A-MedSurg Exam 1: Practice Questions

The intensive care department nurse is calculating the total intake for a client diagnosed with hypertensive crisis. The client has received 880 mL of D5W, IVPB of 100 mL of 0.9% NS, 8 ounces of water, 4 ounces of milk, and 6 ounces of chicken broth. The client has had a urinary output of 1,480 mL. What is the total intake for this client? _______

1,520 mL total intake. The urinary output is not used in this calculation. The nurse must add up both intravenous fluids and oral fluids to obtain the total intake for this client: 880 + 100 = 980 IV fluids Oral fluids (1 ounce = 30 mL): 8 ounces × 30 mL = 240 mL, 4 ounces × 30 mL = 120 mL, 6 ounces × 30 mL = 180 mL 240 + 120 + 180 = 540 mL oral fluids Total intake is 980 + 540 = 1,520 mL.

A 45-year-old patient with chronic arterial disease has a brachial systolic blood pressure (SBP) of 132 mm Hg and an ankle SBP of 102 mm Hg. The ankle-brachial index is and indicates (mild/moderate/severe) arterial disease.

102 ÷ 132 = 0.77; mild

The nurse is teaching a class on coronary artery disease. Which modifiable risk factor should the nurse discuss when teaching about atherosclerosis? 1. Stress. 2. Age. 3. Gender. 4. Family history.

Answer: 1 1. A modifiable risk factor is a risk factor that can possibly be altered by modify- ing or changing behavior, such as de- veloping new ways to deal with stress. 2. The client cannot do anything about getting older, so it cannot be modified. 3. Gender is a risk factor that cannot be changed. 4. Having a family history of coronary artery disease predisposes the client to a higher risk, but this cannot be changed by the client.

The nurse is discussing the pathophysiology of atherosclerosis with a client who has a normal high-density lipoprotein (HDL) level. Which information should the nurse discuss with the client concerning HDL? 1. A normal HDL is good because it has a protective action in the body. 2. HDL lipoprotein level measures the free fatty acids and glycerol in the blood. 3. HDLs are the primary transporters of cholesterol into the cell. 4. The client needs to decrease the amount of cholesterol and fat in the diet.

Answer: 1 1. A normal HDL level is good because HDL transports cholesterol away from the tissues and cells of the arterial wall to the liver for excretion. This helps decrease the development of atherosclerosis. 2. The normal HDL level was the result of a test measuring high-density lipoproteins, not free fatty acids and glycerol in the blood, which are measured by the serum triglyceride level. Triglycerides are a source of energy. 3. Low-density lipoproteins (LDLs), not HDLs, are the primary transporters of cholesterol into the cell. They have the harmful effect of depositing cholesterol into the walls of the arterial vessels. 4. A normal HDL level is good and the client does not need to change the diet.

Which health-care provider's order should the nurse question in a client diagnosed with an expanding abdominal aortic aneurysm who is scheduled for surgery in the morning? 1. Type and crossmatch for two (2) units of blood. 2. Tap water enema until clear fecal return. 3. Bedrest with bathroom privileges. 4. Keep NPO after midnight.

Answer: 2 1. The client is at risk for bleeding; therefore, this order would not be questioned. 2. Increased pressure in the abdomen secondary to a tap water enema could cause the AAA to rupture. 3. The client should be able to ambulate to the bathroom without any problems. 4. Clients are NPO prior to surgery to help prevent aspiration or problems from general anesthesia.

The nurse is unable to assess a pedal pulse in the client diagnosed with arterial occlusive disease. Which intervention should the nurse implement first? 1. Complete a neurovascular assessment. 2. Use the Doppler device. 3. Instruct the client to hang the feet off the side of the bed. 4. Wrap the legs in a blanket.

Answer: 1 1. An absent pulse is not uncommon in a client diagnosed with arterial occlusive disease, but the nurse must ensure that the feet can be moved and are warm, which indicates adequate blood supply to the feet. 2. To identify the location of the pulse, the nurse should use a Doppler device to amplify the sound, but it is not the first intervention. 3. This position will increase blood flow and may help the nurse palpate the pulse, but it is not the first intervention. 4. Cold can cause vasoconstriction and decrease the ability to palpate the pulse, and warming will dilate the arteries, help- ing the nurse find the pedal pulse, but it is not the first intervention.

Which assessment data would require immediate intervention by the nurse for the client who is six (6) hours postoperative abdominal aortic aneurysm repair? 1. Absent bilateral pedal pulses. 2. Complaints of pain at the site of the incision. 3. Distended, tender abdomen. 4. An elevated temperature of 100 ̊F.

Answer: 1 1. Any neurovascular abnormality in the client's lower extremities indicates the graft is occluded or possibly bleeding and requires immediate intervention by the nurse. 2. The nurse would expect the client to have incisional pain six (6) hours after surgery, so this is not priority over a complication. 3. The nurse would expect the client to have a distended, tender abdomen as a result of postoperative edema. 4. A slightly elevated temperature would not be uncommon in a client who has had surgery.

The client had an abdominal aortic aneurysm repair two (2) days ago. Which inter- vention should the nurse implement first? 1. Assess the client's bowel sounds. 2. Administer an IV prophylactic antibiotic. 3. Encourage the client to splint the incision. 4. Ambulate the client in the room with assistance.

Answer: 1 1. Assessment is the first part of the nurs- ing process and is the first intervention the nurse should implement. 2. Administering an antibiotic is an appropri- ate intervention, but it is not priority over assessment. 3. The client should splint the incision when coughing and deep breathing to help decrease the pain, but this interven- tion is not priority over assessment. 4. Ambulating the client as soon as possible is an appropriate intervention to help decrease complications from immobility, but it is not priority over assessment.

The client tells the nurse that his cholesterol level is 240 mg/dL. Which action should the nurse implement? 1. Praise the client for having a normal cholesterol level. 2. Explain that the client needs to lower the cholesterol level. 3. Discuss dietary changes that could help increase the level. 4. Allow the client to ventilate feelings about the blood test result.

Answer: 2 1. The cholesterol level should be less than 200 mg/dL. 2. The client needs to be taught ways to lower the cholesterol level. 3. The client should be taught a low-fat, low-cholesterol diet to help lower the cholesterol level. 4. The nurse needs to discuss facts concern- ing the cholesterol level and teach the client. A therapeutic conversation would not be appropriate.

The nurse is discussing the importance of exercising with a client who is diagnosed with CAD. Which statement best describes the scientific rationale for encouraging 30 minutes of walking daily to help prevent complications of atherosclerosis? 1. Exercise promotes the development of collateral circulation. 2. Isometric exercises help develop the client's muscle mass. 3. Daily exercise helps prevent plaque from developing in the vessel. 4. Isotonic exercises promote the transport of glucose into the cell.

Answer: 1 1. Collateral circulation is the develop- ment of blood supply around narrowed arteries; it helps prevent complications of atherosclerosis, including myocardial infarction, cerebrovascular accidents, and peripheral vascular disease. Exer- cise promotes the development of collateral circulation. 2. Isometric (weight-lifting) exercises help develop muscle mass, but this type of exercise does not help decrease complications of atherosclerosis. 3. A low-fat, low-cholesterol diet may help decrease the plaque formation, but exercise will not do this. 4. Isotonic exercises, such as walking and swimming, promote the movement of glucose across the cell membrane, but this is not why such exercises are recom- mended for prevention of atherosclerotic complications.

The client diagnosed with essential hypertension asks the nurse, "I don't know why the doctor is worried about my blood pressure. I feel just great." Which statement by the nurse would be the most appropriate response? 1. "Damage can be occurring to your heart and kidneys even if you feel great." 2. "Unless you have a headache, your blood pressure is probably within normal limits." 3. "When is the last time you saw your doctor? Does he know you are feeling great?" 4. "Your blood pressure reflects how well your heart is working."

Answer: 1 1. Even if the client feels great, the blood pressure can be elevated, causing dam- age to the heart, kidney, and blood vessels. 2. A headache may indicate an elevated blood pressure, but the client with essential hy- pertension can be asymptomatic and still have a very high blood pressure reading. 3. This response does not answer the client's question as to why the doctor is worried about the client's blood pressure. 4. The blood pressure does not necessarily reflect how well the heart is working. Many other diagnostic tests assess how well the heart is working, including an electrocardiogram (ECG), an ultrasound, and a chest x-ray.

