Question 1

A nurse prepares a plan of care for a patient receiving anticoagulant therapy. Which major side effect of this drug must a nurse prioritize?

Accepted Answer

The nurse caring for a patient receiving anticoagulant therapy must prioritize and take note of any signs of bleeding or hemorrhage. Major side effects of anticoagulant therapy includes: fever, chills (hypersensitivity), skin rash (hypersensitivity), hemorrhage (interference with clotting mechanisms), diarrhea (GI irritation).

Question 2

A physician is about to defibrillate a patient and about to deliver shock at 200 joules. The patient's cardiac monitor indicates ventricular fibrillation. The physician says in a loud voice "CLEAR" What should the nurse do immediately?

Accepted Answer

As the physician is about to defibrillate a patient the nurse assisting should step back from the bed once the physician says "CLEAR". This prevents the nurse or others from being defibrillated along with the patient. Shutting off the IV line has no useful purpose. All necessary interventions must resume after the shock has been given.

Question 3

A patient with MI is receiving heparin therapy. The nurse notes that the laboratory results for activated partial thromboplastin time value is 110 seconds. The nurse should know that before reporting the results to the physician, the following must be immediately available if prescribed?

Accepted Answer

The nurse must ensure that protamine sulphate is available if prescribed. The nurse must have the initiative to keep antidotes available in case of emergency such as over dosage. The therapeutic value of a PTT on heparin therapy is between 60-70 seconds. The antidote for heparin over dosage is protamine sulfate. Vitamin K is the antidote for warfarin. Vitamin B12 is used to treat pernicious anemia.

Question 4

The nurse is assessing a patient suspected to have myocardial infarction. Which of the following questions is a priority?

Accepted Answer

The priority question should be "When did these symptoms start?" The nurse must be able to identify the onset of symptoms and this should be a priority during assessment. It is important to know the details when the symptoms had started since patient's presenting symptoms of MI will be considered for thrombolytic therapy provided that these symptoms had started no longer than six hours ago.

Question 5

A patient was admitted to the ER diagnosed with MI unrelieved by nitrates. The physician orders morphine IV push. Which of the following assessments is a priority nursing action?

Accepted Answer

The priority nursing action is to check the blood pressure of the patient. The nurse must check the blood pressure before administering morphine. The nurse should be able to check the vital signs but must put emphasis on checking the blood pressure especially when the physician orders morphine. Before administration of this medication, BP is checked to have a baseline data and to prevent hypotension.

Question 6

A patient in the coronary care unit with atrial fibrillation has been prescribed verapamil 5mg IV. What is a required item that should be at the bedside of the patient?

Accepted Answer

The required item for a patient of atrial fibrillation is a cardiac monitor. The nurse should understand that this patient is unstable. As prescribed by the physician, verapamil is to be administered. This medication is a calcium channel blocker to treat atrial flutter or atrial fibrillation. The patient should be placed on cardiac monitor to check his/her response to the drug.

Question 7

A nurse is caring for a patient with digoxin therapy. In order to prevent toxicity in digoxin therapy, the nurse must assess for which three things?

Accepted Answer

The nurse must assess the digoxin level, potassium level and heart rate of the patient. Nursing consideration in managing the patient undergoing digoxin therapy include correct administration and monitoring the patient for toxicity. The apical pulse should be monitored for one full minute. Withhold the dose and notify physician if pulse <60 per minute.

Question 8

A nurse is performing an assessment on a patient with a diagnosis of angina pectoris who is receiving Isosorbide (Isordil). Which assessment finding indicates that the patient is experiencing a side effect of the medication?

Accepted Answer

A headache indicates that the patient is experiencing a side effect of the medication. Isosorbide is a coronary vasodilator. Side effects of this drug would include: headache (dilatation of cerebral vessels); flushing (peripheral vasodilation); orthostatic hypotension (loss of compensatory vasoconstriction with position change); tachycardia (reflex reaction to severe hypotension); and dizziness (orthostatic hypotension).

Question 9

A patient is scheduled to undergo cardiac catheterization. The nurse should be able inform the patient that:

Accepted Answer

The nurse should inform the patient that the procedure may cause an urge to cough, palpitations, and a flushed and warm feeling. Catheter insertion is the introduction of a catheter into the heart via a peripheral vessel. Prior to the procedure the nurse should inform the patient of the procedure's purpose, it's possible complications, and the sensation it causes (e.g., urge to cough, nausea, warm flush feeling). The nurse should also assess the patient if he/ she have allergies to iodine and keep the patient on NPO for 8- 12 hours. The X- ray table is hard and may be tilted periodically. The procedure may take up to 2 hours.

