a clients diet will most likely be based during the
acute phase of MI?

1. Liquids as ordered
2. Small, easily digested meals
3. Three regular meals per day
4. NPO
63) An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual
because of:

1. Left ventricular atrophy

2. Irregular heartbeats
3. peripheral vascular occlusion
4. Pacemaker placement
64) Which of the following nursing diagnoses would be appropriate for a client with heart failure? Select all
that apply.

1. Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac
output.
2. Activity intolerance related to increased cardiac output.
3. Decreased cardiac output related to structural and functional changes.
4. Impaired gas exchange related to decreased sympathetic nervous system activity.
65) Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary
edema?

1. Risk for infection related to stasis of alveolar secretions

2. Impaired skin integrity related to pressure
3. Activity intolerance related to pump failure
4. Constipation related to immobility
66) Captopril may be administered to a client with HF because it acts as a:

1. Vasopressor
2. Volume expander
3. Vasodilator
4. Potassium-sparing diuretic
67) Furosemide is administered intravenously to a client with HF. How soon after administration should the nurse
begin to see evidence of the drugs desired effect?

1. 5 to 10 minutes
2. 30 to 60 minutes
3. 2 to 4 hours
4. 6 to 8 hours
68) Which of the following foods should the nurse teach a client with heart failure to avoid or limit when
following a 2-gram sodium diet?

1. Apples
2. Tomato juice
3. Whole wheat bread
4. Beef tenderloin
69) The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects:

1. Left atrial enlargement

2. Left ventricular enlargement
3. Right atrial enlargement
4. Right ventricular enlargement
ANSWERS

1. 2. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of
cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual
nitroglycerin is administered to treat acute angina, but administration isnt the first priority. Although
educating the client and decreasing anxiety are important in care delivery, neither are priorities when
a client is compromised.
2. 3. Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac
catherization isnt a treatment, but a diagnostic tool. Coronary artery bypass surgery and
percutaneous transluminal coronary angioplasty are invasive, surgical treatments.
3. 1. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart.
Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the
body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result
from reduced cardiac output, producing arrhythmias.
4. 4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases with
movement. Cardiac and GI pains dont change with respiration.
5. 3. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels arent
detectable in people without cardiac injury. Lactate dehydrogenase (LDH) is present in almost all
body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury.
CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes.
Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac
injury.
6. 4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease
pain and anxiety while causing sedation, but it isnt primarily given for those reasons.
7. 3. Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is
an outpouching of a vessel and doesnt cause an MI. Renal failure can be associated with MI but isnt
a direct cause. Heart failure is usually a result from an MI.
8. 1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or

systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as a
murmur.
9. 1. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease
in left ventricular function. When the left ventricle doesnt function properly, resulting in left-sided heart
failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles.
Pulmonic and tricuspid valve malfunction causes right sided heart failure.
10.
2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is
deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation
and prevent further damage. Morphine and nitro are also used to treat MI, but theyre more
commonly administered after the oxygen. An ECG is the most common diagnostic tool used to
evaluate MI.
11.
1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the
response to catecholamines and sympathetic nerve stimulation. They protect the myocardium,
helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium
channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce
myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce
myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and
systemic vascular resistance (afterload).
12.
3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common
complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage
of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because
the pumping function of the heart is compromised by an MI, heart failure is the second most common
complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after
the MI.
13.
2. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to
pump. JVD isnt a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough,
can progress to heart failure, however, in and of itself, an MI doesnt cause JVD.
14.
1. One of the most common signs of digoxin toxicity is the visual disturbance known as the greenyellow halo sign. The other medications arent associated with such an effect.
15.
1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid
backing up into the pulmonary system. Arrhythmias can be associated with both right- and left-sided
heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the
system.
16.
4. The most accurate area on the body to assess dependent edema in a bed-ridden client is the
sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.
17.
3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid
retention, which causes oliguria.
18.
4. Inotropic agents are administered to increase the force of the hearts contractions, thereby
increasing ventricular contractility and ultimately increasing cardiac output.
19.
2. Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. The
other symptoms listed are related to the parasympathetic nervous system, which is responsible for
slowing the heart rate.
20.
4. Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart
failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart
failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesnt
cause weight gain, nausea, or a decrease in urine output.
21.
1. Cardiomyopathy isnt usually related to an underlying heart disease such as atherosclerosis. The
etiology in most cases is unknown. CAD and MI are directly related to atherosclerosis. Pericardial
effusion is the escape of fluid into the pericardial sac, a condition associated with Pericarditis and
advanced heart failure.
22.
1. Although the cause isnt entirely known, cardiac dilation and heart failure may develop during the
last month of pregnancy or the first few months after birth. The condition may result from a preexisting
cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal
symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis
isnt specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive
pericarditis; the underlying cause is usually myocardial.
23.
3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septumnot the ventricle
chambersis apparent. This abnormality isnt seen in other types of cardiomyopathy.
24.
1. Because the structure and function of the heart muscle is affected, heart failure most commonly
occurs in clients with cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced
blood flow through one of the coronary arteries. Pericardial effusion is most predominant in clients with
pericarditis.
25.
4. These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest and
auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual
disturbances, and a flushed face. MI causes heart failure but isnt related to these symptoms.
26.
2. Cardiac output isnt affected by hypertrophic cardiomyopathy because the size of the ventricle

27.

