Deck 19: Advanced Cardiovascular Care

Question 1

The nurse is admitting a client for an acute myocardial infarction. What part of the ECG does the nurse assess for signs of ischemia?

A) P wave
B) QRS complex
C) ST segment
D) U wave

Answer 1

ST segment

Question 2

Which client is the best candidate for telemetry monitoring?

A) Acute coronary syndrome, in coronary care unit
B) In PACU after abdominal surgery
C) Trauma client in the Emergency Department
D) Pneumonia, on the step-down unit

Answer 2

Pneumonia, on the step-down unit

Question 3

When caring for clients on cardiac monitors, what action by the nurse is most important for client safety?

A) Ensuring that the grounding pad is on correctly
B) Analyzing the client's ECG strip every 4 hours
C) Responding to all alarms promptly when they sound
D) Confirming that the leads are placed in correct positions

Answer 3

Responding to all alarms promptly when they sound

Question 4

What assessment data indicates that a goal for a client related to cardiac monitoring has been met?

A) Skin under electrode leads is intact.
B) Client can disconnect leads from monitor.
C) Nurse responds to alarms promptly.
D) Client has normal cardiac functioning.

Question 5

The nurse is applying cardiac monitoring leads to a client with large, pendulous breasts. What action by the nurse is most appropriate?

A) Cleanse the skin under the breast with isopropyl alcohol.
B) Have the client lift her breast while you apply the electrode.
C) Place the V6 electrode over the breast on dry skin.
D) Place the V6 electrode on the right sternal margin.

Question 6

A client is having a scheduled elective cardioversion due to a chronic atrial dysrhythmia. The procedure is successful, and the client is now in a normal sinus rhythm. What assessment does the nurse do next?

A) Mental status
B) Skin integrity
C) Blood pressure
D) Oxygen saturation

Question 7

A client is being cardioverted. What action by the nurse is most important to ensure a successful outcome?

A) Administer the appropriate sedation to the client.
B) Make sure the cardiac monitor alarms are on.
C) State "All clear!" prior to delivering the shock.
D) Place the defibrillator in synchronous mode.

Question 8

A nurse caring for a client who has a pacemaker sees the following rhythm on the cardiac monitor. What action by the nurse is best?

A) Notify the provider immediately.
B) Prepare to defibrillate the client.
C) Document the findings in the chart.
D) Assess the client's perfusion.

Question 9

A client is admitted to have a biventricular pacemaker inserted. When asked by a student what this device does, which answer by the nurse is best?

A) "It causes both ventricles to contract at the same time."
B) "It has an extra lead placed in the right atrium."
C) "It has two leads placed in the left ventricle."
D) "It has an external generator for easier access."

Question 10

A client has a temporary transcutaneous pacemaker applied and the nurse notes electrical capture on the monitor. What action does the nurse take next?

A) Analyze the entire ECG strip.
B) Take the client's pulse.
C) Assess the client for pain.
D) Document the procedure.

Question 11

A client had a cardiac catheterization 4 hours ago via the femoral approach and reports worsening dull flank pain. What action does the nurse take first?

A) Notify the provider immediately.
B) Assess the blood pressure and pulse.
C) Administer ordered pain medication.
D) Check for bleeding at the site.

Question 12

A client has been defibrillated and the monitor shows a normal sinus rhythm. What action by the nurse is most appropriate?

A) Reorient the client to surroundings if necessary.
B) Take the patches off and clean the skin.
C) Verify that the client has a pulse.
D) Administer nitroglycerin sublingually.

Question 13

The student hears in handoff report that a client has a lot of artifact on the cardiac monitor. The student asks the faculty to explain. What response by the faculty is best?

A) Distorted appearance of the ECG due to outside interference
B) Energy waveforms that appear to travel in two directions
C) Resistance to the flow of energy during defibrillation
D) An increasing amount of "disordered" rhythms seen on the monitor

Question 14

A client is told that his/her cardiac ejection fraction is 62% and asks the nurse what that means. What response from the nurse is best?

A) Very low
B) Normal
C) Borderline
D) Too high

Question 15

A client has a transcutaneous pacemaker and the nurse notes random pacemaker spikes on the ECG. What action does the nurse take?

A) Notifies the provider immediately
B) Checks all connections and leads
C) Adjusts the sensitivity on the pacemaker
D) Repositions the pacemaker pads

Question 16

A nurse needs to defibrillate a client who collapsed in the bathroom with the shower running and is all wet. What action does the nurse take prior to defibrillating the client?

A) Dry the client's entire body.
B) Make sure the client's chest is dry.
C) Nothing; water improves conductivity.
D) Nothing, defibrillate the client there.

Question 17

During a code situation, what action is best to ensure safety for the responding staff?

A) Shout "clear" prior to defibrillating the client.
B) Synchronize the defibrillator for a cardioversion.
C) Tell the compressor to switch every 2 minutes.
D) Turn off the oxygen prior to defibrillating.

Question 18

A child in the Emergency Department is in cardiac arrest and the monitor shows ventricular fibrillation. The child weight 72 pounds. What is the proper dose of joules for the first attempt at defibrillation?

A) 15 joules
B) 42 joules
C) 65 joules
D) 88 joules

Question 19

The nurse caring for a client admitted with heart failure would assess for which signs and symptoms? (Select all that apply.)

A) Increased blood pressure
B) Urine output <0.5 mg/kg/hour
C) Warm, hot skin
D) Weak, thready pulses in extremities
E) Decreased activity tolerance

Question 20

The student learns that which are characteristics of cardiac conduction? (Select all that apply.)

A) Automaticity
B) Conductivity
C) Contractility
D) Reversibility
E) Transmissibility

Question 21

The nurse in the coronary care unit knows that all dysrhythmias have the potential to cause which of the following? (Select all that apply.)

A) Decreased cardiac output
B) Light-headedness
C) Syncope or near-syncope
D) Bounding extremity pulses
E) Chest pain or tightness

Question 22

A client has a temporary pacemaker. Which settings are matched with their correct function? (Select all that apply.)

A) Mode: Determines if the pacemaker can sense the client's own rhythm
B) Energy output: Is adjusted until adequate "capture" is achieved
C) Rate: Synchronizes the pacemaker to match the client's heart rate
D) Sensitivity: Demonstrates the ability to sense the client's own rhythm
E) Battery mode: Allows extra battery life by reducing electrical demand

Question 23

The nurse is assessing a client's chest pain using the PQRST format. Which letter is matched with the correct meaning? (Select all that apply.)

A) P: Provoking factors-what brings on the pain?
B) Q: Queasy-does the client have nausea?
C) R: Radiating-does the pain go anywhere else?
D) S: Sweating-does the patient have diaphoresis?
E) T: Time-when did the pain start or how long did it last?

Question 24

A client's cardiac monitor has been displaying artifact much of the time. What actions does the nurse take? (Select all that apply.)

A) Assesses the client for shivering
B) Checks to see if the electrode gel is still moist
C) Shaves the client's hair in the area of the electrodes
D) Observes the client for restlessness and agitation
E) Determines if the cords are attached to the monitor