BH7 CARDIAC

Physiological Integrity 6. The nurse would clarify to a client that sinus arrest differs from sinus block in that with sinus arrest a. the sinoatrial (SA) node occasionally fails to fire. b. an atrial focus totally takes over pacing responsibility. c. the rhythm is regular. d. the atrioventricular (AV) node is the primary pacemaker.

a Sinus arrest differs from SA exit block in that the SA node intermittently fails to fire at all. DIF: Cognitive Level: Comprehension REF: Text Reference: 1676 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 4. The nurse would clarify for a client that the lipoproteins representing the "good" cholesterol are the a. HDLs. b. LDLs. c. VLDLs. d. VDRLs.

a The HDLs (high-density lipoproteins) have a lower concentration of cholesterol than the other lipoproteins. DIF: Cognitive Level: Application REF: Text Reference:1629 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 13. A client admitted to the intensive care unit with severe dyspnea, fear, noisy respirations, sweating, and tachypnea. The nurse would recognize that the client is exhibiting manifestations of a. acute pulmonary edema. b. chronic congestive heart failure. c. acute myocardial infarction. d. right ventricular failure.

a Acute pulmonary edema, a medical emergency, usually results from left ventricular failure. Typical manifestations include severe dyspnea, orthopnea, pallor, tachycardia, expectoration of large amounts of frothy blood and sputum, fear, wheezing, sweating, bubbling respirations, cyanosis, nasal flaring, use of accessory breathing muscles, tachypnea, vasoconstriction, and hypoxia. DIF: Cognitive Level: Application REF: Text Reference: 1655 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 3. A nurse is telephoned by a neighbor who describes non-radiating substernal chest pain that was precipitated by climbing three flights of stairs. The neighbor has taken one sublingual (SL) nitroglycerin tablet and asks what he should do since the pain is unrelieved. The nurse's best response would be a. "Take another nitroglycerin tablet in 5 minutes and lie down." b. "Drive to the emergency department at once." c. "Call 911." d. "I'm not qualified to advise you about this. Let me call your doctor."

a As many as 3 SL nitroglycerin tablets can be taken 5 minutes apart; if this does not relieve the pain, MI should be suspected. The client should self-medicate and rest to relieve the pain of angina. DIF: Cognitive Level: Application REF: Text Reference: 1563 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 8. The nurse monitoring a CHF client would detect the early manifestations of heart failure by a. obtaining daily weights. b. monitoring cardiac enzymes. c. checking vital signs frequently. d. evaluating the electrocardiogram (ECG).

a Body weight is a sensitive indicator of water and sodium retention and increases even before edema occurs. DIF: Cognitive Level: Application REF: Text Reference: 1567 TOP: Nursing Process Step: Assessment MSC:

1. The nurse establishing teaching priorities for a community health program would rank cardiovascular disease as a cause of death as a. first. b. fifth. c. seventh. d. tenth.

a Cardiovascular disease is the leading cause of illness and death in the United States, affecting more than one in five people. DIF: Cognitive Level: Comprehension REF: Text Reference: 1560 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 9. In teaching a client about directional coronary atherectomy (DCA), the nurse would know that the nature of the process is understood when the client compares it to a a. Roto-Rooter. b. milking machine. c. sandblaster. d. blowtorch.

a During DCA a catheter is introduced into a coronary artery. The catheter has a cylindrical housing with a small rotating blade that "shaves" away plaque. DIF: Cognitive Level: Application REF: Text Reference: 1638 TOP: Nursing Process Step: Evaluation MSC:

Physiological Integrity 3. When performing cardiac auscultation on an apparently healthy 32-year-old client with mitral valve prolapse, the nurse would anticipate hearing a a. midsystolic click. b. harsh, systolic crescendo-decrescendo murmur. c. loud S2 heart sound. d. prominent S4 heart sound.

a In a healthy client, physical examination may reveal a regurgitant murmur, or a midsystolic click on auscultation. DIF: Cognitive Level: Analysis REF: Text Reference: 1602 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 25. The nurse is attempting to identify the timing of a murmur detected in a 40-year- old woman. The additional assessment necessary to make this assessment would be a. identification of S1 and S2. b. evaluation of peripheral pulses. c. assessment of blood pressure. d. estimation of the client's fluid status.

a It is imperative to identify S1 and S2 heart sounds to determine the place and duration. The murmur is then described as occurring in early, mid-, or late systole or diastole. DIF: Cognitive Level: Application REF: Text Reference: 1579, Table 56-5; TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 10. The nurse would caution a client with arthritis that this chronic inflammatory disease increases the risk for CHD through the a. increased level of C-reactive protein. b. amount of aspirin taken as remedy for arthritis. c. decreased physical activity relative to arthritic discomfort. d. increased release of histamines.

a It is thought that the increased C-reactive protein from arthritis becomes unstable and breaks off into the circulating volume. DIF: Cognitive Level: Analysis REF: Text Reference: 1631 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 32. To assess the efficiency of the lateral surface of the left ventricle using a 12-lead ECG, the nurse would reference 1. lead 1. 2. lead aVF. 3. lead V1. 4. lead V4.

a Leads 1, aVL, V5, and V6 record electrical events occurring on the lateral surface of the left ventricle. DIF: Cognitive Level: Knowledge REF: Text Reference: 1586 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 3. In advising a client with higher levels of high-density lipoproteins (HDLs) in proportion to low-density lipoproteins (LDLs), the nurse would state that the client a. is less likely to develop CHD. b. should consider a reduced-fat diet. c. initiate a moderate exercise program.. d. consult the physician for an anticholesterol prescription.

a People with high levels of HDLs in proportion to LDLs are at less risk for CHD than those with a low HDL-LDL ratio. High concentrations of HDL seem to protect against the development of CHD. DIF: Cognitive Level: Analysis REF: Text Reference: 1629 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 13. When teaching a client about taking quinidine for atrial fibrillation, the nurse would explain that the client should a. take the medication with meals. b. drink large amounts of citrus juice. c. avoid milk products. d. have blood pressure monitored frequently.

a Quinidine may cause gastrointestinal upset and should be taken with meals. DIF: Cognitive Level: Comprehension REF: Text Reference: 1677 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 43. The nurse recommends that persons with cardiovascular disorders be vaccinated against influenza and pneumonia a. every year. b. every 2 years. c. every 5 years. d. not at all.

