Nokea
The nurse is admitting a patient for a coronary arteriogram and angiogram. Which of the following information about the patient is most important for the nurse to communicate to the health care provider?
- A. The patient's pedal pulses are +1.
- B. The patient is allergic to iodine.
- C. The patient has not eaten anything today.
- D. The patient had an arteriogram a year ago.
Correct Answer: B
Rationale: The contrast dye used for the procedure is iodine based, so patients who have an iodine allergy should be communicated to the health care provider. The other information also is communicated to the health care provider but will not require a change in the usual prearteriogram orders or medications.
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The nurse is caring for a patient who is being treated for heart failure. Which of the following laboratory results should the nurse assess to determine the effects of therapy?
- A. Myoglobin
- B. Homocysteine (Hcy)
- C. Low-density lipoprotein (LDL)
- D. B-type natriuretic peptide (BNP)
Correct Answer: D
Rationale: Increased levels of BNP are a marker for heart failure. The other laboratory results would be used to assess for myocardial infarction (myoglobin) or risk for coronary artery disease (Hcy and LDL).
The nurse is assessing a patient who was admitted with heart failure and notes that the patient has jugular venous distension (JVD) when lying flat in bed. Which of the following actions should the nurse take next?
- A. Use a ruler to measure the level of the JVD.
- B. Document this finding in the patient's record.
- C. Observe for JVD with the head at 45 degrees.
- D. Have the patient perform the Valsalva manoeuvre.
Correct Answer: C
Rationale: When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not clinically significant) finding. JVD that persists when the patient is sitting at a 45-degree angle or greater is significant. The nurse may use a ruler to determine the level of JVD above the heart if the JVD persists when the patient is at a 45-degree angle or more. JVD is an expected finding when a patient performs the Valsalva manoeuvre because right atrial pressure increases. The nurse will document the JVD in the record if it persists when the head is elevated.
Which of the following information obtained by the nurse who is admitting the patient for magnetic resonance imaging (MRI) will be most important to report to the health care provider before the MRI?
- A. The patient has an allergy to shellfish and iodine.
- B. The patient has a history of coronary artery disease.
- C. The patient has a permanent ventricular pacemaker in place.
- D. The patient took all the prescribed cardiac medications today.
Correct Answer: C
Rationale: MRI is contraindicated for patients with implanted metallic devices such as pacemakers as the magnets can alter the function of the device. The other information also will be reported to the health care provider but does not impact whether or not the patient can have an MRI.
The standard policy on the cardiac unit states: 'Notify the health care provider for mean arterial pressure (MAP) less than 70 mm Hg.' Which of the following patients should the nurse report to the health care provider?
- A. Postoperative patient with a BP of 116/42
- B. Newly admitted patient with a BP of 122/60
- C. Patient with left ventricular failure who has a BP of 110/70
- D. Patient with a myocardial infarction who has a BP of 114/50
Correct Answer: A
Rationale: The mean arterial pressure (MAP) is calculated using the formula MAP = (diastolic BP + 1/3 pulse pressure). The MAP for the postoperative patient with a BP of 116/42 is 67. The MAP in the other three patients is higher than 70 mm Hg.
During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. Which of the following actions should the nurse implement next?
- A. Document that the PMI is in the normal anatomic location.
- B. Ask the patient about risk factors for coronary artery disease.
- C. Auscultate both the carotid arteries for the presence of a bruit.
- D. Assess the patient for symptoms of left ventricular hypertrophy.
Correct Answer: D
Rationale: The PMI should be felt at the intersection of the 5th intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with coronary or carotid artery disease.