Chapter 30 Quiz
The nurse is caring for a client who experienced a recent cardiac event. Which client statement indicates maladaptive denial? -"I don't know how I am going to change my lifestyle." -"I don't need to change. It hasn't killed me yet." -"I don't think it is as bad as the doctors say." -"I will have to change my diet and exercise more."
"I don't need to change. It hasn't killed me yet." An example of maladaptive denial to a recent cardiovascular diagnosis is when the client says that change is not needed, because "it hasn't killed me yet." This type of denial is a defense mechanism that enables the client to cope with threatening circumstances. He or she may deny the current cardiovascular condition, may state that it was present but is now absent, or may be excessively cheerful. Denial becomes maladaptive when the client does not adhere to the interprofessional plan of care.Not knowing how to change indicates that the client is overwhelmed, not in denial. Not thinking it is that bad indicates denial, but not maladaptive denial. Changing diet and exercising more indicate a willingness to change.
Which nursing statement reflects appropriate cardiac physical assessment technique? -"I will auscultate the aortic valve in the second intercostal space at the right sternal border." -"I will assess for orthostatic hypotension by moving the client from a standing to a reclining position." -"I will palpate the apical pulse over the third intercostal space in the midclavicular line." -"I will assess for carotid bruit by auscultating over the anterior neck."
"I will auscultate the aortic valve in the second intercostal space at the right sternal border." The statement that shows correct cardiac physical assessment technique is toauscultate the aortic valve in the second intercostal space at the right sternal border.Orthostatic hypotension is measured when a person moves from a reclining to a standing position. The apical pulse is palpated over the fifth intercostal space in the midclavicular line. A bruit is assessed by auscultating the carotid artery in the neck.
A client who is to undergo cardiac catheterization must be taught which essential information by the nurse? -"Monitor the pulses in your feet when you get home." -"Keep your affected leg straight for 2 to 6 hours." -"Do not take your blood pressure medications on the day of the procedure." -"Take your oral hypoglycemic with a sip of water on the morning of the procedure."
"Keep your affected leg straight for 2 to 6 hours." The client undergoing cardiac catheterization must be taught to keep the affected leg straight for 2 to 6 hours after the test. The client will remain in bed and the affected leg kept straight for 2 to 6 hours after the procedure, depending on the type of vascular closure device used, to allow the arterial puncture to heal well and prevent bleeding.The nurse monitors the pulses in the affected extremity until discharge, then teaches the client to contact the primary health care provider immediately if pallor, pain, paresthesia, or coolness of the extremity develops. The client may take regular medications except oral hypoglycemics. Blood pressure may be elevated due to anxiety before the procedure, so antihypertensive medications are taken. Oral hypoglycemics are taken with or before meals based on an anticipated rise in glucose after eating. They are not taken when the client is NPO for procedures or surgery.
The nurse is teaching a client about the purpose of electrophysiology studies (EPS). Which teaching will the nurse include? -"This is a noninvasive test performed to assess your heart rhythm." -"You will receive an injection of dobutamine and will walk on a treadmill to reveal whether you have coronary artery disease." -"This is a painless test that is done to assess the structure of your heart using sound waves." -"This test evaluates you for potentially fatal cardiac rhythms."
"This test evaluates you for potentially fatal cardiac rhythms." The correct teaching about the purpose of EPS is when the nurse says that the test evaluates the potential for fatal cardiac rhythms. EPS are invasive tests performed to determine whether the client has lethal dysrhythmias and conduction abnormalities.A noninvasive test to assess the heart rhythm best describes the electrocardiogram. Injection of dobutamine followed by walking on a treadmill best describes an exercise stress test. Using sound waves to assess the structure of the heart best describes echocardiography.
The nurse is teaching a class regarding reduction of risk factors for cardiovascular disease. Which teaching statement will the nurse include? Select all that apply. A. "If you tend to get angry easily, then your risk for heart disease is higher." B. "To reduce your overall risk, it is important to keep your BMI greater than 30." C. "Do not eat more calories on a daily basis that you are able to burn." D. "Decreasing the amount that you smoke will decrease your overall cardiovascular risk." E. "Secondhand smoke creates a significant risk to others for cardiovascular disease." F. "Exercise moderately at least 2 days per week for a total of 150 minutes."
A. "If you tend to get angry easily, then your risk for heart disease is higher." C. "Do not eat more calories on a daily basis that you are able to burn." E. "Secondhand smoke creates a significant risk to others for cardiovascular disease." F. "Exercise moderately at least 2 days per week for a total of 150 minutes."
