Nokea
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.
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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.
The nurse is reviewing the 12-lead electrocardiogram (ECG) of a healthy older-adult patient who is having an annual physical examination. Which of the following findings should be of most concern to the nurse?
- A. The heart rate is 43 beats/minute.
- B. The PR interval is 0.21 seconds.
- C. There is a right bundle-branch block.
- D. The QRS duration is 0.13 seconds.
Correct Answer: A
Rationale: The resting supine HR is not markedly affected with aging, so the decrease in HR requires further investigation. Bundle-branch block and slight increases in PR interval or QRS duration are common in older individuals because of increases in conduction time through the AV node, the bundle of His, and the bundle branches.
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.
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 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.