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cardio rationales[1]

cardio rationales[1]

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Cardio Rationales Saunders

1. The nurse should counsel the client to keep
the total cholesterol level under 200 mg/dL.
This will aid in the prevention of
atherosclerosis, which can lead to a number of
cardiovascular disorders later in life. Options
3 and 4 are elevated values and place the
client at risk for cardiovascular disease.
Although option 1 is a low cholesterol level,
option 2 identifies the realistic value to assist
in preventing cardiovascular disease.

2. Troponin is a regulatory protein found in
striated muscle. The troponins function
together in the contractile apparatus for
striated muscle in skeletal muscle and in the
myocardium. Increased amounts of troponins
are released into the bloodstream when an
infarction causes damage to the myocardium.
A troponin T value that is higher than 0.1 to
0.2 ng/mL is consistent with a myocardial
infarction. A normal troponin I level is lower
than 0.6 ng/mL.

3. Creatine kinase (CK) is a cellular enzyme that
can be fractionated into three isoenzymes. The
MB band reflects CK from cardiac muscle.
This is the level that elevates with myocardial
infarction. The MM band reflects CK from
skeletal muscle. The BB band reflects CK
from the brain. There is no MK band.

4. The normal prothrombin time (PT) is 9.6 to
11.8 seconds (male adult) or 9.5 to 11.3
seconds (female adult). A therapeutic PT level

is 1.5 to 2.0 times higher than the normal
level. Because the value of 35 seconds is high
(and perhaps near the critical range), the nurse
should anticipate that the client would not
receive further doses at this time.

5. The normal therapeutic range for digoxin is
0.5 to 2.0 ng/mL. A level of 2.4 ng/mL
exceeds the therapeutic range and indicates
toxicity. The most important action is to notify
the physician, who may give further orders
about holding further doses of digoxin. Option
3 is incorrect because the level is not normal.
The next dose should not be administered
because the serum digoxin level exceeds the
therapeutic range. Checking the client\u2019s last
pulse rate is not incorrect but may have
limited value in this situation. Depending on

the time that has elapsed since the last
assessment, a current assessment of the
client\u2019s status may be more useful.

6. The normal activated partial thromboplastin
time (aPTT) varies between 20 and 36
seconds, depending on the type of activator
used in testing. The therapeutic dose of
heparin for treatment of deep vein thrombosis
is to keep the aPTT between 1.5 and 2.5 times
normal. Thus, the client\u2019s aPTT is within the
therapeutic range, and the dose should remain
unchanged.

7. The normal serum potassium level in the adult
is 3.5 to 5.1 mEq/L. Option 1 is the only value
that falls below the therapeutic range.
Administering furosemide to a client with a
low potassium level and a history of cardiac
problems could precipitate ventricular
dysrhythmias. Options 2, 3, and 4 are within
the normal range.

8. Foods that are lower in sodium include fruits
and vegetables (option 4), because they do not
contain physiological saline. Highly processed
or refined foods (options 1 and 3) are higher in
sodium unless their food labels specifically
state \u201clow sodium.\u201d Saltwater fish and
shellfish are high in sodium.

9. Fruits and vegetables tend to be lower in fat
because they do not come from animal
sources. Fish is also naturally lower in fat.
Cream cheese is a high-fat food.

10. Pt with hypertension foods Smoked foods are high in sodium. Options 1, 2, and 4 are fruits and vegetables that are low in sodium.

11. When performing cardiopulmonary
resuscitation (CPR) on an adult client, the
sternum is depressed 1\u00bd to 2 inches. Options
1 and 2 identify compression depths that
would be ineffective in an adult. Option 4
identifies a depth that could cause injury to the
client.

12. When performing cardiopulmonary
resuscitation (CPR) on adults, the ratio of
chest compressions to breaths is 30:2.

13. Chest pain is assessed by using the standard
pain assessment parameters (e.g.,
characteristics, location, intensity, duration,
precipitating and alleviating factors, and

1
Cardio Rationales Saunders

associated symptoms). Options 1, 2, and 4
may or may not help discriminate the origin of
pain. Pain of pleuropulmonary origin usually
worsens on inspiration.

14. Cardiogenic shock occurs with severe damage
(more than 40%) to the left ventricle. Classic
signs include hypotension, a rapid pulse that
becomes weaker, decreased urine output, and
cool, clammy skin. Respiratory rate increases
as the body develops metabolic acidosis from
shock. Cardiac tamponade is accompanied by
distant, muffled heart sounds and prominent
neck vessels. Pulmonary embolism presents
suddenly with severe dyspnea accompanying
the chest pain. Dissecting aortic aneurysms
usually are accompanied by back pain.

15. On transfer from the coronary care unit, the
client is allowed self-care activities and
bathroom privileges. Supervised ambulation in
the hall for brief distances is encouraged, with
distances gradually increased (50, 100, 200
feet).

16. Metformin (Glucophage) needs to be withheld
48 hours before and after cardiac
catheterization because of the injection of
contrast medium during the procedure. If the
contrast medium affects kidney function, with
metformin in the system, the client would be
at increased risk for lactic acidosis. The
medications in options 1, 2, and 3 do not need
to be withheld 48 hours before and after
cardiac catheterization.

17. Hypotension and dizziness are signs of
decreased cardiac output. Transcutaneous
pacing provides a temporary measure to
increase the heart rate and thus perfusion in
the symptomatic client. Digoxin will further
decrease the client\u2019s heart rate. Defibrillation
is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation.
Continuing to monitor the client delays
necessary intervention.

18. Edema, the accumulation of excess fluid in the
interstitial spaces, can be measured by intake
greater than output and by a sudden increase
in weight. Diuretics should be given in the
morning whenever possible to avoid nocturia.