a Recommendations for persons with cardiovascular disease include vaccination against influenza and pneumonia every year. DIF: Cognitive Level: Application REF: Text Reference: 1568 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 28. A client taking multiple medications including digoxin, diuretics, and an oral iron preparation, begins to experience ventricular dysrhythmia. As a possible cause of this problem, the nurse would consider 1. hypokalemia. 2. anemia. 3. an increase in afterload. 4. increased sodium levels.

a Serum potassium level decreases as a result of diuretic therapy, vomiting, diarrhea, and alkalosis. Hypokalemia increases cardiac electrical instability, ventricular dysrhythmias, and increased risk of digitalis toxicity. DIF: Cognitive Level: Analysis REF: Text Reference: 1581 TOP: Nursing Process Step: Assessment MSC:

Health Promotion and Maintenance 17. For a client waiting for a heart transplant who has been fitted with a left ventricular assist device (LVAD), the nurse would explain that the purpose of this device is to a. extract blood from the left ventricle and propel it into the systemic circulation. b. sound an alarm when the intraventricular pressure drops. c. measure hemodynamics of cardiac output. d. electrically stimulate the left ventricle to contract.

a The LVAD helps support the dangerously impaired heart while the client is waiting for a donor heart by extracting blood from the left ventricle and propelling it into the systemic circulation. DIF: Cognitive Level: Analysis REF: Text Reference: 1610, 1611, Bridge to Critical Care Box; TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 19. The nurse would clarify to a client considering a MIDCABG that this procedure is less invasive and does not utilize a. cardiopulmonary bypass. b. anticoagulants. c. mammary arteries. d. long-term anesthesia.

a The MIDCABG is less invasive, using the mammary arteries. The cardiopulmary bypass machine is not needed, but the standard anticoagulant therapies and anesthesia are used. DIF: Cognitive Level: Comprehension REF: Text Reference: 1641 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 40. In providing instruction to a client about the dye used during a procedure, the nurse's most important responsibility would be a. alerting the client to the possibility of chest pain when the dye is injected. b. ensuring that the client drinks the entire dose of the dye before the study. c. encouraging fluids before and after the study to dilute the dye. d. ascertaining that no dye leaks into the tissue surrounding the injection site.

a The client may experience pain when contrast material is injected and the dye replaces blood flowing through the arteries. The lack of oxygenated blood causes regional cardiac hypoxia. DIF: Cognitive Level: Application REF: Text Reference: 1593 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 11. The nurse would be most concerned about premature ventricular contractions (PVCs) that a. fall on a T wave. b. occur at a rate of four per minute. c. are uniform in appearance. d. occur with angina.

a The downward slope of the T wave is the most vulnerable period of the cardiac cycle. PVCs occurring during this vulnerable period can precipitate the more life-threatening dysrhythmias of ventricular tachycardia and ventricular fibrillation. DIF: Cognitive Level: Comprehension REF: Text Reference: 1682 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 21. When the client with rheumatic fever becomes irritable and impatient with the re strictions of the disease, the home health nurse would remind the client that manifestations of rheumatic fever usually abate in about a. 3 months. b. 6 months. c. 9 months. d. 1 year.

a The manifestations of rheumatic fever usually abate within 3 months of onset. DIF: Cognitive Level: Knowledge REF: Text Reference: 1613 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 6. The nurse would explain to a client who reports being frequently short of breath that the most common form of dyspnea associated with cardiac disorders is a. exertional dyspnea. b. paroxysmal nocturnal dyspnea. c. orthopnea. d. idiopathic dyspnea.

a The most frequently reported dyspnea in clients with cardiovascular disorders is that associated with exertion. DIF: Cognitive Level: Comprehension REF: Text Reference: 1566 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 17. If the nurse records that a client has a pulse deficit, this would mean that the client has a difference between a. apical and radial pulses. b. apical and carotid pulses. c. radial and femoral pulses. d. femoral and pedal pulses.

a The nurse should assess for a pulse deficit by taking apical and radial pulses simultaneously, noting differences in rate. DIF: Cognitive Level: Knowledge REF: Text Reference: 1573 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 36. In developing a standard teaching plan for the outpatient unit where stress testing is performed, the nurse would include information that a. the test may cause chest pain. b. the test should not be interrupted for any reason. c. the client should attempt to exercise before arriving for the test. d. the client's balance must be good for performance of this test.

a The nurse should include a warning that this test may trigger chest pain and dyspnea. DIF: Cognitive Level: Application REF: Text Reference: 1587 TOP: Nursing Process Step: Intervention MSC:

Health Promotion and Maintenance 2. The nurse would explain that angina pain usually differs from the pain of a myocardial infarction (MI) in that angina pain a. lasts less than 15 minutes. b. radiates to the arm, jaw, or throat. c. is seldom relieved by rest. d. is accompanied by palpitations.

a The pain of angina is usually short lived, lasting less than 15 minutes; does not radiate; can be relieved by rest, with or without vasodilators; and is not associated with palpitations. DIF: Cognitive Level: Analysis REF: Text Reference: 1563 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 37. To best facilitate a client's understanding of an electrophysiologic study, the nurse would explain that this study will a. enable the physician to reproduce dysrhythmias and evaluate the effects of antiarrhythmic drugs. b. increase the understanding of the strength of the muscles in the ventricles. c. evaluate the relationship of the atrium to the ventricles during contractions. d. cause an interruption in blood flow to the coronary arteries and evaluate the effect on the heart's electrical system.

a The purpose of the electrophysiologic study is to reproduce any dysrhythmia so that its origin may be isolated. Antiarrhythmic drugs may be administered during the study to evaluate their effect. DIF: Cognitive Level: Application REF: Text Reference: 1589 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 2. The nurse teaching a class on long-term effects of rheumatic fever would stress that the most common problem following bouts of rheumatic fever is a. valvular disorder. b. cardiac tamponade. c. coronary artery disease. d. pericarditis.