28.

29.
30.

31.
32.
33.

34.
35.
36.
37.

38.
39.

40.
41.

42.

43.

44.

45.

remains relatively unchanged. All of the rest decrease cardiac output.

4. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The
increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesnt
cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is
heard as a third heart sound. An S4 isnt heard in a normally functioning heart.
2. By decreasing the heart rate and contractility, beta-blockers improve myocardial filling and
cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives arent
usually indicated because they would decrease cardiac output in clients who are already
hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers;
however, they arent as effective as beta-blockers and cause increased hypotension. Nitrates arent
used because of their dilating effects, which would further compromise the myocardium.
3. The only definitive treatment for cardiomyopathy that cant be controlled medically is a heart
transplant because the damage to the heart muscle is irreversible.
2. The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum
intensity. Unstable angina doesnt always need a trigger, is more intense, and lasts longer than stable
angina. Variant angina usually occurs at restnot as a result of exercise or stress.
4. Unstable angina progressively increases in frequency, intensity, and duration and is related to an
increased risk of MI within 3 to 18 months.
4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina.
Increased preload would be responsible for right-sided heart failure. Decreased afterload causes
increased cardiac output. Coronary artery spasm is responsible for variant angina.
4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina,
the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart
failure, but isnt used to diagnose angina.
1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and
increasing oxygen supply. An infarction is permanent and cant be reversed.
1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the
client down. An ECG can be obtained after the client is sitting down. After the ECGm sublingual nitro
would be administered. When the clients condition is stabilized, he can be returned to bed.
3. Myocardial oxygen consumption increases as preload, afterload, renal contractility, and heart rate
increase. Cerebral blood flow doesnt directly affect myocardial oxygen consumption.
3. A high Fowlers position promotes ventilation and facilitates breathing by reducing venous return.
Lying flat and side-lying positions worsen the breathing and increase workload of the heart. SemiFowlers position wont reduce the workload of the heart as well as the Fowlers position will.
4. In an attempt to compensate for increased work of breathing due to hyperventilation, carbon
dioxide decreases, causing hypocapnea. If the condition persists, CO2 retention occurs and
hypercapnia results.
4. The body compensates for a decrease in cardiac output with a rise in BP, due to the stimulation of
the sympathetic NS and an increase in blood volume as the kidneys retain sodium and water. Blood
pressure doesnt initially drop in response to the compensatory mechanism of the body. Alteration in
LOC will occur only if the decreased cardiac output persists.
1. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the client is
at high risk for decompensation, the nurse should call for help but not leave the room. The other three
interventions would immediately follow.
1. Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the
condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles.
Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an
abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of
diastole.
3. The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is
damaged, the output decreases and fluid accumulates in the interstitial and alveolar spaces, causing
pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldnt affect
cardiac output or, therefore, the onset of pulmonary edema. If the right atrium and right ventricle
were damaged, right-sided heart failure would result.
1. Diagnosis of rheumatic fever requires that the client have either two major Jones criteria or one
minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis,
polyarthritis, Sydenhams chorea, subcutaneous nodules, and erythema maginatum (transient,
nonprurtic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include
fever, arthralgia, elevated levels of acute phase reactants, and a prolonged PR-interval on ECG.
1. Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team.
The next step is to open the airway using the head-tilt, chin-lift maneuver and check for breathing
(looking, listening, and feeling for no more than 10-seconds). If the client isnt breathing, give two slow
breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid
pulse.
2. MI results from prolonged myocardial ischemia caused by reduced blood flow through the
coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion

46.
47.

48.

49.

50.

51.
52.

53.

54.

55.
56.

57.
58.

59.
60.
61.

62.

63.

(cardiopulmonary). Anxiety, acute pain, and ineffective therapeutic regimen management are
appropriate but dont take priority.
1. SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy sputum are
late signs of pulmonary edema.
4. The client with A-fib has the greatest potential to become unstable and is on IV medication that
requires close monitoring. After assessing this client, the nurse should assess the client with
thrombophlebitis who is receiving a heparin infusion, and then go to the 58-year-old client admitted 2days ago with heart failure (her s/s are resolving and dont require immediate attention). The lowest
priority is the 89-year-old with end stage right-sided heart failure, who requires time consuming
supportive measures.
1. The most essential teaching point is to report signs of relapse, such as fever, anorexia, and night
sweats, to the physician. To prevent further endocarditis episodes, prophylactic antibiotics are taken
before and sometimes after dental work, childbirth, or GU, GI, or gynecologic procedures. A
potassium-rich diet and daily pulse monitoring arent necessary for a client with endocarditis.
3. Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections,
anemia, thyroid disorders, pregnancy, Pagets disease, nutritional deficiencies (thiamine, alcoholism),
pulmonary disease, and hypervolemia.
2. Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a
variety of mechanisms. Digoxin is the medication of choice to treat heart failure. Diltiazem (calcium
channel blocker) and propranolol and metoprolol (beta blockers) have a negative inotropic effect
and would worsen the failing heart.
4. Pulmonary edema causes the client to be extremely agitated and anxious. The client may
complain of a sense of drowning, suffocation, or smothering.
3. The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened
digitalis effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also
predisposes the client to ventricular dysrhythmias.
4. The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low
cardiac output, or vasopressor medication therapy. Renal insult is signaled by decreased urine output,
and increased BUN and creatinine levels. The client may need medications such as dopamine
(Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.
2. The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac
surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from
pain, and allow better participation in activities such as coughing, deep breathing, and ambulation.
Options 1 and 3 will not help in tolerating ambulation. Removal of telemetry equipment is
contraindicated unless prescribed.
1.
4. Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus
that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly
to cerebral and myocardial ischemia. Clients frequently experience a feeling of impending death.
Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate,
cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can
deteriorate into ventricular defibrillation at any time.
2. The first signs and symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual
disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and other
dysrhythmias.
3. Stable angina is induced by exercise and is relieved by rest or nitroglycerin tablets. Unstable angina
occurs at lower and lower levels of activity and rest, is less predictable, and is often a precursor of
myocardial infarction. Variant angina, or Prinzmetals angina, is prolonged and severe and occurs at
the same time each day, most often in the morning.
1. IV nitro infusion requires an infusion pump for precise control of the medication. BP monitoring would
be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are
not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.
2. Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason ASA is
administered to the client experiencing an MI is its antithrombotic action.
4. By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care
without chest pain. Day 2 hospitalization may be too soon for clients to be able to identify risk factors
for MI or begin a walking program; however, the client may be sitting up in a chair as part of the
cardiac rehabilitation program. Severe chest pain should not be present.
2. Recommended dietary principles in the acute phase of MI include avoiding large meals because
small, easily digested foods are better digested foods are better tolerated. Fluids are given according
to the clients needs, and sodium restrictions may be prescribed, especially for clients with
manifestations of heart failure. Cholesterol restrictions may be ordered as well. Clients are not
prescribed a diet of liquids only or NPO unless their condition is very unstable.
1. In older adults who are less active and do not exercise the heart muscle, atrophy can result. Disuse
or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result,
under sudden emotional or physical stress, the left ventricle is less able to respond to the increased

demands on the myocardial muscle.

1 and 3. HF is a result of structural and functional abnormalities of the heart tissue muscle. The heart
muscle becomes weak and does not adequately pump the blood out of the chambers. As a result,
blood pools in the left ventricle and backs up into the left atrium, and eventually into the lungs.
Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing
cardiac output. In addition, this pooling leads to thrombus formation and ineffective tissue perfusion
because of the decrease in blood flow to the other organs and tissues of the body. Typically, these
clients have an ejection fraction of less than 50% and poorly tolerate activity. Activity intolerance is
related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, the
decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic
nervous system activity.
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3. Activity intolerance is a primary problem for clients with heart failure and pulmonary edema. The
decreased cardiac output associated with heart failure leads to reduced oxygen and fatigue. Clients
frequently complain of dyspnea and fatigue. The client could be at risk for infection related to stasis of
secretions or impaired skin integrity related to pressure. However, these are not the priority nursing
diagnoses for the client with HF and pulmonary edema, nor is constipation related to immobility.
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3. ACE inhibitors have become the vasodilators of choice in the client with mild to severe HF.
Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt heart failure.
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1. After IV injection of furosemide, diuresis normally begins in about 5 minutes and reaches its peak
within about 30 minutes. Medication effects last 2 to 4 hours.
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2. Canned foods and juices, such as tomato juice, are typically high in sodium and should be avoided
in a sodium-restricted diet. BRING ON THE STEAK!
2. A normal apical impulse is found under over the apex of the heart and is typically located and auscultated
in the left fifth intercostal space in the midclavicular line. An apical impulse located or auscultated below the
fifth intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement.
64.