The nurse is assessing the client's heart sounds. Which instruction will the nurse provide if there is difficulty in hearing heart sounds? A. "Please roll onto your left side." B. "Lay all the way down on your back." C. "Please hold your breath while I use my stethoscope." D. "I will just take your pulse instead."
A. "Please roll onto your left side."
The nurse is conducting an admission assessment on a male client. Which assessment data does the nurse identify as a risk factor for cardiovascular disease? Select all that apply. A. BMI of 26 B. BP of 120/66 mm Hg C. Triglycerides 140 mg/dL D. Moderate exercise for 20 to 30 minutes weekly E. Exposure to secondhand cigarette smoke F. History of repeated streptococcal tonsillitis G. Family history of cardiovascular disease
A. BMI of 26 D. Moderate exercise for 20 to 30 minutes weekly E. Exposure to secondhand cigarette smoke G. Family history of cardiovascular disease
The nurse is teaching a class on diagnostic cardiovascular testing. Which teaching will the nurse include? -Complications of coronary arteriography include stroke, nonlethal dysrhythmias, arterial bleeding, and thromboembolism. -An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. -Holter monitoring allows periodic recording of cardiac activity during an extended period of time. -The left side of the heart is catheterized first and may be the only side examined.
An alternative to injecting a medium into the coronary arteries is intravascular ultrasonography The correct statement about diagnostic cardiovascular testing is that an alternative to injecting a medium into the coronary arteries is intravascular ultrasonography. Intravascular ultrasonography (IVUS) is performed when a flexible catheter with a miniature transducer is inserted at the distal tip to view the coronary arteries. The transducer emits sound waves, which reflect off the plaque and the arterial wall to create an image of the blood vessel. It is another option besides using the medium injection method of diagnostic cardiovascular testing.Lethal, not nonlethal, dysrhythmias are a complication of diagnostic cardiovascular testing. Holter monitoring allows periodic recording of cardiac activity during short periods of time. Several parts of the heart are examined during diagnostic cardiovascular testing and not just the left side of the heart.
3. Which statement made by the client on the way to the catheterization laboratory requires an immediate action by the nurse? A. "My allergies are bothering me, so I took some Benadryl last night before bed." B. "I was nervous last night, but I still remembered to take my warfarin." C. "I sure am hungry. I haven't had anything to eat since I went to bed last night." D. "I don't know what I will do if they find a blockage in my heart."
B. "I was nervous last night, but I still remembered to take my warfarin."
The nurse is caring for a client immediately following a cardiac catheterization. Which assessment data require immediate nursing intervention? A. Blood pressure 146/70 mm Hg B. Hematoma developing at insertion site C. Client reports headache pain D. Client reports extreme thirst
B. Hematoma developing at insertion site
The nurse is assessing a client with heart failure. Which assessment data are the best indicator of fluid balance? A. Blood pressure 144/79 mm Hg B. Urine output 200 mL in the last 4 hours C. Weight increase of 9 lb in the past week D. Generalized edema in the lower extremities
C. Weight increase of 9 lb in the past week
Which assessment data will the nurse associate with suspected pericarditis? (Select all that apply.) -Squeezing, vise-like chest pain. -Chest pain relieved by sitting upright. -Chest and abdominal pain relieved by antacids. -Sudden-onset chest pain relieved by anti-inflammatory agents. -Pain in the chest described as sharp or stabbing.
Chest pain relieved by sitting upright. Sudden-onset chest pain relieved by anti-inflammatory agents. Pain in the chest described as sharp or stabbing. The chest pain of pericarditis is relieved when sitting upright or forward, may appear abruptly, and is relieved by anti-inflammatory agents. The inflammatory pain of pericarditis tends to be sharp, stabbing, and related to breathing.Squeezing, vise-like chest pain is characteristic of myocardial infarction. Chest and abdominal pain relieved by antacids is characteristic of peptic ulcer.
The client asks the nurse about modifiable risk factors for heart disease. What nursing response is appropriate? (Select all that apply.) -Cigarette smoking is one of the most significant modifiable risk factors. -Your personal health over the past 10 years a modifiable risk. -Diabetes mellitus is a modifiable risk factor. -Your overall body mass index is nonmodifiable. -Increasing physical exercise is a method to modify your risk.
