Troponin is a regulatory protein found in striated naturally lower in fat.

Cream cheese is a high-fat

muscle. The troponins function together in the food.
contractile apparatus for striated muscle in skeletal
muscle and in the myocardium. Increased amounts of When performing cardiopulmonary resuscitation
troponins are released into the bloodstream when an (CPR) on an adult client, the sternum is depressed
infarction causes damage to the myocardium. A 1½ to 2 inches.
troponin T value that is higher than 0.1 to 0.2 ng/mL is
consistent with a myocardial infarction. A normal When performing cardiopulmonary resuscitation
troponin I level is lower than 0.6 ng/mL. (CPR) on adults, the ratio of chest compressions to
breaths is 30:2.
Creatine kinase (CK) is a cellular enzyme that can be
fractionated into three isoenzymes. The MB band Chest pain is assessed by using the standard pain
reflects CK from cardiac muscle. This is the level that assessment parameters (e.g., characteristics,
elevates with myocardial infarction. The MM band location, intensity, duration, precipitating and
reflects CK from skeletal muscle. The BB band reflects alleviating factors, and associated symptoms).
CK from the brain. There is no MK band.
Cardiogenic shock occurs with severe damage (more
The normal prothrombin time (PT) is 9.6 to 11.8 than 40%) to the left ventricle. Classic signs include
seconds (male adult) or 9.5 to 11.3 seconds (female hypotension, a rapid pulse that becomes weaker,
adult). A therapeutic PT level is 1.5 to 2.0 times higherdecreased urine output, and cool, clammy skin.
than the normal level. Because the value of 35 seconds Respiratory rate increases as the body develops
is high (and perhaps near the critical range), the nurse metabolic acidosis from shock. Cardiac tamponade is
should anticipate that the client would not receive accompanied by distant, muffled heart sounds and
further doses at this time. prominent neck vessels. Pulmonary embolism
presents suddenly with severe dyspnea
The normal therapeutic range for digoxin is 0.5 to 2.0 accompanying the chest pain. Dissecting aortic
ng/mL. A level of 2.4 ng/mL exceeds the therapeutic aneurysms usually are accompanied by back pain.
range and indicates toxicity. The most important action
is to notify the physician, who may give further orders On transfer from the coronary care unit, the client is
about holding further doses of digoxin. Option 3 is allowed self-care activities and bathroom privileges.
incorrect because the level is not normal. The next Supervised ambulation in the hall for brief distances
dose should not be administered because the serum is encouraged, with distances gradually increased
digoxin level exceeds the therapeutic range. Checking (50, 100, 200 feet).
the client’s last pulse rate is not incorrect but may
have limited value in this situation. Depending on the Metformin (Glucophage) needs to be withheld 48
time that has elapsed since the last assessment, a hours before and after cardiac catheterization
current assessment of the client’s status may be more because of the injection of contrast medium during
useful. the procedure. If the contrast medium affects kidney
function, with metformin in the system, the client
The normal activated partial thromboplastin time would be at increased risk for lactic acidosis.
(aPTT) varies between 20 and 36 seconds, depending
on the type of activator used in testing. The Hypotension and dizziness are signs of decreased
therapeutic dose of heparin for treatment of deep vein cardiac output. Transcutaneous pacing provides a
thrombosis is to keep the aPTT between 1.5 and 2.5 temporary measure to increase the heart rate and
times normal. Thus, the client’s aPTT is within the thus perfusion in the symptomatic client. Digoxin will
therapeutic range, and the dose should remain further decrease the client’s heart rate. Defibrillation
unchanged. is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation. Continuing to
The normal serum potassium level in the adult is 3.5 to monitor the client delays necessary intervention.
5.1 mEq/L. Option 1 is the only value that falls below
the therapeutic range. Administering furosemide to a Edema, the accumulation of excess fluid in the
client with a low potassium level and a history of interstitial spaces, can be measured by intake
cardiac problems could precipitate ventricular greater than output and by a sudden increase in
dysrhythmias. weight. Diuretics should be given in the morning
whenever possible to avoid nocturia. Strict sodium
Foods that are lower in sodium include fruits and restrictions are reserved for clients with severe
vegetables (option 4), because they do not contain symptoms.
physiological saline. Highly processed or refined foods
(options 1 and 3) are higher in sodium unless their Heart failure is precipitated or exacerbated by
food labels specifically state “low sodium.” Saltwater physical or emotional stress, dysrhythmias,
fish and shellfish are high in sodium. infections, anemia, thyroid disorders, pregnancy,
Fruits and vegetables tend to be lower in fat because Paget’s disease, nutritional deficiencies (thiamine,
they do not come from animal sources. Fish is also alcoholism), pulmonary disease, and hypervolemia.
Digoxin exerts a positive inotropic effect on the heart Normal sinus rhythm is defined as a regular rhythm,
while slowing the overall rate through a variety of with an overall rate of 60 to 100 beats/min. The PR
mechanisms. Digoxin is the medication of choice to and QRS measurements are normal, measuring 0.12
treat heart failure. Diltiazem and verapamil (calcium to 0.20 second and 0.04 to 0.10 second, respectively.
channel blockers) and propranolol (β-adrenergic
blocker) have a negative inotropic effect and would Sinus tachycardia has the characteristics of normal
worsen the failing heart. sinus rhythm, including a regular PP interval and
normal width PR and QRS intervals; however, the
rate is the differentiating factor. In sinus tachycardia,
Pulmonary edema is characterized by extreme the atrial and ventricular rates are higher than 100
breathlessness, dyspnea, air hunger, and the beats/min.
production of frothy, pink-tinged sputum. Auscultation
of the lungs reveals crackles. Rhonchi and diminished Motion artifact, or “noise,” can be caused by frequent
breath sounds are not associated with pulmonary client movement, electrode placement on limbs, and
edema. Stridor is a crowing sound associated with insufficient adhesion to the skin, such as placing
laryngospasm or edema of the upper airway. electrodes over hairy areas of the skin. Electrode
placement over bony prominences also should be
Pulmonary edema causes the client to be extremely avoided. Signal interference also can occur with
agitated and anxious. The client may complain of a electrode removal and cable disconnection.
sense of drowning, suffocation, or smothering.
Ventricular tachycardia is characterized by the
The serum potassium level is measured in the client absence of P waves, wide QRS complexes (longer
receiving digoxin and furosemide. Heightened digoxin than 0.12 second), and typically a rate between 140
effect leading to digoxin toxicity can occur in the client and 180 impulses/min. The rhythm is regular.
with hypokalemia. Hypokalemia also predisposes the
client to ventricular dysrhythmias. Ventricular tachycardia is a life-threatening
dysrhythmia that results from an irritable ectopic
Classic signs of cardiogenic shock as they relate to this focus that takes over as the pacemaker for the heart.
question include low blood pressure and tachycardia. The low cardiac output that results can lead quickly
The central venous pressure would rise as the to cerebral and myocardial ischemia. Clients
backward effects of the severe left ventricular failure frequently experience a feeling of impending doom.
became apparent. Dysrhythmias commonly occur as a Ventricular tachycardia is treated with
result of decreased oxygenation and severe damage to antidysrhythmic medications, cardioversion (client
greater than 40% of the myocardium. awake), or defibrillation (loss of consciousness).
Ventricular tachycardia can deteriorate into
Sternotomy incision sites are assessed for signs and ventricular fibrillation at any time.
symptoms of infection, such as redness, swelling,
induration, and drainage. Elevated temperature and First-line treatment of ventricular tachycardia in a
white blood cell count after 3 to 4 days postoperatively client who is hemodynamically stable is the use of
usually indicate infection. antidysrhythmics such as amiodarone (Cordarone),
lidocaine (Xylocaine), and procainamide (Pronestyl).
The client who undergoes cardiac surgery is at risk for Cardioversion also may be needed to correct the
renal injury from poor perfusion, hemolysis, low cardiac rhythm (cardioversion is recommended for stable
output, or vasopressor medication therapy. Renal insult ventricular tachycardia). Defibrillation is used with
is signaled by decreased urine output and increased pulseless ventricular tachycardia. Epinephrine would
blood urea nitrogen and creatinine levels. The client stimulate an already excitable ventricle and is
may need medications to increase renal perfusion and contraindicated.
possibly could need peritoneal dialysis or hemodialysis.
No data in the question indicate the presence of Cough cardiopulmonary resuscitation (CPR)
hypovolemia, urinary tract infection, or sometimes is used in the client with unstable
glomerulonephritis. ventricular tachycardia. The nurse tells the client to
use cough CPR, if prescribed, by inhaling deeply and
The nurse should encourage regular use of pain coughing forcefully every 1 to 3 seconds. Cough CPR
medication for the first 48 to 72 hours after cardiac may terminate the dysrhythmia or sustain the
surgery because analgesia will promote rest, decrease cerebral and coronary circulation for a short time
myocardial oxygen consumption resulting from pain, until other measures can be implemented.
and allow better participation in activities such as
coughing, deep breathing, and ambulation. Options 2 The client with uncontrolled atrial fibrillation with a
and 4 will not help in tolerating ambulation. Removal of ventricular rate more than 100 beats/min is at risk
telemetry equipment is contraindicated unless for low cardiac output because of loss of atrial kick.
prescribed. The nurse assesses the client for palpitations, chest
pain or discomfort, hypotension, pulse deficit,
fatigue, weakness, dizziness, syncope, shortness of who have survived sudden cardiac death unrelated
breath, and distended neck veins. to myocardial infarction, those who are refractive to
medication therapy, and those who have syncopal
Atrial fibrillation is characterized by a loss of P waves episodes related to ventricular tachycardia.
and fibrillatory waves before each QRS complex. The
atria quiver, which can lead to thrombi formation. In the first several hours after insertion of a
permanent or a temporary pacemaker, the most
Carotid sinus massage is one maneuver used for vagal common complication is pacing electrode
stimulation to decrease a rapid heart rate and possibly dislodgement. The nurse helps prevent this
terminate a tachydysrhythmia. The others include complication by limiting the client’s activities of the
inducing the gag reflex and asking the client to strain arm on the side of the insertion site.
or bear down. Medication therapy often is needed as
an adjunct to keep the rate down or maintain the Pulmonary embolism is a life-threatening
normal rhythm. complication of deep vein thrombosis and
thrombophlebitis. Chest pain is the most common
Ventricular fibrillation is characterized by irregular symptom, which is sudden in onset, and may be
chaotic undulations of varying amplitudes. Ventricular aggravated by breathing. Other signs and symptoms
fibrillation has no measurable rate and no visible P include dyspnea, cough, diaphoresis, and
waves or QRS complexes and results from electrical apprehension.
chaos in the ventricles.
Sclerotherapy is the injection of a sclerosing agent
Until the defibrillator is attached and charged, the into a varicosity. The agent damages the vessel and
client is resuscitated by using cardiopulmonary causes aseptic thrombosis, which results in vein
resuscitation. Once the defibrillator has been attached, closure. With no blood flow through the vessel, there
the electrocardiogram is checked to verify that the is no distention. The surgical procedure for varicose
rhythm is ventricular fibrillation or pulseless ventricular veins is vein ligation and stripping. This procedure
tachycardia. Leads also are checked for any loose involves tying off the varicose vein and large
connections. A nitroglycerin patch, if present, is tributaries and then removing the vein with hook and
removed. The client does not have to be intubated to wires via multiple small incisions in the leg.
be defibrillated. Lidocaine may be given subsequently
but is not required before defibrillation. The machine is Hypersensitivity or a sensation of “pins and needles”
not set to the synchronous mode because there is no in the surgical limb may indicate temporary or
underlying rhythm with which to synchronize. permanent nerve injury following surgery. The
saphenous vein and saphenous nerve run close
The client may be defibrillated up to three times in together in the distal third of the leg. Because
succession. The energy levels used are 200, 300, and complications from this surgery are relatively rare,
360 J for the first, second, and third attempts, this symptom should be reported.
respectively.
The mixture of arterial and venous manifestations
After defibrillation, the client requires continuous (claudication and phlebitis, respectively) in the young
monitoring of electrocardiographic rhythm, male client suggests thromboangiitis obliterans
hemodynamic status, and neurological status. (Buerger’s disease). This disorder is characterized by
Respiratory and metabolic acidosis develops during inflammation and thrombosis of smaller arteries and
ventricular fibrillation because of lack of respiration veins. It typically is found in young adult males who
and cardiac output. These can cause cerebral and smoke. The cause is not known precisely but is
cardiopulmonary complications. Arousable status, suspected to have an autoimmune component.
adequate blood pressure, and a sinus rhythm indicate
successful response to defibrillation. Raynaud’s disease responds favorably to eliminating
caffeine from the diet and cessation of smoking.
The nurse or rescuer puts two large adhesive patch Medications may inhibit vessel spasm and prevent
electrodes on the client’s chest in the usual symptoms. Avoiding exposure to cold through a
defibrillator positions. The nurse stops variety of means is important. However, moving to a
cardiopulmonary resuscitation and orders anyone near warmer climate may not necessarily be beneficial
the client to move away and not touch the client. The because the symptoms still could occur with the use
defibrillator then analyzes the rhythm, which may take of air conditioning and during periods of cooler
up to 30 seconds. The machine then indicates if weather.
defibrillation is necessary
After inferior vena cava filter insertion, the nurse
An automatic internal cardioverter-defibrillator (AICD) inspects the surgical site for bleeding and signs and
detects and delivers an electrical shock to terminate symptoms of infection. Otherwise, care is the same
life-threatening episodes of ventricular tachycardia and as for any other postoperative client.
ventricular fibrillation. These devices are implanted in
clients who are considered high risk, including those
An electrocardiogram taken during a chest pain halos around lights), bradycardia, and other
episode captures ischemic changes, which include ST dysrhythmias.
segment elevation or depression. Tall, peaked T waves
may indicate hyperkalemia. A prolonged PR interval The magnetic fields used for magnetic resonance
indicates first-degree heart block. A widened QRS imaging (MRI) can deactivate the pacemaker
complex indicates delay in intraventricular conduction,
such as a bundle branch block. Variant angina, or Prinzmetal’s angina, is prolonged
and severe and occurs at the same time each day,
This test is an alternative to the exercise thallium-201 most often at rest. Stable angina is induced by
scan. Dipyridamole (Persantine) dilates the coronary exercise and relieved by rest or nitroglycerin tablets.
arteries as exercise would. Before the procedure, any Unstable angina occurs at lower and lower levels of
form of caffeine should be withheld, as should activity or at rest, is less predictable, and is often a
bronchodilators such as theophylline. Theophylline precursor of myocardial infarction.
may decrease the effects of dipyridamole.
The antidote to heparin is protamine sulfate; it
Blood pressure should be taken with the client seated should be readily available for use if excessive
with the arm bared, positioned with support and at bleeding or hemorrhage should occur. Vitamin K is an
heart level. The client should sit with the legs on the antidote for warfarin sodium. Aminocaproic acid is
floor, feet uncrossed, and not speak during the the antidote for thrombolytic therapy. Potassium
recording. The client should not have smoked tobacco chloride is administered for a potassium deficit.
or taken caffeine in the 30 minutes preceding the
measurement. The client should rest quietly for 5 The therapeutic range for prothrombin time is 1.5 to
minutes before the reading is taken. The cuff bladder 2 times the control for clients at high risk for
should encircle at least 80% of the limb being thrombus. Based on the client’s control value, the
measured. Finally, two or more BP readings should be therapeutic range for this individual would be 16.5 to
averaged. 22 seconds. Therefore the result is within the
therapeutic range.
Following pericardiocentesis, a rise in blood pressure
and a fall in central venous pressure are expected. The Warfarin sodium works in the liver and inhibits
client usually expresses immediate relief. Heart sounds synthesis of four vitamin K-dependent clotting factors
are no longer muffled or distant. (X, IX, VII, and II), but it takes 3 to 4 days before the
therapeutic effect of warfarin is exhibited.
Not all clients with abdominal aortic aneurysm exhibit
symptoms. Those who do may describe a feeling of the The antidote to warfarin sodium (Coumadin) is
“heart beating” in the abdomen when supine or being vitamin K and should be readily available for use if
able to feel the mass throbbing. A pulsatile mass may excessive bleeding or hemorrhage occurs.
be palpated in the middle and upper abdomen. A Aminocaproic acid is the antidote for thrombolytic
systolic bruit may be auscultated over the mass. agents. Protamine sulfate is the antidote for heparin.
Hyperactive bowel sounds are not related specifically Potassium chloride is administered to treat potassium
to an abdominal aortic aneurysm. deficit.

Following abdominal aortic aneurysm resection or Thrombolytic therapy is contraindicated in a number

repair, the nurse monitors the client for signs of renal of preexisting conditions in which there is a risk of
failure. Renal failure can occur because often much uncontrolled bleeding, similar to the case in
blood is lost during the surgery and, depending on the anticoagulant therapy. Thrombolytic therapy also is
aneurysm location, the renal arteries may be contraindicated in severe uncontrolled hypertension
hypoperfused for a short period during surgery. The because of the risk of cerebral hemorrhage.
nurse monitors hourly intake and output and notes the Therefore, the nurse would report the results of the
results of daily blood urea nitrogen and creatinine blood pressure to the physician before initiating
levels. Urine output lower than 30 to 50 mL/hr is therapy.
reported to the physician.
The ACLS nurse would place one gel pad to the right
Venous leg ulcers, also called stasis ulcers, tend to be of the sternum just below the clavicle and the other
more superficial than arterial ulcers, and the ulcer bed gel pad to the left of the precordium. The nurse
is pink. The edges of the ulcer are uneven, and would then place the electrode paddles over the
granulation tissue is evident. The skin has a brown pads. Options 1, 3, and 4 identify incorrect positions.
pigmentation from accumulation of metabolic waste
products resulting from venous stasis. The client also The client who has had vein ligation and stripping
exhibits peripheral edema. should avoid standing or sitting for prolonged
periods. The client should remain lying down unless
The first signs and symptoms of digoxin toxicity in performing a specific activity for the first few days
adults include abdominal pain, nausea, vomiting, following the procedure. Prolonged standing and
visual disturbances (blurred, yellow, or green vision, sitting increase the risk of edema in the legs by
decreasing blood return to the heart. The client should supply of oxygen and nutrients. A venous stasis ulcer
avoid crossing the legs at any level for the same is one that has a dark red base and is surrounded by
reason. brown skin with local edema. This type of ulcer is
caused by the accumulation of waste products of
The jaw thrust without the head tilt maneuver is used metabolism that are not cleared, as a result of
when head and/or neck trauma is suspected. This venous congestion. A stage 1 ulcer indicates a
maneuver opens the airway while maintaining proper reddened area with an intact skin surface.
head and neck alignment, thus reducing the risk of
further damage to the neck. Option 1 is incorrect. In Standard management for the client with DVT
situations requiring CPR, the client will be unconscious. includes bed rest for 5 to 7 days, limb elevation,
Option 4 is also incorrect. Additionally, it is unlikely relief of discomfort with warm moist heat, and
that the nurse will be able to obtain these data. analgesics as needed. Ambulation is contraindicated
because such activity can cause the thrombus to
Fruits and vegetables, except avocado, olives, and dislodge and travel to the lungs. Opioid analgesics
coconut, contain minimal amounts of fat. are not required to relieve pain, and pain normally is
relieved with acetaminophen (Tylenol).
TSS is caused by infection and is often associated with
tampon use. Disseminated intravascular coagulation is Sclerotherapy is the injection of a sclerosing agent
a complication of TSS. into a varicosity. The agent damages the vessel and
causes aseptic thrombosis that results in vein
Assessment findings associated with cardiac closure. With no blood flow through the vessel,
tamponade include tachycardia, distant or muffled distention will not occur. The surgical procedure for
heart sounds, jugular vein distention, and a falling varicose veins is vein ligation and stripping. This
blood pressure accompanied by pulsus paradoxus (a procedure involves tying off the varicose vein and
drop in inspiratory BP greater than 10 mm Hg). large tributaries and then removal of the vein with
Bradycardia is not a sign of cardiac tamponade. the use of a hook and wires applied through multiple
small incisions in the leg.
Foot care instructions for the client with peripheral
arterial disease are the same instructions as those for A sensation of pins and needles, or feeling as though
a client with diabetes mellitus. The client with arterial the surgical limb is falling asleep, may indicate
disease, however, should avoid raising the legs above temporary or permanent nerve damage after surgery.
the level of the heart unless instructed to do so as part The saphenous vein and the saphenous nerve run
of an exercise program, such as Buerger-Allen close together, and damage to the nerve will produce
exercises, or unless venous stasis is also present. paresthesias.

Captopril is an antihypertensive medication A PASG may be useful in the treatment of

(angiotension-converting enzyme inhibitor). hypovolemic shock associated with traumatic injury
Orthostatic hypotension can occur in clients taking this to provide circulatory assistance. The device is used
medication. Clients are advised to avoid standing in only as a temporary measure until definitive
one position for long periods of time, to change treatment is given because it can compromise blood
positions slowly, and to avoid extreme warmth such as flow to the lower half of the body. The critical nursing
with baths, showers, or heat from the sun in warm assessment includes monitoring the vascular status
weather. The client should be instructed to monitor for of the lower extremities.
signs of orthostatic hypotension such as dizziness,
lightheadedness, weakness, and syncope. An The normal LAP is 1 to 10 mm Hg. Because the left
increased intake of water could actually aggravate the atrium does not generate significant pressure during
hypertension. atrial contraction, the atrial pressure is recorded as
an average (mean) pressure, rather than as a systolic
The sodium level can increase by the use of several or diastolic pressure.
types of products including toothpaste and
mouthwash; over-the-counter medications such as The normal fibrinogen level is 180 to 340 mg/dL for
analgesics, antacids, laxatives, and sedatives; and males and 190 to 420 mg/dL for females. A critical
softened water, as well as some mineral water. Clients value is one that is less than 100 mg/dL. With DIC,
are instructed to read labels for sodium content. Water the fibrinogen level drops because fibrinogen is used
that is bottled, distilled, deionized, and demineralized up in the clotting process.
may be used for drinking and cooking. Fresh fruits and
vegetables are low in sodium. The client would avoid Raynaud’s disease is peripheral vascular disease
consuming mineral water. characterized by abnormal vasoconstriction in the
extremities. Smoking cessation is one of the most
Arterial ulcers have a pale, deep base and are important lifestyle changes that the client needs to
surrounded by tissue that is cool with trophic changes make. The nurse should emphasize the effects of
such as dry, skin and loss of hair. Arterial ulcers are tobacco on the blood vessels and the principles
caused by tissue ischemia from inadequate arterial involved in stopping smoking. The nurse needs to
provide information to the client about smoking discuss what has happened. Denial is a common
cessation programs available in the community early reaction associated with chest discomfort,
angina, or myocardial infarction (MI). Anxiety usually
In the client with a venous disorder, the legs are is manifested by symptoms of sympathetic nervous
elevated above the level of the heart to assist with the system arousal. No data are provided in the question
return of venous blood to the heart. Option 2 specifies that would lead the nurse to interpret the client’s
infrequent care intervals, so it is not the priority behavior as boredom or as either understanding or
intervention. Alcohol is very irritating and drying to not understanding the material provided at the
tissues and should not be used in areas of skin teaching session.
breakdown.
The recommended INR range for oral anticoagulant
IABP therapy most often is used in the treatment of therapy is 2.0 to 3.0, but this value may vary with
cardiogenic shock and is most effective if instituted the goals of therapy. A recommended INR range with
early in the course of treatment. Use of the IABP is mechanical prosthetic heart valve is 2.5 to 3.5, and
contraindicated in clients with aortic insufficiency and for survivors of acute myocardial infarction (MI), 2.5
thoracic and abdominal aneurysms. This therapy is not to 3.5.
used in the treatment of congestive heart failure or
pulmonary edema. The heart is located in the mediastinum. Its apex or
distal end points to the left and lies at the level of the
Cardiac troponin T or cardiac troponin I has been found fifth intercostal space. A stethoscope should be
to be a protein marker in the detection of myocardial placed in this area to pick up heart sounds most
infarction, and assay for this protein is used in some clearly
institutions to aid in the diagnosis of a myocardial
infarction. The pain associated with angina results from
ischemia of myocardial cells. The pain often is
The client with heart failure may present with different precipitated by activity that places more oxygen
symptoms depending on whether the right or the left demand on heart muscle. Supplemental oxygen will
side of the heart is failing. Peripheral and sacral help to meet the added demands on the heart
edema, jugular vein distention, and organomegaly all muscle. Oxygen does not dilate blood vessels or
are manifestations of problems with right-sided heart prevent thrombus formation and does not directly
function. Lung sounds constitute an accurate indicator calm the client.
of left-sided heart function.
Pressure should be applied to the site after an
Spironolactone is a potassium-sparing diuretic. Side arterial blood gas specimen is drawn. The blood
effects include hyperkalemia, dehydration, pressure in the artery is higher than in the veins, so
hyponatremia, and lethargy. Although the concern with applying pressure to the punctured artery is
most diuretics is hypokalemia, this medication is necessary to control bleeding. Covering the site with
potassium sparing, which means that the concern with gauze may protect the site but would not control
this medication is hyperkalemia. Additional side effects bleeding. Heat (by application of warm packs) causes
include nausea, vomiting, cramping, diarrhea, vasodilation, which would increase bleeding to the
headache, ataxia, drowsiness, confusion, and fever. site. Exercise would increase circulation to the area.

The client should be instructed to take quinidine
sulfate exactly as prescribed. The client should not
chew the sustained-release capsules or open the
capsules and mix them with food. The client should be
instructed to wear a medical identification bracelet or
tag and to continue taking digoxin as prescribed.
Quinidine sulfate is administered for atrial flutter or
fibrillation only after the client has been digitalized.
The PR interval represents the time it takes for the
cardiac impulse to spread from the atria to the
ventricles. The normal range for the PR interval is 0.12
to 0.20 second
VT is associated with a significant decrease in cardiac
output. Assessing for unresponsiveness determines
whether the client is affected by the decreased cardiac
output.
The MM fraction of creatine kinase (CK-MB) is specific
in determining the presence of MI. The CK-MM
reflects injury to skeletal muscle. The WBC count
would most likely be elevated in the client with an MI
Morphine sulfate is an opioid analgesic that may be
administered to relieve pain in a client with MI.
Although monitoring mental status is a component of
the nurse’s assessment, it is not the priority after
administration of morphine sulfate. The nurse would
monitor the client’s respirations and blood pressure.
Signs of morphine toxicity include respiratory
depression and hypotension. Urinary output is
unrelated to the administration of this medication.
Monitoring the temperature also is not associated
with the use of this medication.

Denial is a defense mechanism that allows the client to

minimize a threat that may be manifested by refusal to