NSG 430/ NSG430 Exam 2 (2026/ 2027 Updated Edition) Adult Health Nursing II Complete Guide| Comprehensive Questions & Answers| Grade A| 100% Correct (Verified Solutions)- GCU

NSG 430/ NSG430 Exam 2 (2026/ 2027 Updated Edition) Adult Health Nursing II Complete Guide| Comprehensive Questions & Answers| Grade A| 100% Correct (Verified Solutions)- GCU Q. The nurse is developing a teaching plan for a patient with coronary artery disease (CAD). Which factor would the nurse focus on during the teaching session? a. Family history of coronary artery disease b. Elevated low-density lipoprotein (LDL) level c. Greater risk associated with the patient's gender d. Increased risk of cardiovascular disease with aging ANSWER Elevated low-density lipoprotein (LDL) level Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient's LDL level. Decreases in LDL will help reduce the patient's risk for developing CAD. Q. Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make dietary changes? a. Inform the patient about a diet containing no saturated fat and minimal salt. b. Emphasize the increased cardiac risk unless the patient makes dietary changes. c. Help the patient modify favorite high-fat recipes by using monounsaturated oils. d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet. ANSWER Help the patient modify favorite high-fat recipes by using monounsaturated oils. Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences. The highest percentage of calories from fat should come from monounsaturated or polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the patient with a list alone is not likely to be successful in making dietary changes. Completely removing saturated fat from the diet is not a realistic expectation. Up to 7% of calories in the therapeutic lifestyle changes diet can come from saturated fat. Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful. Q. The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain may be from an acute myocardial infarction? a. The pain increases with deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms. ANSWER The pain has lasted longer than 30 minutes. Chest pain that lasts for 20 minutes or more is characteristic of AMI. Changes in pain that occur with raising the arms or with deep breathing are more typical of musculoskeletal pain or pericarditis. Stable angina is usually relieved when the patient takes nitroglycerin. Q. Which patient statement would help the nurse confirm the previous diagnosis of chronic stable angina? a. ―The pain wakes me up at night.‖ b. ―The pain is level 3 to 5 (0 to 10 scale).‖ c. ―The pain has gotten worse over the last week.‖ d. ―The pain goes away with a nitroglycerin tablet.‖ ANSWER ―The pain goes away with a nitroglycerin tablet.‖ Chronic stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina. Q. Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective? a. ―I can expect nausea as a side effect of nitroglycerin.‖ b. ―I should only take nitroglycerin when I have chest pain.‖ c. ―Nitroglycerin helps prevent a clot from blocking blood flow to my heart.‖ d. ―I will call an ambulance if I have pain 5 minutes after taking nitroglycerin.‖ ANSWER ―I will call an ambulance if I have pain 5 minutes after taking nitroglycerin.‖ The emergency response system (ERS) should be activated when chest pain or other symptoms are the same or worse 5 minutes after taking a sublingual nitroglycerin tablets. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis. Q. Which statement made by a patient with coronary artery disease indicates that further diet teaching is needed? a. ―I will switch from whole milk to 1% milk.‖ b. ―I like salmon and I will plan to eat it more often.‖ c. ―I can have a glass of wine with dinner if I want one.‖ d. ―I will miss being able to eat peanut butter sandwiches.‖ ANSWER ―I will miss being able to eat peanut butter sandwiches.‖ Although only 30% of the daily calories should come from fats, most of the fat in the diet should come from monounsaturated fats such as are found in nuts, olive oil, and canola oil. The patient can include peanut butter sandwiches as part of the diet. The other patient comments indicate a good understanding of the recommended diet. Q. Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective? a. ―Carvedilol will help my heart muscle work harder.‖ b. ―It is important not to suddenly stop taking the carvedilol.‖ c. ―I can expect to feel short of breath when taking carvedilol.‖ d. ―Carvedilol will increase the blood flow to my heart muscle.‖ ANSWER ―It is important not to suddenly stop taking the carvedilol.‖ Patients who have been taking -adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases myocardial contractility. Shortness of breath that occurs when taking -adrenergic blockers for angina may be due to bronchospasm and should be reported to the health care provider. Carvedilol works by decreasing myocardial O2 demand, not by increasing blood flow to the coronary arteries. Q. A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI? a. Myoglobin b. Homocysteine c. C-reactive protein d. Cardiac-specific troponin ANSWER Cardiac-specific troponin Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI) and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but it lacks specificity and its use is limited. The other laboratory data are useful in determining the patient's risk for developing coronary artery disease but are not helpful in determining whether an acute MI is in progress. Q. Diltiazem is prescribed for a patient newly diagnosed with Prinzmetal's (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan? a. Reduces heart palpitations. b. Prevents coronary artery plaque. c. Decreases coronary artery spasms. d. Increases contractile force of the heart. ANSWER Decreases coronary artery spasms. Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., diltiazem, amlodipine) are a first-line therapy for this type of angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and -adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations). Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing O2 demand. Q. Which data indicates to the nurse that the patient with stable angina is experiencing a side effect of metoprolol? a. Patient is restless and agitated. b. Patient reports feeling anxious. c. Blood pressure is 90/54 mm Hg. d. Heart monitor shows normal sinus rhythm. ANSWER Blood pressure is 90/54 mm Hg. Patients taking -adrenergic blockers should be monitored for hypotension and bradycardia. Because this class of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, and anxiety will not be side effects. Normal sinus rhythm is a normal and expected heart rhythm. Q. Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. Which data would indicate to the nurse that the drug is effective? a. Decreased blood pressure and heart rate b. Improvement in the strength of the distal pulses c. Fewer complaints of having cold hands and feet d. Participation in daily activities without chest pain ANSWER Participation in daily activities without chest pain Because the drug is ordered to improve the patient's angina, effectiveness is indicated if the patient is able to accomplish daily activities without chest pain. Blood pressure and heart rate may decrease, but these data do not indicate that the goal of decreased angina has been met. The noncardioselective -adrenergic blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in distal pulse quality or skin temperature. Q. Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of the heparin to the patient? a. ―Heparin enhances platelet aggregation at the plaque site.‖ b. ―Heparin decreases the size of the coronary artery plaque.‖ c. ―Heparin prevents the development of new clots in the coronary arteries.‖ d. ―Heparin dissolves clots that are blocking blood flow in the coronary arteries.‖ ANSWER ―Heparin prevents the development of new clots in the coronary arteries.‖ Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation. Q. Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)? a. Monitor heart rate. b. Ask about chest pain. c. Check blood pressure. d. Observe for dysrhythmias. ANSWER Ask about chest pain. The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. The nurse will also monitor heart rate and blood pressure and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective. Q. A patient is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question would the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. ―Do you have any allergies?‖ b. ―Did you take aspirin today?‖ c. ―What time did your pain begin?‖ d. ―Can you rate the pain on a 0 to 10 scale?‖ ANSWER ―What time did your pain begin?‖ Thrombolytic therapy criteria include chest pain for less than 12 hours with 12-lead ECG findings consistent with an acute STEMI. The other information is not a factor in the decision about thrombolytic therapy. Q. A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest? a. O2 saturation drops from 99% to 95%. b. Heart rate increases from 66 to 98 beats/min. c. Respiratory rate goes from 14 to 20 breaths/min. d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg. ANSWER Heart rate increases from 66 to 98 beats/min. A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in O2 saturation, are normal responses to exercise. The nurse is administering a thrombolytic agent to a patient having an acute myocardial infarction. Which patient data indicates that the nurse should stop the drug infusion? a. Bleeding from the gums b. An increase in blood pressure c. Decreased level of consciousness d. A nonsustained episode of ventricular tachycardia Decreased level of consciousness The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding, a possible complication of thrombolytic therapy. Some bleeding of the gums is an expected side effect of the therapy but not an indication to stop infusion of the thrombolytic medication. A decrease in blood pressure could indicate internal bleeding. A nonsustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective. A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action would the nurse take as focused follow-up on this symptom? a. Assess both feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias. Auscultate for a pericardial friction rub. The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms. In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? a. ―I will sit down before I put the nitroglycerin under my tongue.‖ b. ―I will check my pulse rate before I take any nitroglycerin tablets.‖ c. ―I will put the nitroglycerin patch on as soon as I get any chest pain.‖ d. ―I will remove the nitroglycerin patch before taking sublingual nitroglycerin.‖ ―I will sit down before I put the nitroglycerin under my tongue.‖ The patient should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin. Although the nurse should check blood pressure before giving nitroglycerin, patients do not need to check the pulse rate before taking nitrates. The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI). Which information would the nurse anticipate teaching the patient? a. Sudden cardiac death events rarely reoccur. b. Additional diagnostic testing will be required. c. Long-term anticoagulation therapy will be needed. d. Limiting physical activity will prevent future SCD events. Additional diagnostic testing will be required. Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac catheterization) is used to determine the possible cause of the SCD and treatment options. SCD is likely to recur. Anticoagulation therapy will not have any effect on the incidence of SCD, and SCD can occur even when the patient is resting. A patient with diabetes mellitus and chronic stable angina has a new order for captopril. Which information would the nurse teach this patient about the primary purpose of captopril? a. Decreases the heart rate. b. Controls blood glucose levels. c. Prevents changes in heart muscle. d. Reduces the frequency of chest pain. Prevents changes in heart muscle. The purpose for angiotensin-converting enzyme (ACE) inhibitors in patients with chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling. ACE inhibitors do not directly impact angina frequency, blood glucose, or heart rate. After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, ―It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned.‖ Which reply would be most appropriate for the nurse to make? a. ―What do you think caused your chest pain?‖ b. ―Where are you planning to go for your vacation?‖ c. ―Sometimes plans need to change after a heart attack.‖ d. ―Recovery from a heart attack takes at least a few weeks.‖ ―What do you think caused your chest pain?‖ When the patient is experiencing denial, the nurse should assist the patient in testing reality until the patient has progressed beyond this step of the emotional adjustment to MI. Asking the patient about vacation plans reinforces the patient's plan, which is not appropriate in the immediate post-MI period. Reminding the patient in denial about the MI is likely to make the patient angry and lead to distrust of the nursing staff. The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed? a. ―They will circulate my blood with a machine during surgery.‖ b. ―I will have incisions in my leg where they will remove the vein.‖ c. ―They will use an artery near my heart to go around the area that is blocked.‖ d. ―I will need to take aspirin every day after the surgery to keep the graft open.‖ ―I will have incisions in my leg where they will remove the vein.‖ When the internal mammary artery is used, there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective. A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. Which response by the nurse provides the most useful information for the patient? a. ―Most patients are able to enjoy intercourse without any complications.‖ b. ―Sexual activity uses about as much energy as climbing two flights of stairs.‖ c. ―The doctor will provide sexual guidelines when your heart is strong enough.‖ d. ―Holding and cuddling are good ways to maintain intimacy after a heart attack.‖ ―Sexual activity uses about as much energy as climbing two flights of stairs.‖ Sexual activity places about as much physical stress on the cardiovascular system as moderate-energy activities, such as climbing two flights of stairs. The other responses are general statements that may be accurate, but do not provide useful guidelines for judging the physical safety of the activity. A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which action would the nurse take? a. Administer the medication at the patient's usual bedtime. b. Have the patient take the colesevelam 1 hour before breakfast. c. Give the patient's other medications 3 hours after colesevelam. d. Have the patient take the dose at the same time as the prescribed aspirin. Give the patient's other medications 3 hours after colesevelam. The bile acid sequestrants interfere with the absorption of many other drugs and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. For maximum effect, colesevelam should be administered with meals. The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Which information would the nurse plan to provide today? a. Typical emotional responses to AMI b. When cardiac rehabilitation will begin c. Pathophysiology of coronary artery disease d. Information regarding discharge medications When cardiac rehabilitation will begin Early after an AMI, the patient will want to know when resumption of usual activities can be expected. At this time, the patient's anxiety level or denial will interfere with good understanding of complex information such as the pathophysiology of coronary artery disease. Teaching about discharge medications should be done closer to discharge. The nurse should support the patient by decreasing anxiety with information rather than discussing the typical emotional responses to myocardial infarction. A patient who has recently started taking pravastatin (Pravachol) and niacin reports several new symptoms to the nurse. Which information is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness with rapid position changes c. Nausea when taking the drugs before meals d. Flushing and pruritus after taking the drugs Generalized muscle aches and pains Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and although the nurse should follow-up with the health care provider, they do not indicate that a change in medication is needed. A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Sildenafil (Viagra) b. Furosemide (Lasix) c. Warfarin (Coumadin) d. Diltiazem (Cardizem) Sildenafil (Viagra) The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation. The other home medications should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment. Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision Pallor and weakness of the right hand The changes in the right hand indicate compromised blood flow, which requires immediate evaluation and actions, such as prescribed calcium channel blockers or surgery. The other changes are expected or require nursing interventions. The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. Which task could the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? a. Teach the patient about the postprocedure plan of care. b. Give the scheduled aspirin and lipid-lowering medication. c. Perform the initial assessment of the catheter insertion site. d. Titrate the heparin infusion according to the agency protocol. Give the scheduled aspirin and lipid-lowering medication. Administration of oral medications is within the scope of practice for LPNs/VNs. The initial assessment of the patient, patient teaching, and titration of IV anticoagulant medications should be done by the registered nurse (RN). Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider? a. Inverted P wave b. Sinus tachycardia c. ST-segment elevation d. First-degree atrioventricular block ST-segment elevation The patient is likely to be experiencing an ST-segment-elevation myocardial infarction. Immediate therapy with percutaneous coronary intervention or thrombolytic medication is indicated to minimize myocardial damage. The other ECG changes may also suggest a need for therapy but not as rapidly. A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse? a. Report of chest pain b. Heart rate 102 beats/min c. Pedal pulses 1+ bilaterally d. Blood pressure 103/54 mm Hg Report of chest pain The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse. A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority? a. Acute pain b. Deficient knowledge c. Impaired cardiac function d. Health maintenance alteration Impaired cardiac function The hypotension and tachycardia indicate decreased cardiac output and shock from the impaired function of the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g., brain, kidney, heart) and is a priority. When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action would the nurse perform first? a. Attach the heart monitor. b. Obtain the blood pressure. c. Assess the peripheral pulses. d. Auscultate the breath sounds. Attach the heart monitor Because dysrhythmias are the most common complication of myocardial infarction (MI), the first action should be to place the patient on a heart monitor. The other actions are also important and should be accomplished as quickly as possible. Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? a. An increase in troponin levels from baseline b. A large bruise at the patient's IV insertion site c. No change in the patient's reported level of chest pain d. A decrease in ST-segment elevation on the electrocardiogram No change in the patient's reported level of chest pain Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention may be needed. Bruising is a possible side effect of thrombolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring, and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac biomarkers into the circulation as the blocked vessel is opened. The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies having a heart attack. c. Bilateral crackles in the mid-lower lobes. d. Occasional premature atrial contractions (PACs). Bilateral crackles in the mid-lower lobes. The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme inhibitors for the patient. Elevation in troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI. A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? a. Reinforcement of teaching about the prescribed medications b. Evaluation of the patient's response to walking in the hallway c. Completion of the referral form for a home health nurse follow-up d. Education of the patient about the pathophysiology of heart disease Reinforcement of teaching about the prescribed medications LPN/VN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient's response to exercise after a NSTEMI requires more education and should be done by the RN. Teaching and discharge planning and referral are skills that require RN education and scope of practice. patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one would the nurse arrange to be completed first? a. Chest x-ray b. Troponin level c. Electrocardiogram (ECG) d. Insertion of a peripheral IV Electrocardiogram (ECG) The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that the appropriate therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion, and an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours. Data from the chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction. Peripheral IV access will be needed but not before the ECG. After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient would the nurse assess first? a. A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain b. A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia) c. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge d. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI) A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI) After PCI, the patient is at risk for hemorrhage from the arterial access site. The nurse should assess the patient's blood pressure, pulses, and the access site immediately. The other patients should also be assessed as quickly as possible, but assessment of this patient has the highest priority. To improve the physical activity level for a 68-year-old patient who is mildly obese, which action would the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity. Determine what kind of physical activities the patient usually enjoys. Because patients are more likely to continue physical activities that they already enjoy, the nurse will plan to ask the patient about preferred activities. The goal for older adults is 30 minutes of moderate activity on most days. Older adults should plan for a longer warm-up period. Benefits of exercises, such as improved activity tolerance, should be emphasized rather than aiming for significant weight loss in older mildly obese adults. Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg Patient with stable angina whose chest pain has recently increased in frequency The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are more stable. While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. What does this finding indicate? a. Jugular vein atherosclerosis b. Incompetent jugular vein valves c. Increased ventricular filling pressure d. Decreased intravascular fluid volume Increased ventricular filling pressure The jugular veins empty into the superior vena cava and then into the right atrium and ventricle, so JVD with the patient sitting at a 45-degree angle reflects increased atrial and ventricular pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis. The nurse is caring for a patient who is receiving IV furosemide and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 lb in 24 hours b. Hourly urine output greater than 60 mL c. Reduced dyspnea with the head of bed at 30 degrees d. Patient denies experiencing chest pain or chest pressure Reduced dyspnea with the head of bed at 30 degrees Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data may also indicate that diuresis or improvement in cardiac output has occurred but are not specific to evaluating this patient's response. Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)? a. Need to begin an aerobic exercise program several times weekly b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors c. Use of salt substitutes to replace table salt when cooking and at the table d. Importance of making an annual appointment with the health care provider Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors Patients with HFrEF would receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be possible for a patient with this level of heart failure. Salt substitutes are not usually recommended because of the risk of hyperkalemia. The patient will need to see the primary care provider more often than annually. IV sodium nitroprusside is prescribed for a patient with acute pulmonary edema. Which reassessment finding indicates that the nurse should decrease the rate of nitroprusside infusion? a. Ventricular ectopy b. Dry, hacking cough c. Systolic BP below 90 mm Hg d. Heart rate below 50 beats/min Systolic BP below 90 mm Hg Sodium nitroprusside is a potent vasodilator and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy. A patient who has chronic heart failure tells the nurse, ―I was fine when I went to bed, but I woke up feeling like I was suffocating!‖ How would the nurse document this finding? a. Orthopnea b. Pulsus alternans c. Paroxysmal nocturnal dyspnea d. Acute bilateral pleural effusion Paroxysmal nocturnal dyspnea Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alteration of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period. Which statement by a patient newly diagnosed with heart failure indicates to the nurse that teaching was effective? a. ―I will take furosemide (Lasix) every day just before bedtime.‖ b. ―I will use the nitroglycerin patch whenever I have chest pain.‖ c. ―I will use an additional pillow if I am short of breath at night.‖ d. ―I will call the clinic if my weight goes up 3 pounds in a week.‖ ―I will call the clinic if my weight goes up 3 pounds in a week.‖ Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 lb in 2 days or 3 to 5 lb in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an ―as needed‖ basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops rather than just compensating by further elevating the head of the bed. Which foods would the nurse recommend limiting for a patient on a 2000-mg sodium diet? a. Chicken and eggs b. Canned and frozen fruits c. Yogurt and milk products d. Fresh or frozen vegetables Yogurt and milk products Yogurt and milk products (e.g., cheese) naturally contain a significant amount of sodium, and the intake of these would be limited for patients on a diet that limits sodium to 2000 mg daily. The other foods listed have minimal levels of sodium and can be eaten without restriction. While admitting an 82-yr-old patient with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the ―water pill‖ with the ―heart pill.‖ What would the nurse include in the discharge plan? a. Consult with a psychologist b. Transfer to a long-term care facility c. Referral to a home health care agency d. Arrangements for around-the-clock care Referral to a home health care agency The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patient's home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as a psychologist consult, long-term care, or around-the-clock home care. Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. Which medication topic would the nurse anticipate including in discharge teaching? a. Calcium channel blocker b. Selective SA node inhibitor c. Digoxin and potassium therapy regimen d. Angiotensin-converting enzyme (ACE) inhibitor Angiotensin-converting enzyme (ACE) inhibitor ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other drugs such as ACE-inhibitors, diuretics, and -adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. Ivabradine would likely be used for a patient with HF who has symptoms despite optimal doses of other medications. A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is an option. Which response is accurate? a. ―Your heart failure has not reached the end stage yet.‖ b. ―You could not manage the multiple complications of surgery.‖ c. ―The suitability of a heart transplant depends on many factors.‖ d. ―Because you have diabetes, you would not be a heart transplant candidate.‖ ―The suitability of a heart transplant depends on many factors.‖ Indications for a heart transplant include end-stage heart failure (stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Patients with diabetes who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, there are no data to suggest that the patient could not manage the care. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram B-type natriuretic peptide B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure. Elevated BNP indicates a very probable diagnosis of heart failure. A 12-lead electrocardiogram, arterial blood gases, and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP. A hospitalized patient with chronic heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. ―I plan to take the medication with food.‖ b. ―I should eat more potassium-rich foods.‖ c. ―I will call for help when I need to get up to use the bathroom.‖ d. ―I can expect to feel more short of breath for the next few days.‖ ―I will call for help when I need to get up to use the bathroom.‖ Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of -adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating. A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication would the nurse question before giving? a. Captopril (Capoten) 25 mg b. Furosemide (Lasix) 60 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg Carvedilol (Coreg) 3.125 mg Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients in pulmonary edema with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. -Blockers can reduce myocardial contractility, so care must be taken in patients with volume overload. The other drugs are appropriate for the patient with ADHF. A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action would the nurse take first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Ask about the patient's allergies. Auscultate the breath sounds. This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) may be occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority. A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor is on a low-sodium diet. The patient tells the home health nurse about a 5-lb weight gain in the past 3 days. Which action is the nurse's priority? a. Teach the patient about restricting dietary sodium. b. Assess the patient for manifestations of acute heart failure. c. Ask the patient about the use of the prescribed medications. d. Have the patient recall the dietary intake for the past 3 days. Assess the patient for manifestations of acute heart failure. The 5-lb weight gain over 3 days indicates that the patient's chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated. A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient. Which action would the nurse take first? a. Give PRN IV morphine sulfate 4 mg. b. Give PRN IV diazepam (Valium) 2.5 mg. c. Increase nitroglycerin infusion by 5 mcg/min. d. Increase dopamine infusion by 2 mcg/kg/min. Give PRN IV morphine sulfate 4 mg. Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea. After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient would the nurse assess first? a. A patient who has dizziness after a dose of captopril. b. A patient who has new-onset confusion and restlessness. c. A patient who is receiving oxygen and has crackles in the bilateral lung bases. d. A patient who is receiving IV nesiritide (Natrecor), with a BP of 100/62. A patient who has new-onset confusion and restlessness. The patient who has neurological manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also would be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion. Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires immediate action by the nurse? a. O2 saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/min d. Urine output of 50 mL over 2 hours O2 saturation of 88% A decrease in O2 saturation to less than 92% indicates hypoxemia, and the nurse would start supplemental O2 immediately. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output may also indicate worsening heart failure and require nursing actions, but the low O2 saturation rate requires the most immediate nursing action. A patient who has heart failure recently started taking digoxin in addition to furosemide and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1+ to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days Serum potassium level 3.0 mEq/L after 1 week of therapy Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions) and potentiate the actions of digoxin. Hypokalemia also increases the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level. An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ bilateral pedal edema b. Heart rate of 52 beats/min c. Report of increased fatigue d. Blood pressure 88/42 mm Hg Blood pressure 88/42 mm Hg The