a Valvular disorders are the most frequent complication after episodes of rheumatic fever. DIF: Cognitive Level: Application REF: Text Reference: 1613 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 9. The nurse performing an admission assessment of a 36-year-old client with cardiac valve disease would know the most relevant fact is that the client has a. a recent rash on the upper extremities. b. a childhood history of rheumatic fever. c. been a smoker for the last 3 years. d. allergies to shellfish.

b A childhood history of rheumatic fever is associated with structural mitral valve disease. DIF: Cognitive Level: Analysis REF: Text Reference: 1567 TOP: Nursing Process Step: Assessment MSC:

Health Promotion and Maintenance 21. Reporting that a client's total cholesterol reading is 230, the nurse would know this result indicates a reading that is a. low. b. borderline high. c. high. d. very high.

b A total cholesterol reading of 240 is considered "high" and a reading of 200 to 239 "borderline high." DIF: Cognitive Level: Comprehension REF: Text Reference: 1629 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 4. The nurse would explain to a client that the catabolism related to the hypermetabolic state caused by the client's rheumatic fever can be avoided by eating a a. high-protein, low-carbohydrate diet. b. high-carbohydrate, high-protein diet. c. high-fat, high-protein diet. d. high-protein, low-sodium diet.

b An enriched diet high in carbohydrates and protein will answer the body's nutritional needs in the client with a hypermetabolic state induced by inflammatory processes and temperature elevation. DIF: Cognitive Level: Analysis REF: Text Reference: 1616 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 35. The nurse would explain to a client that an exercise ECG is useful as one means of detecting a. cardiac dysrhythmias. b. coronary artery disease. c. heart failure. d. valvular disorders.

b An exercise ECG, referred to as a "stress test," is helpful as an adjunctive diagnostic study for coronary artery disease, although it can produce false-positive findings in some clients, especially women. DIF: Cognitive Level: Knowledge REF: Text Reference: 1587 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 7. A male client receiving a diuretic is concerned about a 2-pound weight gain in the last 24 hours because he has congestive heart failure (CHF). The nurse would reply a. "There's nothing to worry about; 2-pound weight changes can occur to anyone in 24 hours." b. "You may experience a small fluid weight gain within 24 hours when receiving diuretic therapy." c. "You should notify a health care provider if your weight increases by 3 pounds in 24 hours." d. "You should focus on a total lifestyle change, not just one aspect of your health."

b An increase in body weight of 3 pounds or more within 24 hours results from fluids rather than body mass changes. DIF: Cognitive Level: Application REF: Text Reference: 1567 TOP: Nursing Process Step: Intervention MSC:

Health Promotion and Maintenance 20. Examining the electrocardiogram strips of a client with mitral stenosis, the nurse would recognize the characteristic dysrhythmia of a. ventricular tachycardia. b. atrial fibrillation. c. artial flutter. d. sinus tachycardia.

b Atrial fibrillation is a dysrhythmia that frequently develops as a result of mitral stenosis. DIF: Cognitive Level: Analysis REF: Text Reference: 1602 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 8. A client's ECG reveals a rapid atrial rate of 300 beats/min, and the P waves resemble a picket fence without 1:1 conduction. The nurse would identify this dysrhythmia as a. paroxysmal atrial tachycardia. b. atrial flutter. c. atrial fibrillation. d. atrial block.

b Atrial flutter is a dysrhythmia arising in an ectopic pacemaker or the site of a rapid reentry circuit in the atria, characterized by rapid "saw-toothed" atrial wave formations and usually a slower ventricular response. Atrial flutter differs from PAT in that it produces a much more rapid atrial rate. The P waves are actually inverted or bidirectional, producing a "picket fence" or saw-toothed pattern of "fluttering waves." The atrial rate generally ranges from 220 to 350 beats/min. DIF: Cognitive Level: Application REF: Text Reference: 1677 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 3. A client with no history of heart disease is seen in the clinic for periodic episodes of tachycardia with a regular rate. When obtaining the client's history, the nurse would be sure to question the client regarding the incidence of a. asthma. b. stress. c. diabetes. d. weight gain.

b Causes of sinus tachycardia include fever; emotional and physical stress; heart failure; hyperthyroidism; hypercalcemia; medications, including caffeine, atropine, nitrates, epinephrine, isoproterenol, and nicotine; and exercise. DIF: Cognitive Level: Application REF: Text Reference: 1674 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 13. In caring for a client considering mechanical mitral valve replacement, the essential d etermination for the nurse (and physician) to make would be whether the client can or will a. comply with the lifelong requirement for anticoagulant therapy. b. require a high level of energy at work. c. experience body image problems. d. cooperate fully and participate in a cardiac rehabilitation program.

b Clients with mechanical valves require continuous anticoagulation therapy for the remainder of their lives. DIF: Cognitive Level: Analysis REF: Text Reference: 1605 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 15. When the client with left ventricular heart failure develops dependent edema, the nurse would assess that this could be an early manifestation of a. renal failure. b. right ventricular failure. c. fluid deficit. d. liver failure.

b Dependent edema is one of the early manifestations of right ventricular failure. DIF: Cognitive Level: Application REF: Text Reference: 1655 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 4. In a client admitted to the medical unit with dysrhythmias and left ventricular failure, the nurse would anticipate the associated clinical manifestation of a. chills. b. dyspnea. c. peripheral edema. d. temperature elevation.

b Dyspnea develops when the left ventricle fails to function and the lungs become congested with fluid. DIF: Cognitive Level: Application REF: Text Reference: 1566 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 7th Edition Chapter 59: Management of Clients with Dysrhythmias MULTIPLE CHOICE 1. The nurse would explain that a heart rate of 55 beats/min is a normal finding in a client who a. is taking a diuretic. b. is an athlete. c. is obese. d. weighs less than 90 pounds.

b In some people, sinus bradycardia can be a normal condition. Athletes often have sinus bradycardia because their heart is an effective pump with a greater-than-normal stroke volume. DIF: Cognitive Level: Comprehension REF: Text Reference: 1675 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 22. The nurse would recognize that the client at greatest risk for CHD is 1. a 35-year-old man who is 15 pounds overweight. 2. a 40-year-old woman who repeatedly gains and loses 15 pounds. 3. a 45-year-old man who lost 30 pounds by following a strenuous diet. 4. a 50-year-old man 20 pounds overweight but a lifelong swimmer.

