NCLEX-PN › Cardiovascular Conditions
What is cardiac tamponade?
Accumulation of fluid in the pericardium that puts pressure on the heart
A loud, systolic mumur heard best over the 5th left intercostal space
A potentially life-threatening arrhythmia arising from improper ventricular electrical activity
Pain in the chest due to ischemia that is worse with exertion and better with rest
Cardiac tamponade is a condition in which blood, air, pus, or some other type of fluid accumulates in the pericardium, putting pressure on the heart and reducing it's ability to fill during diastole. Cardiac tamponade is not an arrhythmia, a murmur, or any type of ischemia. Signs include pulsus paradoxus (a greater than 10mmHg drop of systolic blood pressure on inspiration) and changes on ECG.
What is cardiac tamponade?
Accumulation of fluid in the pericardium that puts pressure on the heart
A loud, systolic mumur heard best over the 5th left intercostal space
A potentially life-threatening arrhythmia arising from improper ventricular electrical activity
Pain in the chest due to ischemia that is worse with exertion and better with rest
Cardiac tamponade is a condition in which blood, air, pus, or some other type of fluid accumulates in the pericardium, putting pressure on the heart and reducing it's ability to fill during diastole. Cardiac tamponade is not an arrhythmia, a murmur, or any type of ischemia. Signs include pulsus paradoxus (a greater than 10mmHg drop of systolic blood pressure on inspiration) and changes on ECG.
The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
Limit movement and abduction of right arm
Limit movement and abduction of left arm
Ask for help in getting out of bed and use walker to ambulate
Do active range-of-motion exercises with right arm
The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.
The nurse instructs the client to do which of the following to prevent dislodgment of the pacing catheter after insertion of a permanent demand pacemaker via the right subclavian vein has been made?
Limit movement and abduction of right arm
Limit movement and abduction of left arm
Ask for help in getting out of bed and use walker to ambulate
Do active range-of-motion exercises with right arm
The nurse should instruct the patient to limit movement and abduction of right arm. The muscles and movement of the right arm most directly effect the placement of the pacing catheter.
A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at ?
ST elevation
PR widening
QT prolongation
ST depression
PR shortening
Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about . ST segment elevation is classically seen in myocardial infarctions that result in positive troponin.
A patient presents with thirty minute history of substernal chest pain that radiates to his left jaw. Which of the following EKG changes would you expect in this patient if his troponin level came back positive at ?
ST elevation
PR widening
QT prolongation
ST depression
PR shortening
Substernal chest pain that radiates to the jaw is classic of myocardial infarction. Elevated troponin and EKG changes help confirm the diagnosis (reference levels are about . ST segment elevation is classically seen in myocardial infarctions that result in positive troponin.
You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?
Atrial fibrillation (A-fib)
Atrial flutter
Sick sinus syndrome
First-degree heart block
Complete heart block
The most likely cardiac rhythm on this patient's ECG is a trial fibrillation.
Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.
When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.
Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.
The other answers are incorrect for the following reasons:
Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength.
Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.
First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.
You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?
Atrial fibrillation (A-fib)
Atrial flutter
Sick sinus syndrome
First-degree heart block
Complete heart block
The most likely cardiac rhythm on this patient's ECG is a trial fibrillation.
Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.
When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.
Clinically, the other clues are that the patient is complaining of palpitations while simultaneously experiencing sudden onset of severe, diffuse abdominal pain that is out of proportion to the abdominal physical exam, and is accompanied by rectal bleeding. This is very consistent with mesenteric ischemia (a condition in which a patient, typically in atrial fibrillation, projects a blood clot to one of the mesenteric vessels, causing ischemia to the bowel served by the affected vessel). While, this was not asked in the question explicitly, and the question could be answered without this knowledge, this helps confirm the diagnosis if you are aware of it.
The other answers are incorrect for the following reasons:
Atrial flutter typically presents with a "sawtooth" waveform and has more regularity in wavelength.
Sick sinus syndrome is also known as tachy-brady syndrome, indicating that the patient has frequent fluctuations between tachycardia and bradycardia. In this instance, we have ECG findings that are very consistent with atrial fibrillation and show no evidence of bradycardia.
First-degree heart block and complete heart block are each typically characterized by bradycardia rather than tachycardia, and do not appear like atrial fibrillation on ECG.
Which part of the heart is most susceptible to infective endocarditis?
The valves
The myocardium
The chordae tendinae
The endocardium
Because the valves of the heart don't have their own blood vessels, white blood cells can't directly get there via the bloodstream. In addition, due to the lack of vasculature, if infection does occur antimicrobial medications may have difficulty reaching the infection.
Which part of the heart is most susceptible to infective endocarditis?
The valves
The myocardium
The chordae tendinae
The endocardium
Because the valves of the heart don't have their own blood vessels, white blood cells can't directly get there via the bloodstream. In addition, due to the lack of vasculature, if infection does occur antimicrobial medications may have difficulty reaching the infection.