Question 10

A patient was received in the CCU following open heart surgery. Upon assessment the nurse notes the patient's temperature is 102ºF (38.8ºC). The nurse notifies the physician because elevated temperature:

Accepted Answer

The nurse should notify the physician because elevated temperature increases the cardiac output. Increase in temperature indicates increased metabolism and cardiac workload. An elevated temperature is not an early sign for cerebral edema. Fever is unrelated to hemorrhage; in hemorrhage with shock, the temperature actually decreases.

Question 11

Cardioversion is an electrical current administration used to convert certain dysrhythmias to normal rhythm. This procedure is most effective when the patient demonstrates:

Accepted Answer

Cardioversion is most effective when the patient is having ventricular tachycardia. Cardioversion is a procedure that involves administration of precordial shock, which is synchronized with the R wave to interrupt an abnormally fast heart rate or cardiac arrhythmia. It is used for atrial fibrillation, ventricular tachycardia and paroxysmal atrial tachycardia when all pharmaceutical interventions fail.

Question 12

A nurse observes a patient's cardiac monitor and observes atrial fibrillation with a rapid ventricular response. The nurse prepares for cardioversion. How should the nurse avoid the potential danger of inducing ventricular fibrillation during cardioversion?

Accepted Answer

The nurse should turn on the synchronizer switch to avoid the potential danger of inducing ventricular fibrillation during cardioversion. The precordial shock during cardioversion must not be delivered on T wave or ventricular fibrillation may occur. The synchronizer must be switched on and the energy level may be set from 50 to 400 watt- seconds depending if its biphasic or monophasic machine.

Question 13

A nurse observes a patient's monitor and identifies asystole. Which of the following is the correct initial drug and dose for treatment of asystole?

Accepted Answer

Epinephrine 1 mg IV is the initial drug for treatment of asystole. Asystole is a cardiac standstill with no cardiac output and no ventricular depolarization. When a patient displays asystole, the treatment of choice is injection of epinephrine and atropine.

Question 14

Which of the following is the drug of choice for Torsades de Pointes?

Accepted Answer

The drug of choice for Torsades de Pointes is magnesium 1 to 2 g mixed in 50-100 ml D5W. The ECG reading in Torsades demonstrates a rapid, polymorphic ventricular tachycardia with a characteristic twist of QRS complex around the isoelectric baseline. Treatment is directed at withdrawal of the offending agent, infusion of magnesium sulfate and electrical therapy as needed.

Question 15

A nurse is assisting a physician to defibrillate a patient. Which of the following items should a nurse note as not safe to remove from the patient before defibrillation?

Accepted Answer

The back board is not safe to remove from the patient before defibrillation. Metal devices, liquids and flammable materials must be removed before discharging a shock to patient who needs to be defibrillated. The nitroglycerin has a metallic backing and oxygen supports combustion, thus they should be removed.

Question 16

A patient arrives in the ER and was diagnosed with angina pectoris. After taking 2 sublingual nitroglycerin tablets for chest pain, the patient states that the chest pain is relieved but he is now complaining of headache. The nurse should inform the patient that:

Accepted Answer

The nurse should inform the patient that headache is an expected side effect of the medication. The nurse must realize that headache is a major side effect of nitroglycerin due to the vasodilating action of this drug. As the patient becomes accustomed to this medication, headaches are usually diminished.

Question 17

The physician orders metoprolol for a patient with hypertension. The nurse should assess the patient's compliance to this medication due to which major side effect?

Accepted Answer

The nurse should assess the patient's compliance to metoprolol due to side effect of impotence. One of the most common side effects of metoprolol is impotence. Other side effects include: fatigue and weakness.

Question 18

A patient with MI is admitted in the coronary care unit. The patient was placed on cardiac monitor and he is not experiencing any chest pain at this time. The nurse reviews the ECG rhythm and notes that the P-R interval is 0.12 seconds. This rhythm would indicate:

Accepted Answer

This rhythm indicates normal rhythm. The normal PR interval range 0.12 - 0.2 seconds. Therefore the finding is normal.

Question 19

A patient diagnosed with cardiac problem says to the nurse, "I guess I will never be able to eat Chocó Fudge ice cream." What would be the best response of the nurse?

Accepted Answer

The nurse best response would be to rephrase the question of the patient and say that "You don't think you won't be able to eat Chocó Fudge ice cream at all?" This is the most therapeutic response.

Question 20

A patient is scheduled to undergo cardiac catheterization. He says to the nurse: "I am so afraid of the outcome of this surgery." What is the best response of the nurse?

Accepted Answer

The best response of the nurse is to ask the patient "tell me what concerns you have on this surgery". The nurse must assess the feelings of the patient regarding the impending surgery. Asking the concerns of patient about the surgery will generate a response that will assist the patient in exploring her feelings with the surgery.

Quiz 1: Cardiac Medicine