Cardiovascular Conditions - NCLEX-PN
Card 0 of 348
Which EKG lead localizes to the base of the heart?
Which EKG lead localizes to the base of the heart?
aVF is the main lead that points to the base of the heart (inferiorly). ST segment elevations in this lead help localize the area of infarction and can help identify the coronary artery involved. The precordial leads (V1-V6) do not point towards the base of the heart. Lead I is considered a lateral lead.
aVF is the main lead that points to the base of the heart (inferiorly). ST segment elevations in this lead help localize the area of infarction and can help identify the coronary artery involved. The precordial leads (V1-V6) do not point towards the base of the heart. Lead I is considered a lateral lead.
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Which of the following is least likely to be a co-morbidity with congestive heart failure?
Which of the following is least likely to be a co-morbidity with congestive heart failure?
Congestive heart failure tends to be precipitated by hypertension, type II diabetes, nutritional deficiencies such as thiamine, pulmonary disease, and chronic stress. Atrial fibrillation is not generally a causative factor in congestive heart failure, but these conditions are frequently seen together as they share an etiology. Vestibular irregularities are not generally observed in congestive heart failure.
Congestive heart failure tends to be precipitated by hypertension, type II diabetes, nutritional deficiencies such as thiamine, pulmonary disease, and chronic stress. Atrial fibrillation is not generally a causative factor in congestive heart failure, but these conditions are frequently seen together as they share an etiology. Vestibular irregularities are not generally observed in congestive heart failure.
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The nurse works in the emergency department and assesses a patient who is complaining of mid-sternal chest pain. What is the nurse’s first action?
The nurse works in the emergency department and assesses a patient who is complaining of mid-sternal chest pain. What is the nurse’s first action?
The first nursing action for a patient arriving in distress to the emergency department is always to begin with priority assessments including vital signs. It provides a baseline for the healthcare team to use when further assessment and treatment is implemented. An electrocardiogram may be used later but is not a priority action, and is ordered by the primary care provider and not the nurse. A thorough medical history and physical assessment will be useful but is not the first action the nurse must take. The physician should be notified but the nurse must assess vital signs first.
The first nursing action for a patient arriving in distress to the emergency department is always to begin with priority assessments including vital signs. It provides a baseline for the healthcare team to use when further assessment and treatment is implemented. An electrocardiogram may be used later but is not a priority action, and is ordered by the primary care provider and not the nurse. A thorough medical history and physical assessment will be useful but is not the first action the nurse must take. The physician should be notified but the nurse must assess vital signs first.
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A 50-year-old female presents to emergency room after complaining of chest pain that came on while at home watching television, she thought she was having a heart attack. The nurse proceeds to gather more history about this client. The client does not have a history of coronary artery or heart disease, but does report a history of migraine headaches and Raynaud's disease. There was a previous episode at this hospital where a transient ST segment elevation was identified on her EKG.
Based on these findings, the nurse might suspect what condition?
A 50-year-old female presents to emergency room after complaining of chest pain that came on while at home watching television, she thought she was having a heart attack. The nurse proceeds to gather more history about this client. The client does not have a history of coronary artery or heart disease, but does report a history of migraine headaches and Raynaud's disease. There was a previous episode at this hospital where a transient ST segment elevation was identified on her EKG.
Based on these findings, the nurse might suspect what condition?
The client describes pain at rest without a history of heart disease. This type of chest pain often describes prinzmetal's angina which is a spasm of a major coronary artery and can occur while at rest. Many times the client may have a history of other vasospastic conditions such as Raynaud's. It may be treated with a calcium channel blocker or nitrates.
The client describes pain at rest without a history of heart disease. This type of chest pain often describes prinzmetal's angina which is a spasm of a major coronary artery and can occur while at rest. Many times the client may have a history of other vasospastic conditions such as Raynaud's. It may be treated with a calcium channel blocker or nitrates.
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When checking on a patient receiving parenteral nutrition the nurse observes that the patient has gained excessive weight, has increased blood pressure, and has a bounding pulse. The nurse responds by:
When checking on a patient receiving parenteral nutrition the nurse observes that the patient has gained excessive weight, has increased blood pressure, and has a bounding pulse. The nurse responds by:
A client with excessive weight gain, headache, increased blood pressure, and bounding pulse is demonstrating symptoms of hypervolemia. The nurse should slow or stop the IV infusion, restrict fluids, an administer diuretics.
A client with excessive weight gain, headache, increased blood pressure, and bounding pulse is demonstrating symptoms of hypervolemia. The nurse should slow or stop the IV infusion, restrict fluids, an administer diuretics.
