Exam 1 - Question Medley
A patient states, "The doctor says I have hyperlipidemia. What does that mean?" What is the best explanation the nurse can provide? -"Hyperlipidemia means you have atherosclerosis." -"Hyperlipidemia means you have arteriosclerosis." -"Hyperlipidemia is an elevation of serum lipid levels." -"Hyperlipidemia describes a diet high in fat and cholesterol."
-"Hyperlipidemia is an elevation of serum lipid levels." Rationale The best explanation of hyperlipidemia is that it is an elevation of serum lipid levels. Hyperlipidemia is a risk factor for the development of atherosclerosis. A diet high in fat and cholesterol may contribute to the development of hyperlipidemia. Hyperlipidemia puts the patient at risk for arteriosclerosis. p.729
Which statement by a patient scheduled for a percutaneous coronary intervention (PCI) indicates a need for further preoperative teaching? -"I will be awake during this procedure." -"I will have a balloon in my artery to widen it." -"I must lie still after the procedure." -"My angina will be gone for good."
-"My angina will be gone for good." Rationale Reocclusion is possible after PCI. The patient is typically awake, but drowsy, during this procedure. PCI uses a balloon to widen the artery, and the patient will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the hole to heal and prevent hemorrhage. p. 778
What decrease in blood pressure (BP) defines diagnostic criteria for orthostatic hypotension? -5 mm Hg systolic and/or 15 mm Hg diastolic -15 mm Hg systolic and/or 5 mm Hg diastolic -10 mm Hg systolic and/or 20 mm Hg diastolic -20 mm Hg systolic and/or 10 mm Hg diastolic
-20 mm Hg systolic and/or 10 mm Hg diastolic Rationale Orthostatic hypotension is a decrease in BP of 20 mm Hg systolic and/or 10 mm Hg diastolic when the patient changes position from lying to sitting. Decreases of 5 mm Hg systolic and/or 15 mm Hg diastolic, 15 mm Hg systolic and/or 5 mm Hg diastolic, or 10 mm Hg systolic and/or 20 mm Hg diastolic do not meet diagnostic criteria for orthostatic hypotension. p.723
Which complementary and alternative therapy can be helpful in preventing coronary atherosclerotic disease? -Reducing or stopping smoking -Avoiding foods with trans-fatty acids -Taking a multivitamin tablet each day -Consuming foods high in omega-3 fatty acids
-Consuming foods high in omega-3 fatty acids Rationale Consuming omega-3 fatty acids from fish and plant sources has been effective in decreasing lipid levels, stabilizing atherosclerotic plaque, and reducing sudden death from myocardial infarction (MI). Smoking reduction or cessation and avoiding trans-fatty acids are standard health promotion recommendations. There is no evidence that taking a multivitamin aids in the prevention of coronary atherosclerotic disease. p. 791
The nurse assesses a patient with pneumonia who has been receiving oxygen 45% via Venturi mask for 2 days and notes dyspnea when getting to a chair and a nonproductive cough. The patient reports chest pain below the sternum and gastrointestinal (GI) upset. Which initial action by the nurse is correct? -Request an order for arterial blood gases. -Increase the oxygen to 50% via facemask. -Contact the provider to report these findings. -Notify the Rapid Response Team immediately.
-Contact the provider to report these findings. Rationale This patient is manifesting signs of oxygen toxicity, and the nurse should notify the provider. The patient does not need an increase in oxygen. The chest pain is related to oxygen toxicity and not myocardial infarction, so the Rapid Response Team is not needed. The provider may order arterial blood gases. p.530
Upon reviewing the laboratory reports of a patient with a family history of coronary artery disease, the primary health care provider prescribed statin drug therapy. What finding in the laboratory reports is responsible for this prescription? -Blood pressure of 120/80 mm Hg -Triglyceride level of 115 mg/dL -Preprandial blood glucose level of 120 mg/dL -High-density lipoprotein cholesterol level of 30 mg/dL
-High-density lipoprotein cholesterol level of 30 mg/dL Rationale The normal high-density lipoprotein cholesterol (HDL-C) level should be greater than 45 mg/dL. A decreased HDL-C level can increase the levels of low-density lipid cholesterol (LDL-C), which increases the risk for cardiovascular diseases. Therefore, a patient with an HDL-C level of 30 mg/dL is at risk for coronary artery disease and should use statins as ordered regularly. A blood pressure of 120/80 mm Hg indicates hypertension, which is treated with antihypertensive medications. A triglyceride level of 115 mg/dL is a normal finding. A preprandial blood glucose level of 120 mg/dL indicates hyperglycemia, which is generally treated with antidiabetic drugs. p. 777
Which statement about fatigue is correct? -It is referred to as difficult or labored breathing. -It is referred to as a brief loss of consciousness. -It is a feeling of tiredness or weariness resulting from activity. -It is a feeling of fluttering or an unpleasant feeling in the chest caused by an irregular heartbeat.