The client is admitted for surgical repair of an 8-cm abdominal aortic aneurysm. Which sign/symptom would make the nurse suspect the client has an expanding AAA? 1. Complaints of low back pain. 2. Weakened radial pulses. 3. Decreased urine output. 4. Increased abdominal girth.

Answer: 1 1. Low back pain is present because of the pressure of the aneurysm on the lumbar nerves; this is a serious symp- tom, usually indicating that the aneurysm is expanding rapidly and about to rupture. 2. If any pulses were affected, it would be the pedal pulses, not the radial pulses. 3. Decreased urine output would not indi- cate an expanding AAA, but decreased urine output may occur when the AAA ruptures, causing hypovolemia. 4. The abdominal girth would not increase for an expanding AAA, but it might in- crease with a ruptured AAA.

The nurse is discussing discharge teaching with the client who is three (3) days post- operative abdominal aortic aneurysm repair. Which discharge instructions should the nurse include when teaching the client? 1. Notify HCP of any redness or irritation of the incision. 2. Do not lift anything that weighs more than 20 pounds. 3. Inform client there may be pain not relieved with pain medication. 4. Stress the importance of having daily bowel movements.

Answer: 1 1. Redness or irritation of the incision indicates infection and should be reported immediately to the HCP. 2. The client should not lift anything heavier than five (5) pounds because it may cause dehiscence or evisceration of the bowel. 3. The pain medication should keep the client comfortable; if it doesn't, the client should call the HCP. 4. Some clients do not have daily bowel movements, but the nurse should instruct the client not to allow himself or herself to become constipated, which will increase pressure on the incision.

The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet? 1. "I should eat at least four (4) to five (5) servings of vegetables a day." 2. "I should eat meat that has a lot of white streaks in it." 3. "I should drink no more than two (2) glasses of whole milk a day." 4. "I should decrease my grain intake to no more than twice a week."

Answer: 1 1. The DASH diet has proved beneficial in lowering blood pressure. It recommends eating a diet high in vegetables and fruits. 2. The DASH diet recommends two (2) or fewer servings of lean meats, which have very few white streaks; the white streaks indicate the meat is high in fat. 3. The DASH diet recommends two (2) to three (3) servings of nonfat or low-fat milk, not whole milk. 4. The DASH diet recommends seven (7) to eight (8) servings of grain a day.

Which client problem would be priority in a client diagnosed with arterial occlusive disease who is admitted to the hospital with a foot ulcer? 1. Impaired skin integrity. 2. Activity intolerance. 3. Ineffective health maintenance. 4. Risk for peripheral neuropathy.

Answer: 1 1. The client has a foot ulcer; therefore, the protective lining of the body—the skin—has been impaired. 2. This is an appropriate problem, but would not take priority over impaired skin integrity. 3. The client needs teaching, but it does not take priority over a physiological problem. 4. The client has peripheral neuropathy, not a risk for it; this is the primary pathological change in a client with arterial occlusive disease.

The nurse is assessing the client diagnosed with long-term arterial occlusive disease. Which assessment data support the diagnosis? 1. Hairless skin on the legs. 2. Brittle, flaky toenails. 3. Petechiae on the soles of feet. 4. Nonpitting ankle edema.

Answer: 1 1. The decreased oxygen over time causes the loss of hair on the tops of the feet and ascending both legs. 2. The toenails are usually thickened due to hypoxemia. 3. Petechiae are tiny purple or red spots that appear on the skin as a result of minute hemorrhages within the dermal layer; this does not occur with arterial occlusive disease. 4. There may be edema but it is usually pitting; nonpitting edema resolves with elevation, but not in clients with arterial occlusive disease.

The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing exercise? 1. Walk at least 30 minutes a day on flat surfaces. 2. Perform light weight lifting three (3) times a week. 3. Recommend high-level aerobics daily. 4. Encourage the client to swim laps once a week.

Answer: 1 1. Walking 30 to 45 minutes a day will help to reduce blood pressure, weight, and stress and will increase a feeling of overall well-being. 2. Isometric exercises (such as weight lifting) should be discouraged because performing them can raise the systolic blood pressure. 3. The client should walk, cycle, jog, or swim daily, but high-level aerobic exercise may increase the client's blood pressure. 4. Swimming laps is recommended, but it should be daily, not once a week.

Which medical treatment would be prescribed for the client with an AAA less than 3 cm? 1. Ultrasound every six (6) months. 2. Intravenous pyelogram yearly. 3. Assessment of abdominal girth monthly. 4. Repair of abdominal aortic aneurysm.

Answer: 1 1. When the aneurysm is small (<5 to 6 cm), an abdominal sonogram will be done every six (6) months until the aneurysm reaches a size at which surgery to prevent rupture is of more benefit than possible complications of an abdominal aortic aneurysm repair. 2. An intravenous pyelogram evaluates the kidney. 3. The abdomen will not distend as the AAA enlarges. 4. This AAA is too small to perform surgery to remove it.

Which interventions should the nurse discuss with the client diagnosed with atherosclerosis? Select all that apply. 1. Include the significant other in the discussion. 2. Stop smoking or using any type of tobacco products. 3. Maintain a sedentary lifestyle as much as possible. 4. Avoid stressful situations. 5. Daily isometric exercises are important.

Answer: 1, 2 1. Adherence to lifestyle modifications is enhanced when the client receives support from significant others. 2. Tobacco use is the most significant modifiable risk factor that contributes to the development of atherosclerosis. 3. A sedentary lifestyle should be discouraged; daily walking or swimming is encouraged. 4. This is an unrealistic intervention. The nurse needs to help the client learn ways to deal with stressful situations, not avoid the situations. 5. Isometric exercises are weight-lifting exercises, which should be discouraged; isotonic exercises, such as walking or swimming, are encouraged.

The client is diagnosed with a small abdominal aortic aneurysm. Which interven- tions should be included in the discharge teaching? Select all that apply. 1. Tell the client to exercise three (3) times a week for 30 minutes. 2. Encourage the client to eat a low-fat, low-cholesterol diet. 3. Instruct the client to decrease tobacco use. 4. Discuss the importance of losing weight with the client. 5. Teach the client to wear a truss at all times.

Answer: 1, 2, 4 1. The most common cause of AAA is atherosclerosis, so teaching should address this area. 2. A low-fat, low-cholesterol diet will help decrease development of atherosclerosis. 3. The client should not decrease tobacco use—he or she must quit totally. Smoking is the one modifiable risk factor that is not negotiable. 4. Losing weight will help decrease the pressure on the AAA and will help address decreasing the cholesterol level. 5. A truss is worn by a client with a hernia, not an AAA.

The nurse is teaching the client diagnosed with arterial occlusive disease. Which interventions should the nurse include in the teaching? Select all that apply. 1. Wash legs and feet daily in warm water. 2. Apply moisturizing cream to feet. 3. Buy shoes in the morning hours only. 4. Do not wear any type of knee stocking. 5. Wear clean white cotton socks.

Answer: 1, 2, 4, 5 1. Cold water causes vasoconstriction and hot water may burn the client's feet; therefore, warm (tepid) water should be recommended. 2. Moisturizing prevents drying of the feet. 3. Shoes should be purchased in the afternoon when the feet are the largest. 4. This will further decrease circulation to the legs. 5. Colored socks have dye, and dirty socks may cause foot irritation that may lead to breaks in the skin.

The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse? 1. The telemetry reads normal sinus rhythm. 2. The client has a weight gain of 2 kg within 1 to 2 days. 3. The client's blood pressure is 148/92. 4. The client's serum potassium level is 4.5 mEq.

Answer: 2 1. Normal sinus rhythm indicates that the client's heart is working normally. 2. Rapid weight gain—for example, 2 kg in one (1) to two (2) days—indicates that the loop diuretic is not working effec- tively; 2 kg equals 4.4 lbs; 1 L of fluid weighs l kg. 3. This blood pressure is not life-threateningly high and does not require immediate intervention. 4. Loop diuretics cause an increase in potas- sium excretion in the urine; therefore, the potassium level should be assessed, but 4.5 mEq/L is within normal limits (3.5 to 5.5 mEq/L).