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What is cardiac tamponade?
What is cardiac tamponade?
Cardiac tamponade is a condition in which blood, air, pus, or some other type of fluid accumulates in the pericardium, putting pressure on the heart and reducing it's ability to fill during diastole. Cardiac tamponade is not an arrhythmia, a murmur, or any type of ischemia. Signs include pulsus paradoxus (a greater than 10mmHg drop of systolic blood pressure on inspiration) and changes on ECG.
Cardiac tamponade is a condition in which blood, air, pus, or some other type of fluid accumulates in the pericardium, putting pressure on the heart and reducing it's ability to fill during diastole. Cardiac tamponade is not an arrhythmia, a murmur, or any type of ischemia. Signs include pulsus paradoxus (a greater than 10mmHg drop of systolic blood pressure on inspiration) and changes on ECG.
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A 60-year-old male enters the emergency room complaining of burning pain under his sternum that radiates to his jaw. He has been experiencing this pain for three weeks, periodically, with episodes that occur as often as three times a week. The nurse proceeds in which of the following ways?
A 60-year-old male enters the emergency room complaining of burning pain under his sternum that radiates to his jaw. He has been experiencing this pain for three weeks, periodically, with episodes that occur as often as three times a week. The nurse proceeds in which of the following ways?
The patient is describing symptoms of heartburn. While it is important to rule out a cardiac-related cause, the nurse must do more assessment before reaching a conclusion.
The patient is describing symptoms of heartburn. While it is important to rule out a cardiac-related cause, the nurse must do more assessment before reaching a conclusion.
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What EKG rhythm is considered "irregularly irregular?"
What EKG rhythm is considered "irregularly irregular?"
Atrial fibrillation (AFib) is considered an "irregularly irregular" rhythm. There are no discernible p waves because the atria are not contracting properly. The rate is irregular. This means that the rate varies from beat to beat.
Atrial fibrillation (AFib) is considered an "irregularly irregular" rhythm. There are no discernible p waves because the atria are not contracting properly. The rate is irregular. This means that the rate varies from beat to beat.
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Which of the following is not a risk factor for hypertension?
Which of the following is not a risk factor for hypertension?
All of the answer choices listed are risk factors for hypertension:
Gender - more common in men
Race - more common in people of African American descent
Family history - more common in patients who have family members with a history of hypertension
All of the answer choices listed are risk factors for hypertension:
Gender - more common in men
Race - more common in people of African American descent
Family history - more common in patients who have family members with a history of hypertension
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An EKG of your patient shows peaked T-waves. This finding correlates to which electrolyte abnormality?
An EKG of your patient shows peaked T-waves. This finding correlates to which electrolyte abnormality?
Peaked T-waves are a warning sign for elevated levels of potassium in the body. On the other hand, flattened T-waves are potentially indicative of low levels of potassium. Hyperkalemia (high potassium) is a potentially dangerous condition that can lead to cardiac abnormalities and potentially death.
Peaked T-waves are a warning sign for elevated levels of potassium in the body. On the other hand, flattened T-waves are potentially indicative of low levels of potassium. Hyperkalemia (high potassium) is a potentially dangerous condition that can lead to cardiac abnormalities and potentially death.
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A client has just undergone an electrocardiogram (ECG), the nurse notes that the QRS complex is measured to be 0.09 seconds. What is the first action the nurse should take?
A client has just undergone an electrocardiogram (ECG), the nurse notes that the QRS complex is measured to be 0.09 seconds. What is the first action the nurse should take?
This is a normal finding, the QRS should have a duration between 0.6-0.12 seconds.
This is a normal finding, the QRS should have a duration between 0.6-0.12 seconds.
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You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?
You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?
The most likely cardiac rhythm on this patient's ECG is a trial fibrillation.
Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.
When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.
Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.
The other answers are incorrect for the following reasons:
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Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength.
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Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.
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First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.
The most likely cardiac rhythm on this patient's ECG is a trial fibrillation.
Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.
When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.
Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.
The other answers are incorrect for the following reasons:
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Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength.
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Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.
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First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.
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A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at 
?
A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at
Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about 
. ST segment elevation is classically seen in myocardial infarctions that result in positive troponin.
Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about
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You are a nurse taking care of a patient in the emergency room. Among other acute labwork and imaging, you obtain an electrocardiogram (ECG) of the patient. The ECG shows Osborn waves. Which of the following is the most common cause of Osborn waves on ECG?
You are a nurse taking care of a patient in the emergency room. Among other acute labwork and imaging, you obtain an electrocardiogram (ECG) of the patient. The ECG shows Osborn waves. Which of the following is the most common cause of Osborn waves on ECG?
