Chapter 48: Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder

The patient with congestive heart failure who is on a diuretic drug shows a weight loss of 6.6 lb. The nurse is aware that the patient has lost L of fluid.

ANS: 3 A liter of fluid equals 2.2 lb. A loss of 6.6 lb would mean the loss of 3 L of fluid. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1564 OBJ: 9 TOP: Fluid loss KEY: Nursing Process Step: Assessment

An is an enlarged, dilated portion of an artery and may be the result of arteriosclerosis, trauma, or a congenital defect.

ANS: aneurysm REF: Page 1595 TOP: Aneurysm

The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause: a. hypotension. b. thrombophlebitis. c. pulmonary emboli. d. heart failure.

ANS: D Heart failure can result from rapid infusion of intravenous fluids in older adults. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1542, Lifespan OBJ: 9 TOP: Heart failure KEY: Nursing Process Step: Assessment

In older adults, rapid infusion of fluids can lead to a. Hypotension b. Thrombophlebitis c. Mitral insufficiency d. Heart failure

ANS: D Heart failure can result from rapid infusion of intravenous fluids in older adults. DIF: Cognitive Level: Knowledge REF: Page 1548, Life Span Considerations box, Box 8-4 TOP: Function of cardiovascular system

The cardiac marker rises 3 hours after a myocardial infarct and measures myocardial contractile protein.

ANS: troponin I Troponin I is a serum cardiac marker that rises 3 hours after an MI and can measure myocardial contractile tissue. Troponin I is not affected by skeletal muscle injury as is troponin T. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1541 OBJ: 6 TOP: Troponin I KEY: Nursing Process Step: Assessment

The nurse identifies the "LUBB" sound of the "LUBB/DUBB" of the cardiac cycle as the sound of the: a. AV valves closing. b. closure of the semilunar valves. c. contraction of the papillary muscles. d. contraction of the ventricles.

ANS: A The LUBB is the first sound of a low pitch heard when the AV valves close. PTS: 1 DIF: Cognitive Level: Application REF: Page 1535 OBJ: 4 TOP: Lubb sound KEY: Nursing Process Step: Assessment

Trace the impulse pattern of conduction in sequence through the heart. (Separate letters by a comma and space as follows: A, B, C, D) a. Atrial wall b. Atrial-ventricular (AV) node c. Purkinje fibers d. Sinoatrial (SA) node e. Bundle branches f. Bundle of His

ANS: D, A, B, F, E, C 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. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1535-1534 OBJ: 3 TOP: Conduction KEY: Nursing Process Step: N/A

Arrange in sequence the path of the blood through the coronary circulation. (Separate letters by a comma and space as follows: A, B, C, D) a. Right atrium b. Pulmonary artery c. Tricuspid valve d. Right ventricle e. Superior and inferior vena cava f. Pulmonary vein g. Left atrium h. Mitral valve i. Left ventricle j. Lungs

ANS: E, A, C, D, B, J, F, G, H, I The blood travels through the vena cava to the right atrium, through the tricuspid valve to the right ventricle, through the pulmonary artery to the lungs. The pulmonary veins deliver the blood to the left atrium, then through the mitral valve to the left ventricle and out the aorta to the body. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1535, Figure 47-4 OBJ: 5 TOP: Path of blood through heart KEY: Nursing Process Step: N/A

The life support system that uses special techniques, ventilation equipment, and therapies for emergency situations is .

ANS: advanced cardiac life support (ACLS) advanced cardiac life support ACLS ACLS is a life support system that uses special techniques, ventilation equipment, and therapies for emergency situations. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1550 OBJ: 9 TOP: ACLS KEY: Nursing Process Step: N/A

The nurse explains that the heart has the ability to contract in a rhythmic pattern that is called .

ANS: automaticity Automaticity is the special ability of the myocardium to contract in a rhythmic pattern. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1534 OBJ: 2 TOP: Automaticity KEY: Nursing Process Step: Assessment

The process by which a heart is shocked from a persistent arrhythmia back into sinus rhythm is called a _.

ANS: cardioversion Cardioversion is the restoration of the heart's normal sinus rhythm with the delivery of synchronized electric shock. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1540 OBJ: 10 TOP: Cardioversion KEY: Nursing Process Step: N/A

The pain that a person with arterial insufficiency feels on exertion, which is relieved by rest, is .

ANS: intermittent claudication Intermittent claudication is a pain caused by ischemia when a person with arterial insufficiency exerts to the point that the tissues have inadequate oxygen-rich blood. The pain is relieved by rest. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1581 OBJ: 9 TOP: Intermittent claudication KEY: Nursing Process Step: Assessment

B-type natriuretic peptide (BNP) is a , which is secreted by the heart in response to an expanded left .

ANS: neurohormone; ventricle B-type natriuretic peptide (BNP) is a neurohormone secreted by the heart in response to ventricular expansion. REF: Page 1547 TOP: Heart failure Step: Assessment

Serum cardiac markers are that indicate cardiac muscle damage after a myocardial infarction.

ANS: proteins Serum cardiac markers are certain proteins that are released into the blood in large quantities from necrotic heart muscle after a myocardial infarction. REF: Pages 1547, 1564 TOP: Myocardial infarction

A patient, age 34, is diagnosed with infective endocarditis. The nurse identifies the nursing diagnosis of Activity intolerance related to generalized weakness for him. Which intervention does the nurse plan while he is febrile? a. Decreased activity b. Activity as tolerated c. Monitoring vital signs during ambulation d. Allowing moderate activity if heart rate is not above 100

ANS: A During the acute phase, it is essential to maintain the patient on decreased activity and provide a calm, quiet environment. REF: Page 1579 TOP: Endocarditis Step: Planning

oliguria, jugular vein distention, and abdominal distention are signs and symptoms of a. right-sided heart failure. b. left-sided heart failure. c. cardiac dysrhythmias. d. valvular heart disease.