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record? 1. Peripheral vascular disease. 2. Intermittent claudication. 3. Deep vein thrombosis. 4. Dependent rubor.

Answer: 2 1. Peripheral vascular disease is a broad term that encompasses both venous and arterial peripheral problems of the lower extremities. 2. This is the classic symptom of arterial occlusive disease. 3. This is characterized by calf tenderness, calf edema, and a positive Homans' sign. 4. This term is a sign of arterial occlusive disease; the legs are pale when elevated but are dark red when in the dependent position.

The nurse is teaching a class on arterial essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation? 1. Include information on retinopathy and nephropathy. 2. Discuss sedentary lifestyle and smoking cessation. 3. Include discussions on family history and gender. 4. Provide information on a low-fiber and high-salt diet.

Answer: 2 1. Retinopathy and nephropathy are compli- cations of uncontrolled hypertension, not modifiable risk factors. 2. Sedentary lifestyle is discouraged in clients with hypertension; daily isotonic exercises are recommended. Smoking (cigars have problems too) increases the atherosclerotic process in vessels; causes vasoconstriction of vessels; and adheres to hemoglobin, decreasing oxygen levels. 3. Family history and gender are nonmodifi- able risk factors. The question is asking for information on modifiable risk factors. 4. A low-salt diet is recommended because increased salt intake causes water reten- tion, which increases the workload of the heart. A high-fiber diet is recommended because it helps decrease cholesterol levels.

Which assessment data would the nurse recognize to support the diagnosis of abdominal aortic aneurysm (AAA)? 1. Shortness of breath. 2. Abdominal bruit. 3. Ripping abdominal pain. 4. Decreased urinary output.

Answer: 2 1. Shortness of breath indicates a respiratory problem or possible a thoracic aneurysm, not an AAA. 2. A systolic bruit over the abdomen is a diagnostic indication of an AAA. 3. Ripping or tearing pain indicates a dissect- ing aneurysm. 4. Urine output is not diagnostic of an AAA.

The nurse is caring for clients on a telemetry floor. Which nursing task would be most appropriate to delegate to an unlicensed assistive personnel (UAP)? 1. Teach the client how to perform a glucometer check. 2. Assist feeding the client diagnosed with congestive heart failure. 3. Check the cholesterol level for the client diagnosed with atherosclerosis. 4. Assist the nurse to check the unit of blood at the client's bedside.

Answer: 2 1. Teaching cannot be delegated to a UAP. 2. The UAP can feed a client. 3. The UAP cannot assess the client and does not have the education to interpret laboratory data. 4. A unit of blood must be checked by two (2) registered nurses at the bedside.

The client is one (1) day postoperative abdominal aortic aneurysm repair. Which information from the unlicensed assistive personnel (UAP) would require immediate intervention from the nurse? 1. The client refuses to turn from the back to the side. 2. The client's urinary output is 90 mL in six (6) hours. 3. The client wants to sit on the side of the bed. 4. The client's vital signs are T 98, P 90, R 18, and BP 130/70.

Answer: 2 1. The nurse needs to intervene, but it does not require immediate intervention. 2. The client must have 30 mL of urinary output every hour. Clients who are post-AAA are at high risk for renal failure because of the anatomical location of the AAA near the renal arteries. 3. The client can sit on the bed the first day postoperation; this is, in fact, encouraged. 4. These vital signs would not warrant immediate intervention by the nurse.

The wife of a client with arterial occlusive disease tells the nurse, "My husband says he is having rest pain. What does that mean?" Which statement by the nurse would be most appropriate? 1. "It describes the type of pain he has when he stops walking." 2. "His legs are deprived of oxygen during periods of inactivity." 3. "You are concerned that your husband is having rest pain." 4. "This term is used to support that his condition is getting better."

Answer: 2 1. The pain stops when the client quits walking; therefore, it is not rest pain. 2. Rest pain indicates a worsening of the arterial occlusive disease; the muscles of the legs are not getting enough oxygen when the client is resting to prevent muscle ischemia. 3. This is a therapeutic response and does not answer the wife's question. 4. Rest pain indicates that the arterial occlusive disease is getting worse.

The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement? 1. Notify the health-care provider if the potassium level is 3.8 mEq. 2. Question administering the medication if the BP is <90/60 mm Hg. 3. Do not administer the medication if the client's radial pulse is >100. 4. Monitor the client's BP while he or she is lying, standing, and sitting.

Answer: 2 1. The potassium level is within normal limits (3.5 to 5.5 mEq/L), and it is not usually checked prior to administering beta blockers. 2. The nurse should question administering the beta blocker if the BP is low because this medication will cause the blood pressure to drop even lower, leading to hypotension. 3. The nurse would not administer the med- ication if the apical (not radial) pulse were less than 60 beats per minute. 4. The nurse needs to assess the blood pressure only once prior to administering the medica- tion (not take all three blood pressures prior to administering the medication).

The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first? 1. Recommend that the client have his blood pressure checked in one (1) month. 2. Instruct the client to see his health-care provider as soon as possible. 3. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. 4. Explain that this BP is within the normal range for an elderly person.

Answer: 2 1. This BP is elevated, and the client should have his BP checked frequently but not before seeking medical treatment. 2. The diastolic blood pressure should be less than 85 mm Hg according to the American Heart Association; therefore, this client should see the health-care provider. 3. Teaching is important, but the nurse must first make sure the client sees the health- care provider for a thorough checkup and antihypertensive medication prescription. Diet alone should not be recommended by the nurse. 4. This is not the normal range for an elderly person's blood pressure; the diastolic should be less than 85 mm Hg.

The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease who has a BP of 170/100. 2. The client diagnosed with deep vein thrombosis who is complaining of chest pain. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis who has nonbloody diarrhea.

Answer: 2 1. This blood pressure is elevated, but it is not life threatening. 2. The chest pain could be a pulmonary embolus secondary to deep vein thrombosis and requires immediate intervention by the nurse. 3. A pulse oximeter reading of greater than 93% is within normal limits. 4. Nonbloody diarrhea is an expected sign of ulcerative colitis and would not require immediate intervention by the nurse.

The client is diagnosed with an abdominal aortic aneurysm. Which statement would the nurse expect the client to make during the admission assessment? 1. "I have stomach pain every time I eat a big, heavy meal." 2. "I don't have any abdominal pain or any type of problems." 3. "I have periodic episodes of constipation and then diarrhea." 4. "I belch a lot, especially when I lay down after eating."

Answer: 2 1. This statement would not make the nurse suspect an AAA. 2. Only about two-fifths of clients with AAA have symptoms; the remainder are asymptomatic. 3. Periodic episodes of constipation and diarrhea may indicate colon cancer but do not support a diagnosis of AAA. 4. Belching does not support a diagnosis of AAA, but it could possibly indicate gastroesophageal reflux or a hiatal hernia.

The HCP prescribes an HMG-CoA reductase inhibitor (statin) medication to a client with CAD. Which should the nurse teach the client about this medication? 1. Take this medication on an empty stomach. 2. This medication should be taken in the evening. 3. Do not be concerned if muscle pain occurs. 4. Check your cholesterol level daily.

Answer: 2 1.A statin medication can be taken with food or on an empty stomach. 2. Statin medications should be taken in the evening for best results because the enzyme that destroys cholesterol works best in the evening and the medication enhances this process. 3. Cholesterol-reducing medications can cause serious liver problems, and if a client has muscle pain, it is an adverse effect that should be reported to the HCP. 4. The cholesterol level is checked every few months, not on a daily basis.

Which assessment data would cause the nurse to suspect the client has atherosclerosis? 1. Change in bowel movements. 2. Complaints of a headache. 3. Intermittent claudication. 4. Venous stasis ulcers.