Strict sodium restrictions are reserved for
clients with severe symptoms.

19. Heart failure is precipitated or exacerbated by
physical or emotional stress, dysrhythmias,
infections, anemia, thyroid disorders,
pregnancy, Paget\u2019s disease, nutritional
deficiencies (thiamine, alcoholism),
pulmonary disease, and hypervolemia.

20. Digoxin exerts a positive inotropic effect on
the heart while slowing the overall rate
through a variety of mechanisms. Digoxin is
the medication of choice to treat heart failure.
Diltiazem and verapamil (calcium channel
blockers) and propranolol (\u03b2-adrenergic
blocker) have a negative inotropic effect and
would worsen the failing heart.

21. Pulmonary edema is characterized by extreme
breathlessness, dyspnea, air hunger, and the
production of frothy, pink-tinged sputum.
Auscultation of the lungs reveals crackles.
Rhonchi and diminished breath sounds are not
associated with pulmonary edema. Stridor is a
crowing sound associated with laryngospasm
or edema of the upper airway.

22. Pulmonary edema causes the client to be
extremely agitated and anxious. The client
may complain of a sense of drowning,
suffocation, or smothering

23. The serum potassium level is measured in the
client receiving digoxin and furosemide.
Heightened digoxin effect leading to digoxin
toxicity can occur in the client with
hypokalemia. Hypokalemia also predisposes
the client to ventricular dysrhythmias.

24. Classic signs of cardiogenic shock as they
relate to this question include low blood
pressure and tachycardia. The central venous
pressure would rise as the backward effects of
the severe left ventricular failure became
apparent. Dysrhythmias commonly occur as a
result of decreased oxygenation and severe
damage to greater than 40% of the
myocardium.

25. Sternotomy incision sites are assessed for
signs and symptoms of infection, such as
redness, swelling, induration, and drainage.
Elevated temperature and white blood cell

2
Cardio Rationales Saunders
count after 3 to 4 days postoperatively usually
indicate infection.

26. The client who undergoes cardiac surgery is at
risk for renal injury from poor perfusion,
hemolysis, low cardiac output, or vasopressor
medication therapy. Renal insult is signaled by
decreased urine output and increased blood
urea nitrogen and creatinine levels. The client
may need medications to increase renal
perfusion and possibly could need peritoneal
dialysis or hemodialysis. No data in the
question indicate the presence of
hypovolemia, urinary tract infection, or
glomerulonephritis.

27. The nurse should encourage regular use of
pain medication for the first 48 to 72 hours
after cardiac surgery because analgesia will
promote rest, decrease myocardial oxygen
consumption resulting from pain, and allow
better participation in activities such as
coughing, deep breathing, and ambulation.
Options 2 and 4 will not help in tolerating
ambulation. Removal of telemetry equipment
is contraindicated unless prescribed.

28. Normal sinus rhythm is defined as a regular
rhythm, with an overall rate of 60 to 100
beats/min. The PR and QRS measurements are
normal, measuring 0.12 to 0.20 second and
0.04 to 0.10 second, respectively.

29. Sinus tachycardia has the characteristics of
normal sinus rhythm, including a regular PP
interval and normal width PR and QRS
intervals; however, the rate is the
differentiating factor. In sinus tachycardia, the
atrial and ventricular rates are higher than 100
beats/min.

30. Motion artifact, or \u201cnoise,\u201d can be caused by
frequent client movement, electrode
placement on limbs, and insufficient adhesion
to the skin, such as placing electrodes over
hairy areas of the skin. Electrode placement
over bony prominences also should be
avoided. Signal interference also can occur
with electrode removal and cable
disconnection.

31. Ventricular tachycardia is characterized by the
absence of P waves, wide QRS complexes
(longer than 0.12 second), and typically a rate

between 140 and 180 impulses/min. The
rhythm is regular.

32. Ventricular tachycardia is a life-threatening
dysrhythmia that results from an irritable
ectopic focus that takes over as the pacemaker
for the heart. The low cardiac output that
results can lead quickly to cerebral and
myocardial ischemia. Clients frequently
experience a feeling of impending doom.
Ventricular tachycardia is treated with
antidysrhythmic medications, cardioversion
(client awake), or defibrillation (loss of
consciousness). Ventricular tachycardia can
deteriorate into ventricular fibrillation at any
time.

33. First-line treatment of ventricular tachycardia
in a client who is hemodynamically stable is
the use of antidysrhythmics such as
amiodarone (Cordarone), lidocaine
(Xylocaine), and procainamide (Pronestyl).
Cardioversion also may be needed to correct
the rhythm (cardioversion is recommended for
stable ventricular tachycardia). Defibrillation
is used with pulseless ventricular tachycardia.
Epinephrine would stimulate an already
excitable ventricle and is contraindicated.

34. Cough cardiopulmonary resuscitation (CPR)
sometimes is used in the client with unstable
ventricular tachycardia. The nurse tells the
client to use cough CPR, if prescribed, by
inhaling deeply and coughing forcefully every
1 to 3 seconds. Cough CPR may terminate the
dysrhythmia or sustain the cerebral and
coronary circulation for a short time until
other measures can be implemented. Options
1, 2, and 3 will not assist in terminating the
dysrhythmia.

35. The client with uncontrolled atrial fibrillation
with a ventricular rate more than 100
beats/min is at risk for low cardiac output
because of loss of atrial kick. The nurse
assesses the client for palpitations, chest pain
or discomfort, hypotension, pulse deficit,
fatigue, weakness, dizziness, syncope,
shortness of breath, and distended neck veins.

36. Atrial fibrillation is characterized by a loss of
P waves and fibrillatory waves before each
3

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