The correct answer is "hypothermia." Osborn waves on electrocardiogram are the pathognomonic finding associated with hypothermia (to a core body temperature of lower than 32 C). Osborn waves are observed as upward deflections in the ECG reading between the QRS and ST intervals with an elevation at the S point (which is sometimes also referred to as the J point). While hypothermia is the most common cause of Osborn waves, they may also be observed in patients with coronary vasospasm, hypercalcemia, ventricular fibrillation, or brain trauma.
Neither hyperthermia, ethanol toxicity, carbon monoxide poisoning, nor lead poisoning are associated with Osborn waves on ECG.
The correct answer is "hypothermia." Osborn waves on electrocardiogram are the pathognomonic finding associated with hypothermia (to a core body temperature of lower than 32 C). Osborn waves are observed as upward deflections in the ECG reading between the QRS and ST intervals with an elevation at the S point (which is sometimes also referred to as the J point). While hypothermia is the most common cause of Osborn waves, they may also be observed in patients with coronary vasospasm, hypercalcemia, ventricular fibrillation, or brain trauma.
Neither hyperthermia, ethanol toxicity, carbon monoxide poisoning, nor lead poisoning are associated with Osborn waves on ECG.
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What is the most common EKG finding in a patient with a pulmonary embolism?
What is the most common EKG finding in a patient with a pulmonary embolism?
Sinus tachycardia is the most common EKG finding in a pulmonary embolism. This represents the heart beating faster as an infarction occurs within the lung tissue. Peaked T waves are seen in hyperkalemia. ST elevation is seen in myocardial infarction, and ST depression is seen in myocardial ischemia. Sinus bradycardia would not be the expected finding in a PE.
Sinus tachycardia is the most common EKG finding in a pulmonary embolism. This represents the heart beating faster as an infarction occurs within the lung tissue. Peaked T waves are seen in hyperkalemia. ST elevation is seen in myocardial infarction, and ST depression is seen in myocardial ischemia. Sinus bradycardia would not be the expected finding in a PE.
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The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.
The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.
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A 57-year-old female presents to the clinic after newly diagnosed with stage one hypertension. The nurse is responsible for teaching this client about the condition.
The nurse should include what information in teaching this client about her medications?
A 57-year-old female presents to the clinic after newly diagnosed with stage one hypertension. The nurse is responsible for teaching this client about the condition.
The nurse should include what information in teaching this client about her medications?
Hypertension is an incurable condition, and can be controlled by various interventions. Sodium should be redced but not eliminated, and blood pressure taken by the patient should be performed once daily then weekly after blood pressure has stabilized. Patient should be encouraged to report serious side effects to the physician before stopping the medications. Optimal times to take medications are on a regular basis, not after warm baths, alcohol ingestion, or strenous exercise.
Hypertension is an incurable condition, and can be controlled by various interventions. Sodium should be redced but not eliminated, and blood pressure taken by the patient should be performed once daily then weekly after blood pressure has stabilized. Patient should be encouraged to report serious side effects to the physician before stopping the medications. Optimal times to take medications are on a regular basis, not after warm baths, alcohol ingestion, or strenous exercise.
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Which of the following results would indicate a therapeutic effect in the client taking epoetin alfa?
Which of the following results would indicate a therapeutic effect in the client taking epoetin alfa?
Epoetin alfa is used to treat anemia by causing bone marrow to produce oxygen-carrying red blood cells. Patients experiencing the therapeutic effects of the drug will have hematocrit in the range of 27-32%.
Epoetin alfa is used to treat anemia by causing bone marrow to produce oxygen-carrying red blood cells. Patients experiencing the therapeutic effects of the drug will have hematocrit in the range of 27-32%.
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The nurse recognizes the following as a client's successful response to defibrillation:
The nurse recognizes the following as a client's successful response to defibrillation:
If defibrillation is successful, the client should be arousable, have a sinus rhythm, and have BP in a normal range.
If defibrillation is successful, the client should be arousable, have a sinus rhythm, and have BP in a normal range.
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Which part of the heart is most susceptible to infective endocarditis?
Which part of the heart is most susceptible to infective endocarditis?
Because the valves of the heart don't have their own blood vessels, white blood cells can't directly get there via the bloodstream. In addition, due to the lack of vasculature, if infection does occur antimicrobial medications may have difficulty reaching the infection.
Because the valves of the heart don't have their own blood vessels, white blood cells can't directly get there via the bloodstream. In addition, due to the lack of vasculature, if infection does occur antimicrobial medications may have difficulty reaching the infection.
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