Answer: 3 1. A change in bowel movements may indicate cancer but not atherosclerosis. 2. A headache is not a sign/symptom of atherosclerosis. 3. Intermittent claudication is a sign of generalized atherosclerosis and is a marker of atherosclerosis. 4. Atherosclerosis indicates arterial involve- ment, not venous involvement.

Which client would be most likely to develop an abdominal aortic aneurysm? 1. A 45-year-old female with a history of osteoporosis. 2. An 80-year-old female with congestive heart failure. 3. A 69-year-old male with peripheral vascular disease. 4. A 30-year-old male with a genetic predisposition to AAA.

Answer: 3 1. AAAs affect men four (4) times more often than women. 2. AAAs affect men four (4) times more often than women. 3. The most common cause of AAA is atherosclerosis (which is the cause of peripheral vascular disease); it occurs in men four (4) times more often than women and primarily in Caucasians. 4. AAAs occur most often in elderly men, and there is no genetic predisposition.

Which medication should the nurse expect the health-care provider to order for a client diagnosed with arterial occlusive disease? 1. An anticoagulant medication. 2. An antihypertensive medication. 3. An antiplatelet medication. 4. A muscle relaxant.

Answer: 3 1. An anticoagulant medication is prescribed for venous problems, such as deep vein thrombosis. 2. Arterial occlusive disease is caused by atherosclerosis, which may cause hypertension as well, but antihypertensive medications are not prescribed for arterial occlusive disease. 3. Antiplatelet medications, such as aspirin or clopidogrel (Plavix), inhibit platelet aggregations in the arterial blood. 4. A muscle relaxant will not help the leg pain since the origin of the pain is decreased oxygen to the muscle.

The health-care provider prescribes an ACE inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for adminis- tering this medication? 1. ACE inhibitors prevent beta receptor stimulation in the heart. 2. This medication blocks the alpha receptors in the vascular smooth muscle. 3. ACE inhibitors prevent vasoconstriction and sodium and water retention. 4. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.

Answer: 3 1. Beta-adrenergic blocking agents, not ACE in- hibitors, prevent the beta receptor stimulation in the heart, which decreases heart rate and cardiac output. 2. Alpha-adrenergic blockers, not ACE in- hibitors, block alpha receptors in the vascular smooth muscle, which decreases vasomotor tone and vasoconstriction. 3. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II, and this, in turn, prevents vasoconstriction and sodium and water retention. 4. Vasodilators, not ACE inhibitors, reduce blood pressure by relaxing vascular smooth muscle, especially in the arterioles.

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? 1. Encourage the client to use a heating pad on the lower extremities. 2. Demonstrate to the client the correct way to apply elastic support hose. 3. Instruct the client to walk daily for at least 30 minutes. 4. Tell the client to check both feet for red areas at least once a week.

Answer: 3 1. External heating devices are avoided to reduce the risk of burns. 2. Elastic support hose reduce the circulation to the skin and are avoided. 3. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis. 4. The feet must be checked daily, not weekly.

The nurse knows the client understands the teaching concerning a low-fat, low- cholesterol diet when the client selects which meal? 1. Fried fish, garlic mashed potatoes, and iced tea. 2. Ham and cheese on white bread and whole milk. 3. Baked chicken, baked potato, and skim milk. 4. A hamburger, French fries, and carbonated beverage.

Answer: 3 1. Fried foods are high in fat and cholesterol. 2. White bread is not high in fiber; wheat bread should be recommended because it is high in fiber. Whole milk is high in fat; skim milk should be used. 3. Baked, broiled, or grilled meats are recommended; a plain baked potato is appropriate; and skim milk is low in fat—so this meal is appropriate for a low-fat, low-cholesterol diet. 4. Hamburger meat is high in fat, French fries are usually cooked in oil (which is high in fat), and carbonated beverages are high in calories.

The nurse is teaching a class on atherosclerosis. Which statement describes the scientific rationale as to why diabetes is a risk factor for developing atherosclerosis? 1. Glucose combines with carbon monoxide, instead of with oxygen, and this leads to oxygen deprivation of tissues. 2. Diabetes stimulates the sympathetic nervous system, resulting in peripheral constriction that increases the development of atherosclerosis. 3. Diabetes speeds the atherosclerotic process by thickening the basement membrane of both large and small vessels. 4. The increased glucose combines with the hemoglobin, which causes deposits of plaque in the lining of the vessels.

Answer: 3 1. Glucose does not combine with carbon monoxide. 2. Vasoconstriction is not a risk factor for developing atherosclerosis. 3. This is the scientific rationale for why diabetes mellitus is a modifiable risk factor for atherosclerosis. 4. When glucose combines with the hemo- globin in a laboratory test called glycosy- lated hemoglobin, the result can determine the client's average glucose level over the past three (3) months.

The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate? 1. "You probably have some type of kidney disease that causes the high BP." 2. "More than likely you have had a diet high in salt, fat, and cholesterol." 3. "There is no specific cause for hypertension, but there are many known risk factors." 4. "You are concerned that you have high blood pressure. Let's sit down and talk."

Answer: 3 1. Kidney disease leads to secondary hyperten- sion; secondary hypertension is elevated blood pressure resulting from an identifi- able underlying process. 2. A high-salt, high-fat, high-cholesterol diet is a risk factor for essential hypertension, but it is not the only cause; therefore, this would be an incorrect answer. 3. There is no known cause for essential hypertension, but many factors—both modifiable (obesity, smoking, diet) and nonmodifiable (family history, age, gender)—are risk factors for essential hypertension. 4. This is a therapeutic reply that is inappro- priate because the client needs facts.

Which assessment data would warrant immediate intervention in the client diagnosed with arterial occlusive disease? 1. The client has 2+ pedal pulses. 2. The client is able to move the toes. 3. The client has numbness and tingling. 4. The client's feet are red when standing.

Answer: 3 1. These are normal pedal pulses and would not require any intervention. 2. Moving the toes is a good sign in a client with arterial occlusive disease. 3. Numbness and tingling are paresthesia, which is a sign of a severely decreased blood supply to the lower extremities. 4. Reddened extremities are expected secondary to increased blood supply when the legs are in the dependent position.

The nurse and an unlicensed assistive personnel (UAP) are caring for a 64-year-old client who is four (4) hours postoperative bilateral femoral-popliteal bypass surgery. Which nursing task should be delegated to the UAP? 1. Monitor the continuous passive motion machine. 2. Assist the client to the bedside commode. 3. Feed the client the evening meal. 4. Elevate the foot of the client's bed.

Answer: 4 1. A continuous passive motion machine is used for a client with a total knee replace- ment, not for this type of surgery. 2. The client will be on bedrest at four (4) hours after the surgery. Remember, the client had bilateral surgery on the legs. 3. There is nothing in the stem that would indicate the client could not feed himself or herself. The nurse should encourage independence as much as possible. 4. After the surgery, the client's legs will be elevated to help decrease edema. The surgery has corrected the decreased blood supply to the lower legs.

The client asks the nurse, "My doctor just told me that atherosclerosis is why my legs hurt when I walk. What does that mean?" Which response by the nurse would be the best response? 1. "The muscle fibers and endothelial lining of your arteries have become thickened." 2. "The next time you see your HCP, ask what atherosclerosis means." 3. "The valves in the veins of your legs are incompetent so your legs hurt." 4. "You have a hardening of your arteries that decreases the oxygen to your legs."

Answer: 4 1. The nurse should assume the client is a layperson and should not explain disease processes using medical terminology. 2. This is passing the buck; the nurse should have the knowledge to answer this question. 3. Atherosclerosis involves the arteries, not the veins. 4. This response explains in plain terms why the client's legs hurt from athero- sclerosis.

The male client diagnosed with essential hypertension has been prescribed an alpha- adrenergic blocker. Which intervention should the nurse discuss with the client? 1. Eat at least one (1) banana a day to help increase the potassium level. 2. Explain that impotence is an expected side effect of the medication. 3. Take the medication on an empty stomach to increase absorption. 4. Change position slowly when going from lying to sitting position.