ANS: A Inability of the right ventricle to pump blood forward into the lungs results in peripheral congestion. Edema is a sign of increased fluid in interstitial tissue and appears in dependent areas of the body such as the sacrum when supine and the feet and ankles while in an upright position. REF: Page 1570, Box 48-3 TOP: Heart failure Step: Assessment

The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg. What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot? a. Pain, which would be a positive Homans sign b. Muscular spasm, which would be a sign of hypocalcemia c. Rigidity, which would be a sign of ankylosis d. Crepitus, which would be a sign of a joint disorder

ANS: A A positive Homans sign for deep vein thrombosis (DVT) is a report of pain when the affected leg is flexed and the foot is dorsiflexed. PTS: 1 DIF: Cognitive Level: Application REF: Page 1595 OBJ: 21 TOP: DVT KEY: Nursing Process Step: Assessment

A thrombectomy is done to a. prevent the flow of emboli to the lungs. b. prevent the emboli from forming. c. improve blood flow. d. limit blood flow.

ANS: A A thrombectomy or the transvenous placement of a grid or umbrella in the vena cava may be done to prevent the flow of emboli into the lungs. This inferior venacaval interruption device is called a Greenfield filter. REF: Page 1600 TOP: Thrombophlebitis

The nurse takes into consideration that age-related changes can affect the peripheral circulation because of: a. sclerosed blood vessels. b. hypotension. c. inactivity. d. poor nutrition.

ANS: A Aging causes sclerotic changes in the blood vessels that lead to decreased elasticity and narrowing of the vessel lumen. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1542, Lifespan OBJ: 16 TOP: Endocarditis KEY: Nursing Process Step: Planning

The nurse is treating a patient who has had a pacemaker inserted for the correction of atrial fibrillation. Which diagnostic test is no longer available to the patient because of the implanted device? a. MRI b. CT scan c. Thallium scan d. PET

ANS: A Because of the large magnets in the MRI cabinet, the pacemaker may be reset to a fixed mode and interfere with the functioning of the pacemaker. PTS: 1 DIF: Cognitive Level: Application REF: Page 1551 OBJ: 10 TOP: Pacemaker KEY: Nursing Process Step: Planning

The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)? a. Cocaine use b. Viral infections c. Vitamin B1 deficiencies d. Pregnancy

ANS: A Cardiomyopathy caused by cocaine abuse is seen more frequently than ever before. Cocaine also causes high circulating levels of catecholamines, which may further damage myocardial cells, leading to ischemic or dilated cardiomyopathy. The cardiomyopathy produced is difficult to treat. Interventions deal mainly with the HF that ensues. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1578 OBJ: 14 TOP: Cardiomyopathy KEY: Nursing Process Step: Assessment

The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to a. cocaine use. b. viral infections. c. vitamin B1 deficiencies. d. pregnancy.

ANS: A Cardiomyopathy caused by cocaine abuse is seen more frequently than ever before. Cocaine also causes high circulating levels of catecholamines, which may further damage myocardial cells, leading to ischemic or dilated cardiomyopathy. The cardiomyopathy produced is difficult to treat. Interventions deal mainly with the HF that ensues. REF: Page 1583 TOP: Cardiomyopathy

The nurse identifies the problem of a potential complication—pulmonary edema— for a patient in acute congestive heart failure (CHF). For which early symptom of this problem does the nurse assess? a. Pink, frothy sputum b. Lethargy and faintness c. Decreased urinary output d. Bradycardia

ANS: A Frothy sputum is produced from air mixing with the fluid in the alveoli; the sputum is blood-tinged from blood cells that have exuded into the alveoli. REF: Page 1569 TOP: Pulmonary edema

A patient with newly diagnosed hypertension tells the nurse he uses a lot of salt on his foods and has not been able to lose the 30 pounds that he has gained in the last 10 years. He does not understand why he has hypertension, since he is not an anxious person. Which nursing diagnosis does the nurse identify for this patient? a. Ineffective health maintenance related to the lack of knowledge of disease process and management b. Risk of noncompliance related to lifestyle patterns c. Disturbed body image related to diagnosis of hypertension d. Anxiety related to complexity of management regimen and lifestyle changes associated with hypertension

ANS: A Hypertension is a blood pressure higher than 140/90 mm Hg, which increases and individual's risk of developing cardiovascular disease. Adhering to medical therapy for control of elevated blood pressure helps to modify the individual's risk. REF: Page 1580, Box 48-4 TOP: Hypertension

During a health interview by the home health nurse, which patient complaint suggests left-sided heart failure? a. "I have to sleep in my recliner and I have this hacking cough." b. "I have no appetite and I have lost 3 lb in the last week." c. "I have to urinate every 2 hours, even during the night." d. "I go barefoot most of the time because my feet are so hot."

ANS: A Left ventricular failure; the first is signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1565, Box 47-3 OBJ: 9 TOP: Heart failure KEY: Nursing Process Step: Planning

During the nursing history and physical assessment of a patient with left-sided heart failure, which finding might the nurse expect related to the patient's diagnosis? a. Orthopnea with bubbling crackles throughout the lungs b. Anorexia with weight loss of 3 pounds in 1 week c. Increased urinary output, especially during waking hours d. Periorbital and facial edema

ANS: A Left ventricular failure; the first is the signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough. REF: Page 1576, Box 48-5 TOP: Heart failure Step: Planning

In evaluating pain for the management of myocardial infarction, the most important aspect using objective data is a. patient's vital signs during painful periods. b. dilation of the patient's pupils. c. painful expression on the patient's face. d. report of the severity of the pain.

ANS: A MI: typical vital signs reveal hypotension, pulse abnormalities such as tachycardia, a barely perceptible pulse, and early temperature elevation. Administer oxygen per protocol for 24 to 48 hours and longer if pain, hypotension, dyspnea, or dysrhythmia persist. Administer medications as prescribed: IV morphine sulfate for relief of pain and apprehension and to produce vasodilation. REF: Page 1563, Table 48-2 TOP: Myocardial infarction Step: Evaluation

The nurse caring for a patient recovering from a myocardial infarction (MI) teaches which method to avoid the Valsalva maneuver during a bowel movement? a. Mouth breathing b. Pursing the lips and whistling c. Taking a deep breath and holding it d. Breathing rapidly through the nose

ANS: A Mouth breathing will lessen the severity of straining and will decrease the effect of the Valsalva maneuver on intrathoracic pressure. PTS: 1 DIF: Cognitive Level: Application REF: Page 1562 OBJ: 9 TOP: MI KEY: Nursing Process Step: Implementation

A patient has a diagnosis of heart failure. When the nurse walks into his room, he is orthopneic. The patient is a. sitting or standing in order to breathe deeply and comfortably. b. complaining of sudden awakenings from sleep because of shortness of breath. c. complaining of pain in lower extremities. d. unable to respond to simple questions.