b Losing and regaining weight puts the client at greater risk for CHD. DIF: Cognitive Level: Analysis REF: Text Reference: 1631 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 42. A client's pulmonary capillary wedge pressure is 35 mm Hg, up from a reading 2 hours ago of 12 mm Hg. The nurse would recognize this value as most indicative of a. myocardial infarction. b. pulmonary edema. c. hypovolemia. d. shock lung.

b Pressure climbing to more than 30 mm Hg generally heralds the onset of pulmonary edema. DIF: Cognitive Level: Application REF: Text Reference: 1595 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 10. The client's ECG shows normal-appearing P waves that occur at regular intervals. Every third impulse from the atria is missing a QRS complex. The nurse would recognize this pattern as the dysrhythmia of a. first-degree AV block. b. second-degree AV block. c. third-degree AV block. d. fourth-degree AV block.

b Some impulses are conducted and others are blocked in second-degree AV block, a dysrhythmia that results in intermittently dropped QRS complexes. DIF: Cognitive Level: Application REF: Text Reference: 1680 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 7th Edition Chapter 58: Management of Clients with Functional Cardiac Disorders MULTIPLE CHOICE 1. The nurse would assess that the individual most at risk for death from coronary heart disease (CHD) is a. a 55-year-old African American man. b. a 62-year-old white man. c. a 30-year-old Hispanic woman. d. a 42-year-old white woman.

b Symptomatic CHD appears predominantly in clients over age 40. The risk for women increases significantly at menopause; one of every three women in the United States age 65 and older has CHD. For those 35 to 74 years old, the age-adjusted death rate from CHD for African American women is 72% higher than for white women. DIF: Cognitive Level: Analysis REF: Text Reference: 1628 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 19. During the physical examination of a professonal auctioneer, the nurse notes prominent and visible neck veins when the client is sitting in an upright position. Continuing the assessment, the nurse then would a. evaluate blood vessels with the client lying flat. b. check blood vessels for compressibility. c. monitor blood pressure with the client standing. d. obtain a standing carotid pulse.

b The distensibility of the neck veins reflects the pressure and volume changes within the right atrium in most people. Exceptions are weight lifters, football players, and professional speakers and singers, who have overdeveloped neck muscles and tendons. The vessels are prominent and visible, but soft and compressible. DIF: Cognitive Level: Application REF: Text Reference: 1574 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 27. The nurse would explain to a client that the isoenzyme specific for damage to the myocardial muscle is a. CK-MM. b. CK-MB. c. CK-BB. d. LDH-5.

b The enzymes most often used to detect MI are creatine kinase (CK) and lactic acid dehydrogenase (LDH). There are three isoenzymes of CK: CK-MM (skeletal muscle), CK-MB (myocardial muscle), and CK-BB (brain). An elevated CK-MB indicates myocardial damage. DIF: Cognitive Level: Comprehension REF: Text Reference: 1581 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 22. The nurse auscultating heart sounds would recognize that the normal closure of the mitral and tricuspid valves creates a. the atrial gallop. b. the S1 heart sound. c. the apical pulse. d. the S2 heart sound.

b The first heart sound (S1) is linked to closure of the mitral and tricuspid valves. DIF: Cognitive Level: Knowledge REF: Text Reference: 1575 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 5. When a client develops sinus bradycardia after a myocardial infarction (MI), the nurse would anticipate the administration of a. digitalis. b. atropine. c. procainamide. d. propranolol.

b The goal of intervention is to increase the heart rate just enough to relieve manifestations but not enough to cause tachycardia. The intervention sequence for treating symptomatic bradycardia is atropine, transcutaneous pacing if available, dopamine, epinephrine, and isoproterenol or insertion of a temporary transvenous pacemaker. DIF: Cognitive Level: Application REF: Text Reference: 1675 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 8. The nurse explains that in addition to having a PTCA to clear the artery, the client will also have plaque vaporized by the use of a. intracoronary stent. b. laser ablation. c. transmyocardial revascularization. d. anticoagulant therapy.

b The laser ablation "vaporizes" the plaque so that is will not re-occlude the vessel. DIF: Cognitive Level: Application REF: Text Reference: 1639 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 14. For a client who has undergone a tissue valve replacement, the most appropriate anticipatory guidance provided by the nurse would be a. activity should be restricted to reduce stress on the valve. b. follow-up is important, since most tissue valves eventually need replacement. c. modification of lifestyle can prevent associated dysrhythmias. d. long periods of standing will decrease venous return to the heart.

b The mechanical valves are very durable but require anticoagulant therapy; the tissue valves may not require anticoagulant therapy but are less durable. Almost every client with a tissue valve will require replacement. DIF: Cognitive Level: Application REF: Text Reference: 1605 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 11. The nurse auscultating heart sounds notes that a client has an opening snap and a low-pitched, rumbling murmur over the apex. This assessment would indicate a. mitral prolapse. b. mitral stenosis. c. mitral regurgitation. d. aortic stenosis.

b The murmur characteristic of mitral stenosis is low pitched and rumbling and is preceded by an opening snap due to the built-up pressure. It is heard best over the apex. DIF: Cognitive Level: Application REF: Text Reference: 1601 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 18. The finding during a routine assessment that would most strongly suggest to the nurse the presence of serious heart or lung disease is a. pulse rate greater than 90. b. duskiness of the buccal mucosa. c. broken vessels in the legs. d. blanching of nail beds when compressed.

b The nurse should observe the skin and mucous membranes for abnormalities such as central or peripheral cyanosis. The presence of a bluish tinge or duskiness is indicative of central cyanosis. Central cyanosis implies serious heart or lung disease in which the hemoglobin is fully saturated with oxygen. Peripheral cyanosis, seen in lips, ear lobes, and nail beds, suggests peripheral vasoconstriction. DIF: Cognitive Level: Analysis REF: Text Reference: 1571 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 20. The nurse speaking to a group of high school girls would caution that the risk of CHD in women who smoke is greater than that for nonsmoking women by a. two times. b. three times. c. four times. d. five times.

b The risk of CHD in smoking women is three times greater than for nonsmokers. DIF: Cognitive Level: Comprehension REF: Text Reference: 1629 TOP: Nursing Process Step: Intervention MSC:

Health Promotion and Maintenance 44. The nurse would remind a client that for aerobic exercise to be effective, the pulse rate must be raised above the mean pulse level by at least a. 25%. b. 50%. c. 75%. d. 100%.

b To be effective in terms of cardiovascular fitness, the pulse rate must be raised a minimum of 50% above the mean pulse level. DIF: Cognitive Level: Application REF: Text Reference: 1578 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 11. When a client is admitted to the hospital with clinical manifestations of left ventricular heart failure, the nurse would question the client about a. leg swelling. b. breathlessness. c. abdominal pain. d. nausea.

b To some degree, exertional dyspnea occurs in all clients. Therefore the nurse should elicit a description of the degree of exertion that results in the sensation of breathlessness from the client with clinical manifestations of heart failure. DIF: Cognitive Level: Application REF: Text Reference: 1653 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 12. A client with mitral stenosis tells the nurse that she will not seek treatment for this disorder because she "doesn't really feel that bad." The nurse's best response would be that untreated mitral stenosis can result in a. frequent bouts of pericarditis. b. creation of small emboli. c. pulmonary effusion. d. potentially fatal myocardial infarcts.

b Untreated mitral stenosis can progress from mild disability to severe disability in about 3 years. Ineffective atrial contractions allow some stagnation of blood in the left atrium and encourage the formation of mural thrombi. These thrombi easily break away and travel as small emboli in the arterial system, causing tissue infarction. DIF: Cognitive Level: Analysis REF: Text Reference: 1602 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 24. If the nurse detects an opening snap while auscultating a client's precordium, this would indicate that a. the client has coronary artery disease. b. the cardiac valves are not opening normally. c. ventricular hypertrophy is increasing the force of contraction. d. the client has experienced an MI at some time in the past.

b Valves normally open silently, but when they become calcified or rigid from disease, greater pressure is required to force them open. When they do "pop" open, the valves produce a characteristic sound. DIF: Cognitive Level: Comprehension REF: Text Reference: 1577 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 16. Using a diagram depicting plaque formation, the nurse points out that stable agina usually occurs when plaque formation is at a. phase 1. b. phase 2. c. phase 3. d. phase 4.

b When plaque had advanced to phase 2, stable angina usually occurs. DIF: Cognitive Level: Application REF: Text Reference: 1632, Table 58-1; TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 17. To a client with heart failure who is prescribed an angiotensin-converting enzyme (ACE) inhibitor, the nurse would explain that this drug alleviates manifestations of heart failure by a. increasing myocardial contractility. b. decreasing circulating volume. c. increasing vasodilation. d. slowing atrioventricular conduction time.

c ACE inhibitors interfere with the production of angiotensin, a potent vasoconstrictor. DIF: Cognitive Level: Analysis REF: Text Reference: 1659 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 21. The nurse palpating the precordium of a 73-year-old client for the point of maximal intensity (PMI) would place the hands a. to the left of the angle of Louis. b. at the level of the sternal manubrium. c. the fifth intercostal space, medial to the midclavicular line. d. at Erb's point in an elderly client.

c Also called the point of maximal impulse, the PMI, or apical impulse, is usually seen at the apex. The PMI is associated with left ventricular contraction and should appear at the fifth intercostal space medial to the left midclavicular line. DIF: Cognitive Level: Knowledge REF: Text Reference: 1574 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 9. The change in vital signs the would most strongly suggest cardiac tamponade to the nurse is a. bradycardia. b. tachypnea. c. a narrowing pulse pressure. d. muffled heart sounds.

c Although muffled heart sounds indicate accumulation of fluid around the heart, narrowing pulse pressure signals cardiac tamponade. DIF: Cognitive Level: Analysis REF: Text Reference: 1622 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 7. When a client in the cardiac care unit (CCU) suddenly develops paroxysmal atrial tachycardia (PAT) of 200 beats/min and clinical manifestations of severe dizziness, the nurse would help decrease the heart rate by a. lowering the head of the bed. b. administering oxygen. c. asking the client to perform the Valsalva maneuver. d. administering digitalis intravenously.

c Any maneuver that stimulates the vagus nerve can successfully terminate PAT or increase AV block. Vagotonic maneuvers include carotid sinus massage and the Valsalva maneuver (bearing down as with bowel movements). DIF: Cognitive Level: Analysis REF: Text Reference: 1677 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 14. When the a client with left ventricular heart failure complains that she has to get up several times during the night to urinate, the nurse would explain that this bothersome event is a. an indication that the right ventricle is being affected. b. a late clinical manifestation of heart failure. c. caused by an increase in blood flow to the kidneys when lying down. d. the result of increased secretion of aldosterone at night.

c At night, urine formation increases as blood flow to the kidneys improves. DIF: Cognitive Level: Application REF: Text Reference: 1655 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 15. In counseling a client who is considering a heart transplant, the nurse would know the client has an accurate perception of this treatment option when the client says a. "This is an experimental treatment, but I want to take the chance." b. "People under 75 years of age may have a heart transplant." c. "The survival rate for patients having a heart transplant is about 80%." d. "Less than half of those who survive a heart transplant live 10 years."

c Cardiac transplantation is now a standard and effective treatment for clients with end-stage cardiac disease. Currently, 84% of heart transplant patients survive 1 year, and 77% survive 3 years. Selection criteria include age less than 65 years. DIF: Cognitive Level: Application REF: Text Reference: 1609 TOP: Nursing Process Step: Evaluation MSC:

Health Promotion and Maintenance 16. The nurse would stress in a discharge teaching plan for a client recovering from endocarditis that to avoid further complication, the client should a. initiate a comprehensive daily exercise program. b. become actively involved in social and community activities. c. notify the physician when invasive dental procedures are planned. d. drink at least 1000 ml of fluid daily to ensure adequate hydration.

c Clients recovering from endocarditis should take special precaution by contacting the physician for extra antibiotic coverage when invasive dental procedures are scheduled. DIF: Cognitive Level: Application REF: Text Reference: 1619, Box 57-3; TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 5. The nurse would recognize that splinter hemorrhages in the nails, painful swollen nodules on the fingertips, and splenomegaly indicate a. mitral valve prolapse. b. mitral stenosis. c. infective endocarditis. d. pericarditis.