Answer: 4 1. The potassium level is not affected by an alpha-adrenergic blocker. 2. Impotence is a major cause of noncompliance with taking prescribed medications for hypertension in male clients. The noncom- pliance should be reported to the HCP immediately so the medication can be changed. 3. The medication can be taken on an empty or a full stomach, depending on whether the client becomes nauseated after taking the medication. 4. Orthostatic hypotension may occur when the blood pressure is decreasing and may lead to dizziness and light- headedness, so the client should change position slowly.

The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement? 1. Keep the right leg in the dependent position. 2. Apply sequential compression devices to lower extremities. 3. Monitor the client's pedal pulses every shift. 4. Assess the client's leg dressing every four (4) hours.

Answer: 4 1. The right leg should be elevated to decrease edema, not flat or hanging off the side of the bed (dependent). 2. The left leg could have a sequential compression device to prevent deep vein thrombosis, but it should not be on the leg with an operative incision site. 3. The client is one (1) day postoperative, and the pedal pulses must be assessed more than once every eight (8) or 12 hours. 4. The leg dressing needs to be assessed for hemorrhaging or signs of infection.

The health-care provider ordered a femoral angiogram for the client diagnosed with arterial occlusive disease. Which intervention should the nurse implement? 1. Explain that this procedure will be done at the bedside. 2. Discuss with the client that he or she will be on bedrest with bathroom privileges. 3. Inform the client that no intravenous access will be needed. 4. Inform the client that fluids will be increased after the procedure.

Answer: 4 1. This procedure will be done in a catheterization laboratory or special room, not at the bedside, because machines are used to visualize the extent of the arterial occlusion. 2. The client will have to keep the leg straight for at least six (6) hours after the procedure to prevent bleeding from the femoral artery. 3. An intravenous contrast medium is injected and vessels are visualized using fluoroscopy and x-rays. 4. Fluids will help flush the contrast dye out of the body and help prevent kidney damage.

The client diagnosed with peripheral vascular disease is overweight, has smoked two (2) packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest factor in the development of atherosclerotic lesions? 1. Being overweight. 2. Sedentary lifestyle. 3. High-fat, high-cholesterol diet. 4. Smoking cigarettes.

Answer: 4 1. Being overweight is not a risk factor for atherosclerotic lesions, but it does indicate that the client does not eat a healthy diet or exercise as needed. 2. Lack of exercise is a risk factor, but it is not the strongest. 3. Although the stem did not explicitly identify diet, the nurse should assume that a client who is obese would not eat a low-fat, low-cholesterol diet. 4. Tobacco use is the strongest factor in the development of atherosclerotic lesions. Nicotine decreases blood flow to the extremities and increases heart rate and blood pressure. It also increases the risk of clot formation by increasing the aggregation of platelets.

10. After defibrillation, the advanced cardiac life support (ACLS) nurse says that the patient has pulseless electrical activity (PEA). What is most important for the nurse to understand about this rhythm? a. The heart rate is 40 to 60 bpm. b. Hypoxemia and hypervolemia are common with PEA. c. There is dissociated activity of the ventricle and atrium. d. There is electrical activity with no mechanical response

D

What are characteristic of arteriospastic disease (Raynaud's phenomenon) (select all that apply)? a. Predominant in young females b. May be associated with autoimmune disorders c. Precipitated by exposure to cold, caffeine, and tobacco d. Involves small cutaneous arteries of the fingers and toes e. Inflammation of small and medium-sized arteries and veins f. Episodes involve white, blue, and red color changes of fingertips

a, b, c, d, f. Raynaud's phenomenon is predominant in young females and may be associated with autoimmune disorders (e.g., rheumatoid arthritis, scleroderma, systemic lupus erythematosus). Incidents occur with cold, emotional upsets, and caffeine or tobacco use due to vasoconstrictive effects. Small cutaneous arteries are involved and cause color changes of the fingertips or toes. When conservative management is ineffective, it may be treated with nifedipine (Procardia).

16. A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. Decreased renal function b. Increased baroreceptor reflexes c. Increased peripheral vascular resistance d. Increased adrenergic receptor sensitivity e. Increased collagen and stiffness of the myocardium f. Loss of elasticity in large arteries from arteriosclerosis

a, c, e, f. The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis. The baroreceptor reflexes are blunted. The adrenergic receptor sensitivity and renin response are both decreased with aging.

A patient with PAD has a nursing diagnosis of ineffective peripheral tissue perfusion. What should be included in the teaching plan for this patient (select all that apply)? a. Keep legs and feet warm. b. Apply cold compresses when the legs become swollen. c. Walk at least 30 minutes per day to the point of discomfort. d. Use nicotine replacement therapy as a substitute for smoking. e. Inspect lower extremities for pulses, temperature, and any injury.

a, c, e. Warm legs and feet increase circulation. The lower extremities should be assessed at regular intervals for changes. Walking exercise increases oxygen extraction in the legs and improves skeletal muscle metabolism. The patient with PAD should walk at least 30 minutes a day, preferably twice a day. Exercise should be stopped when pain occurs and resumed when the pain subsides. Nicotine in all forms causes vasoconstriction and must be eliminated.

17. What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)? a. The drug should never be stopped abruptly. b. The drug should be taken early in the day to prevent nocturia. c. The first dose should be taken when the patient is in bed for the night. d. Because aspirin will decrease the drug's effectiveness, Tylenol should be used instead.

a. Centrally acting α-adrenergic blockers may cause severe rebound hypertension if the drugs are abruptly discontinued and patients should be taught about this effect because many are not consistently compliant with drug therapy. Diuretics should be taken early in the day to prevent nocturia and the profound orthostatic hypotension that occurs with first-dose α-adrenergic blockers can be prevented by taking the initial dose at bedtime. Aspirin use may decrease the effectiveness of ACE inhibitors.

21. What action is included in the nurse's responsibilities in preparing to administer defibrillation? a. Applying gel pads to the patient's chest b. Setting the defibrillator to deliver 50 joules c. Setting the defibrillator to a synchronized mode d. Sedating the patient with midazolam (Versed) before defibrillation

a. In preparation for defibrillation the nurse should apply conductive materials (e.g., saline pads, electrode gel, defibrillator gel pads) to the patient's chest to decrease electrical impedance and prevent burns. For defibrillation, the initial shock is 200 joules with biphasic defibrillators and the synchronizer switch used for cardioversion must be turned off. Sedatives may be used before cardioversion if the patient is conscious but the pa

22. During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea, and vomiting, the nurse initially titrates the medications to achieve which goal? a. Decrease the mean arterial pressure (MAP) to 129 mm Hg b. Lower the BP to the patient's normal within the second to third hour d. Reduce the systolic BP (SBP) to 158 mm Hg and the diastolic BP (DBP) to 111 mm Hg within the first 2 hours c. Decrease the SBP to 160 mm Hg and the DBP to between 100 and 110 mm Hg as quickly as possible

a. Initially the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure (MAP) by no more than 20% to 25% in the first hour, with further gradual reduction over the next 24 hours. In this case the MAP is 172, so decreasing it by 25% equals 129. Lowering the BP too far or too fast may cause a stroke, myocardial infarction (MI), visual changes, or renal failure. Only when the patient has an aortic dissection, angina, or signs of MI or an ischemic stroke does the SBP need to be lowered to 100 to 120 mm Hg or less as quickly as possible.

19. Which rhythm pattern finding is indicative of PVCs? a. A QRS complex ≥0.12 second followed by a P wave b. Continuous wide QRS complexes with a ventricular rate of 160 bpm c. P waves hidden in QRS complexes with a regular rhythm of 120 bpm d. Saw-toothed P waves with no measurable PR interval and an irregular rhythm

a. PVC is an ectopic beat that causes a wide, distorted QRS complex ≥0.12 second because the impulse is not conducted normally through the ventricles. Because it is premature, it precedes the P wave and the P wave may be hidden in the QRS complex, or the ventricular impulse may be conducted retrograde and the P wave may be seen following the PVC but the rhythm is not regular. Continuous wide QRS complexes with a ventricular rate between 150 and 250 bpm are seen in ventricular tachycardia, whereas saw-toothed P waves are characteristic of atrial flutter.

