Deck 15: Cardiovascular Therapeutic Management

Question 1

A patient is undergoing ventricular pacing via a transvenous pacing lead.The nurse notes a pacing artifact,but it is not followed by a QRS on the electrocardiogram (ECG)monitoring.Which nursing intervention may correct this situation?

A) Position the patient on the left side
B) Decrease the milliamperes as ordered
C) Increase the rate as ordered
D) Monitor the patient in a different lead

Answer 1

Position the patient on the left side

Question 2

What parameter must be assessed frequently in the patient with an intraaortic balloon in place?

A) Skin turgor in the affected extremity
B) Peripheral pulses distal to the insertion site
C) Blood pressures in both arms and legs
D) Oxygen saturation

Answer 2

Peripheral pulses distal to the insertion site

Question 3

Which mechanism is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intraaortic balloon pump?

A) The vacuum created in the aorta as a result of balloon deflation
B) Diastolic inflation with retrograde perfusion
C) Forward flow to the peripheral circulation
D) Inflation during systole to augment blood pressure

Answer 3

Diastolic inflation with retrograde perfusion

Question 4

A patient has an implantable cardioverter defibrillator (ICD)for chronic ventricular tachydysrhythmias.What action should the nurse take when the patient's rhythm deteriorates to ventricular fibrillation?

A) Apply an external defibrillator to the patient.
B) Call a code and start cardiopulmonary resuscitation (CPR) on the patient.
C) Wait for the ICD to defibrillate the patient.
D) Turn the ICD off and administer epinephrine.

Question 5

Which hemodynamic alteration is the most common cause of a decrease in cardiac output in the postoperative cardiovascular patient?

A) Reduced preload
B) Increased afterload
C) Increased contractility
D) Bradycardia

Question 6

A patient is connected to an external temporary pulse generator.What does the sensitivity control regulate?

A) The time interval between the atrial and ventricular pacing stimuli
B) The amount of electrical current and is measured in milliamperes
C) The ability of the pacemaker to detect the heart's intrinsic electrical activity
D) The number of impulses that can be delivered to the heart per minute

Question 7

Which dosage of dopamine results in stimulation of beta1 receptors and increased myocardial contractility?

A) 1 mcg/kg/min
B) 5 mcg/kg/min
C) 15 mcg/kg/min
D) 20 mcg/kg/min

Question 8

What is the rationale for administrating a fibrinolytic agent to a patient experiencing acute ST-elevation myocardial infarction (STEMI)?

A) Dilation of the blocked coronary artery
B) Anticoagulation to prevent formation of new emboli
C) Dissolution of atherosclerotic plaque at the site of blockage
D) Restoration of blood flow via lysis of the thrombus

Question 9

A patient is admitted with left-sided heart failure and a blood pressure of 220/118 mm Hg.Which drug will be most effective in decreasing the blood pressure and reducing afterload?

A) Dopamine
B) Verapamil
C) Propranolol
D) Sodium nitroprusside

Question 10

What is the most common complication of fibrinolytic therapy?

A) Reperfusion chest pain
B) Lethargy
C) Bleeding
D) Heart blocks

Question 11

Adenosine is an antidysrhythmic agent that is given primarily what reason?

A) To convert supraventricular tachycardias
B) To suppress premature ventricular contractions (PVCs)
C) To treat second and third degree AV blocks
D) To coarsen ventricular fibrillation so that defibrillation is effective

Question 12

A nurse is providing care to a patient on fibrinolytic therapy.Which of the following statements from the patient warrants further assessment and intervention by the nurse?

A) "My back is killing me!"
B) "There is blood on my toothbrush!"
C) "Look at the bruises on my arms!"
D) "My arm is bleeding where my IV is!"

Question 13

Which of the following statements regarding beta-blockers is correct?

A) They increase heart rate and are contraindicated in tachydysrhythmias.
B) They result in bronchospasm and should not be used in patients with chronic obstructive pulmonary disease (COPD).
C) They increase cardiac output and help with left ventricular failure.
D) They are helpful in increasing atrioventricular node conduction and are used in heart blocks.

Question 14

Through what mechanism does enalapril decrease blood pressure?

A) Direct arterial vasodilation
B) Block the conversion of angiotensin I to angiotensin II
C) Increase fluid excretion at the loop of Henle
D) Peripheral vasoconstriction and central vasodilation.

Question 15

Which finding is a reliable indicator of reperfusion after fibrinolytic therapy?

A) Dysrhythmias
B) Q waves
C) Elevated ST segments
D) Immediate rapid decrease in cardiac biomarkers

Question 16

How does a percutaneous transluminal coronary angioplasty (PTCA)improve blood flow?

A) The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen.
B) Medication is delivered through the catheter that dissolves the plague and enhances vessel patency.
C) The balloon removes blood clots from the vessel improving patency of the vessel.
D) The balloon compresses the plaque against the vessel wall enlarging the vessel lumen.

Question 17

A transvenous pacemaker is inserted through the right subclavian vein and threaded into the right ventricle.The pacemaker is placed on demand at a rate of 70.What is the three letter code for this pacing mode?

A) VVI
B) AOO
C) DDD
D) VAT

Question 18

Noninvasive emergency pacing is best achieved via the use of which type of temporary pacing?

A) Transvenous (endocardial)
B) Epicardial
C) Transthoracic
D) Transcutaneous

Question 19

The possibility of microshock when handling a temporary pacemaker can be minimized by which intervention?