patient's blood pressure indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of -adrenergic blockade, though it may need to be monitored. -Adrenergic blockade initially will worsen symptoms of heart failure in many patients and patients would be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs. A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action would be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? a. Teach the patient the reasons for remaining on bed rest. b. Change the peripheral IV site according to agency policy. c. Monitor the patient's blood pressure and heart rate every hour. d. Titrate the dobutamine to keep the systolic blood pressure 90 mm Hg. Monitor the patient's blood pressure and heart rate every hour. An experienced LPN/VN would be able to monitor BP and heart rate and report significant changes to the RN. Teaching patients, adjusting the drip rate for vasoactive drugs, and inserting a new peripheral IV catheter require RN level education and scope of practice. After receiving change-of-shift report, which patient would the nurse assess first? a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58 b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L c. Patient who is taking captopril and has a frequent nonproductive cough d. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache Patient who is taking digoxin and has a potassium level of 3.1 mEq/L The patient's low potassium level increases the risk for digoxin toxicity and potentially life-threatening dysrhythmias. The nurse would assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their drugs, but their symptoms do not indicate potentially life-threatening complications. An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which data would indicate to the nurse that the goals of IABP treatment are being met? a. Urine output of 25 mL/hr b. Heart rate of 110 beats/min c. Cardiac output (CO) of 5 L/min d. Stroke volume (SV) of 40 mL/beat Cardiac output (CO) of 5 L/min A CO of 5 L/min is normal and indicates that the IABP has been successful in treating the shock. The low SV signifies continued cardiogenic shock. The tachycardia and low urine output also suggest continued cardiogenic shock. The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action would the nurse include in the plan of care? a. Avoid the use of anticoagulant medications. b. Monitor the patient's urinary output every hour. c. Provide passive range of motion for all extremities. d. Position the patient supine with head flat at all times. Monitor the patient's urinary output every hour. Monitoring urine output will help determine whether the patient's cardiac output has improved. It also will help assess for balloon displacement blocking the renal arteries. The head of the bed can be elevated up to 30 degrees. Heparin is used to prevent thrombus formation. Limited movement is allowed for the extremity with the balloon insertion site to prevent displacement of the balloon. While waiting for heart transplantation, a patient with severe cardiomyopathy has a ventricular assist device (VAD) implanted. Which action would the nurse include in the plan of care for this patient? a. Preparing the patient for a permanent VAD b. Teaching the patient the reason for bed rest c. Monitoring the incision for signs of infection d. Administering immunosuppressants medications Monitoring the incision for signs of infection The insertion site for the VAD provides a source for transmission of infection to the circulatory system and requires frequent monitoring. Patients with VADs can have some mobility and may not be on bed rest. The VAD is a bridge to transplantation, not a permanent device. Immunosuppression is not necessary for nonbiologic devices such as the VAD. What would the nurse measure to determine whether there is a delay in electrical impulse conduction through the patient's ventricles? a. P wave b. Q wave c. PR interval d. QRS complex QRS complex The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the atria. The PR interval represents depolarization of the atria, atrioventricular node, bundle of His, bundle branches, and the Purkinje fibers. The Q wave is the first negative deflection following the P wave and would be narrow and short. The nurse needs to measure the heart rate for a patient with an irregular heart rhythm. Which method will be accurate? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. The accurate way to measure the heart rate from an EKG of a patient with an irregular rhythm is to count the number of QRS complexes in 1 minute. The other methods are accurate for regular heart rhythms. A patient has a junctional escape rhythm on the monitor. Which range of heart rate would the nurse expect? a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100 40 to 60 If the sinoatrial (SA) node does not discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60 beats/min. The slower rates are typical of the bundle of His and Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/min. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, QRS complex wide and distorted, and QRS duration of 0.18 second. How would the nurse interpret this cardiac rhythm? a. Atrial flutter b. Sinus tachycardia c. Ventricular fibrillation d. Ventricular tachycardia Ventricular tachycardia The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration. A patient's heart monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Multifocal premature ventricular contractions Ventricular bigeminy Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the premature ventricular contractions are multifocal or that the R-on-T phenomenon is occurring. A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. Which action would the nurse take? a. Notify the health care provider immediately. b. Document the finding and monitor the patient. c. Give atropine per agency dysrhythmia protocol. d. Prepare the patient for temporary pacemaker insertion. Document the finding and monitor the patient. First-degree atrioventricular block is asymptomatic and usually not serious. There is no treatment for first-degree AV block; treatment of associated conditions may be considered. Monitor patients for changes in heart rhythm (e.g., more serious AV block). The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary. A patient who was admitted with a myocardial infarction has a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action would the nurse take next? a. Immediately notify the health care provider. b. Document the rhythm and continue to monitor the patient. c. Prepare for synchronized cardioversion per agency protocol. d. Prepare to give IV amiodarone per agency dysrhythmia protocol. Prepare to give IV amiodarone per agency dysrhythmia protocol. The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medication is started. Cardioversion is not indicated given that the patient has returned to a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation. After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the drug has been effective? a. Increase in the patient's heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions Increase in the patient's heart rate Atropine will increase the heart rate and conduction through the AV node. Because the drug increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. Premature atrial or ventricular contractions are not a feature of second degree AV block. A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for four days. Which topic would the nurse plan to include in patient teaching? a. Anticoagulant therapy b. Permanent pacemakers c. Emergency cardioversion d. IV adenosine (Adenocard) Anticoagulant therapy Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate. Which information will the nurse include when teaching a patient with atrial flutter who is scheduled for a radiofrequency catheter ablation? a. The procedure stimulates the growth of new pathways between the atria. b. The procedure uses cold therapy to stop the formation of the flutter waves. c. The procedure uses electrical energy to destroy areas of the conduction system. d. The procedure prevents or minimizes the patient's risk for sudden cardiac death. The procedure uses electrical energy to destroy areas of the conduction system. Radiofrequency catheter ablation therapy uses electrical energy to ―burn‖ or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and tachydysrhythmias. All other statements about the procedure are incorrect. Which patient statement indicates that discharge teaching about the management of a new permanent pacemaker was effective? a. ―It will be several weeks before I can return to my usual activities.‖ b. ―I will avoid cooking with a microwave oven or being near one in use.‖ c. ―I will notify the airlines when I make a reservation that I have a pacemaker.‖ d. ―I won't lift the arm on the incision side until I see the health care provider.‖ ―I won't lift the arm on the incision side until I see the health care provider.‖ The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period. Which action by a nurse caring for a patient after an implantable cardioverter-defibrillator (ICD) insertion indicates a need for more teaching about the care of patients with ICDs? a. The nurse administers amiodarone (Cordarone) to the patient. b. The nurse helps the patient fill out the application for obtaining a Medic Alert device. c. The nurse encourages the patient to do active range-of-motion exercises for all extremities. d. The nurse teaches the patient that sexual activity can be resumed when the incision is healed. The nurse encourages the patient to do active range-of-motion exercises for all extremities. The patient should avoid moving the arm on the ICD insertion site until healing has occurred to prevent displacement of the ICD leads. The other actions by the nurse are appropriate for this patient. A patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg is being prepared for cardioversion. Which action should the nurse expect to take? a. Turn the synchronizer switch to the ―off‖ position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device. Give a sedative before cardioversion is implemented. When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned ―on‖ for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this alert patient. A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team. The patient is found to have sinus bradycardia, rate 52 and blood pressure (BP) 114/54 mm Hg. The student denies any health problems. Which action would the nurse take? a. Approve the student to participate on the soccer team. b. Refer the student to a cardiologist for further testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the student's family health history. Approve the student to participate on the soccer team. In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family's health history. Dyspnea during an aerobic activity such as soccer is normal. Which finding from a newly admitted adult patient's electrocardiogram (ECG) requires further investigation by the nurse? a. Isoelectric ST segment b.