ANS: A Orthopnea is an abnormal condition in which a person must sit or stand in order to breathe deeply and comfortably. REF: Page 1570 TOP: Orthopnea

A patient has a diagnosis of heart failure. When the nurse walks into his room he is leaning over his bedside table and is short of breath. The medical term to describe his respiratory status is a. orthopnea. b. dyspnea. c. dysrhythmia. d. disorientation.

ANS: A Orthopnea is an abnormal condition in which a person must sit or stand in order to breathe deeply and comfortably. REF: Page 1604 TOP: Orthopnea

What is the major cause of cardiac valve disease? a. Rheumatic fever b. Long history of malnutrition c. Drug abuse d. Obesity

ANS: A Rheumatic fever, a streptococcal infection, is the major cause of cardiac valve disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1572 OBJ: 10 TOP: Valvular disease KEY: Nursing Process Step: Implementation

What is the difference between primary and secondary hypertension? a. Secondary hypertension is caused by another disorder like renal disease. b. Secondary hypertension is related to hereditary factors. c. Secondary hypertension cannot be treated effectively. d. Secondary hypertension is no real threat to health.

ANS: A Secondary hypertension is a consistently elevated blood pressure that is caused by another disorder, such as renal disease, diabetes, or Cushing syndrome. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1584 OBJ: 18 TOP: Secondary hypertension KEY: Nursing Process Step: Planning

A 56-year-old patient was admitted to the emergency department with a myocardial infarction. Cardiac enzymes were drawn. In a patient with a myocardial infarction, which laboratory values would be abnormal? a. Elevated levels of serum glutamic oxaloacetic transaminase (SGOT) (AST), creatine phosphokinase (CPK-MB), and lactic dehydrogenase (LDH), troponin 1 b. Decreased levels of SGOT (AST), CPK and LDH, troponin 1 c. Elevated levels of SGOT (AST), decreased levels of CPK and LDH, troponin 1 d. Decreased levels of SGOT (AST), increased levels of CPK and LDH, troponin 1

ANS: A Serum cardiac markers are certain proteins that are released into the blood in large quantities from necrotic heart muscle after a myocardial infarction. These markers, specifically cardiac serum enzymes and troponin 1, are important screening diagnostic criteria for acute MI. REF: Pages 1547, 1564 TOP: Diagnostic procedures

A patient with angina pectoris is being discharged with nitroglycerin tablets. Which of the instructions does the nurse include in the teaching? a. "When your chest pain begins, lie down and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes." b. "Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital." c. "Continue your activity. If the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down." d. "Place one nitro tablet under your tongue. If a burning sensation and headache occur, call your doctor immediately."

ANS: A Sit and stand slowly after taking nitroglycerin. Place nitroglycerin tablets under the tongue at the onset of anginal pain; the second tablet can be taken after 5 minutes and the third tablet after another 5 minutes if pain is unrelieved. Then, if pain is not relieved, go to the hospital. REF: Page 1562, Patient Teaching box TOP: Angina pectoris

The nurse assesses that the home health patient has no signs or symptoms of heart failure, but does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The nurse is aware that using the American College of Cardiology and the American Heart Association (ACC/AHA) staging, this patient would be a: a. stage A. b. stage B. c. stage C. d. stage D.

ANS: A The ACC/AHA staging describes stage A as a person without symptoms of heart failure, but with primary conditions associated with the development of the disease. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1565, Box 47-3 OBJ: 9 TOP: Heart failure KEY: Nursing Process Step: Assessment

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

ANS: A The CK-MB is elevated when there is infarcted myocardial muscle. The elevated white count, low sodium, and ESR are nonspecific. PTS: 1 DIF: Cognitive Level: Application REF: Page 1559 OBJ: 6 TOP: CK-MB KEY: Nursing Process Step: Assessment

What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient? a. Walk 2 miles in less than 60 minutes after 12 weeks. b. Jog mile in less than 30 minutes after 12 weeks. c. "Fast walk" 1 mile in less than 20 minutes after 12 weeks. d. Walk 1 mile in 15 minutes without dyspnea after 12 weeks.

ANS: A The goal of the 12-week walking program is that the patient can walk 2 miles in less than 60 minutes. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1563, Home Care OBJ: 11 TOP: Cardiac rehab KEY: Nursing Process Step: Planning

A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include: a. substernal pain that radiates down the left arm. b. epigastric pain that radiates to the jaw. c. indigestion, nausea, and eructation. d. fatigue, shortness of breath, and dyspnea.

ANS: A The pain often radiates down the left inner arm to the little finger and also upward to the shoulder and jaw. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1553, figure 47-1 OBJ: 9 TOP: Angina pectoris KEY: Nursing Process Step: Assessment

The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low-density lipid (LDL) of 80. The nurse's reaction is one of: a. satisfaction. This is good cholesterol control. b. determination. This is evidence that more instruction is necessary. c. inquiry. This needs to clarified as to the cause of noncompliance with the drug protocol. d. regret. This shows very poor cholesterol control.

ANS: A Total cholesterol of less than 200 is desirable. The higher the number of HDLs the better. A high number of LDLs puts the patient at risk for heart disease. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1541, Box 47-1 OBJ: 6 TOP: Lipid studies KEY: Nursing Process Step: Planning

Which are signs of digoxin (Lanoxin) toxicity? a. Nausea b. Bradycardia c. Headache d. Visual disturbance e. Heart rate >60 f. Gastrointestinal complaints

ANS: A, B, C, D F Major signs of digoxin toxicity are nausea, bradycardia (HR <60), headache, and visual disturbances, as well as fatigue and dysrhythmias. Heart rate >60 is normal. REF: Page 1554, Table 48-1, Table 48-7 TOP: Function of cardiovascular system

Which statements are true? (Select all that apply) a. Anticoagulant therapy is used for DVT prevention. b. Anticoagulant therapy prevents development of new clots, embolization, and clot extension. c. Anticoagulant therapy will dissolve clots. d. Pulmonary embolus is a life-threatening complication requiring treatment with anticoagulant therapy.