A) Decreasing the milliamperes
B) Wearing gloves
C) Positioning the patient on the left side
D) Wearing rubber-soled shoes

Question 20

When analyzing the electocardiogram (ECG)strip of the patient with a pacemaker,the nurse notices there is a spike before each QRS complex.What is this phenomenon indicative of?

A) 60-cycle electrical interference; check equipment
B) Pacing artifact; the pacemaker is sensing and capturing
C) Electrical artifact; the pacemaker is not sensing
D) Patient movement; check electrodes

Question 21

A patient is admitted after a positive exercise treadmill test with a diagnosis of coronary artery disease (CAD)and stable angina.Radiographic tests show that the patient has blockage in the left main coronary artery and four other vessels.The nurse anticipates that the patient's treatment plan will include what treatment or procedure?

A) Medical therapy
B) PCI
C) TAVR
D) CABG

Question 22

Identify complications with the above rhythm strip.

A) Undersensing from a pacemaker
B) Oversensing from a pacemaker
C) ICD firing caused by VF
D) Atrial pacing failure to capture

Question 23

A patient is admitted after a femorotibial bypass graft.What nursing action is critical in the immediate postoperative period?

A) Frequent assessment of the skin
B) Hourly assessment of intake and output
C) Monitoring for ST segment changes
D) Frequent pulse checks to the affected limb

Question 24

What is the preferred initial treatment of an acute myocardial infarction?

A) Fibrinolytic therapy
B) Percutaneous coronary intervention (PCI)
C) Coronary artery bypass surgery (CABG)
D) Implanted Cardioverter defibrillator (ICD)

Question 25

Why are vasopressors used cautiously in the treatment of critical care patients?

A) They cause vasoconstriction of the smooth muscles.
B) They cause vasodilation of the smooth muscles.
C) They increase afterload.
D) They decrease preload.

Question 26

Which anticoagulant enhances the activity of antithrombin III and does not require activated partial thromboplastin time (aPTT)or activated clotting time (ACT)monitoring?

A) Heparin
B) Enoxaparin
C) Bivalirudin
D) Argatroban

Question 27

Nursing interventions after angioplasty would include which of the following?

A) Elevating the head of the bed to 45 degrees
B) Hydration as a renal protection measure
C) Assessing pedal pulses on the involved limb every 15 minutes for the first 2 hours after the procedure
D) Monitoring the vascular hemostatic device for signs of bleeding
E) Educating the patient on the necessity of staying supine for 1 to 2 hours after the procedure

Question 28

A patient suddenly develops a wide QRS complex tachycardia.The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min,and the patient is awake without complaint except for palpitations.Which of the following interventions would be best to try first?

A) Adenosine 6 mg rapid IV push
B) Lidocaine 1 mg/kg IV push
C) Verapamil 5 mg IV push
D) Digoxin 0.5 mg IV push

Question 29

Which patients would be a candidate for fibrinolytic therapy?

A) The patient's chest pain started 8 hours ago. She has a diagnosis of non-ST-elevation myocardial infarction (NSTEMI).
B) The patient's chest pain started 3 hours ago, and her electrocardiogram (ECG) shows a new left bundle branch block.
C) The patient presents to the emergency department with chest pain of 30 minutes' duration. She has a history of cerebrovascular accident 1 month ago.
D) The patient has a history of unstable angina. He has been experiencing chest pain with sudden onset.
E) The patient's chest pain started 1 hour ago, and his ECG shows ST elevation.

Question 30

Which calcium channel blocker is beneficial in the treatment of patients with coronary artery disease or ischemic stroke?

A) Nifedipine
B) Nicardipine
C) Clevidipine
D) Diltiazem

Question 31

When is a patient a candidate for a surgical repair of an abdominal aortic aneurysm (AAA)?

A) Size is 1 cm
B) Patient experiencing symptoms
C) Aneurysm size unchanged over several years
D) Size less than 4 cm

Question 32

What two medications are commonly prescribed at discharge for patients who have had a coronary artery stent placed?

A) Aspirin and prasugrel
B) Aspirin and abciximab
C) Clopidogrel and eptifibatide
D) Tirofiban and tricagrelor

Question 33

A patient is diagnosed with third-degree heart failure.The nurse reviews the patient's medication list.Which classifications of drugs should be avoided with this patient?

A) Nonsteroidal antiinflammatory drugs (NSAIDs)
B) Antidysrhythmics
C) Angiotensin-converting enzyme (ACE) inhibitors
D) Calcium channel blockers
E) Beta-blockers

Question 34

The patient is 72 hours postoperative for a coronary artery bypass graft (CABG).The patient's vital signs include temperature 103° F,heart rate 112,respiratory rate 22,blood pressure 134/78 mm Hg,and O₂ saturation 94% on 3L nasal cannula.The nurse suspects that the patient has developed what problem?

A) Infection and notifies the physician immediately
B) Infection, which is common postoperatively, and monitors the patient's condition
C) Cardiac tamponade and notifies the physician immediately
D) Delirium caused by the elevated temperature

Question 35

Which signs and symptoms would indicate successful reperfusion after administration of a fibrinolytic agent?

A) Gradual decrease in chest pain
B) Intermittent, multifocal premature ventricular contractions
C) Rapid resolution of ST elevation
D) Rapid rise in creatine kinase MB fraction