24. A patient on the cardiac telemetry unit goes into ventricular fibrillation and is unresponsive. Following initiation of the emergency call system (Code Blue), what is the next priority for the nurse in caring for this patient? a. Begin CPR. b. Get the crash cart. c. Administer amiodarone IV. d. Defibrillate with 360 joules.

a. Until the defibrillator is available, the patient needs CPR. Defibrillation is needed as soon as possible, so someone should bring the crash cart to the room. Defibrillation would be with 360 joules for monophasic defibrillators and 120 to 200 joules for biphasic defibrillators. Amiodarone is an antidysrhythmic that is part of the advanced cardiac life support (ACLS) protocol for ventricular fibrillation.

25. What are characteristics of arterial disease (select all that apply)? a. Pruritus b. Thickened, brittle nails c. Dull ache in calf or thigh d. Decreased peripheral pulses e. Pallor on elevation of the legs f. Ulcers over bony prominences on toes and feet

b, d, e, f. Arterial disease is manifested in thick, brittle nails; decreased peripheral pulses; pallor when the legs are elevated; and ulcers over bony prominences on the toes and feet, as well as paresthesia.

During preoperative preparation of the patient scheduled for an AAA, why should the nurse establish baseline data for the patient? a. All physiologic processes will be altered postoperatively. b. The cause of the aneurysm is a systemic vascular disease. c. Surgery will be canceled if any physiologic function is not normal. d. BP and HR will be maintained well below baseline levels during the postoperative period.

b. Because atherosclerosis is a systemic disease, the patient with an A A A is likely to have cardiac, pulmonary, cerebral, or lower extremity vascular problems that should be noted and monitored throughout the perioperative period. Postoperatively, the BP is balanced: high enough to keep adequate flow through the artery to prevent thrombosis but low enough to prevent bleeding at the surgical site. b. The BP and peripheral pulses are evaluated every hour in the acute postoperative period to ensure that BP is adequate and that extremities are being perfused. BP is kept within normal range. If BP is too low, thrombosis of the graft may occur; if it is too high, it may cause leaking or rupture at the suture line. Hypothermia is induced during surgery but the patient is rewarmed as soon as surgery is completed. Fluid replacement to maintain urine output at 100 mL/hr would increase the BP too much and only 30 mL/hr of urine is needed to show adequate renal perfusion.

17. Which finding is associated with a blue tinge around the lips and conjunctiva? a. Finger clubbing b. Central cyanosis c. Peripheral cyanosis d. Delayed capillary filling time

b. Central cyanosis is evident with a blue tinge in the lips, conjunctiva, or tongue. Finger clubbing results from endocarditis, congenital defects, or prolonged O2 deficiency. Peripheral cyanosis is evident with blue-tinged extremities or in the nose and ears. Decreased capillary refill may be seen in reduced arterial capillary perfusion or anemia.

22. While providing discharge instructions to the patient who has had an implantable cardioverter-defibrillator (ICD) inserted, the nurse teaches the patient that if the ICD fires, he or she should do what? a. Lie down. b. Call the cardiologist. c. Push the reset button on the pulse generator. d. Immediately take his or her antidysrhythmic medication.

b. If the cardioverter-defibrillator delivers a shock, the patient has experienced a lethal dysrhythmia and needs to notify the cardiologist. The patient will want to lie down to allow recovery from the dysrhythmia. In the event that the patient loses consciousness or there is repetitive firing, a call should be placed to the emergency medical services (EMS) system by anyone who finds the patient.

A patient with a small AAA is not a good surgical candidate. What should the nurse teach the patient is one of the best ways to prevent expansion of the lesion? a. Avoid strenuous physical exertion. b. Control hypertension with prescribed therapy. c. Comply with prescribed anticoagulant therapy. d. Maintain a low-calcium diet to prevent calcification of the vessel.

b. Increased systolic blood pressure (SBP) continually puts pressure on the diseased area of the artery, promoting its expansion. Small aneurysms can be treated by decreasing blood pressure (BP), modifying atherosclerosis risk factors, and monitoring the size of the aneurysm. Anticoagulants are used during surgical treatment of aneurysms but physical activity is not known to increase their size. Calcium intake is not related to calcification in arteries.

When teaching the patient with PAD about modifying risk factors associated with the condition, what should the nurse emphasize? a. Amputation is the ultimate outcome if the patient does not alter lifestyle behaviors. b. Modifications will reduce the risk of other atherosclerotic conditions such as stroke. c. Risk-reducing behaviors initiated after angioplasty can stop the progression of the disease. d. Maintenance of normal body weight is the most important factor in controlling arterial disease.

b. PAD occurs as a result of atherosclerosis and the risk factors are the same as for other diseases associated with atherosclerosis, such as CAD, cerebrovascular disease, and aneurysms. Major risk factors are tobacco use, hyperlipidemia, elevated C-reactive protein, diabetes mellitus, and uncontrolled hypertension. The risk for amputation is high in patients with severe occlusive disease but this is not the best approach to encourage patients to make lifestyle modifications.

14. A patient with stage 2 hypertension who is taking hydrochlorothiazide (HydroDiuril) and lisinopril (Prinivil) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention b. Change position slowly and avoid prolonged standing c. Use sugarless gum or candy to help relieve dry mouth d. Take the pulse daily to note any slowing of the heart rate

b. Prazosin is an α-adrenergic blocker that causes dilation of arterioles and veins and causes orthostatic hypotension. The patient may feel dizzy, weak, and faint when assuming an upright position after sitting or lying down and should be taught to change positions slowly, avoid standing for long periods, do leg exercises to increase venous return, and lie or sit down when dizziness occurs. Direct-acting vasodilators often cause fluid retention; dry mouth occurs with diuretic use, although orthostatic hypotension may occur with hydrochlorothiazide as well; and centrally acting α- and β-blockers may cause bradycardia.

17. In the patient with a dysrhythmia, which assessment indicates decreased cardiac output (CO)? a. Hypertension and bradycardia b. Chest pain and decreased mentation c. Abdominal distention and hepatomegaly d. Bounding pulses and a ventricular heave

b. Symptoms of decreased cardiac output (CO) related to cardiac dysrhythmias include a sudden drop in BP and symptoms of hypoxemia, such as decreased mentation, chest pain, and dyspnea. Peripheral pulses are weak and the HR may be increased or decreased, depending on the type of dysrhythmia present.

During the patient's acute postoperative period following repair of an AAA, the nurse should ensure that which goal is achieved? a. Hypothermia is maintained to decrease oxygen need. b. BP and all peripheral pulses are evaluated at least every hour. c. IV fluids are administered at a rate to maintain urine output of 100 mL/hr. d. The patient's BP is kept lower than baseline to prevent leaking at the incision line.

b. The BP and peripheral pulses are evaluated every hour in the acute postoperative period to ensure that BP is adequate and that extremities are being perfused. BP is kept within normal range. If BP is too low, thrombosis of the graft may occur; if it is too high, it may cause leaking or rupture at the suture line. Hypothermia is induced during surgery but the patient is rewarmed as soon as surgery is completed. Fluid replacement to maintain urine output at 100 mL/hr would increase the BP too much and only 30 mL/hr of urine is needed to show adequate renal perfusion.

A patient who is postoperative following repair of an AAA has been receiving IV fluids at 125 mL/hr continuously for the last 12 hours. Urine output for the last 4 hours has been 60 mL, 42 mL, 28 mL, and 20 mL, respectively. What is the priority action that the nurse should take? a. Monitor for a couple more hours. b. Contact the physician and report the decrease in urine output. c. Send blood for electrolytes, blood urea nitrogen (BUN), and creatinine. d. Decrease the rate of infusion to prevent blood leakage at the suture line.

b. The decreasing urine output is evidence that either the patient needs volume or there is reduced renal blood flow. The physician will want to be notified as soon as possible of this change in condition and may order laboratory tests. The other options are incorrect.

8. The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain c. Retina b. Heart d. Kidney

b. The increased systemic vascular resistance (SVR) of hypertension directly increases the workload of the heart and heart failure occurs when the heart can no longer pump effectively against the increased resistance. The heart may be indirectly damaged by atherosclerotic changes in the blood vessels, as are the brain, retina, and kidney.

