Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:
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Solution
“Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell on his negativity about it.
When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:
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Solution
Impulse to travel to the ventricles
The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?
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Solution
“Avoid salt substitutes.”
Because Spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content.
Options A, B, and C: The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue.
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?
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Solution
Hypokalemia
Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?
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Solution
Question the physician about the order
Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.
Options A, B, and D: The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.
Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?
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Solution
Preload
Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload.
Option A: Afterload is the force against which the ventricle must expel blood.
Option B: Cardiac index is the individualized measurement of cardiac output, based on the client’s body surface area.
Option C: Cardiac output is the amount of blood the heart is expelling per minute.
Which of the following terms describes the force against which the ventricle must expel blood?
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Solution
Afterload
Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles.
Option B: Cardiac output is the amount of blood expelled from the heart per minute.
Option C: Overload refers to an abundance of circulating volume.
Option D: Preload is the volume of blood in the ventricle at the end of diastole.
Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?
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Solution
Changes in blood pressure
Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.
Which of the following factors can cause blood pressure to drop to normal levels?
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Solution
Kidneys’ excretion of sodium and water
The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.
Which of the following parameters is the major determinant of diastolic blood pressure?
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Solution
Vascular resistance
Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure.
Option B: Cardiac output determines systolic blood pressure.