-It is a feeling of tiredness or weariness resulting from activity. Rationale Fatigue is a feeling of tiredness or weariness resulting from activity. A brief loss of consciousness is referred to as syncope. Dyspnea refers to difficult or labored breathing. Palpitation is a feeling of fluttering or unpleasant feeling in the chest caused by an irregular heartbeat. p. 650
When assessing the adequacy of a patient's oxygenation, which information is important for the nurse to note? -Fraction of inspired oxygen (Fio 2) -Positive end-expiratory pressure (PEEP) -Partial pressure of arterial oxygen (PaO 2) -The patient's acceptance of the continuous positive airway pressure (CPAP) machine.
-Partial pressure of arterial oxygen (PaO 2) Rationale PaO 2 is a measure of the amount of oxygen in the arterial blood. Fio 2 is a measure of the inspired oxygen, which may not all be absorbed. PEEP is a measure of positive expiratory pressure for a patient on a ventilator. CPAP is a delivery system, not a measure of oxygenation. p. 529
Which statements are correct regarding the drug management of asthma? Select all that apply. -Anti-inflammatory medications are used to cause bronchodilation. -Long-acting beta agonists are indicated to relieve acute attack symptoms. -Reliever medications are used to stop an asthma attack once it has started. -Control therapy medications are used to prevent asthma attacks from occurring. -Control therapy medications are used to reduce airway responsiveness.
-Reliever medications are used to stop an asthma attack once it has started. -Control therapy medications are used to prevent asthma attacks from occurring. -Control therapy medications are used to reduce airway responsiveness. Rationale Control (formerly called preventive) therapy is used to reduce airway responsiveness to prevent the occurrence of asthma attacks. This therapy is used every day, regardless of symptoms. Reliever drugs are indicated when symptoms of an attack occur to decrease the duration and severity of the attack. Long-acting beta agonists do not act quickly enough to relieve acute symptoms; they are indicated for their long-term impact on symptoms. Anti-inflammatory drugs decrease inflammation and can be beneficial in the treatment of asthma; however, they do not cause bronchodilation. p. 568
Which statement correctly describes the purpose of the intra-aortic balloon pump (IABP) as treatment for cardiogenic shock? -A laser is used to break up clots that have occluded the coronary artery. -A balloon is placed in the coronary artery to flatten plaque and improve coronary blood flow. -An expandable mesh device is inserted into the coronary artery to maintain patency. -The IABP improves coronary blood flow during diastole and reduces afterload during systole.
-The IABP improves coronary blood flow during diastole and reduces afterload during systole. Rationale The IABP contains a balloon that is synchronized to inflate during diastole and push oxygenated blood into coronary arteries. During systole, the balloon deflates, reducing afterload. The laser procedure that breaks up clots in coronary arteries is known as an atherectomy. A balloon used to open a coronary artery is done during percutaneous transluminal coronary angioplasty (PTCA). A supportive mesh device inserted into coronary arteries to maintain patency refers to a stent. p. 782
Which condition causes subcutaneous emphysema in a patient with a new tracheostomy? -Hemorrhage from a nicked artery -Effusion from fluid in the pleural space -Inflammation from an infectious process -Trapping of air escaped into the tissues
-Trapping of air escaped into the tissues Rationale Subcutaneous emphysema occurs when there is an opening or tear in the trachea and air escapes into the fresh tissue planes of the neck. Air can also progress throughout the chest and other tissues into the face. Hemorrhage from a nicked artery, effusion of fluid in the pleural space, and inflammation from an infectious process are all possible complications related to a new tracheostomy, but they do not cause subcutaneous emphysema. p. 539
Which is a desirable serum lipid level for a female patient at high risk for coronary artery disease (CAD)? -Fasting total cholesterol should be below 250 mg/dL. -Low-density lipoprotein (LDL) cholesterol should be less than 90 mg/dL. -High-density lipoprotein (HDL) cholesterol should be above 35 mg/dL. -Triglycerides should be less than 135 mg/dL.
