Chapter: 19 and 20 Exam3
The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI). The nurse recognizes this finding indicates which problem? a. A recurrent MI b. Pleural effusion c. Pericarditis d. Angina
C
The nurse is caring for a patient with severe congestive heart failure (CHF) who denies pain and is fearful of taking prescribed morphine. Which explanation best works to alleviate the patient's anxiety about risk of addiction? a. "Many people with CHF use morphine for pain control." b. "We can treat your pain with aspirin or ibuprofen." c. "Morphine has properties that help relieve air hunger in CHF patients." d. "You can refuse to take it."
C
The nurse is caring for a post-myocardial infarction (MI) patient who has been started on daily simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse's teaching has been successful? a. "I will need to have blood work every month while taking Zocor." b. "I should take my Zocor with grapefruit juice to help absorption. c. "I should call my doctor if I experience unexplained muscle pain." d. "I should take Zocor an hour before my biggest meal of the day."
C
Which teaching point will the nurse include when providing discharge instructions to the patient with a new permanent pacemaker? a. "You will be able to have an MRI for diagnostic purposes." b. "Avoid using microwave ovens." c. "Avoid lifting heavy objects for as long as your physician prescribes." d. "Airport screening devices may cause your pacemaker to fire incorrectly."
C
The 60-year-old female in the post-coronary care unit confides to the nurse, "My life is over. I'll never be able to care for my family, take a vacation, or work in my garden." Which response is most supportive? a. "You are doing great! You can do all of those things in a few weeks." b. "You may have to give up some things, but there are other activities you might enjoy." c. "You are feeling a little blue today. Would you like medication to help your anxiety?" d. "You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems."
D
what race has the highest incidence of heart failure and have higher mortality rates than other populations?
african americans
the abnormal heart rhythm is known as
arrhythmia or dysrhythmia
____________________ develops because the heart is unable to move the amount of blood it receives efficently through the system
congestion
the _______________ sided pump receives blood from the lungs and pumps it out to the body
left
what sided heart failure occurs first?
left
_______________ sided heart failure is commonly caused by chronic pulmonary disease
right
the _______________ sided pump receives blood from the body and pumps it to the lungs for oxygenation
right
heart failure may be classified as...
right sided heart failure and left sided heart failure
1. The nurse is caring for a patient with suspected right-sided heart failure. Which manifestation best supports this potential diagnosis? a. Wheezing b. Orthopnea c. Edema d. Pallor
c
The nurse is explaining the difference between exertional angina and unstable angina. Which statement about unstable angina is accurate? a. Unstable angina occurs with moderate exercise. b. Unstable angina occurs when the blood pressure increases sharply. c. Unstable angina occurs when the body reacts to high stress levels. d. Unstable angina occurs unpredictably, even in sleep.
d
The statement indicates that the nurse's teaching about the purpose of an implanted cardioverter-defibrillator (ICD) has been successful? a. "The ICD will detect bad rhythms and shock my heart into normal rhythm." b. "I should avoid handheld security devices at the airport." c. "I should ask my doctor how often I should have my ICD checked." d. "I should avoid working on the alternator of my boat."
A
S/S of right sided heart failure
- fatigue - edema in the sacrum, legs, feet, and ankles - abdominal distention - weight gain - dyspnea - hepatomegaly
what is the reason for coumadin with a fib?
- the blood is sitting in a quivering atria which puts it at risk of clots, which could pass to the pulmonary artery of brain and cause PE or stroke
The nurse is caring for a post-myocardial infarction (MI) patient. The patient questions the reason for a stool softener and denies constipation. Which statement indicates that the patient accurately understands the nurse's teaching? a. "Stool softeners help me keep from straining during bowel movements, which can lower my heart rate." b. "Stool softeners help me to get rid of extra wastes that can harm my heart." c. "Stool softeners help reduce swelling that can increase work on my heart." d. "Stool softeners help to reduce discomfort from gas pains."
A
the heart has _________ pumps
2 pumps; right sided and left sided pump
A patient who presented to the emergency room with a myocardial infarction (MI) becomes pale, diaphoretic, and hypotensive. What action should the nurse take first? a. Notify the physician immediately. b. Ensure that the patient has patent IV access. c. Request assistance from respiratory therapy. d. Inform the patient's family of the change in status.
A
The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI). Which statement accurately describes the purpose of this medication? a. "Alteplase (t-PA) dissolves the obstruction in the coronary artery." b. "Alteplase (t-PA) dilates vessels to relieve pain." c. "Alteplase (t-PA) strengthens cardiac contraction." d. "Alteplase (t-PA) increases cardiac output."
A
The nurse caring for a patient who requires a temporary transvenous pacemaker. Which statement indicates that the patient understands the nurse's teaching? a. "I may experience uncomfortable muscle contractions." b. "The procedure will use general anesthesia." c. "I will be given a sedative after the procedure." d. "This device may be left in place for 6 weeks."
A
The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI). The nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new laboratory results. Which laboratory value should the nurse report immediately? a. Troponin of 2.4 mcg/L b. Potassium of 3.4 mEq/L c. Creatine phosphokinase of 134 IU/L d. Sodium of 133 mEq/L
A
The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary angiography earlier in the day. The patient denies pain and no longer requires bed rest. The groin is soft with no palpable hematoma. Which postprocedure care is most important for the patient at this time? a. Encourage increased fluid intake. b. Administer pain medications as ordered. c. Obtain vital signs every 15 minutes. d. Assist the patient with ambulation.
A
The nurse is caring for a patient with uncontrolled hypertension, diabetes, asthma, and gastroesophageal reflux disease (GERD). Which problem serves as a contraindication for a thrombolytic agent? a. Uncontrolled hypertension b. Diabetes c. Asthma d. GERD
A
Which disorganized ECG pattern is recognized as the most fatal of all arrhythmias? a. Ventricular fibrillation b. Premature ventricular beats c. Atrial fibrillation d. Ventricular tachycardia (VT)
A
How does a myocardial infarction (MI) alter the pumping efficiency of the heart? a. An MI reduces the impulse from the sinoatrial node. b. An MI causes myocardial necrosis. c. An MI shunts all myocardial blood flow to a specific cardiac region. d. An MI causes myocardial swelling and inflammation.
B
The nurse is caring for a patient who is taking digitalis. The patient complains of increased thirst, and the nurse observes dry mucous membranes. Which additional finding warrants the nurse's immediate attention? a. Sudden, sharp knee pain b. Blurred vision c. Epistaxis d. Chills
B
The nurse is caring for a patient with agina pectoris who asks what happens to make his body experience pain. The nurse explains that pain results from which underlying causative factor? a. Congestion that backs up into the lungs b. Inadequate blood flow and poor oxygen supply c. Edema from fluid overload d. Inflammation in the vessels
B
The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which response is best for the nurse to make? a. "I'm not really sure. It is better if you ask your surgeon." b. "Every patient has different circumstances, but the average 5-year survival rate is 79%." c. "The survival rate is excellent. Almost all patients with a heart transplant live past 10 years." d. "There are not any really good statistics for me to give you an accurate estimate."
B
S/S of left sided heart failure
Fatigue; dyspnea; wheezing; orthopnea; sleep apnea; pulmonary edema (pink, frothy sputum); pallor; clammy skin
____________ is usually caused by thrombosis resulting from a ruptured atherosclerosis plaque
MI
The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB). Which statement indicates that the patient needs further instruction? a. "It frightens me to think that my heart will be stopped for a long time during surgery." b. "This surgery bypasses my artery that is blocked, and replaces it with sections of a vein or artery taken from another part of my body." c. "This surgery will hopefully control my angina since nothing else we have tried has worked." d. "I may come out of surgery with vessels removed from my legs."
a
The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful. Which reply is best? a. Low-dose aspirin helps reduce clotting. b. Low-dose aspirin helps dilate coronary vessels. c. Low-dose aspirin helps alleviates pain associated with angina. d. Low-dose aspirin helps lower cholesterol.
a
the chest pain that occurs when blood supply to the heart is decreased or totally obstructed
angina pectoris
The home health nurse is caring for a patient with congestive heart failure (CHF). Which assessment finding should the nurse report immediately to the physician? a. Moderate shortness of breath after walking down the hall b. A 3 pound weight gain over the course of a week c. Heart rate of 104 beats/min after ambulating to the bathroom d. Increase in urinary output to 50 mL in the last hour
b
The nurse caring for a patient who is taking amiodarone (Cordarone). What side effect could this patient experience? a. Sudden increase in temperature b. Hypotension c. Bradycardia d. Depressed ventilation
b
The nurse is analyzing a patient's telemetry strip and observes a sawtooth appearance with no P waves. How should the nurse document this finding? a. Premature ventricular contraction (PVC) b. Atrial flutter c. Ventricular tachycardia (VT) d. Premature atrial contraction (PAC)
b
The nurse is caring for a patient with a heart rate of 115 beats/min and complaints of shortness of breath. The nurse anticipates that these findings are most likely related which underlying problem? a. Pulmonary edema b. Decreased cardiac output c. Impending pneumonia d. Increasing anxiety
b
The nurse is caring for a patient with a history of left-sided congestive heart failure (CHF). Which finding leads the nurse to suspect that the patient could be experiencing an acute exacerbation of this condition? a. The abdomen is tight and shiny. b. Wheezes are present during lung auscultation. c. The pupils react sluggishly to light. d. The heart rate is irregularly irregular.
b
The nurse is caring for a patient with atrial fibrillation who asks why she needs to take warfarin. Which statement best answers the patient's question? a. Warfarin increases the ejection fraction. b. Warfarin prevents clots from forming in the atria. c. Warfarin keeps the atrial fibrillation from involving the ventricles. d. Warfarin increases the cardiac output.
b
The nurse is educating a patient on a low-fat, low-cholesterol diet after a myocardial infarction (MI). Which food choice should the nurse recommend? a. "Avoid eating frozen foods." b. "Replace a serving of red meat with a serving of fish." c. "Use nondairy creamer in your decaffeinated coffee." d. "Drink a serving of grapefruit juice each day."
b
Which potential hazard is most important for a patient with an automatic implantable cardioverter-defibrillator (AICD) to avoid? a. Static electricity from synthetic fabric b. Airport security detection devices c. Constricting clothing and belts d. High altitudes
b
The nurse is caring for a male patient with angina who has a new prescription for sublingual nitroglycerin. What information is most important for the nurse to include in the teaching plan? a. Nitroglycerin tablets expire 3 months after the bottle is opened. b. Take a second tablet 15 minutes after the first dose and call the physician if pain persists. c. Store nitroglycerin tablets in a cool, dark location. d. Nitroglycerin may cause an unsafe drop in heart rate when combined with certain medications for erectile dysfunction.
c
The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed. Which response by the nurse is most accurate? a. "We will only roll you to the same side as the catheter insertion site." b. "You will lay flat for several hours, and we will place a sandbag over the dressing in the groin." c. "You will most likely be able to ambulate within a few hours if your doctor uses an arterial closure device at the catheter insertion site." d. "We will encourage you to flex and extend your legs when you return from the procedure to prevent a clot from forming at the insertion site."
c
what are the most common causes of heart failure?
coronary artery disease and hypertension
The nurse is caring for a female patient with a family history of heart disease who is undergoing a workup for cardiovascular disease. Which finding is most concerning to the nurse? a. Fainting b. Dry mouth c. Dizziness d. Fatigue
d
The nurse is caring for a patient with congestive heart failure (CHF). Which intervention should the nurse include in the plan of care? a. Encourage intake of canned soups. b. Place the patient in a side-lying position to prevent venous pooling. c. Encourage large meals for increased nutritional impact. d. Alternate rest with activity.
d
The nurse is caring for several patients on a cardiac care unit. Which patient is most likely to have aortic stenosis? a. 35-year-old with a history of Raynaud disease b. 63-year-old with uncontrolled diabetes c. 73-year-old with a history of hypertension d. 86-year-old with a history of atherosclerosis
d
The nurse is teaching the patient with an arrhythmia. Which statement indicates that the patient requires further teaching? a. "I've cut my coffee from 10 cups to 2 cups a day." b. "I don't drink regular cola drinks anymore." c. "I have given up drinking those high-energy drinks." d. "I've switched from 5 cups of coffee to 5 cups of tea."
d
Which statement accurately explains how calcium channel blocker verapamil assists to correct an arrhythmia? a. The medication desensitizes the heart to the impulse to contract. b. The medication increases the strength of the impulse from the atrioventricular (AV) node. c. The medication alters the impulse from the sinoatrial (SA) node.
d
