Question 1: A nurse assesses an older adult client who is experiencing a myocardial infarction. Which clinical manifestation should the nurse expect? Selected Answer: d. Disorientation and confusion Response Feedback: In older adults, disorientation or confusion may be the major manifestation of myocardial infarction caused by poor cardiac output. Pain manifestations and numbness and tingling of the arm could also be related to the myocardial infarction. However, the nurse should be more concerned about the new onset of disorientation or confusion caused by decreased perfusion. Question 2: Ms. Richards, a 39-year-old female, is seen in the Emergency Department for dizziness, dyspnea, and heart palpitations. Vital Signs: BP 92/58, HR 225/min, RR 24/min; SPO2 90% on Room Air. Ms. Richards' rhythm on the telemetry monitor and subsequent 12-lead ECG show Supraventricular Tachycardia (SVT). Which of these is an intervention a nurse may implement to decrease Ms. Richards’ heart rate? Selected Answer: My Answer àCarotid Massage (Right Answer à Valsalva) Question 3: A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition? Selected Answer: Speech Alterations Question 4: A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, “Why will I need to take anticoagulants for the rest of my life?” How should the nurse respond? Selected Answer: “Blood clots form more easily in artificial replacement valves.” Response Feedback: Synthetic valve prostheses and scar tissue provide surfaces on which platelets can aggregate easily and initiate the formation of blood clots. The other responses are inaccurate. Question 5: Your newly admitted patient has a history of Atrial Fibrillation and is on warfarin at home. On your skin assessment, you note more than 12 large bruises and petechiae in addition when she brushes her teeth you note bleeding gums. Which of the following is most important to check before following the order “continue home medications at current dosages”? Selected Answer: Check for a PT/INR result Question 6: A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure? Selected Answer: A 36-year-old woman with aortic stenosis Response Feedback: Although most people with heart failure will have failure that progresses from left to right, it is possible to have left-sided failure alone for a short period. It is also possible to have heart failure that progresses from right to left. Causes of left ventricular failure include mitral or aortic valve disease, coronary artery disease, and hypertension. Pulmonary hypertension and chronic cigarette smoking are risk factors for right ventricular failure. A cerebral vascular accident does not increase the risk of heart failure. Question 7: A nurse assesses a client who had a myocardial infarction and is hypotensive. Which additional assessment finding should the nurse expect? Selected Answer: Heart rate of 120 beats/min Response Feedback: When a client experiences hypotension, baroreceptors in the aortic arch sense a pressure decrease in the vessels. The parasympathetic system responds by lessening the inhibitory effect on the sinoatrial node. This results in an increase in heart rate and respiratory rate. This tachycardia is an early response and is seen even when blood pressure is not critically low. An increased heart rate and respiratory rate will compensate for the low blood pressure and maintain oxygen saturations and perfusion. The client may not be able to compensate for long, and decreased oxygenation and cool, clammy skin will occur later. Question 8: Mr. Jones was admitted for left-side heart failure. Mr. Jones is in Sinus Tachycardia with frequent Premature Atrial Contractions (PACs). He complains of weakness, fatigue, and SOB. VS: Afebrile, RR: 24/minute, HR: 135 BPM, BP 145/90, SPO2 on room air is 88%. Other assessment findings: disoriented to time and place, lips are cyanotic, posterior bibasilar crackles, wheezes, and S3 are auscultated. The patient is coughing blood tinged sputum. Identify medications which might be ordered to help improve cardiac contractility (inotropy) and control heart rate (chronotropy). Selected Answer: Lanoxin (Digoxin) and Beta Blocker Question 9: A nurse assesses a client with pericarditis. Which assessment finding should the nurse expect to find? Selected Answer: Friction rub at the left lower sternal border Response Feedback: The client with pericarditis may present with a pericardial friction rub at the left lower sternal border. This sound is the result of friction from inflamed pericardial layers when they rub together. The other assessments are not related. Question 10: Which of the following is NOT a common sign of cardiac tamponade? Selected Answer: Hypertension Question 11: The nurse is assessing a client with acute coronary syndrome (ACS). The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. What signs and symptoms are suggestive of ACS? (Select all that apply.) Selected Answers: Unusual fatigue, Syncope, Dyspnea Question 12: Which of the following patient statements indicates the patient requires further education after pacemaker placement? Selected Answer: I cannot prepare my food by myself anymore as it is not safe to be around my fridge, blender, microwave, or toaster