c Clinical manifestations of embolization due to infective endocarditis include splinter hemorrhages, Osler's nodes, finger clubbing, Janeway lesions, ocular signs, and splenomegaly. DIF: Cognitive Level: Analysis REF: Text Reference: 1618 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 26. In doing a breath sound assessment on a client who has left ventricular failure, the nurse would anticipates the finding of a. inspiratory wheeze. b. audible S3 and S4. c. crackles in the lung bases. d. pericardial friction rub.

c Crackles frequently signal left ventricular failure and usually occur just after the onset of an S3 gallop. As pulmonary capillary pressure rises from the backward pressure of left ventricular failure, fluid shifts into the intra-alveolar spaces, and crackles can be auscultated. DIF: Cognitive Level: Comprehension REF: Text Reference: 1578 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 7. The nurse would explain the etiology of heart failure after myocardial infarction (MI) as a. inability of the heart chambers to fill adequately. b. increased oxygen demands of the myocardium. c. impairment of the contractile function of the ventricle. d. increased myocardial workload.

c Heart failure is a physiologic state in which the heart cannot pump enough blood to meet the metabolic needs of the body. It results from changes in systolic or diastolic function of the left ventricle. After an MI, some of the heart muscle is replaced by noncontracting scar tissue, and the ventricles pump less efficiently. DIF: Cognitive Level: Application REF: Text Reference: 1650 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 11. A client admitted to the coronary intensive care unit with dysrhythmias is also being treated for depression and arthritis. The client has anemia and frequent episodes of constipation. The nurse would recognize that the medication most likely to be a factor in the dysrhythmias is a. aspirin. b. an oral iron preparation. c. a tricyclic antidepressant. d. a stool softener.

c Noncardiac medications can have profound secondary effects on cardiovascular performance. For example, tricyclic antidepressants and other psychotropic medications can potentiate dysrhythmias. DIF: Cognitive Level: Application REF: Text Reference: 1568 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 5. A client's record contains a notation that the client is orthopneic. The most beneficial nursing intervention to address this problem would be a. limit fluids. b. encourage ambulation. c. provide several pillows. d. offer extra blankets.

c Orthopnea is difficulty breathing that occurs when a client is resting flat in bed and that is relieved when the client assumes an upright or semi-vertical position. Offering extra pillows eases the breathing effort. DIF: Cognitive Level: Application REF: Text Reference: 1567 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 10. When a client is hospitalized with dilated cardiomyopathy, the nurse would examine the client's record for the characteristic history of a. uncontrolled diabetes. b. previous streptococcal infection. c. long-term alcohol abuse. d. resistent hypertention.

c Risk of cardiomyopathy increases in clients who chronically ingest excessive amounts of alcohol. DIF: Cognitive Level: Application REF: Text Reference: 1607 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 10. In reviewing the history of a client diagnosed with mitral valve stenosis, the nurse would anticipate finding a. the frequent complaint of stress. b. a diet high in fats and carbohydrates. c. frequent streptococcal infections. d. elevated T waves on the ECG.

c Severe streptococcal infections are associated with structural mitral valve disease. DIF: Cognitive Level: Analysis REF: Text Reference: 1567 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 38. The diagnostic study that would provide the nurse with the most relevant information related to cardiac perfusion is a. echocardiography. b. phonocardiography. c. thallium-201 scintigraphy. d. transesophageal echocardiography.

c Thallium-201 is the most widely used isotope to evaluate myocardial perfusion because of its short half-life and low total-body radiation. DIF: Cognitive Level: Application REF: Text Reference: 1591 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 30. To assure an accurate ECG reading, the nurse applying electrodes for cardiac monitoring would be certain to 1. use two electrodes. 2. attach lead wires to electrodes before placement on the chest. 3. dampen the hair on the chest to ensure good contact. 4. apply electrodes to dry skin.

c The electrodes are attached to the lead wires before they are applied to the chest wall. This process avoids applying pressure to the electrode, which could hurt the client and squeeze the gel outward, reducing contact. DIF: Cognitive Level: Application REF: Text Reference: 1583 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 34. The nurse would counsel a client who is to wear a Holter monitor to a. refrain from activities that cause chest pain. b. remove the electrodes when around water. c. keep a record of daily activities. d. exercise as much as possible while the monitor is in place.

c The nurse should encourage the client to go about usual daily activities and keep a written account of these activities along with any clinical manifestations that may develop. DIF: Cognitive Level: Application REF: Text Reference: 1586 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 6. Nursing care of a client after a percutaneous transluminal coronary angioplasty (PTCA) generally would include a. administration of heparin. b. maintaining the client flat in bed for 24 hours. c. forcing fluids. d. assessing for clinical manifestations of shock.

c The nurse should force fluids, orally or intravenously, to assist the body in excreting contrast, which causes diuresis and may cause acute tubular necrosis. DIF: Cognitive Level: Application REF: Text Reference: 1640 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 16. The nurse preparing to evaluate a client for the presence of a pulsus paradoxus would ensure that a. pulses in both arms are monitored. b. lying and standing blood pressures are measured. c. Korotkoff sounds are evaluated during inspiration and expiration. d. systolic blood pressure is determined by Doppler measurement.

c The nurse should slowly deflate the cuff and listen for Korotkoff sounds to be present only during expiration. The nurse continues deflating the cuff until Korotkoff sounds are heard equally well during inspiration and expiration. DIF: Cognitive Level: Application REF: Text Reference: 1573 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 2. The nurse quickly calculating a client's heart rate by examining the electrocardiogram (ECG) would count the number of a. P waves in a 6-inch strip and multiply by 5. b. large squares between P waves and multiply by 10. c. R waves in a 6-inch strip and multiply by 10. d. large squares between R waves and multiply by 10.

c The simplest method for obtaining the heart rate is to count the number of R waves in a 6-inch strip of the ECG tracing (which equals 6 seconds), then multiply this sum by 10 to obtain the rate per minute. DIF: Cognitive Level: Application REF: Text Reference: 1674, Box 59-1; TOP: Nursing Process Step: Assessment MSC:

Health Promotion and Maintenance 13. The nurse preparing to measure central venous pressure (CVP) would confirm that the location for the zero point on the CVP transducer is the a. sternal manubrium. b. second intercostal space at the midclavicular line. c. midaxillary line at the fourth intercostal space. d. fifth intercostal space at the midclavicular line.

c The zero point on the CVP transducer needs to be at the level of the right atrium. The right atrium is located at the midaxillary line at the fourth intercostal space. DIF: Cognitive Level: Application REF: Text Reference: 1596 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 14. To improve a client's cardiovascular status, the nurse would advise the client to engage in an aerobic exercise at least a. 2 hours once a week. b. 1 hour every day. c. 30 minutes three times a week. d. 15 minutes five times a week.

c To be effective, aerobic exercise should raise the heart rate from 50% to 100% of baseline for at least 20 to 30 minutes at least three times per week to be beneficial. DIF: Cognitive Level: Knowledge REF: Text Reference: 1570 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 5. The nurse would advise a group of young persons that the risk of CHD can be decreased by keeping the fasting blood sugar at the optimal level of a. 56 mg/dl. b. 72 mg/dl. c. 105 mg/dl. d. 126 mg/dl.

d A fasting blood sugar of 126 mg/dl is the optimal level to decrease the risk for CHD. DIF: Cognitive Level: Comprehension REF: Text Reference: 1631 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 33. The nurse explaining the purpose of a signal-averaged ECG would tell the client a. "This type of ECG is able to specifically pinpoint damaged areas of your heart." b. "A computer is able to read signal-averaged ECGs; otherwise, this study is identical to your usual ECG." c. "Signal-averaged ECG is an electrical study that monitors the response of your heart to a measured amount of electricity." d. "The signal-averaged ECG is used to identify an electrical impulse associated with sudden death."

d A signal-averaged ECG is used to identify the presence of electrical impulses called "late potentials." This noninvasive test may be done at the bedside and is used to predict which clients may be prone to ventricular tachycardia resulting in sudden death. DIF: Cognitive Level: Application REF: Text Reference: 1586 TOP: Nursing Process Step: Intervention MSC:

Health Promotion and Maintenance 15. The nurse monitoring the blood pressure of a 68-year-old man notes that the first Korotkoff sound appears at 140, muffles at 80, and disappears at 70 mm Hg. Using the criteria of the American Heart Association (AHA), the nurse would a. reevaluate the blood pressure. b. record the diastolic pressure as 140. c. record the diastolic pressure as 80. d. record the diastolic pressure as 70.

d AHA recommends recording the point at which the first Korotkoff sound disappears as the diastolic pressure in adults. DIF: Cognitive Level: Comprehension REF: Text Reference: 1572 TOP: Nursing Process Step: Assessment MSC:

Health Promotion and Maintenance 4. A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of a. no change. b. inverted QRS complex. c. increased PR interval. d. tall T wave.

d An abnormally high serum potassium level will cause the T wave to become very tall, sometimes the height of the QRS complex. DIF: Cognitive Level: Application REF: Text Reference: 1674, Box 59-1; TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 9. If a client admitted to the hospital for treatment of atrial fibrillation complains of dyspnea and chest pain, the nurse would suspect a. heart block. b. myocardial infarction. c. pulmonary edema. d. pulmonary emboli.

d Blood pools in the "quivering" atria because contraction of the atrial muscle is inadequate. This blood can clot, which increases the potential for cerebral and pulmonary vascular emboli. DIF: Cognitive Level: Analysis REF: Text Reference: 1678 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 20. The nurse evaluating the head and neck of a client would assess the carotid arteries by a. palpating the arteries simultaneously, comparing pulse amplitudes, rates, and rhythms. b. instructing the client to lie down on a pillow and examining the arteries with oblique lighting. c. asking the client to bear down and hold the breath while observing the arteries. d. auscultating the arteries with the diaphragm of the stethoscope.

d Carotid artery examination indicates the adequacy of stroke volume and the patency of the arteries. Using the fingertips, the nurse gently palpates the carotid arteries one side at a time. The nurse notes whether a bruit is present by listening to the carotid arteries with the diaphragm of the stethoscope. DIF: Cognitive Level: Application REF: Text Reference: 1573 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 12. After saying that "everybody always tells me coke is bad for your heart," a young client asks the nurse, "What does cocaine do?" The nurse would respond a. "Illegal drugs decrease blood flow to the heart as well as the brain and kidneys." b. "Cocaine causes the heart to slow down to a point where life can no longer be supported." c. "Cocaine causes the blood vessels to the heart to constrict, resulting in blocked heartbeats, which can cause death." d. "A fight-or-flight reaction occurs when cocaine is used, stressing the heart, often beyond its capacity."

d Cocaine toxicity is a major threat to the cardiovascular system. Cocaine's systemic sympathomimetic effects result in a "fight or flight" response characterized by increases in heart rate and contractility, increase in blood glucose levels, and peripheral vasoconstriction. DIF: Cognitive Level: Application REF: Text Reference: 1568 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 31. In evaluating a client's ECG tracing, the nurse notes three small squares between the upstroke and downstroke of the QRS wave. The nurse would record the QRS interval as 1. 0.04 second. 2. 0.06 second. 3. 0.08 second. 4. 0.12 second.

d Each small square on ECG tracing paper is 0.04 second, making the QRS interval in this client 0.12 second, which is a little long. DIF: Cognitive Level: Analysis REF: Text Reference: 1584 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 39. In anticipation of a client's technetium-99m stress ventriculography (MUGA scan), the nurse would teach the client to a. practice coughing and deep breathing. b. monitor radial pulse rate. c. eliminate red meat from the diet on the day before the test. d. wear shoes that will allow the client to use the bicycle ergometer.

d If a stress-gated pool study is to be performed, the client is put on a bicycle ergometer with a gamma camera positioned to view the right and left blood pools. DIF: Cognitive Level: Application REF: Text Reference: 1592 TOP: Nursing Process Step: Intervention MSC:

Health Promotion and Maintenance Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive Outcomes, 7th Edition Chapter 57: Management of Clients with Structural Cardiac Disorders MULTIPLE CHOICE 1. The physician has expressed concern about the development of rheumatic fever in a client with a throat infection. The nurse would explain to the client that the organism causing the infection is a. Streptococcus pneumoniae. b. Streptococcus pyogenes. c. Staphylococcus aureus. d. beta-hemoloytic streptococcus.