-Triglycerides should be less than 135 mg/dL. Rationale Recommended triglyceride levels should be less than 135 mg/dL in women. Fasting total cholesterol should be below 200 mg/dL (according to the American Heart Association). Recommended LDL levels in patients at high risk for CAD should be less than 70 mg/dL, while recommended HDL levels should be above 40 mg/dL. p. 772
What condition can be suspected in a patient if his or her eosinophil count is 700/mm 3? Asthma Tuberculosis Viral infection Bacterial infection
Asthma Rationale The normal eosinophil count ranges between 50 and 500/mm 3. An increased eosinophil count indicates possible asthma. An elevated monocyte count indicates possible tuberculosis. An elevated lymphocyte count indicates a viral infection. An increased count of neutrophils indicates the possibility of acute bacterial infection. p. 522, Chart 27-3
During a diagnostic test for a patient suspected of having a cardiac tumor, the nurse elevates the patient's head to 20 degrees and places a small transducer on the patient's chest at the level of fourth intercostal space near the left sternal border. Which diagnostic test is the patient undergoing? Echocardiography Electrocardiography Magnetic resonance imaging Myocardial nuclear perfusion imaging
Echocardiography Rationale Echocardiography helps to assess and diagnose cardiac tumors. The nurse prepares the patient by instructing him or her to lie on the left side with the head elevated 15 to 20 degrees. During an echocardiogram, a small transducer lubricated with gel to facilitate transducer movement and conduction is placed on the patient's chest at the level of the third or fourth intercostal space near the left sternal border. During electrocardiography, the technician places electrodes on the patient's chest and attaches them to a multilead monitoring system. During magnetic resonance imaging, the nurse ensures that the patient has removed all metallic objects. Myocardial nuclear perfusion imaging test involves injection of different types of radioactive isotopes into the antecubital vein to view, record, and evaluate cardiovascular abnormalities. pp. 660-661
Which non-pulmonary manifestation of cystic fibrosis is commonly seen in this patient population? Vitamin toxicity Increased weight Excessive fat in stools Increased insulin production
Excessive fat in stools Rationale Cystic fibrosis causes steatorrhea, a non-pulmonary manifestation which is characterized by excessive fat in the stools resulting from malabsorption and malnourishment. Vitamin deficiencies, not vitamin toxicities, also contribute to this. A patient with cystic fibrosis is thin, not overweight, as a result of malabsorption. Pancreatic function is decreased in cystic fibrosis patients resulting in diabetes mellitus; therefore insulin production is decreased p.582
A patient has just been admitted to the emergency department and requires high-flow oxygen therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device should the nurse use initially? Face tent Venturi mask Nasal cannula Non-rebreather mask
Face tent Rationale A patient with smoke inhalation and facial burns who requires high-flow oxygen should initially be placed on a face tent because this is the only noninvasive high-flow device that will minimize painful and contaminating contact with burned facial tissue. Although a Venturi mask and a non-rebreather mask are high-flow oxygen delivery devices, they require snug fitting on the face, which can be painful and can introduce infection to compromised facial skin. A nasal cannula is not a high-flow device. p. 534
What treatment is indicated for a patient diagnosed with uremic pericarditis? Radiation Antibiotics Hemodialysis Pericardial window
Hemodialysis Rationale Hemodialysis is the treatment for patients with uremic pericarditis. Radiation, antibiotics, and a pericardial window are not treatments for uremic pericarditis. p. 713
Which is considered "good" cholesterol? Lipids Triglycerides Low-density lipoprotein cholesterol (LDL-C) High-density lipoprotein cholesterol (HDL-C)
High-density lipoprotein cholesterol (HDL-C) Rationale HDL-C is considered "good" cholesterol. LDL-C is considered "bad" cholesterol. Triglycerides are a type of fat in the blood. Lipids include fatty acids, oils, waxes, sterols, and triglycerides. p. 730
Which chemical is responsible for a prolonged inflammatory response, leading to airway obstruction? Kinins Heparin Histamine Leukotriene
Leukotriene Leukotriene is a slow-acting chemical that is released slowly, causing a prolonged inflammatory response. Kinins dilate arterioles and increase capillary permeability. Heparin inhibits blood and protein clotting. Histamine starts immediate inflammatory response by constricting small veins, inhibiting blood flow, and decreasing the venous return. p. 565
Which parameter, determined through laboratory testing, is known as the "early warning detector" for heart failure? Hematocrit Microalbuminuria Electrocardiogram B-type natriuretic peptide
Microalbuminuria Rationale Microalbuminuria is called the "early warning detector" because it is an early indicator of decreased compliance of the heart, presenting before the B-type natriuretic peptide (BNP) rises. Microalbumin levels in the urine indicate decreased compliance long before symptoms occur. The hematocrit test is used to identify heart failure resulting from anemia. An electrocardiogram shows ventricular hypertrophy, dysrhythmias, and any degree of myocardial ischemia, injury, or infarction; it is not helpful in determining the presence or extent of heart failure. B-type natriuretic peptide is used for diagnosing heart failure in patients with acute dyspnea. p. 683
Which of these oxygen delivery systems is known to deliver low-flow fraction of inspired oxygen (FiO 2)? Face tent Venturi mask Nasal cannula Tracheostomy
Nasal cannula Rationale The nasal cannula is the only type of oxygen delivery system which delivers low-flow FiO 2. Face tents, Venturi masks, and tracheostomies are examples of oxygen delivery systems that deliver high-flow FiO 2. p. 532, Table 28-1
What is the disadvantage of off-pump coronary artery bypass (OPCAB) surgery performed on patients with coronary artery disease (CAD)? Longer hospital stays Increased risk for infection Increased cost Need for skilled surgeons
Need for skilled surgeons Rationale The disadvantage of OPCAB surgery is that it requires skilled cardiac surgeons to master the technique. Advantages of OPCAB surgery are shorter hospital stays, decreased risk for infection, and decreased cost. p. 789
What is a definitive treatment for constrictive pericarditis? Antibiotics Pericardiectomy Pericardiocentesis Pericardial window
Pericardiectomy Rationale Pericardiectomy is the only definitive treatment for constrictive pericarditis. Antibiotics, pericardiocentesis, and a pericardial window are not definitive treatments for constrictive pericarditis. p. 713
What health care professional should be consulted when planning exercise for a patient who had heart transplant surgery? Case manager Cardiac surgeon Physical therapist Discharge planner
Physical therapist Rationale A physical therapist should be consulted to plan an appropriate exercise program for a patient who has had a heart transplantation surgery. The case manager and discharge planning will not be involved in planning an exercise program for the patient. The cardiac surgeon may have input, but the exercise plan is not made by the cardiac surgeon. p. 717
Which class of drugs provides the best specific dilation of pulmonary blood vessels in a patient with pulmonary hypertension? Anticoagulants Prostacyclin agents Calcium channel blockers Endothelin-receptor agonists
Prostacyclin agents Rationale Natural and synthetic prostacyclins provide the best specific dilation of pulmonary blood vessels in a patient with pulmonary hypertension. They reduce pulmonary pressure and increase lung blood flow. Anticoagulants prevent clot formation. Calcium channel blockers dilate blood vessels, but are less specific than synthetic prostacyclins. Endothelin-receptor agonists dilate blood vessels, but are less specific than synthetic prostacyclins. p.585
Which test helps to assess the amount of air remaining in the lungs at the end of a full, forced exhalation? Residual volume Total lung capacity Forced vital capacity Functional residual capacity
Residual volume Rationale A residual volume test is used to determine the amount of air remaining in the lungs at the end of a full, forced exhalation. Total lung capacity is performed to determine the amount of air in the lungs at the end of maximum inhalation. Forced vital capacity is performed to determine the maximum amount of air that can be exhaled as quickly as possible after maximum inspiration. Functional residual capacity is performed to determine the amount of air remaining in the lungs after normal expiration. p. 525, Table 27-6
Which key feature is associated with stage II of chronic peripheral arterial disease? -The patient wakes up with pain at night -The symptoms are reproducible with exercise -The toes, forefoot, and heel have ulcers and blackened tissue -The patient describes the pain as numbness, burning, and toothache-like
The symptoms are reproducible with exercise Rationale Peripheral vascular disease causes change in natural blood flow through the arteries and veins of the peripheral circulation. These conditions may decrease perfusion to the body tissues. Stage II of this disease is characterized by the reproducibility of symptoms when the patient exercises. Waking up with pain at night occurs during stage III of chronic peripheral arterial disease. The occurrence of ulcers and blackened tissue on the toes, forefoot, and heel are manifestations of stage IV of chronic peripheral arterial disease. Describing the pain as numbness, burning, or toothache-like is typical of stage III of chronic peripheral arterial disease. p. 732
What is the function of the epiglottis? To act as a passageway for food and air. To facilitate gas exchange and perfusion. To prevent food from entering the trachea. To act as an opening between the true vocal cords.
To prevent food from entering the trachea Rationale The epiglottis covers the glottis while a person is swallowing to prevent food from entering the trachea. The pharynx acts as a passageway for both the respiratory and digestive tracts. The gas exchange of oxygen and carbon dioxide takes place in the alveoli. The glottis is the opening between the true vocal cords. p. 510.
Which are causes of chronic endothelial injury that result in acute coronary syndromes? Select all that apply. Toxins Viruses Smoking Immune reactions Ruptured atherosclerotic plaque
Toxins Viruses Smoking Immune reactions Rationale Causes of chronic endothelial injury that result in acute coronary syndromes include viruses, smoking, toxins, and immune reactions. Ruptured atherosclerotic plaque occurs as a result of chronic endothelial injury. p. 769
When assessing a patient with evolving myocardial infarction (MI), for which associated symptom should the nurse be alert? Vomiting Leg pain Depression S 1 heart sound
Vomiting Rationale In addition to chest pain, patients sustaining MI may also display dyspnea; ashen, cool, and clammy skin; diaphoresis; nausea, vomiting or epigastric pain; anxiety; and feeling of impending doom or dizziness. Leg pain may occur with fracture or deep vein thrombosis. Denial is the typical response to MI; depression may occur after an MI. An S 1 heart sound or "lub" should be present at all times. p. 773
