Chapter 20: Patient History: The Heart

The nurse is taking the medication history of a 60-year-old patient with heart-related symptoms. Which of the following questions, asked by the nurse, would alert the nurse to potential cardiac issues? "Are you taking any diuretics or cardiotonic medications?" "Have you taken any antibiotics in the past month?" "Have you taken any over-the-counter vitamin B or C recently?" "How often do you use herbal supplements?"

"Are you taking any diuretics or cardiotonic medications?"

Which questions should a nurse ask a patient who complains of chest pain? Select all that apply. "Describe the location of the pain." "Does the pain radiate to other areas of the body?" "Please rate the pain on a scale of 0 (no pain) to 10 (most severe)?" "What were you doing before the pain started" "Is the pain accompanied by leg pain?"

"Describe the location of the pain." "Does the pain radiate to other areas of the body?" "Please rate the pain on a scale of 0 (no pain) to 10 (most severe)?" "What were you doing before the pain started"

What would be an appropriate question to ask the patient with heart-related symptoms who reports recent travel outside the United States? "Did others on the trip develop diarrhea?" "Have you had an unexplained fever since returning home?" "How long did you stay outside the United States?" "Were you able to sleep well while away?"

"Did others on the trip develop diarrhea?" A question regarding others' diarrheal symptoms does not focus on the patient's symptoms. "Have you had an unexplained fever since returning home?" Travel outside of the United States puts the patient at risk for contracting infectious diseases, and fever associated with inflammation may be a symptom of an infectious disease that could affect the heart if left untreated. "How long did you stay outside the United States?" A question regarding length of stay does not address heart-specific information. "Were you able to sleep well while away?" A question regarding a patient's sleeping habits while away does not address heart-specific information surrounding an infectious process.

Obtaining a complete cardiac history includes which questions regarding medical history? Select all that apply. "Do any of your siblings ever complain of chest pain?" "Have you ever had angina?" "Did you have a congenital heart defect as a child?" "Have you had heart valve problems in the past?" "Do you have a history of high triglycerides?"

"Do any of your siblings ever complain of chest pain?" A question regarding a patient's siblings is related to family history, not the patient's medical history. "Have you ever had angina?" A question regarding previous angina provides information about coronary artery disease. "Did you have a congenital heart defect as a child?" Congenital heart defects can cause a number of heart-related conditions and are often a cause of cyanosis and dyspnea on exertion. "Have you had heart valve problems in the past?" Heart valve problems may indicate rheumatic fever, which, if left untreated, could cause heart failure. "Do you have a history of high triglycerides?" Elevated triglycerides are a risk factor for coronary heart disease.

Which questions should the nurse ask the patient when obtaining a cardiac history to obtain more information about potential modifiable risk factors? Select all that apply. "Do you currently smoke cigarettes?" "Have you ever been told that you have high cholesterol?" "What type of exercise do you engage in?" "Is there a family history of diabetes?" "Has a physician told you that you have high blood pressure?"

"Do you currently smoke cigarettes?" Tobacco use is associated with an increased risk for heart disease. Decreasing or ceasing use of tobacco can significantly decrease this risk. "Have you ever been told that you have high cholesterol?" High cholesterol is associated with an increased risk for coronary artery disease. Lowering cholesterol through diet and exercise or medication can decrease this risk. "What type of exercise do you engage in?" Thirty minutes of exercise, five times a week, can prevent obesity and hypertension, two risk factors for heart disease. "Is there a family history of diabetes?" A family history of diabetes is a nonmodifiable risk factor for heart disease. "Has a physician told you that you have high blood pressure?" High blood pressure, or hypertension, is a risk factor for heart disease. Controlling hypertension through diet, exercise, or medication can decrease this risk.

The patient works in a paper plant and is exposed daily to noxious fumes. What additional information should the nurse obtain regarding this patient's employment-related risk for heart disease? "When was the first time that you fainted after the breathing problems started?" "What concerns do your co-workers have about their health problems?" "Do you ever have pain in your chest during work hours?" "How much blood was in the sputum that you coughed up?

"Do you ever have pain in your chest during work hours?"

Which questions, if asked by the nurse during a cardiac history, would indicate the potential for heart failure? Select all that apply. "Do you have a cough?" "Do you tire easily?" "If you have fluid in your ankles, does it go away at night?" "How often do you eat fast food?" "How much caffeine do you have in a day?"

"Do you have a cough?" "Do you tire easily?" "If you have fluid in your ankles, does it go away at night?"

The nurse is assessing a 5-year-old patient for potential heart-related symptoms. Which of the following questions should the nurse ask the caregivers to gain additional information about potential heart symptoms? Select all that apply. "Has your child had a fever recently?" "Has your child complained of painful joints?" "Have you noticed your child taking longer naps or having difficulty with physical activity?" "Does your child play well with other children?" "What types of games does your child show interest in?" "Has your child had an upper respiratory tract infection recently?"

"Has your child had a fever recently?" "Has your child complained of painful joints?" "Have you noticed your child taking longer naps or having difficulty with physical activity?"

Which of the following questions, if asked by the nurse, would indicate potential cardiac risk factors for the patient? "Have you ever been told that you have high blood sugar?" "How would you describe your breathing when walking?" "How often do you experience heart palpitations?" "Do you ever experience chest pain or discomfort?"

"Have you ever been told that you have high blood sugar?" The nurse should ask the patient about a history of high blood sugar because this condition suggests diabetes, which is a risk factor for heart disease. "How would you describe your breathing when walking?" Although a question regarding breathing when walking is an appropriate heart-related question, it does not specifically address the patient's risk factors. "How often do you experience heart palpitations?" Atrial fibrillation, or an irregular heartbeat, is a complication of the disease process, not a risk factor. "Do you ever experience chest pain or discomfort?" Chest pain that occurs with congestive heart failure is a complication of the disease process, not a risk factor.

The nurse is interviewing a patient with a complaint of chest pain. Which of the following questions would provide the nurse with information about the patient's activity tolerance? "How do you spend your time during the day?" "Have you been diagnosed with a lipid disorder?" "What activity do you enjoy after your evening meal?" "Are you able to complete your housework without taking frequent breaks?"

"How do you spend your time during the day?" A question regarding how the patient spends the day does not specifically address the patient's ability to perform tasks. "Have you been diagnosed with a lipid disorder?" Although high lipid levels can increase the risk for coronary artery disease, a question about lipid disorders does not specifically address the patient's ability to perform tasks. "What activity do you enjoy after your evening meal?" A question regarding activity following a meal provides information about whether the patient engages in activity but does not address the patient's ability to perform tasks. "Are you able to complete your housework without taking frequent breaks?" The nurse should ask the patient how easily he or she can perform housework because this question provides information about cardiac output and activity tolerance.

The nurse is interviewing a patient who reports activity intolerance. Which of the following questions, if asked by the nurse, would provide further information on the patient's heart-related symptoms? "How many days a week do you exercise?" "Are you able to describe how you were feeling just before you fainted?" "How do you care for yourself when the chest pain begins?" "How far are you able to walk before becoming short of breath?"

"How far are you able to walk before becoming short of breath?"

The nurse is interviewing a patient with a complaint of chest pain. Which of the following questions is appropriate for gathering information on the history of present illness? Select all that apply. "How long does the chest pain last once it begins?" "How would you describe the pain?" "What do you do to relieve the chest pain?" "What makes the pain worse?" "When do you usually see fluid in your legs?"

"How long does the chest pain last once it begins?" "How would you describe the pain?" "What do you do to relieve the chest pain?" "What makes the pain worse?"

The nurse is gathering a personal/social history from a patient with heart-related symptoms. Which of the following questions might the nurse ask to identify additional risk factors for heart disease? Select all that apply. "How much caffeine do you consume each day?" "How much alcohol do you drink per day?" "What type of exercise do you perform?" "How do you manage stress in your life?" "Have you had a cardiac catheterization?"

"How much caffeine do you consume each day?" "How much alcohol do you drink per day?" "What type of exercise do you perform?" "How do you manage stress in your life?"

The nurse is interviewing a patient with a complaint of exertional dyspnea. Which of the following questions is most appropriate for the nurse to ask to gather more information on the patient's current symptoms? "Have you tried sleeping with more than one pillow?" "What do you do to relieve the cough?" "How many times a day do you have trouble breathing?" "What do you do to alleviate the breathing difficulty?"

"What do you do to alleviate the breathing difficulty?"

When taking a cardiac history, which question would a nurse ask to identify possible orthopnea in the patient?" "What type of physical activity causes you to get short of breath?" "Do you ever awaken with a severe breathing attack?" "How much weight have you gained in the last week?" "How many pillows do you need to sleep comfortably?"

"What type of physical activity causes you to get short of breath?" A question regarding exertional dyspnea, which is a common form of heart-related dyspnea, would provide information related to shortness of breath associated with physical exertion but not with position. "Do you ever awaken with a severe breathing attack?" A question asking about awakening with a severe breathing attack is appropriate to obtain information about paroxysmal nocturnal dyspnea but not to identify orthopnea. "How much weight have you gained in the last week?" A question regarding weight gain in the last week may give the nurse insight into the amount of water and sodium retention but does not provide information that may suggest the patient has orthopnea. "How many pillows do you need to sleep comfortably?" The nurse should ask the patient about the number of pillows used to sleep because patients with orthopnea need to be in an upright position to breathe more easily.

The nurse is assessing a patient who complains of a cough. Which of the following questions would be appropriate for the nurse to ask regarding the patient's current symptoms? Select all that apply. "When did your cough start?" "Do you ever cough up blood?" "What makes the cough worse?" "Do family members cough up blood?" "Have you ever been diagnosed with a liver disorder?"

"When did your cough start?" Assessing the onset and duration of symptoms is an important part of the history of present illness. "Do you ever cough up blood?" The nurse should ask about any associated symptoms that accompany the patient's cough. "What makes the cough worse?" An important part of the history of present illness is identification of exacerbating and alleviating factors related to the current symptoms. "Do family members cough up blood?" Family history is important, but it is a separate part of the patient history interview. "Have you ever been diagnosed with a liver disorder?" Although the nurse should question the patient about chronic illnesses, this is a separate part of the patient history interview. It is not part of the history of present illness.

When interviewing a patient with heart-related symptoms, the nurse should ask whether anyone in the patient's family has been diagnosed with which of the following illnesses? Select all that apply. Hypertension Breast cancer Diabetes Dyslipidemia Marfan syndrome

Hypertension Hypertension is a risk factor for heart disease and occurs in families. Breast cancer Breast cancer is not a risk factor for heart disease. Diabetes Diabetes is a risk factor for heart disease and occurs in families. Dyslipidemia High cholesterol and triglyceride levels (dyslipidemia) can occlude the coronary arteries and cause a myocardial infarction. Marfan syndrome Marfan syndrome is an inherited genetic defect of connective tissue that has an autosomal dominant mode. It can affect the connective tissue that supports the heart valves and blood vessels and could predispose patients to mitral valve prolapse or formation of an aneurysm.

The nurse is interviewing a patient with a complaint of chest tightness. Which of the following conditions would indicate the patient has an increased risk for heart disease? Select all that apply. Arthritis Renal disorders Joint pain Hypertension High cholesterol

Renal disorders Hypertension High cholesterol