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The nurse is caring for a patient who is scheduled for a cardiac catheterization with coronary angiography. Which of the following information should the nurse provide to the patient before the test?
- A. Electrocardiographic (ECG) monitoring will be required for 24 hours after the test.
- B. It will be important to lie completely still during the procedure.
- C. A warm feeling may be noted when the contrast dye is injected.
- D. Monitored anaesthesia care will be provided during the procedure.
Correct Answer: C
Rationale: A sensation of warmth or flushing is common when the iodine-based contrast material is injected, which can be anxiety-producing unless it has been discussed with the patient. The patient may receive a sedative drug before the procedure, but monitored anaesthesia care is not used. ECG monitoring is used during the procedure to detect dysrhythmias, but there is not a risk for dysrhythmias after the procedure. The patient is not immobile during cardiac catheterization and may be asked to cough or take deep breaths.
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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).
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.
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.
The nurse is monitoring a patient who is undergoing exercise (stress) testing on a treadmill. Which of the following assessment findings requires the most rapid action by the nurse?
- A. Patient complaint of feeling tired
- B. Pulse change from 80 to 96 beats/minute
- C. BP increase from 134/68 to 150/80 mm Hg
- D. Electrocardiographic changes indicating coronary ischemia
Correct Answer: D
Rationale: ECG changes associated with coronary ischemia (such as T-wave inversions and ST segment depression) indicate that the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately. Increases in BP and heart rate (HR) are normal responses to aerobic exercise. Tiredness also is normal as the intensity of exercise increases during the stress testing.
The nurse is providing teaching to a patient being evaluated for rhythm disturbances with a Holter monitor. Which of the following information should the nurse include in the teaching plan?
- A. Exercise more than usual while the monitor is in place.
- B. Remove the electrodes when taking a shower or tub bath.
- C. Keep a diary of daily activities while the monitor is worn.
- D. Connect the recorder to a telephone transmitter once daily.
Correct Answer: C
Rationale: The patient is instructed to keep a diary describing daily activities while Holter monitoring is being accomplished to help correlate any rhythm disturbances with patient activities. Patients are taught that they should not take a shower or bath during Holter monitoring and that they should continue with their usual daily activities. The recorder stores the information about the patient's rhythm until the end of the testing, when it is removed and the data are analyzed.