23. A patient with a sinus node dysfunction has a permanent pacemaker inserted. Before discharge, what should the nurse include when teaching the patient? a. Avoid cooking with microwave ovens. b. Avoid standing near antitheft devices in doorways. c. Use mild analgesics to control the chest spasms caused by the pacing current. d. Start lifting the arm above the shoulder right away to prevent a "frozen shoulder."

b. The patient should avoid standing near antitheft devices in doorways of department stores and libraries but walking through them at normal pace is fine. High-output electrical generators or large magnets, such as those used in magnetic resonance imaging (MRI), can reprogram pacemakers and should be avoided. Microwave ovens pose no problems to pacemaker function but the arm should not be raised above the shoulder for 1 week after placement of the pacemaker. The pacing current of an implanted pacemaker is not felt by the patient but an external pacemaker may cause uncomfortable chest muscle contractions.

12. A patient with an acute myocardial infarction (MI) develops the following ECG pattern: atrial rate of 82 and regular; ventricular rate of 46 and regular; P wave and QRS complex are normal but there is no relationship between the P wave and the QRS complex. What dysrhythmia does the nurse identify this as and what treatment is expected? a. Sinus bradycardia treated with atropine b. Third-degree heart block treated with a pacemaker c. Atrial fibrillation treated with electrical cardioversion d. Type I second-degree AV block treated with observation

b. Third-degree or complete heart block is recognized with the atrial and ventricular dissociation and treated with a pacemaker. Sinus bradycardia does not have atrial and ventricular dissociation. Atrial fibrillation does not have normal P waves, as they are stimulated by ectopic foci. In type 1 second-degree AV heart block the P-R interval gradually lengthens and a QRS complex is dropped. Then the cycle begins again.

13. Which rhythm abnormality has an increased risk of ventricular tachycardia and ventricular fibrillation? a. PAC b. PVC on the T wave c. Accelerated idioventricular rhythm d. Premature ventricular contraction (PVC) couplet

b. When premature ventricular contraction (PVC) falls on the T wave of the preceding beat, R-on-T phenomenon occurs. Because the ventricle is repolarizing and there is increased excitability of cardiac cells, there is an increased risk of ventricular tachycardia or ventricular fibrillation. The other options do not increase this risk.

16. The nursing student is seeking assistance in hearing the patient's abnormal heart sounds. What should the nurse tell the student to do for a more effective assessment? a. Use the diaphragm of the stethoscope with the patient prone b. Use the diaphragm of the stethoscope with the patient supine c. Use the bell of the stethoscope with the patient leaning forward d. Use the bell of the stethoscope with the patient on the right side

c.

A surgical repair is planned for a patient who has a 5.5-cm abdominal aortic aneurysm (AAA). On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and dysphagia b. Severe back pain with flank ecchymosis c. Presence of a bruit in the periumbilical area d. Weakness in the lower extremities progressing to paraplegia

c. Although most abdominal aortic aneurysms (AAAs) are asymptomatic, on physical examination a pulsatile mass in the periumbilical area slightly to the left of the midline may be detected and bruits may be audible with a stethoscope placed over the aneurysm. Hoarseness and dysphagia may occur with aneurysms of the ascending aorta and the aortic arch. Severe back pain with flank ecchymosis is usually present on rupture of an AAA and neurovascular loss in the lower extremities may occur from pressure of a thoracic aneurysm.

21. When caring for a patient after a cardiac catheterization with coronary angiography, which finding would be of most concern to the nurse? a. Swelling at the catheter insertion site b. Development of raised wheals on the patient's trunk c. Absence of pulses distal to the catheter insertion site d. Patient pain at the insertion site as 4 on a scale of 0 to 10

c. An absence of pulses distal to the catheter insertion site indicates that clotting is occluding blood flow to the extremity and is an emergency that requires immediate medical attention. Some swelling and pain at the site are expected but the site is also monitored for bleeding and a pressure dressing and perhaps a sandbag or clamp may be applied. Hives may occur as a result of iodine sensitivity and will require treatment but the priority is the lack of pulses.

12. Which classification of drugs used to treat hypertension prevents the action of angiotensin II and promotes increased salt and water excretion? a. Thiazide diuretics c. Angiotensin II receptor blockers (ARBs) b. Direct vasodilators d. Angiotensin-converting enzyme (ACE) inhibitors

c. Angiotensin II receptor blockers (ARBs) prevent the action of angiotensin II and produce vasodilation and increased salt and water excretion. Thiazide diuretics decrease extracellular fluid volume by increasing Na+ and Cl- excretion with water. Direct vasodilators act directly on smooth muscle of arterioles to cause vasodilation. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II.

11. What is the primary BP effect of β-adrenergic blockers such as atenolol (Tenormin)? a. Vasodilation of arterioles by blocking movement of calcium into cells b. Decrease Na+ and water reabsorption by blocking the effect of aldosterone c. Decrease CO by decreasing rate and strength of the heart and renin secretion by the kidneys d. Vasodilation caused by inhibiting sympathetic outflow from the central nervous system (CNS)

c. Cardioselective β-adrenergic blockers decrease CO, reduce sympathetic vasoconstrictor tone, and decrease renin secretion by kidneys. Calcium channel blockers reduce BP by causing blocking movement of calcium into cells, which causes vasodilation of arterioles. Spironolactone blocks the effect of aldosterone. Central adrenergic antagonists such as clonidine (Catapres) inhibit sympathetic outflow from the central nervous system (CNS).

20. Which manifestation is an indication that a patient is having a hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP >200 mm Hg and a diastolic BP >120 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks

c. Hypertensive emergency, a type of hypertensive crisis, is a situation that develops over hours or days in which a patient's BP is severely elevated with evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular, renal, or retinal). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke. Hypertensive crises are defined by the degree of organ damage and how rapidly the BP rises, not by specific BP measurements. A hypertensive urgency is a less severe crisis in which a patient's BP becomes severely elevated over days or weeks but there is no evidence of target organ damage.

During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider if the patient experiences a. fever and redness at the incision site. b. 2+ edema of the extremity and pain at the incision site. c. a loss of palpable pulses and numbness and tingling of the feet. d. increasing ankle-brachial indices and serous drainage from the incision.

c. Loss of palpable pulses, numbness and tingling of the extremity, extremity pallor, cyanosis or cold, and decreasing ankle-brachial indices are indications of occlusion of the bypass graft and need immediate medical attention. Pain, redness, and serous drainage at the incision site are expected postoperatively.

18. A patient with an acute MI is having multifocal PVCs and ventricular couplets. He is alert and has a BP of 118/78 mm Hg with an irregular pulse of 86 bpm. What is the priority nursing action at this time? a. Continue to assess the patient. b. Ask the patient to perform Valsalva maneuver. c. Prepare to administer antidysrhythmic drugs per protocol. d. Be prepared to administer cardiopulmonary resuscitation (CPR).

c. Multifocal PVCs in a patient with an MI indicate significant ventricular irritability that may lead to ventricular tachycardia or ventricular fibrillation. Antidysrhythmics, such as β-adrenergic blockers, procainamide, amiodarone, or lidocaine, may be used to control the dysrhythmias. Valsalva maneuver may be used to treat paroxysmal supraventricular tachycardia. The nurse must always be ready to perform cardiopulmonary resuscitation (CPR).

Following teaching about medications for PAD, the nurse determines that additional instruction is necessary when the patient makes which statement? a. "I should take one aspirin a day to prevent clotting in my legs." b. "The lisinopril I use for my blood pressure may help me walk further without pain." c. "I will need to have frequent blood tests to evaluate the effect of the Coumadin I will be taking." d. "Pletal should help me increase my walking distance and help prevent clots from forming in my legs."

c. Oral anticoagulants (warfarin) are not recommended for treatment of PAD but all of the other statements are correct in relation to treatment of PAD.

15. A 38-year-old man is treated for hypertension with triamterene and hydrochlorothiazide (Maxzide) and metoprolol (Lopressor). Four months after his last clinic visit, his BP returns to pretreatment levels and he admits he has not been taking his medication regularly. What is the nurse's best response to this patient? a. "Try always to take your medication when you carry out another daily routine so you do not forget to take it." b. "You probably would not need to take medications for hypertension if you would exercise more and stop smoking." c. "The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing any problems in this area? d. "You need to remember that hypertension can be only controlled with medication, not cured, and you must always take your medication."

c. Sexual dysfunction, which can occur with many of the antihypertensive drugs, including thiazide and potassium- sparing diuretics and β-adrenergic blockers, can be a major reason that a male patient does not adhere to his treatment regimen. It is helpful for the nurse to raise the subject because sexual problems may be easier for the patient to discuss and handle once it has been explained that the drug might be the source of the problem.

20. In the patient experiencing ventricular fibrillation (VF), what is the rationale for using cardiac defibrillation? a. Enhance repolarization and relaxation of ventricular myocardial cells b. Provide an electrical impulse that stimulates normal myocardial contractions c. Depolarize the cells of the myocardium to allow the SA node to resume pacemaker function d. Deliver an electrical impulse to the heart at the time of ventricular contraction to convert the heart to a sinus rhythm

c. The intent of defibrillation is to apply an electrical current to the heart that will depolarize the cells of the myocardium so that subsequent repolarization of the cells will allow the SA node to resume the role of pacemaker. An artificial pacemaker provides an electrical impulse that stimulates normal myocardial contractions. Synchronized cardioversion involves delivery of a shock that is programmed to occur during the QRS complex of the ECG but this cannot be done during ventricular fibrillation because there is no normal ventricular contraction or QRS complex.

During the nursing assessment of the patient with a distal descending aortic dissection, what should the nurse expect the patient to manifest? a. Altered LOC with dizziness and weak carotid pulses b. A cardiac murmur characteristic of aortic valve insufficiency c. Severe "ripping" back or abdominal pain with decreasing urine output d. Severe hypertension and orthopnea and dyspnea of pulmonary edema

c. The onset of an aortic dissection involving the distal descending aorta is usually characterized by a sudden, severe, tearing pain in the back; as it progresses down the aorta, the kidneys, abdominal organs, and lower extremities may begin to show evidence of ischemia. Aortic dissections of the ascending aorta and aortic arch may affect the heart and circulation to the head, with the development of cerebral ischemia, murmurs, ventricular failure, and pulmonary edema.

11. The nurse is evaluating the telemetry ECG rhythm strip. How should the nurse document the distorted P wave causing an irregular rhythm? a. Atrial flutter b. Sinus bradycardia c. Premature atrial contraction (PAC) d. Paroxysmal supraventricular tachycardia (PSVT)

c. The premature atrial contraction (PAC) has a distorted P wave that may feel like a skipped beat to the patient. Atrial flutter is an atrial tachydysrhythmia with recurring, regular, saw-toothed flutter waves from the same focus in the right or possibly left atrium. Sinus bradycardia has a regular heart rate less than 100 bpm. Paroxysmal supraventricular tachycardia (PSVT) starts in an ectopic focus above the bundle of His and may be triggered by PAC. If seen, the P wave may have an abnormal shape and has a spontaneous start and termination with a rate of 150 to 220 bpm.

A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include which test? a. Angiography b. Ultrasonography c. Echocardiography d. Computed tomography (CT) scan

d. A computed tomography (CT) scan is the most accurate test to determine the diameter of the aneurysm and whether a thrombus is present. The other tests may also be used but the CT scan yields the most descriptive results.

19. The nurse caring for a patient immediately following a transesophageal echocardiogram (TEE) should consider which action the highest priority? a. Monitor the ECG b. Monitor pulse oximetry c. Assess vital signs (BP, HR, RR, temperature) d. Maintain NPO status until gag reflex has returned

d. All actions will be done but in order to perform a transesophageal echocardiogram (TEE), the throat must be numbed. Until sensation returns, as evidenced by the gag reflex, the patient is at risk of aspiration so this action has the highest priority (priority related to airway—ABCs).

5. What describes the SA node's ability to discharge an electrical impulse spontaneously? a. Excitability b. Contractility c. Conductivity d. Automaticity

d. Automaticity describes the ability to discharge an electrical impulse spontaneously. Excitability is a property of myocardial tissue that enables it to be depolarized by an impulse. Contractility is the ability of the chambers to respond mechanically to an impulse. Conductivity is the ability to transmit an impulse along a membrane.

Which observation made by the nurse should indicate the presence of the complication of graft thrombosis after aortic aneurysm repair? a. Cardiac dysrhythmias or chest pain b. Absent bowel sounds, abdominal distention, or diarrhea c. Increased temperature and increased white blood cell count d. Decreased pulses and cool, painful extremities below the level of repair

d. Decreased or absent pulses in conjunction with cool, painful extremities below the level of repair indicate graft thrombosis. Cardiac dysrhythmias or chest pain indicates myocardial ischemia. Absent bowel sounds, abdominal distention, diarrhea, or bloody stools indicate bowel infarction. Increased temperature and white blood cells, surgical site inflammation, or drainage indicates graft infection.

8. The nurse plans close monitoring for the patient during electrophysiologic testing because this test a. requires the use of dyes that irritate the myocardium. b. causes myocardial ischemia, resulting in dysrhythmias. c. involves the use of anticoagulants to prevent thrombus and embolism. d. induces dysrhythmias that may require cardioversion or defibrillation to correct.

d. Electrophysiologic testing involves electrical stimulation to various areas of the atrium and ventricle to determine the inducibility of dysrhythmias and frequently induces ventricular tachycardia or ventricular fibrillation. The patient may have "near-death" experiences and requires emotional support if this occurs. Dye and anticoagulants are used for coronary angiograms.

13. Dietary teaching that includes dietary sources of potassium is indicated for the hypertensive patient taking which drug? a. Enalapril (Vasotec) c. Spironolactone (Aldactone) b. Labetalol (Normodyne) d. Hydrochlorothiazide (HydroDiuril)

d. Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium loss through the kidneys. High- potassium foods should be included in the diet or potassium supplements should be used to prevent hypokalemia. Enalapril and spironolactone may cause hyperkalemia by inhibiting the action of aldosterone and potassium supplements should not be used by patients taking these drugs. As a combined α/β-blocker, labetalol does not affect potassium levels.

21. Which drugs are most commonly used to treat hypertensive crises? a. Esmolol (Brevibloc) and captopril (Capoten) b. Enalaprilat (Vasotec) and minoxidil (Loniten) c. Labetalol (Normodyne) and bumetanide (Bumex) d. Fenoldopam (Corlopam) and sodium nitroprusside (Nipride)

d. Hypertensive crises are treated with IV administration of antihypertensive drugs, including the vasodilators sodium nitroprusside, fenoldopam, and nicardipine; adrenergic blockers such as phentolamine, labetalol, and esmolol; the ACE inhibitor IV enalaprilat; and the calcium channel blocker clevidipine. Sodium nitroprusside is the most effective parenteral drug for hypertensive emergencies. Drugs that are used specifically for hypertensive emergencies include sodium nitroprusside, nitroglycerin with myocardial infarction, hydralazine with other medications, and oral captopril.

When obtaining a health history from a 72-year-old man with peripheral arterial disease (PAD) of the lower extremities, the nurse asks about a history of related conditions, including a. venous thrombosis. b. venous stasis ulcers. c. pulmonary embolism. d. coronary artery disease (CAD).

d. Regardless of the location, atherosclerosis is responsible for peripheral arterial disease (PAD) and is related to other cardiovascular disease and its risk factors, such as coronary artery disease (CAD) and carotid artery disease. Venous thrombosis, venous stasis ulcers, and pulmonary embolism are diseases of the veins and are not related to atherosclerosis.

Which aneurysm is uniform in shape and a circumferential dilation of the artery? a. False aneurysm b. Pseudoaneurysm c. Saccular aneurysm d. Fusiform aneurysm

d. The fusiform aneurysm is circumferential and relatively uniform in shape. The false aneurysm or pseudoaneurysm is not an aneurysm but a disruption of all of the arterial wall layers with bleeding that is contained by surrounding anatomic structures. Saccular aneurysms are the pouchlike bulge of an artery.