d Infections caused by beta-hemolytic streptococci are precursors to rheumatic fever. DIF: Cognitive Level: Comprehension REF: Text Reference: 1601 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 2. The nurse would explain to a client who smokes that the nicotine in cigarette smoke increases the prevalence of CHD by a. decreasing the oxygen-carrying capacity of the blood. b. increasing fat deposits along the intima of blood vessels. c. causing proliferation of smooth muscle cells. d. increasing the heart rate and the risk of dysrhythmia.

d Nicotine increases the release of epinephrine and norepinephrine, which results in peripheral vasoconstriction, elevated blood pressure and heart rate, greater oxygen consumption, and increased risk of dysrhythmia. DIF: Cognitive Level: Application REF: Text Reference: 1629 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 23. The nurse recognizes a split S2 heart sound on a client who has a medical diagnosis of atrial septal defect. To help determine if the split S2 is physiologic or pathologic, the nurse would a. assess the sound in the mitral area. b. evaluate for the presence of an S3 sound. c. listen to the sound with the client sitting upright. d. auscultate the sound, paying particular attention to the respiratory cycle.

d Physiologic splitting of S2 occurs during inspiration. Normal splitting results from the delayed closure of the pulmonic valve. Both aortic and pulmonic components of S2 can be heard. DIF: Cognitive Level: Analysis REF: Text Reference: 1575 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 12. When auscultating the respirations of a client in left ventricular heart failure, the nurse would most likely detect a. wheezing. b. Loud expiratory sounds. c. Loud inspiratory sounds. d. crackling sounds.

d The client coughs because a large amount of fluid is trapped in the pulmonary tree, irritating the lung mucosa. On auscultation, bilateral crackles may be heard. DIF: Cognitive Level: Application REF: Text Reference: 1655 TOP: Nursing Process Step: Assessment MSC:

Psychsocial Integrity 19. To encourage a client recovering from endocarditis, the nurse would stress that new guidelines for home care are less restrictive than in the past and the client no longer needs to a. take 2 to 5 weeks of antibiotic therapy. b. restrict the amount of activity. c. take precautions against emboli formation. d. observe complete bed rest.

d The client recovering from endocarditis is no longer restricted to bed rest unless there is evidence of fever or heart damage. Antibiotic therapy, limited activity, and precautions against emboli are still part of the recovery protocol. DIF: Cognitive Level: Analysis REF: Text Reference: 1619 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 7. In the discharge teaching plan of a client with chronic myocarditis, the nurse would include the suggestion that a. family members should be screened for upper respiratory infection. b. stairs in the home should be replaced with ramps. c. the client should not operate a motor vehicle. d. family members should learn cardiopulmonary resuscitation (CPR).

d The client should be taught about self-monitoring pertinent to heart rhythm, rate, and palpatations, and family members should be encouraged to take CPR training in case of an emergency. DIF: Cognitive Level: Application REF: Text Reference: 1621 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 6. To help relieve the discomfort of a client with pericarditis who is experiencing pain, the nurse would position the client a. flat in bed. b. prone. c. in the semi-Fowler's position. d. sitting upright.

d The most characteristic subjective clinical manifestation of pericarditis is chest pain. Sitting up often relieves the pain. DIF: Cognitive Level: Application REF: Text Reference: 1622 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 29. The nurse would explain to a client that an electrical representation of the cardiac cycle shows that a normal PR interval is between 0.12 second and 1. 0.15 second. 2. 0.16 second. 3. 0.18 second. 4. 0.20 second.

d The normal PR interval is between 0.12 and 0.20 second, averaging 0.16 second. DIF: Cognitive Level: Knowledge REF: Text Reference: 1584 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 8. The nurse caring for a client with acute infective endocarditis would frequently assess for a. urine output. b. pulse oximetry. c. elevation of blood pressure. d. cardiac murmurs.

d The nurse should auscultate every 8 hours for heart murmurs and assess for rapid pulse, easy fatigability, dyspnea, restlessness, manifestations of heart failure, and embolic manifestations in the client with infective endocarditis. DIF: Cognitive Level: Analysis REF: Text Reference: 1618 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 18. When a client recovering from balloon valvuloplasty asks the nurse when the sheath will be removed, the nurse would respond that the sheath a. was removed with the deflated balloon. b. will remain in place to maintain patency of the vessel. c. will gradually be "digested" by the anticoagulant agents. d. will be removed when clotting time has normalized.

d The sheath is left in place after balloon valvuloplasty until the clotting time has normalized. DIF: Cognitive Level: Application REF: Text Reference: 1605, 1606; TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 12. The nurse noting sudden ventricular fibrillation in a CCU client would immediately administer a. a lidocaine bolus. b. atropine. c. intravenous (IV) phenytoin (Dilantin). d. cardiopulmonary resuscitation (CPR).

d When ventricular fibrillation appears, the nurse must immediately initiate CPR until the defibrillator is engaged, and should defibrillate up to three times if needed. DIF: Cognitive Level: Analysis REF: Text Reference: 1687 TOP: Nursing Process Step: Intervention MSC:

Physiological Integrity 41. A pulmonary artery catheter has been inserted. When this catheter is wedged, the information available to the nurse would be a. right atrial blood flow dynamics. b. cardiac output. c. electrical activity in the lungs. d. left end-diastolic pressure.

d When wedged, the catheter is "pointing" indirectly at the left end-diastolic pressure. DIF: Cognitive Level: Knowledge REF: Text Reference: 1595 TOP: Nursing Process Step: Assessment MSC:

Physiological Integrity 18. When a client with heart failure is receiving loop diuretics, the nurse would be sure to monitor 1. serum calcium level. 2. serum sodium level. 3. cardiac enzyme levels. 4. serum potassium level.

d With the use of loop diuretics, potassium is lost through the kidneys, which can lead to dysrhythmias and electrolyte imbalances. Hypokalemia sensitizes the myocardium to digitalis and therefore predisposes the client to digitalis toxicity. DIF: Cognitive Level: Analysis REF: Text Reference: 1660, Table 58-4; TOP: Nursing Process Step: Assessment MSC: