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Questions and Answers
What is the primary purpose of a Holter monitor?
What is the primary purpose of a Holter monitor?
Which of the following findings in a client's history and presentation are most suggestive of a possible cardiovascular disorder?
Which of the following findings in a client's history and presentation are most suggestive of a possible cardiovascular disorder?
A patient with a total cholesterol level of 240 mg/dL is concerned about lifestyle changes to lower their cholesterol. Which of the following foods should be limited or avoided to help manage cholesterol levels?
A patient with a total cholesterol level of 240 mg/dL is concerned about lifestyle changes to lower their cholesterol. Which of the following foods should be limited or avoided to help manage cholesterol levels?
A client with a history of atrial fibrillation is on warfarin therapy. When monitoring the client's INR, what range indicates a therapeutic level?
A client with a history of atrial fibrillation is on warfarin therapy. When monitoring the client's INR, what range indicates a therapeutic level?
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Which of the following ECG lead placements is located in the 5th intercostal space, left anterior axillary line?
Which of the following ECG lead placements is located in the 5th intercostal space, left anterior axillary line?
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A nurse is reviewing a client's laboratory results. Which of the following cardiac biomarkers would indicate possible myocardial infarction?
A nurse is reviewing a client's laboratory results. Which of the following cardiac biomarkers would indicate possible myocardial infarction?
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A client is experiencing dizziness and weakness. Which of the following is a sign of decreased cardiac output?
A client is experiencing dizziness and weakness. Which of the following is a sign of decreased cardiac output?
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A nurse is assessing a client's blood pressure. Which of the following factors would affect the accuracy of the measurement?
A nurse is assessing a client's blood pressure. Which of the following factors would affect the accuracy of the measurement?
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A client has a Glasgow Coma Scale score of 13. What is this score indicative of?
A client has a Glasgow Coma Scale score of 13. What is this score indicative of?
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What is the normal blood pressure range?
What is the normal blood pressure range?
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A client is being assessed for orthostatic hypotension. When should the nurse take the client's blood pressure readings?
A client is being assessed for orthostatic hypotension. When should the nurse take the client's blood pressure readings?
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A patient presents with sudden onset of dyspnea, cough, and crackles in the lungs. They also have edema in the lower extremities and distended jugular veins. Which of the following conditions is most likely the cause of these symptoms?
A patient presents with sudden onset of dyspnea, cough, and crackles in the lungs. They also have edema in the lower extremities and distended jugular veins. Which of the following conditions is most likely the cause of these symptoms?
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A patient with a history of intravenous drug use presents with fever, petechiae, and a new heart murmur. Which of the following is the most likely diagnosis?
A patient with a history of intravenous drug use presents with fever, petechiae, and a new heart murmur. Which of the following is the most likely diagnosis?
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A patient is diagnosed with endocarditis. Which of the following is the most appropriate treatment for this condition?
A patient is diagnosed with endocarditis. Which of the following is the most appropriate treatment for this condition?
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A patient with pericarditis reports sharp chest pain that worsens when they lie flat and improves when they sit up and lean forward. Which of the following is the most likely cause of this pain?
A patient with pericarditis reports sharp chest pain that worsens when they lie flat and improves when they sit up and lean forward. Which of the following is the most likely cause of this pain?
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A patient with deep vein thrombosis is at risk for which of the following complications?
A patient with deep vein thrombosis is at risk for which of the following complications?
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A patient with hypertension is experiencing severe chest pain. Which of the following should the nurse prioritize?
A patient with hypertension is experiencing severe chest pain. Which of the following should the nurse prioritize?
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A patient scheduled for cardiac surgery is currently taking a diuretic. What action should the nurse take regarding the medication?
A patient scheduled for cardiac surgery is currently taking a diuretic. What action should the nurse take regarding the medication?
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A patient with hypertension is prescribed a beta-blocker. What is the most important nursing action before administering the medication?
A patient with hypertension is prescribed a beta-blocker. What is the most important nursing action before administering the medication?
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A UAP is assisting a patient with orthostatic vital signs. Which of the following instructions should the nurse provide the UAP?
A UAP is assisting a patient with orthostatic vital signs. Which of the following instructions should the nurse provide the UAP?
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A patient has been diagnosed with hypertension. Which of the following factors is considered a non-modifiable risk factor?
A patient has been diagnosed with hypertension. Which of the following factors is considered a non-modifiable risk factor?
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A patient with hypertension is being taught about lifestyle modifications. What is the most important instruction the nurse should provide?
A patient with hypertension is being taught about lifestyle modifications. What is the most important instruction the nurse should provide?
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A nurse is caring for a patient who has undergone cardiac surgery. Which of the following interventions should be prioritized to prevent pneumonia?
A nurse is caring for a patient who has undergone cardiac surgery. Which of the following interventions should be prioritized to prevent pneumonia?
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A patient is taking a beta-blocker. Which of the following symptoms should the nurse immediately report to the physician?
A patient is taking a beta-blocker. Which of the following symptoms should the nurse immediately report to the physician?
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A patient with hypertension is experiencing a sudden drop in blood pressure and dizziness upon standing. What is the most likely cause?
A patient with hypertension is experiencing a sudden drop in blood pressure and dizziness upon standing. What is the most likely cause?
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Which of the following is the biggest non-modifiable risk factor for hypertension ?
Which of the following is the biggest non-modifiable risk factor for hypertension ?
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Which of the following medications should NOT be administered if the patient's potassium level is 3.2 mEq/L?
Which of the following medications should NOT be administered if the patient's potassium level is 3.2 mEq/L?
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Which of the following medications is contraindicated in a patient with a pulse of 68 beats per minute?
Which of the following medications is contraindicated in a patient with a pulse of 68 beats per minute?
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Which of the following medications should be held if the patient's systolic blood pressure is below 100 mmHg?
Which of the following medications should be held if the patient's systolic blood pressure is below 100 mmHg?
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Which of the following medications is NOT associated with increased bleeding risk?
Which of the following medications is NOT associated with increased bleeding risk?
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Which of the following actions is appropriate for a patient taking warfarin?
Which of the following actions is appropriate for a patient taking warfarin?
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A patient taking digoxin has a pulse of 60 beats per minute. Which of the following actions is most appropriate?
A patient taking digoxin has a pulse of 60 beats per minute. Which of the following actions is most appropriate?
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Which of the following is NOT a common complication of valve disorders?
Which of the following is NOT a common complication of valve disorders?
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A patient with a valve disorder is being discharged home on medication. Which of the following instructions should the nurse provide to the patient?
A patient with a valve disorder is being discharged home on medication. Which of the following instructions should the nurse provide to the patient?
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A patient is prescribed warfarin for a mechanical valve replacement. Which of the following is NOT a reason for lifelong anticoagulation?
A patient is prescribed warfarin for a mechanical valve replacement. Which of the following is NOT a reason for lifelong anticoagulation?
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Which of the following is a difference between biologic and mechanical valve replacements?
Which of the following is a difference between biologic and mechanical valve replacements?
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Study Notes
Cardiac Exam Review - May 2024
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Cardiovascular Problems - Possible Indicators:
- Chest pain
- Heart murmurs (turbulent blood flow through a valve)
- Dyspnea on exertion
- Dizziness
- Poikilothermia (peripheral arterial disease)
- Orthostatic hypotension
- Dependent rubor
- Edema
Diagnostic Tests
- Stress Test: NPO 2-4 hours, no smoking/caffeine, wear comfortable clothing, and walk.
- EKG (ECG): Lie still, normal breathing, ensure accurate lead placement; skin clean and dry.
- Holter Monitor: 24-72 hour continuous monitoring (for low risk, intermittent symptoms)
- Echocardiography: Shows heart motion.
- Duplex Ultrasound: Shows blood flow through arteries and veins; identifies blockages.
Cardiac Catheterization/Angioplasty
- Prep: Check for prior reactions to contrast dye. Signed consent needed.
- Pre-procedure: NPO 6-8 hours
- Procedure: Local anesthesia; warm, flushed feeling.
- Post-procedure: Increased fluids. Maintain bed rest, pressure dressing.
- Follow-up: Monitor neurovascular status, vital signs, heart rate, rhythm. No flexion of extremity.
Neurovascular Checks
- Assess circulation: color, temperature, capillary refill, pulse quality.
- Assess motion: ability to move digits.
- Assess sensation: paresthesia, ability to feel pain/pressure.
Cardiac Exam Review - Question and Answers
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Question 1: A client presents with 8-10 hours sleep, smoking, weekend alcohol use, rare exercise, low back pain, dyspnea on exertion, chest discomfort, and a sour taste in their mouth. What findings may indicate cardiovascular issues? Select all that apply.
- Rarely exercising
- Chest discomfort
- Back pain
- Sour taste in mouth
- Dyspnea on exertion
- Smoking history
- Sleep pattern
- Alcohol use
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Question 2: A patient is following cardiac catheterization. What action is needed to assess neurovascular status of the extremity?
- Check pedal pulses bilaterally.
Lab Values
- Cardiac Biomarkers (Troponin, CK-MB): Elevated levels indicate cardiac muscle damage and potential myocardial infarction. Troponin elevated for 7-10 days after injury.
- Total Cholesterol and LDL-C: Levels above 200 mg/dL increase heart disease risk. High levels of LDL-C further increase risk. Major sources: red meat, eggs, cheese, and full-fat dairy.
- PT/INR: Used to monitor warfarin levels. Normal values vary depending on equipment. Therapeutic range is 2-3 regardless of lab used.
Question 3
- Cholesterol Level of 240: Which foods should a client with a high cholesterol level (240 mg/dL) avoid in large amounts? Select all that apply.
- Eggs
- Whole milk
- Red meat
- Pasta
- Chicken
- Whole wheat
Decreased Cardiac Output
- Signs: Dizziness, syncope, weak/rapid pulse, hypotension, weakness, fatigue, activity intolerance, dyspnea.
Hypertension
- Normal BP: Less than 120/80.
- Accuracy: Correct cuff size; patient still; no talking; back/feet supported. Arm supported at heart level.
- Rest: 5 minutes before checking.
- BPI check considerations: avoid testing both arms with mastectomy, dialysis catheter. Orthostatic hypotension: check BP in lying, sitting, and standing position (done sequentially) and look for decrease in BP and increase in pulse with dizziness.
- Risk factors (modifiable): Obesity, sedentary lifestyle, high fat/sodium/calorie diet, stress, smoking, excessive alcohol intake (more than 1-2 drinks/day), less than 5 hours of sleep
- Risk factors (non-modifiable): Family history, age, gender, ethnicity (non-Hispanic blacks at highest risk)
- Complications: Stroke, vision loss, heart failure, cardiomegaly, myocardial infarction, peripheral arterial disease, renal damage (second most common cause of chronic renal failure)
Patient Teaching for Hypertension
- Medications: Take as instructed. Do not stop abruptly. Take medication even if blood pressure is normal.
- Sodium: Decrease sodium intake.
- Pulse/BP Checks: Monitor Pulse and blood pressure before beta-blockers and calcium channel blockers.
- Position changes: Change positions slowly to avoid orthostatic hypotension.
Cardiac Surgery
- Pre-op: Hold anticoagulants and diuretics for up to 1 week and 24 hours before surgery. Diabetics should avoid insulin or antidiabetic medications before surgery.
- Post-Op: Monitor vital signs, heart rhythm, urine output, and lung sounds.
- Pain management: Medicate for pain before moving patients.
- Respiratory Function: Encourage incentive spirometry.
- Additional: Sternotomy dressing changes under sterile technique.
Medications (General)
- Beta-blockers/Calcium Channel Blockers: Check Pulse and blood pressure before administering. Not recommended if pulses or BP are below certain levels.
- ACE Inhibitors/Other Antihypertensives: Check BP before administering. Hold if below certain levels.
- Diuretics: Monitor potassium levels. Diuretics like furosemide , bumetanide can decrease potassium. Spironolactone may increase it. Hold if hypokalemic.
- Warfarin: Monitor PT/INR. Consistent vitamin K intake recommended. No OTC medications without consulting healthcare provider (like aspirin & NSAIDs). Bleeding precautions (soft toothbrush, electric razors, avoid barefooting, medical alert identification)
Question 4
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Question: Nurse is administering 9 a.m. medications; BP 118/64; pulse 68; morning potassium 3.2 mEq/L (range 3.5-5mEq/L) . Which action is needed?
- Administer all medications as prescribed.
Other Topics
- Valve Disorders: Etiology: congenital, aging, endocarditis, rheumatic fever. Symptoms: heart murmur, dysrhythmias, palpitations, chest pain; Complications: heart failure, stroke, endocarditis, Interventions: medications to manage dysrhythmias and heart failure, preventative stroke; valve repair or replacement, Biologic valves last 7-10 years (no anticoagulation required); Mechanical valves require lifelong anticoagulation
- Endocarditis: Risk factors: Valve disorders, IV drug use, gum disease, prior endocarditis, rheumatic fever. Signs and symptoms: Heart murmur, fever, malaise, petechiae, Janeway lesions, Osler's nodes, splinter hemorrhages. Treatment: Antibiotics. Complications: Heart failure, valve dysfunction, stroke.
- Pericarditis: Inflammation of pericardial lining. Symptoms: Pleuritic chest pain (sharp, heavy), worse with coughing and deep breathing, better when sitting up and leaning forward; Friction rub; Dyspnea. Complications: Heart failure, cardiac tamponade (jugular venous distention, tachycardia, hypotension, muffled heart sounds).
- Cardiomyopathy: Enlargement of heart. Dilated (most common): Heart stretched, less contractile. Common etiologies: hypertension, pregnancy, alcoholism; Restrictive: Heart walls rigid, don't expand or contract normally; Hypertrophic: heart muscle enlarged; decreasing volume of heart chambers
- Deep Vein Thrombosis (DVT): Clot in a vein. Risk factors: venous stasis, immobility, oral contraceptives, smoking, vessel injury, (surgery), crush injuries, IV catheters, hypercoagulability (dehydration). Symptoms: redness, warmth, edema, pain, hard (indurated) distended vein. Treatment: anticoagulants, compression/antiembolism stockings, elevation, warm compresses. Complications: Pulmonary embolism, recurrent DVTs, venous insufficiency.
- Math (Cardiac Output): Stroke volume x heart rate; convert to liters/minute and round to the nearest 10th; Drop factors (drops per minute): Volume X drop factor/time; Hourly rate (infusions < 1 hour): volume X 60/time; Hourly rate (infusions > 1 hour): volume / hours
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Description
Prepare for your upcoming cardiac exam with this comprehensive review covering major cardiovascular problems, diagnostic tests, and cardiac procedures. Test your understanding of symptoms, procedures, and patient care protocols in cardiology. Perfect for nursing students and healthcare professionals.