Cigarette smoking is one of the most significant modifiable risk factors. Increasing physical exercise is a method to modify your risk. Modifiable risk factors are those risks that are controllable such as cigarette smoking, personal lifestyle, obesity, and psychological variables. Past history cannot be modified. Diabetes mellitus can be controlled but it a lifelong condition that is not considered modifiable. The body mass index (BMI) is an indicator of weight and can be modified.
A client with heart failure reports a 7.6-lb (3.4 kg) weight gain in the past week. What intervention does the nurse anticipate from the primary health care provider? -Dietary consult -Sodium restriction -Daily weight monitoring -Restricted activity
Daily weight monitoring The nurse expects that the primary health care provider will want the client's daily weights monitored. A sudden weight increase of 2.2 lb (1 kg) can result from excess fluid (1 L) in the interstitial spaces. The best indicator of fluid balance is weight. It is possible for weight gains of up to 10 to 15 lb (4.5 to 6.8 kg), or 4 to 7 L of fluid to occur before excess fluid accumulation (edema) is apparent.The weight change is most likely from excessive fluid, so a dietary consult, sodium restrictions, and restricted activity are not appropriate interventions.
The nurse is teaching a class on risk factors for cardiovascular disease. Which risk factors will the nurse include? (Select all that apply.) -Fiber-rich diet -Elevated C-reactive protein levels -Low blood pressure -Elevated high-density lipoprotein (HDL) level -Smoking history -Family history of heart disease -Decreased bone density -Diabetes Mellitus
Elevated C-reactive protein levels Smoking history Factors that contribute to the risk for cardiovascular disease include elevated C-reactive protein levels, smoking, diabetes mellitus, and family history of heart disease. Elevation in C-reactive protein, suggestive of inflammation, is a risk factor for atherosclerosis and cardiac disease. Smoking cessation must also be emphasized. Smoking is a major modifiable risk factor for cardiovascular disease. Cardiovascular disease does have a genetic component and a history of diabetes mellitus increases the risk for heart disease.A diet rich in fiber is not a risk factor for cardiovascular disease, but rather a desirable behavior. Hypertension, not low blood pressure, is a risk for cardiovascular disease. Elevated low-density lipoprotein cholesterol is a risk for atherosclerosis. Elevated HDL cholesterol is desirable and may be cardioprotective.
A client who is suffering from dyspnea on exertion and heart failure (HF) will most likely report which symptom during the health history? -Fatigue -Swelling of one leg -Slow heart rate -Brown discoloration of lower extremities
Fatigue The HF client with dyspnea on exertion will most likely report fatigue during the health history. Although fatigue in itself is not diagnostic of heart disease, many people with heart failure are limited by leg fatigue during exercise. Fatigue that occurs after mild activity and exertion usually indicates inadequate cardiac output (due to low stroke volume) and anaerobic metabolism in skeletal muscle.Unilateral swelling is more typical with a local finding such as deep vein thrombosis, not a systemic problem such as heart failure. Tachycardia, rather than bradycardia, develops with heart failure and decreased cardiac output. Brown discoloration of the lower extremities is indicative of long-standing venous stasis, such as occurs with varicose veins.
Which client has the highest risk for cardiovascular disease? -Man who smokes and whose father died at 49 of myocardial infarction (MI). -Woman with abdominal obesity who exercises three times per week. -Woman with diabetes whose high-density lipoprotein (HDL) cholesterol is 75 mg/dL (1.94 mmol/L). -Man who is sedentary and reports four episodes of strep throat.
Man who smokes and whose father died at 49 of myocardial infarction (MI). The client who has the highest risk for cardiovascular disease is the man who smokes and whose father died at 49 years of age of MI. Smoking is a major risk factor for MI, and family history is a stronger risk factor than hypertension, obesity, diabetes, or sudden cardiac death.Although abdominal obesity is a risk factor, exercising three times weekly is not. Diabetes is a major risk factor for MI, but an HDL cholesterol of 75 mg/dL (1.94 mmol/L) is in the optimal range of greater than 55 mg/dL (1.42 mmol/L). Sedentary lifestyle is a major risk factor; however, smoking and inherited risk combined make that a greater risk. Frequent strep infections may be associated with valvular disease rather than coronary artery disease.
Which action will the nurse delegate to experienced assistive personnel (AP) working in the cardiac catheterization laboratory? -Assess preprocedure medications the client took that day. -Have the client sign the consent form before the procedure is performed. -Educate the client about the need to remain on bedrest after the procedure. -Obtain client vital signs and a resting electrocardiogram (ECG).
Obtain client vital signs and a resting electrocardiogram (ECG). Checking vital signs and performing a 12-lead ECG can be delegated to the UAP.The primary health care provider will explain the catheterization procedure and have the client sign the consent form. Assessments and client teaching must be done by the RN.
A client recovering from cardiac angiography develops slurred speech. What will the nurse do first? -Maintain NPO status until the slurred speech resolves. -Call in another nurse for a second opinion. -Perform a neurologic assessment and notify the primary care provider. -Assess the site of the procedure for bleeding.
Perform a neurologic assessment and notify the primary care provider. The first action the nurse must do when a client recovering from a cardiac angiography develops slurred speech is to perform a complete neurologic assessment and notify the primary health care provider. Based on the assessment finding, the client probably is suffering a neurologic event, possibly a stroke. Neurologic changes such as visual disturbances, slurred speech, swallowing difficulties, and extremity weakness must be reported immediately for prompt intervention.Keeping the client NPO and waiting for symptoms to resolve are not appropriate. While the nurse can call for help from another nurse, this assessment does not warrant a second opinion and action is required immediately. While it is appropriate to assess the site of the procedure for bleeding, the slurred speech is not from bleeding at the site, rather it is likely a neurologic event so the priority is neurologic assessment.
The nurse is reviewing the medical record of a client admitted with heart failure. Which laboratory result warrants a call to the primary health care provider by the nurse for further instructions? -Calcium 8.5 mEq/L (4.25 mmol/L) -Potassium 3.0 mEq/L (3.0 mmol/L) -Magnesium 2.1 mEq/L (1 mmol/L) -International normalized ratio (INR) of 1.0
Potassium 3.0 mEq/L (3.0 mmol/L) The nurse needs to contact the primary health care provider when a potassium level of 3.0 mEq/L (3.0 mmol/L) is noticed on a client admitted with heart failure. Normal potassium is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Hypokalemia may predispose to the client to dysrhythmia, especially if the client is taking medications that deplete potassium (such as furosemide).A normal calcium level is 8.5 to 10.5 mEq/L (4.25 to 5 mmol/L). A normal magnesium level is 1.7 to 2.4 mEq/L (0.85 to 1.2 mmol/L). INR of 1.0 reflects a normal value.
The nurse is teaching a class about mechanical properties of the heart. What teaching will the nurse include? -Cardiac output is the amount of blood ejected by the ventricles during each contraction. -Preload is the degree of stretch in the myocardial fibers -Stroke volume is the amount of blood pumped out of the heart each minute. -Body size does not affect overall cardiac output.
Preload is the degree of stretch in the myocardial fibers Preload refers to the degree of myocardia fiber stretch at the end of diastole and just before contraction. Cardiac output is the amount of blood pumped from the left ventricle each minute (not with each contraction). Stroke volume is the amount of blood ejected by the left ventricle during each contraction (not each minute). Body size does affect the overall cardiac output. In adults, the cardiac output ranges from 3 to 6 L/min.
Which client assessment data is most consistent with cardiac pain requiring the nurse to notify the primary health care provider? -Reports of abdominal pain and belching -Reports of pressure in the upper abdomen and sternum and diaphoresis -Apparent dyspnea on exertion (DOE) and an inability to sleep flat -Reports claudication with ambulation and fatigue
Reports of pressure in the upper abdomen and sternum and diaphoresis The client with pain most consistent with an MI is the client with pressure in the mid-abdomen and diaphoresis. Typical symptoms of MI include chest pain or pressure, ashen skin color, diaphoresis, and anxiety.Although atypical cardiac pain can be perceived in the abdomen, abdominal pain and belching are more typical of peptic ulcer. DOE and orthopnea are typical problems for clients with heart failure. Claudication (pain in the legs with exercise or at rest) is symptomatic of peripheral arterial occlusive disease.
Which assessment data is most important for the nurse to report to the primary care provider prior to a coronary arteriogram? -The client reports intermittent substernal chest pain for 6 months. -The client develops wheezes and dyspnea after eating crab or lobster. -The client reports that a previous arteriogram was negative for coronary artery disease. -The client has peripheral vascular disease, and the dorsalis pedis pulses are difficult to palpate.