ANS: A, B, D Anticoagulant therapy is used for DVT prevention and treatment. For an existing DVT, anticoagulant therapy prevents extension of the clot, development of a new clot, or embolization (embolus traveling through the blood stream). Anticoagulants do not dissolve a clot. REF: Pages 1598-1599 TOP: Thrombophlebitis

Modifiable risk factors for coronary artery disease include: (Select all that apply.) a. weight. b. diet. c. genetics. d. exercise.

ANS: A, B, D Maintaining proper weight, dieting, and exercise are all modifiable risk factors. However, familial tendency to develop cardiovascular disease has been documented in the literature. A family member such as a parent or sibling who has a cardiovascular problem before 50 years of age places the patient at greater risk for developing cardiovascular disease. REF: Page 1571, Box 48-8 TOP: Risk factors

The nurse encourages the patient who is recovering from a myocardial infarct (MI) to ask the health care provider to prescribe a cardiac rehabilitation series in order to learn to (select all that apply): a. improve stamina. b. strengthen muscles. c. plan an appropriate diet. d. select herbal remedies. e. reduce risk of further problems. f. understand heart condition.

ANS: A, B, E, F Cardiac rehabilitation offers exercise programs to increase strength and increase stamina. Educational opportunities are offered on reduction of risk and understanding the disease process. PTS: 1 DIF: Cognitive Level: Application REF: Page 1563 OBJ: 11 TOP: Cardiac rehab KEY: Nursing Process Step: Implementation

Three kinds of blood vessels are organized for carrying blood to and from the heart: (Select all that apply.) a. Veins b. Bronchioles c. Arteries d. Capillaries

ANS: A, C, D The arteries, veins and capillaries blood vessels carry blood to and from the heart. REF: Page 1543 TOP: Function of cardiovascular system

Following an angiogram with the insertion site of the left groin, the nurse will include in the plan of care provisions for (select all that apply): a. checking pedal pulses. b. ambulating with assistance 2 hours after recovery. c. checking color and warmth of left leg frequently. d. sandbagging over insertion site. e. placing patient in semi-Fowler position.

ANS: A, C, D The pulses below the insertion site are checked to ensure patency of the vessels; the color and warmth of the left extremity is checked to ensure adequate circulation. A sandbag or other pressure device is placed over the insertion site. The patient is maintained in a supine position for several hours postprocedure. PTS: 1 DIF: Cognitive Level: Application REF: Page 1537 OBJ: 6 TOP: Angiogram KEY: Nursing Process Step: Implementation

The nurse points out which of the following as modifiable risks for coronary artery disease (CAD)? (Select all that apply.) a. Diabetes mellitus b. Heredity c. Smoking d. Hypertension e. Hyperlipidemia f. Age

ANS: A, C, D, E Modifiable risks for the development of CAD include smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity, sedentary lifestyle, and stress. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1544-1545 OBJ: 7 TOP: Modifiable risks for CAD KEY: Nursing Process Step: Implementation

The nurse outlines which of the following as conditions that would disqualify a candidate for a heart transplant? (Select all that apply.) a. Recent malignancy b. Dilated cardiomyopathy c. Peptic ulcer disease d. Diabetes type 2 e. Severe obesity f. Inoperable coronary artery disease

ANS: A, C, E Contraindications for candidacy for cardiac transplant include recent malignancy, active peptic ulcer disease, severe obesity, diabetes type 1 with end-organ damage. Dilated cardiomyopathy and inoperable coronary artery disease are indications for transplant. PTS: 1 DIF: Cognitive Level: Application REF: Page 1579, Box 47-7 OBJ: 15 TOP: Contraindications for cardiac transplant KEY: Nursing Process Step: Implementation

What is the transesophageal echocardiogram (TEE) used for? (Select all that apply.) a. Detect thrombi before a cardioversion b. Check for cardiac arrhythmias c. Visualize vegetation on the heart valves d. Measure effectiveness of diuretic therapy e. Visualize abscesses on the heart valves

ANS: A, C, E The TEE is used to check for thrombi before cardioversion, and to visualize vegetation and abscesses on the valves of the heart. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1592 OBJ: 16 TOP: TEE KEY: Nursing Process Step: N/A

The functions of the cardiovascular system are to: (Select all that apply.) a. deliver oxygen and nutrients to the cells. b. deliver carbon dioxide and waste products to the cells. c. remove oxygen and nutrients from the cells as waste products. d. remove carbon dioxide and waste products from the cells.

ANS: A, D The functions of the cardiovascular system are to deliver oxygen and nutrients to the cells and to remove carbon dioxide and waste products from the cells REF: Pages 1541, 1543 TOP: Function of cardiovascular system

A patient is admitted from the emergency department. The emergency department physician notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV. This indicates the patient's condition as: a. moderate heart failure. b. severe heart failure. c. congestive heart failure. d. negligible heart failure.

ANS: B Class IV: Severe; patient unable to perform any physical activity without discomfort. Angina or symptoms of cardiac inefficiency may develop at rest. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1565, Box 47-3 OBJ: 9 TOP: Classification of heart failure KEY: Nursing Process Step: Assessment

The nurse assesses pitting edema that can be depressed approximately inch and refills in 15 seconds. The nurse would document this assessment as: a. +1 edema. b. +2 edema. c. +3 edema. d. +4 edema.

ANS: B A +2 edema can be documented if the skin can be depressed inch and respond within 15 seconds. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1565, Table 47-5 OBJ: 9 TOP: Pitting edema KEY: Nursing Process Step: Assessment

A patient, age 65, has chronic angina pectoris. Her daughter had questions about the proper use of nitroglycerin for pain management. She was unsure about how many times she should take nitroglycerin for an episode of angina. The best reply the nurse could make is 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 physician 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."

ANS: B Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify the physician. Nitroglycerin administered sublingually usually relieves angina symptoms but does not relieve the pain from an MI. Administering nitro more than three times will probably not relieve the pain. REF: Page 1560, Nursing Diagnoses box OBJ: 13 TOP: Angina pectoris

The elderly patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse's most helpful response would be: 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 physician 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."

ANS: B Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify the physician. 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. PTS: 1 DIF: Cognitive Level: Application REF: Page 1545 OBJ: 9 TOP: Angina pectoris KEY: Nursing Process Step: Implementation

What is defined as a distended dilated segment of an artery? a. Embolism b. Aneurysm c. Angina d. Adhesion

ANS: B An aneurysm is an enlarged, dilated portion of an artery. REF: Page 1595 TOP: Aneurysm

Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)? a. "I eat a banana every morning with breakfast." b. "I try to eat more green leafy vegetables, especially broccoli, spinach, and kale." c. "I try to eat a well-balanced, low-fat diet." d. "I don't drink alcohol or caffeine."

ANS: B Avoid marked changes in eating habits, such as dramatically increasing foods high in vitamin K (e.g., broccoli, spinach, kale, greens). Limit alcohol intake to small amounts. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1597 OBJ: 10 TOP: Warfarin KEY: Nursing Process Step: Implementation

The nurse identifies the nursing diagnosis of Ineffective tissue perfusion related to decreased arterial blood flow for a patient with chronic arterial insufficiency. In evaluating the patient outcomes after patient teaching, which statement by the patient does the nurse recognize as indicating a need for further instruction? a. "For about 40 minutes each day, I will walk to the point of pain, then rest, than walk again until I develop pain." b. "I will drink hot coffee several times a day to increase the circulation and warmth in my feet." c. "I will wear loose clothing that doesn't bind across my legs or waist." d. "I will change my position every hour and avoid long periods of sitting with my legs down."

ANS: B Avoiding vasoconstriction from nicotine, caffeine, and stress is an important precaution for patients with decreased arterial blood flow. REF: Pages 1553, 1603, Nursing Diagnoses boxesOBJ: 22 TOP: Arterial disorders Step: Evaluation

A patient admitted from the emergency department with a diagnosis of heart failure and a NYHA classification of IV has edema in his lower extremities of +4. Which nursing intervention would aid in decreasing this edema? a. Ambulate in the hallway. b. Elevate lower extremities. c. Keep the extremities in a dependent position. d. Stand at the bedside.

ANS: B Elevate extremities when sitting or lying to promote venous return and decrease incidence of edema and venous stasis. REF: Page 1572 TOP: Peripheral edema

The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having: a. hepatitis A. b. indigestion. c. urinary infection. d. menopausal complications.

ANS: B Indigestion, gallbladder attack, anxiety attack, and depression are frequent misdiagnoses for women having an MI. PTS: 1 DIF: Cognitive Level: Application REF: Page 1559 OBJ: 16 TOP: MIs in women KEY: Nursing Process Step: Planning

A type of medication useful for preventing venous thrombus is a. anticoagulant. b. low-molecular-weight heparin. c. intravenous thrombolytics. d. percutaneous angiography.

ANS: B Low-molecular-weight heparin (LMWH) is effective for the prevention of venous thrombosis, as well as prevention of extension or recurrence. REF: Page 1600 TOP: Medication

When providing discharge teaching to a patient with endocarditis regarding prevention of infections, what would the nurse stress? a. Avoid crowds. b. Take antibiotics as prescribed. c. Use only aspirin for mild pain. d. Weigh yourself daily.

ANS: B Patient teaching focuses on identifying causes, infective endocarditis precautions, dietary requirements, and gradually increasing activity levels, as well as teaching the need for prophylactic antibiotics before any invasive procedure if the patient has preexisting valvular heart disease. REF: Page 1582 TOP: Endocarditis

The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask? a. "Do you have a toothache?" b. "Have you contacted your physician about your dental appointment?" c. "Is your dentist board certified?" d. "Do you think you should wait that long for your tooth extraction?'

ANS: B Patients with endocarditis are put on a protocol of prophylactic antibiotics for any invasive procedure. The dentist and physician should be contacted before the extraction. PTS: 1 DIF: Cognitive Level: Application REF: Page 1574 OBJ: 13 TOP: Endocarditis KEY: Nursing Process Step: Implementation

The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient says: a. "I can ambulate in the hallway with this gadget on." b. "I always take off the telemetry device when I shower." c. "My EKG is being watched by one of the nurses in CCU on the home unit." d. "I am able to sleep just fine with this device on."

ANS: B Remote telemetry allows the patient to be on a separate unit, but be monitored in a central location. The patients can be ambulatory and can sleep with the monitor on. They should not remove the monitor to shower. PTS: 1 DIF: Cognitive Level: Application REF: Page 1539 OBJ: 6 TOP: Remote telemetry KEY: Nursing Process Step: Evaluation

Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer? a. Cool dry lower limb b. Edematous, red scaly skin on medial surface of the leg c. Lack of hair and shiny appearance of the lower leg d. Lack of a pedal pulse

ANS: B Suggestion of a stasis ulcer in the making is an edematous, dry scaly area on the medial surface of the lower leg that has a darker pigmentation (rubor). Cool hairless limbs with absent or weak pedal pulses are indicative of arterial insufficiency. PTS: 1 DIF: Cognitive Level: Application REF: Page 1582 OBJ: 21 TOP: Medications KEY: Nursing Process Step: Assessment

The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between: a. 1 and 2. b. 2 and 3. c. 3 and 4. d. 4 and 5.

ANS: B The desired INR for the monitoring of anticoagulant therapy is between 2 and 3. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1546 OBJ: 8 TOP: INR KEY: Nursing Process Step: Implementation

Which information should be taught to patients starting on anticoagulant therapy? (Select all that apply.) a. Increase the dose of Aspirin for better therapy. b. Take medication at the same time each day. c. Report to physician cuts that do not stop bleeding with direct pressure. d. No restrictions for food or drink. e. Report for prescribed blood tests (PTT, INR, CBC, blood sugar).

ANS: B, C Aspirin should not be used with anticoagulant therapy because it will increase bleeding. Gums, nosebleeds, excessive bruising, and cuts that do not stop bleeding with direct pressure should be reported to the physician. Alcohol and dark green and yellow vegetables should be avoided because they contain vitamin K. Normal blood tests for anticoagulant therapy are PTT, INR, and PT. REF: Pages 1594, 1600, Nursing Diagnoses box, Safety Alert! TOP: Anticoagulant therapy Step: Planning

Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply.) a. Increase the dose of aspirin for better therapy. b. Take medication at the same time each day. c. Report to physician cuts that do not stop bleeding with direct pressure. d. No restrictions for food or drink. e. Report for prescribed blood tests (PTT, INR, CBC, blood sugar).

ANS: B, C Aspirin should not be used with anticoagulant therapy because it will increase bleeding. Gums, nosebleeds, excessive bruising, and cuts that do not stop bleeding with direct pressure should be reported to the physician. Alcohol and dark green and yellow vegetables should be avoided because they contain vitamin K. Normal blood tests for anticoagulant therapy are PTT, INR, and PT. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1591, Nursing Care Plan OBJ: 10 TOP: Anticoagulant therapy KEY: Nursing Process Step: Planning

The nurse would design teaching for a patient with Raynaud disease to include which of the following? (Select all that apply.) a. Warming hands and feet with a heating pad b. Using mittens in cold weather c. Practicing stress-reducing techniques d. Complete smoking cessation e. Using caution when cleaning the refrigerator or freezer

ANS: B, C, D, E Nursing interventions include patient teaching in techniques for stress reduction, avoiding exposure to cold, and techniques for smoking cessation. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1595, Nursing Care Plan OBJ: 20 TOP: Raynaud disease KEY: Nursing Process Step: Planning

Which would be included in teaching for patients with Raynaud's disease? (Select all that apply.) a. Warm hands and feet with a heating pad b. Use mittens in cold weather c. Practice stress-reducing techniques d. Complete smoking cessation e. Use caution when cleaning the refrigerator or freezer

ANS: B, C, D, E Nursing interventions include patient teaching in techniques for stress reduction, avoiding exposure to cold, and techniques for smoking cessation. REF: Page 1598, Nursing Diagnoses box TOP: Raynaud's disease

When assessing a patient with a possible MI, what should the nurse assess for? (Select all that apply.) a. Pain radiating to left arm and jaw b. Hypertension c. Pallor d. Diaphoresis e. Erratic behavior f. Cardiac rhythm changes

ANS: B, C, D, E, F Hypertension, vomiting, diaphoresis, hypotension, pallor, and cardiac rhythm changes are objective data seen in patients with an MI. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1558, Table 47-2 OBJ: 10 TOP: Myocardial infarction KEY: Nursing Process Step: Assessment

When assessing a patient with a myocardial infarction (MI), which is objective data? (Select all that apply.) a. Pain radiating to left arm and jaw b. Hypertension c. Vomiting d. Diaphoresis e. Nausea f. Cardiac rhythm changes

ANS: B, C, D, F Hypertension, vomiting, diaphoresis, and cardiac rhythm changes are objective data seen in patients with a myocardial infarction (MI). Pain and nausea are subjective data felt by the patient but not measurable. REF: Page 1564 TOP: Myocardial infarction

Which of the following are signs of digoxin (Lanoxin) toxicity? (Select all that apply.) a. Ringing in the ears b. Bradycardia c. Headache d. Visual disturbance e. Hematuria f. Gastrointestinal complaints

ANS: B, C, D, F Major signs of digoxin toxicity are nausea, bradycardia (HR <60), headache, and visual disturbances, as well as fatigue and arrhythmias. PTS: 1 DIF: Cognitive Level: Application REF: Page 1548, Table 47-1 OBJ: 10 TOP: Digitoxin toxicity KEY: Nursing Process Step: Assessment

Which patient teaching would help to prevent venous stasis? (Select all that apply.) a. Dangle legs when sitting b. Avoid crossing legs at the knee c. Elevate legs when lying in bed or sitting d. Massage extremities to help maintain blood flow e. Wear elastic stockings when ambulating

ANS: B, C, E Avoid prolonged sitting or standing. Avoid crossing the legs at the knee. Elevate legs when sitting. Wear elastic stockings when ambulatory. Do not massage extremities because of danger of embolization of clots (thrombus breaking off and becoming an embolus). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1597 OBJ: 16 TOP: Thrombophlebitis KEY: Nursing Process Step: Planning

The nurse would assess closely for signs of right-sided heart failure which include (select all that apply): a. cough. b. increasing abdominal girth. c. shortness of breath. d. edema of feet and ankles. e. distended jugular veins. f. orthopnea.

ANS: B, D, E Indicators of right-sided heart failure are distended jugular veins, anorexia, abdominal distention from ascites, liver enlargement with right upper quadrant pain, and edema of feet and ankles. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1563, Box 47-4 OBJ: 9 TOP: Right-sided heart failure KEY: Nursing Process Step: Assessment

A 53-year-old patient with a history of dysrhythmias is to wear a Holter monitor. The nurse should explain that Holter monitoring a. is a form of stress test. b. amplifies heart sounds. c. is a portable electrocardiographic device. d. regulates heart rate.

ANS: C A Holter monitor (a small portable recorder) is attached to the patient by one to four leads, with a 2-pound tape recorder carried on a belt or shoulder strap. REF: Page 1545 TOP: Dysrhythmias

The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of: a. normal heart action. b. mild heart failure. c. moderate heart failure. d. severe heart failure.

ANS: C An ejection factor (cardiac output) of 42% indicates moderate heart failure. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1540 OBJ: 6 TOP: Heart failure KEY: Nursing Process Step: Assessment

A patient has been admitted after the insertion of a pacemaker because of bradycardia. She asks what third-degree heart block is, and the nurse replies a. "Coronary blood vessel occlusion causing slow contraction of the right ventricles." b. "Sclerosis of cardiac valves causing slow pulse." c. "A defect in AV junctions slows and impairs conduction of impulses from the SA node to the ventricles." d. "Increased pressure in the pulmonary vessels."

ANS: C Atrioventricular block occurs when a defect in the AV junction slows or impairs conduction of impulses from the SA node to the ventricles. REF: Page 1552 TOP: Dysrhythmias

Which nursing intervention reduces myocardial oxygen demand? a. Supplying a portable oxygen unit during activity b. Encouraging participation in cardiac rehabilitation program c. Elevating the head of the bed 30 to 45 degrees d. Positioning patient in supine position

ANS: C Bed rest and semi-Fowler's position reduce myocardial oxygen demands. REF: Page 1571 TOP: Myocardial infarction

A patient admitted from the emergency room with a diagnosis of heart failure and a NYHA classification of IV is requesting ambulation to the bathroom. Which nursing intervention would be appropriate for this patient? a. Assist the patient to the bathroom. b. Obtain a bedside commode. c. Offer a urinal or bedpan. d. Obtain assistance of another nurse and ambulate the patient to the bathroom.

ANS: C Class IV: Severe: patient unable to perform any physical activity without discomfort. REF: Page 1570, Box 48-3 TOP: Heart failure

The patient achieves comfort in breathing only when he assumes a sitting posture. During the charting of this position, the nurse can describe this as a. dyspnea. b. orthophrenia. c. orthopnea. d. orthuria.

ANS: C Collection of subjective data includes complaints of dyspnea and orthopnea (an abnormal condition in which a person must sit or stand in order to breathe deeply or comfortably). REF: Page 1604 TOP: Orthopnea

The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can: a. cause severe episodes of diarrhea. b. cause a severe skin eruption if taken with Coumadin. c. increase the action of the Coumadin. d. cause the Coumadin to be less effective.

ANS: C Herbal remedies such as ginkgo, garlic, angelica, and red clover can increase (potentiate) the action of the Coumadin. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1589 OBJ: 21 TOP: Coumadin KEY: Nursing Process Step: Implementation

A 63-year-old patient with an acute myocardial infarction is on a cardiac monitor and begins to show some dysrhythmias. The physician will probably prescribe which intravenous medication? a. Nitroglycerin b. Digitalis c. Lidocaine d. Amyl nitrite

ANS: C Management of dysrhythmias is accomplished by suppressing the impulse that triggers dysrhythmias. REF: Pages 1552-1553, Table 48-1 TOP: Acute myocardial infarction

The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into: a. atrial fibrillation and possible emboli. b. sinus tachycardia and syncope. c. ventricular tachycardia and death. d. sinus bradycardia and fatigue.

ANS: C PVCs are capable of progressing into ventricular tachycardia and death. PTS: 1 DIF: Cognitive Level: Application REF: Page 1547 OBJ: 10 TOP: PVCs KEY: Nursing Process Step: Assessment

Edema and pulmonary congestion are treated with: a. Unlimited activity, high protein diet, weights weekly b. Bed rest, normal diet, weights four times daily c. Increase in fluids, no activity restrictions d. Diuretics, restriction of sodium diet and fluid intake

ANS: D Edema and pulmonary congestion are treated with diuretics, a sodium-restricted diet, and restriction of fluid intake. Weigh the patient daily to monitor fluid retention. REF: Page 1571 TOP: Right ventricular failure Step: Planning

The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention? a. Lay the patient flat to reduce hypotension and the symptoms of cardiogenic shock. b. Place patient in side-lying position to reduce the symptoms of atrial fibrillation. c. Place patient upright with legs in dependent position to reduce the symptoms of pulmonary edema. d. Lay the patient flat and elevate the feet to increase venous return in cardiogenic shock.

ANS: C Signs and symptoms of pulmonary edema are restlessness; vague uneasiness; agitation; disorientation; diaphoresis; severe dyspnea; tachypnea; tachycardia; pallor or cyanosis; cough producing large quantities of blood-tinged, frothy sputum; audible wheezing and crackles; and cold extremities. The legs in a dependent position will decrease venous return and ease the pulmonary edema. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1572 OBJ: 12 TOP: Pulmonary edema KEY: Nursing Process Step: Implementation

Restlessness, diaphoresis, severe dyspnea, tachypnea, hemoptysis, audible wheezing, and crackles are signs and symptoms of a. heart failure. b. respiratory failure. c. pulmonary edema. d. peripheral edema.

ANS: C Signs and symptoms of pulmonary edema are restlessness; vague uneasiness; agitation; disorientation; diaphoresis; severe dyspnea; tachypnea; tachycardia; pallor or cyanosis; cough producing large quantities of blood-tinged, frothy sputum; audible wheezing and crackles; cold extremities. REF: Page 1576, Box 48-5 TOP: Pulmonary edema

The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this arrhythmia as: a. sinus bradycardia. b. atrial fibrillation. c. sinus tachycardia. d. ventricular tachycardia.

ANS: C Sinus tachycardia has a P wave followed by the QRS and the T. All the components of the complex are present and in the correct order, but the rate is over 100 beats a minute. PTS: 1 DIF: Cognitive Level: Application REF: Page 1545 OBJ: 8 TOP: Arrhythmias KEY: Nursing Process Step: Assessment

How should the nurse advise a patient with an international normalized ratio (INR) of 5.8? a. Make arrangements to go to the emergency room immediately b. Increase fluid intake to 2000 mL/day c. Stop taking the anticoagulant and notify health care provider d. Add more leafy green vegetables to patient diet

ANS: C The INR that is desired should be maintained between 2 and 3. A reading of 5.8 puts the patient at risk for hemorrhage. The patient should stop taking the anticoagulant and contact the physician for further instruction. PTS: 1 DIF: Cognitive Level: Application REF: Page 1546 OBJ: 6 TOP: Myocardial infarction KEY: Nursing Process Step: Assessment

The nurse clarifies that the master pacemaker of the heart is the: a. left ventricle. b. atrioventricular (AV) node. c. sinoatrial (SA) node. d. bundle of His.

ANS: C The SA node is the master pacemaker of the heart. PTS: 1 DIF: Cognitive Level: Application REF: Page 1533 OBJ: 10 TOP: Acute myocardial infarction KEY: Nursing Process Step: Planning

The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for: a. reduction of alcohol intake. b. avoiding cold remedies. c. cessation of smoking. d. weight reduction.

ANS: C The hazards of cigarette smoking and its relationship to Buerger disease are the primary focus of patient teaching. None of the palliative treatments are effective if the patient does not stop smoking. Nowhere are the cause and effect of smoking so dramatically seen as with Buerger disease. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1594 OBJ: 20 TOP: Buerger disease KEY: Nursing Process Step: Assessment

There is a strong relationship between Buerger's disease (thromboangiitis obliterans) and a. Alcohol b. Cocaine c. Smoking d. Obesity

ANS: C The hazards of cigarette smoking and its relationship to Buerger's disease are the primary focus of patient teaching. None of the palliative treatments are effective if the patient does not stop smoking. Nowhere are the cause and effect of smoking so dramatically seen as with Buerger's disease. REF: Pages 1596-1597 TOP: Buerger's disease

A patient, age 59, has Buerger's disease. The most important aspect of patient compliance in order to decrease signs and symptoms of Buerger's disease is a. a low-fat diet. b. weight loss. c. not smoking. d. keeping extremities warm.

ANS: C There is a very strong relationship between Buerger's disease and tobacco use. It is thought that the disease occurs only in smokers, and when smoking is stopped, the disease improves. None of the palliative treatments are effective if the patient does not stop smoking. REF: Page 1597 TOP: Buerger's disease Step: Evaluation

An old term defined as the condition in which the patient suffers peripheral or pulmonary congestion is called a. pneumonia. b. peripheral edema. c. pulmonary edema. d. congestive heart failure.

ANS: D Because many patients suffer pulmonary or systemic congestion with HF, the syndrome was once called congestive heart failure. REF: Page 1568 TOP: Heart failure Step: Assessment

After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of: a. congestive heart failure. b. heart block. c. aortic stenosis. d. infective endocarditis.

ANS: D Collection of subjective data includes noting patient complaints of influenza-like symptoms with recurrent fever, undue fatigue, chest pain, and chills. Objective data may reveal the significant signs of petechiae in the conjunctiva and mouth. Both subjective data and objective data are indicative of infective endocarditis. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1576 OBJ: 13 TOP: Endocarditis KEY: Nursing Process Step: Assessment

A patient has heart failure. His physician's orders include complete bed rest. The nurse knows that this order means he a. is encouraged to rest as much as possible. b. is confined to bed but may assume responsibility for all of his personal care. c. is confined to bed but is allowed to go to the bathroom as needed. d. must remain as quiet as possible, with any task requiring physical effort done for him.

ANS: D Complete bed rest: Lowering oxygen requirements of the body systems with head of the bed elevated to 45 degrees to reduce myocardial oxygen demand and decrease circulating volume returning to the heart. REF: Page 1572 TOP: Heart failure Step: Planning

The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times? a. Late in the afternoon b. At bedtime c. With any meal d. In the morning

ANS: D Diuretics should be scheduled for morning administration to avoid causing the patient nocturia. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1567, Table 47-6 OBJ: 12 TOP: Lasix KEY: Nursing Process Step: Planning

A patient is admitted with a diagnosis of possible aortic aneurysm. In assessing her, it is most important to monitor her a. temperature. b. lung sounds. c. respirations. d. blood pressure.

ANS: D Initial nursing interventions include monitoring the status of an existing aortic aneurysm. The patient should be monitored for signs of rupture of the aneurysm, such as hypotension. REF: Page 1595 TOP: Aortic aneurysm

Modifiable risk factors for coronary artery disease (CAD) include which group? a. Diabetes, family history b. Family history, smoking c. Smoking, heredity d. High cholesterol, obesity

ANS: D Modifiable factors include smoking, hyperlipidemia, hypertension, diabetes mellitus, and obesity. REF: Page 1550 TOP: Risk factors

The patient has been hospitalized for congestive heart failure (CHF) three times in the last 4 months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse's immediate course of action would be to a. reteach him about his medications. b. have a serious talk with him and his family about compliance. c. arrange for home visits after discharge. d. collect more information to identify his reasons for noncompliance.

ANS: D Nursing interventions include measures to prevent disease progression and complications. Reteaching about medication will not identify the cause of noncompliance. REF: Pages 1558, 1572, Box 48-9 TOP: Heart failure Step: Evaluation

The patient has right-sided heart failure. She will probably be comfortable in which position? a. Dorsal recumbent b. Trendelenburg c. Supine d. Orthopneic

ANS: D Restful sleep may be possible only in the sitting position or with the aid of extra pillows. REF: Page 1572 TOP: Heart failure Step: Planning

What do dark or "cold" spots on a thallium scan indicate? a. Tissue with adequate blood supply b. Dilated vessels c. Areas of neoplastic growth d. Tissue that has inadequate perfusion

ANS: D Thallium scans show adequate perfused areas by the collection of thallium. Dark spots or "cold spots" indicate tissues that have inadequate perfusion. PTS: 1 DIF: Cognitive Level: Application REF: Page 1539 OBJ: 6 TOP: Thallium scan KEY: Nursing Process Step: Planning

The nurse reminds the patient that the National Heart, Lung, and Blood Institute recommends a lipid study every years. a. 2 b. 3 c. 4 d. 5

ANS: D The National Heart, Lung, and Blood Institute recommend a lipid study every 5 years for all Americans, but especially for the older adult. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1542 OBJ: 6 TOP: Lipid studies KEY: Nursing Process Step: Implementation

The nurse is aware that the muscle layer of the heart, which is responsible for the heart's contraction, is the: a. endocardium. b. pericardium. c. mediastinum. d. myocardium.

ANS: D The myocardium is the specialized muscle layer that allows the heart to contract. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1533 OBJ: 2 TOP: Myocardium KEY: Nursing Process Step: Implementation

What should a person with unstable angina avoid? a. Walking outside b. Eating red meat c. Swimming in warm pool d. Shoveling snow

ANS: D The person with angina should avoid exposure to cold, heavy exercise, eating heavy meals, and emotional stress. PTS: 1 DIF: Cognitive Level: Application REF: Page 1552 OBJ: 9 TOP: Angina KEY: Nursing Process Step: Planning