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The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into which complication?
- A. atrial fibrillation and possible emboli.
- B. sinus tachycardia and syncope.
- C. ventricular tachycardia and death.
- D. sinus bradycardia and fatigue.
Correct Answer: C
Rationale: PVCs are capable of progressing into ventricular tachycardia and death.
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The older adult patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse should reinforce which instruction?
- A. Continue to take nitroglycerin sublingually at 5-minute intervals until the pain is relieved.'
- B. If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals, call your health care provider and come to the hospital.'
- C. When nitroglycerin is not relieving the pain, lie down and rest.'
- D. Use oxygen at home to relieve pain when nitroglycerin is not successful.'
Correct Answer: B
Rationale: Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify the health care provider. Nitroglycerin administered sublingually usually relieves angina symptoms but does not relieve the pain from an MI. Administering nitroglycerin more than three times will probably not relieve the pain.
The nurse recognizes the echocardiogram report that shows an ejection factor of $42 \%$ as an indication of which situation?
- A. normal heart action.
- B. mild heart failure.
- C. moderate heart failure.
- D. severe heart failure.
Correct Answer: C
Rationale: An ejection fraction (cardiac output) of $42 \%$ indicates moderate heart failure.
A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage?
- A. CK-MB
- B. Elevated white count
- C. Elevated sedimentation rate
- D. Low level of sodium
Correct Answer: A
Rationale: The CK-MB is elevated when there is infarcted myocardial muscle. The elevated white count, low sodium, and ESR are nonspecific.
A 70 year female patient arrives to the emergency department, reporting nausea, vomiting, fatigue and abdominal discomfort. The health care provider requests myocardial infarction (MI) protocols to begin. For which reason is this protocol beginning?
- A. The provider is concerned a lawsuit could occur due to missed diagnosis.
- B. Women tend to have less classic symptoms of a myocardial infarction.
- C. Women are more likely to die from breast or cervical cancer than an MI.
- D. The troponin I level is not as accurate for females as it is in male patients.
Correct Answer: B
Rationale: Women experiencing an MI tend to experience symptoms that are unrelated to chest pain: nausea, vomiting, fatigue, indigestion, shortness of breath, and upper back or abdominal discomfort.
What is the third step in the impulse pattern of conduction through the heart?
- A. Atrial wall
- B. Atrial-ventricular (AV) node
- C. Purkinje fibers
- D. Sinoatrial (SA) node
- E. Bundle branches
- F. Bundle of His
Correct Answer: B
Rationale: The conduction begins with the impulse from the SA node that travels down the atrial wall to the AV node, to the Bundle of His, to the bundle branches, and finally to the Purkinje fibers.