The client develops wheezes and dyspnea after eating crab or lobster. The most important information the nurse needs to report to the primary health care provider before a coronary arteriogram is that the client develops wheezes and dyspnea after eating crab or lobster. The contrast agent injected into the coronary arteries during the arteriogram is iodine based. The client with a shellfish allergy is likely to have an allergic reaction to the contrast and must be medicated with an antihistamine or a steroid before the procedure.The reason the client is having the procedure is to determine whether atherosclerotic plaque obstructing the coronary arteries is the underlying cause of the chest pain. The intermittent substernal chest pain does not need to be reported to the provider. The provider does not need information about the previous arteriogram at this time. It is appropriate to know that, but does not change the current need for the procedure. The nurse will palpate the distal pulses after the procedure. The pulses can be assessed with a Doppler device and marked in ink. Therefore, this information is not needed before the procedure is performed.
Which laboratory finding is consistent with acute coronary syndrome (ACS)? -Troponin 3.2 ng/mL (3.2 mcg/L) -C-reactive protein 13 mg/dL (130 mg/L) -Triglycerides 400 mg/dL (4.52 mmol/L) -Lipoprotein-a 18 mg/dL (0.64 mcmol/L)
Troponin 3.2 ng/mL (3.2 mcg/L) Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).Normal C-reactive protein would be less than 1 mg/dL (10 mg/L). This tests for risk for coronary artery disease (CAD), not ACS. Normal triglycerides would be 35 to 135 mg/dL (0.40 to 1.50 mmol/L) for females and 40 to 160 mg/dL (0.45 to 1.81 mmol/L) for males. This tests for risk for CAD, not ACS. Normal lipoprotein-a is less than 30 mg/dL (1.07 mcmol/L). This also tests for risk for CAD, not ACS.
A client has been admitted to the hospital with chest pain radiating down the left arm. Which test result best confirms that the client sustained a myocardial infarction (MI)? -C-reactive protein of 1 mg/dL (10 mg/L) -Homocysteine level of 13 mcmol/L -Creatine kinase (CK) of 125 units/L -Troponin of 5.2 ng/mL (5.2 mcg/L)
Troponin of 5.2 ng/mL (5.2 mcg/L) The test results that best confirm that this client sustained a MI is a troponin of 5.2 ng/mL (5.2 mcg/L). The presence of elevated troponin indicates myocardial damage. Normal troponin would be less than 0.03 ng/mL (0.03 mcg/L).A C-reactive protein level lower than 1 mg/dL (10 mg/L) is optimal for identifying inflammation and risk for heart disease. A homocysteine level lower than 12 mcmol/L is optimal, but elevation indicates risk, not myocardial damage. CK totals must be broken down into isoenzyme MB to evaluate for heart damage. Elevations in the CK total may be caused by stroke or skeletal muscle damage.
The nurse is assessing a client with mitral stenosis who is to undergo a transesophageal echocardiogram (TEE) today. Which nursing action is essential? -Auscultate the client's precordium for murmurs. -Teach the client about the reason for the TEE. -Reassure the client that they will not feel pain. -Validate that the client has remained NPO.
Validate that the client has remained NPO. The essential nursing action the nurse must take is to validate that the client scheduled for a TEE has remained NPO. Owing to the risk for aspiration, the client must be NPO before the procedure.It is anticipated that the client with mitral stenosis may have an audible murmur, so auscultation is not essential at this time. Although teaching is important, the client could undergo the procedure without understanding the reason for the test. The client will have sedation during the test as it is uncomfortable. However, with sedation, the goal is to maintain client comfort during the procedure.
The nurse is educating a group of women about the differences in symptoms of myocardial infarction (MI) in men versus women. Which teaching will the nurse include? -Men do not tend to report chest pain. -Men are more likely than women to die after MI. -Men more than women tend to deny the importance of symptoms. -Women may experience extreme fatigue and dizziness as sole symptoms.
Women may experience extreme fatigue and dizziness as sole symptoms. The differences in symptoms of MI in men versus women are that women may experience extreme fatigue and dizziness as sole symptoms. Women may have atypical symptoms, including absence of chest pain. Women often present with a "triad" of symptoms. In addition to indigestion or a feeling of abdominal fullness, chronic fatigue despite adequate rest and feeling an inability to "catch the breath" (dyspnea) are also common in heart disease. The client may also describe the sensation as aching, choking, strangling, tingling, squeezing, constricting, or vise-like.Men do report chest pain. Women have higher mortality from MI than men. Because of differences in symptoms, denial may occur more often in women.
