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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

491

Chapter25:AssessmentofCardiovascularFunction  1.

Anurseisdescribingtheprocessbywhichbloodisejectedintocirculationasthechambersoftheheart becomesmaller.Theinstructorcategorizesthisactionoftheheartaswhat?

A)

Systole

B)

Diastole

C)

Repolarization

D)

Ejectionfraction

Ans:

A Feedback: Systoleistheactionofthechambersoftheheartbecomingsmallerandejectingblood.Thisactionofthe heartisnotdiastole(relaxations),ejectionfraction(theamountofbloodexpelled),orrepolarization (electricalcharging).

2.

Duringashiftassessment,thenurseisidentifyingtheclientspointofmaximumimpulse(PMI).Where willthenursebestpalpatethePMI?

A)

Leftmidclavicularlineofthechestatthelevelofthenipple

B)

Leftmidclavicularlineofthechestatthefifthintercostalspace

C)

Midlinebetweenthexiphoidprocessandtheleftnipple

D)

Twotothreecentimeterstotheleftofthesternum

Ans:

B Feedback: Theleftventricleisresponsiblefortheapicalbeatorthepointofmaximumimpulse,whichisnormally palpatedintheleftmidclavicularlineofthechestwallatthefifthintercostalspace.

3.

A)

Thenurseiscalculatingacardiacpatientspulsepressure.Ifthepatientsbloodpressureis122/76mm Hg,whatisthepatientspulsepressure? 46mmHg

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

99mmHg

C)

198mmHg

D)

76mmHg

Ans:

A

492

Feedback: Pulsepressureisthedifferencebetweenthesystolicanddiastolicpressure.Inthiscase,thisvalueis46 mmHg. 4.

Thenurseiscaringforapatientadmittedwithunstableangina.Thelaboratoryresultfortheinitial troponinIiselevatedinthispatient.Thenurseshouldrecognizewhatimplicationofthisassessment finding?

A)

Thisisonlyanaccurateindicatorofmyocardialdamagewhenitreachesitspeakin24hours.

B)

Becausethepatienthasahistoryofunstableangina,thisisapoorindicatorofmyocardialinjury.

C)

Thisisanaccurateindicatorofmyocardialinjury.

D)

Thisresultindicatesmuscleinjury,butdoesnotspecifythesource.

Ans:

C Feedback: TroponinI,whichisspecifictocardiacmuscle,iselevatedwithinhoursaftermyocardialinjury.Even withadiagnosisofunstableangina,thisisanaccurateindicatorofmyocardialinjury.

5.

Thenurseisconductingpatientteachingaboutcholesterollevels.Whendiscussingthepatientselevated LDLandloweredHDLlevels,thepatientshowsanunderstandingofthesignificanceoftheselevelsby statingwhat?

A)

IncreasedLDLanddecreasedHDLincreasemyriskofcoronaryarterydisease.

B)

IncreasedLDLhasthepotentialtodecreasemyriskofheartdisease.

C)

ThedecreasedHDLlevelwillincreasetheamountofcholesterolmovedawayfromtheartery walls.

D)

TheincreasedLDLwilldecreasetheamountofcholesteroldepositedonthearterywalls.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

493

A Feedback: ElevatedLDLlevelsanddecreasedHDLlevelsareassociatedwithagreaterincidenceofcoronary arterydisease.

6.

Thephysicianhasplacedacentralvenouspressure(CVP)monitoringlineinanacutelyillpatientso rightventricularfunctionandvenousbloodreturncanbecloselymonitored.Theresultsshowdecreased CVP.Whatdoesthisindicate?

A)

Possiblehypovolemia

B)

Possiblemyocardialinfarction(MI)

C)

Left-sidedheartfailure

D)

Aorticvalveregurgitation

Ans:

A Feedback: HypovolemiamaycauseadecreasedCVP.MI,valveregurgitationandheartfailurearelesslikely causesofdecreasedCVP.

7.

Whileauscultatingapatientsheartsounds,thenursehearsanextraheartsoundimmediatelyafterthe secondheartsound(S2).AnaudibleS3wouldbeconsideredanexpectedfindinginwhatpatient?

A)

Anolderadult

B)

A20-year-oldpatient

C)

Apatientwhohasundergonevalvereplacement

D)

Apatientwhotakesabeta-adrenergicblocker

Ans:

B Feedback: S3representsanormalfindinginchildrenandadultsupto35or40yearsofage.Inthesecases,itis calledaphysiologicS3.Itisanabnormalfindinginapatientwithanartificialvalve,anolderadult,ora patientwhotakesabetablocker.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

8.

494

Thephysicaltherapistnotifiesthenursethatapatientwithcoronaryarterydisease(CAD)experiencesa muchgreater-than-averageincreaseinheartrateduringphysicaltherapy.Thenurserecognizesthatan increaseinheartrateinapatientwithCADmayresultinwhat?

A)

Developmentofanatrial-septaldefect

B)

Myocardialischemia

C)

Formationofapulmonaryembolism

D)

Releaseofpotassiumionsfromcardiaccells

Ans:

B Feedback: Unlikeotherarteries,thecoronaryarteriesareperfusedduringdiastole.Anincreaseinheartrate shortensdiastoleandcandecreasemyocardialperfusion.Patients,particularlythosewithCAD,can developmyocardialischemia.Anincreaseinheartratewillnotusuallyresultinapulmonaryembolism orcreateelectrolyteimbalances.Atrial-septaldefectsarecongenital.

9.

Thenurseiscaringforapatientwhohasahistoryofheartdisease.Whatfactorshouldthenurseidentify aspossiblycontributingtoadecreaseincardiacoutput?

A)

Achangeinpositionfromstandingtositting

B)

Aheartrateof54bpm

C)

Apulseoximetryreadingof94%

D)

Anincreaseinpreloadrelatedtoambulation

Ans:

B Feedback: Cardiacoutputiscomputedbymultiplyingthestrokevolumebytheheartrate.Cardiacoutputcanbe affectedbychangesineitherstrokevolumeorheartrate,suchasarateof54bpm.Anincreasein preloadwillleadtoanincreaseinstrokevolume.Apulseoximetryreadingof94%doesnotindicate hypoxemia,ashypoxiacandecreasecontractility.Transitioningfromstandingtosittingwouldmore likelyincreaseratherthandecreasecardiacoutput.

10. Thenurseiscaringforan82-year-oldpatient.Thenurseknowsthatchangesincardiacstructureand functionoccurinolderadults.Whatisanormalchangeexpectedintheagingheartofanolderadult?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Decreasedleftventricularejectiontime

B)

DecreasedconnectivetissueintheSAandAVnodesandbundlebranches

C)

Thinningandflaccidityofthecardiacvalues

D)

Wideningoftheaorta

Ans:

D

495

Feedback: Changesincardiacstructureandfunctionareclearlyobservableintheagingheart.Agingresultsin decreasedelasticityandwideningoftheaorta,thickeningandrigidityofthecardiacvalves,increased connectivetissueintheSAandAVnodesandbundlebranches,andanincreasedleftventricularejection time(prolongedsystole). 11. Aresidentofalong-termcarefacilityhascomplainedtothenurseofchestpain.Whataspectofthe residentspainwouldbemostsuggestiveofanginaasthecause? A)

Thepainisworsewhentheresidentinhalesdeeply.

B)

Thepainoccursimmediatelyfollowingphysicalexertion.

C)

Thepainisworsewhentheresidentcoughs.

D)

Thepainismostseverewhentheresidentmoveshisupperbody.

Ans:

B Feedback: Chestpainassociatedwithanginaisoftenprecipitatedbyphysicalexertion.Theotherlistedaspectsof chestpainaremorecloselyassociatedwithnoncardiacetiologies.

12. Thecriticalcarenurseiscaringforapatientwithacentralvenouspressure(CVP)monitoringsystem. ThenursenotesthatthepatientsCVPisincreasing.Ofwhatmaythisindicate? A)

Psychosocialstress

B)

Hypervolemia

C)

Dislodgmentofthecatheter

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Hypomagnesemia

Ans:

B

496

Feedback: CVPisausefulhemodynamicparametertoobservewhenmanaginganunstablepatientsfluidvolume status.Anincreasingpressuremaybecausedbyhypervolemiaorbyacondition,suchasheartfailure, thatresultsindecreasedmyocardialcontractility.Stress,dislodgementofthecatheter,andlow magnesiumlevelswouldnottypicallyresultinincreasedCVP. 13. Thecriticalcarenurseiscaringforapatientwithapulmonaryarterypressuremonitoringsystem.The nurseisawarethatpulmonaryarterypressuremonitoringisusedtoassessleftventricularfunction.What isanadditionalfunctionofpulmonaryarterypressuremonitoringsystems? A)

Toassessthepatientsresponsetofluidanddrugadministration

B)

Toobtainspecimensforarterialbloodgasmeasurements

C)

Todislodgepulmonaryemboli

D)

Todiagnosetheetiologyofchronicobstructivepulmonarydisease

Ans:

A Feedback: Pulmonaryarterypressuremonitoringisanimportanttoolusedincriticalcareforassessingleft ventricularfunction(cardiacoutput),diagnosingtheetiologyofshock,andevaluatingthepatients responsetomedicalinterventions,suchasfluidadministrationandvasoactivemedications.Pulmonary arterymonitoringispreferredforthepatientwithheartfailureovercentralvenouspressuremonitoring. Arterialcathetersareusefulwhenarterialbloodgasmeasurementsandbloodsamplesneedtobe obtainedfrequently.Neitherinterventionisusedtoclearpulmonaryemboli.

14. Thecardiaccarenurseisreviewingtheconductionsystemoftheheart.Thenurseisawarethatelectrical conductionoftheheartusuallyoriginatesintheSAnodeandthenproceedsinwhatsequence? A)

SAnodetobundleofHistoAVnodetoPurkinjefibers

B)

SAnodetoAVnodetoPurkinjefiberstobundleofHis

C)

SAnodetobundleofHistoPurkinjefiberstoAVnode

D)

SAnodetoAVnodetobundleofHistoPurkinjefibers

Ans:

D

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

497

Feedback: ThenormalelectrophysiologicalconductionrouteisSAnodetoAVnodetobundleofHIStoPurkinje fibers. 15. Apatienthashadamyocardialinfarctionandhasbeendiagnosedashavingdamagetothelayerofthe heartresponsibleforthepumpingaction.Youareawarethatthedamageoccurredwhere? A)

Endocardium

B)

Pericardium

C)

Myocardium

D)

Visceralpericardium

Ans:

C Feedback: Themyocardiumisthelayeroftheheartresponsibleforthepumpingaction.

16. Thenurseworkingonacardiaccareunitiscaringforapatientwhosestrokevolumehasincreased.The nurseisawarethatafterloadinfluencesapatientsstrokevolume.Thenurserecognizesthatafterloadis increasedwhenthereiswhat? A)

Arterialvasoconstriction

B)

Venousvasoconstriction

C)

Arterialvasodilation

D)

Venousvasodilation

Ans:

A Feedback: Arterialvasoconstrictionincreasesthesystemicvascularresistance,whichincreasestheafterload. Venousvasoconstrictiondecreasespreloadtherebydecreasingstrokevolume.Venousvasodilation increasespreload.

17. Anurseispreparingapatientforscheduledtransesophagealechocardiography.Whatactionshouldthe nurseperform?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Instructthepatienttodrink1literofwaterbeforethetest.

B)

AdministerIVbenzodiazepinesandopioids.

C)

Informthepatientthatshewillremainonbedrestfollowingtheprocedure.

D)

Informthepatientthatanaccesslinewillbeinitiatedinherfemoralartery.

Ans:

C

498

Feedback: Duringtherecoveryperiod,thepatientmustmaintainbedrestwiththeheadofthebedelevatedto45 degrees.ThepatientmustbeNPO6hourspreprocedure.Thepatientissedatedtomakehimorher comfortable,butwillnotbeheavilysedated,andopioidsarenotnecessary.Also,thepatientwillhavea peripheralIVlineinitiatedpreprocedure. 18. Thenurseiscaringforapatientadmittedwithanginawhoisscheduledforcardiaccatheterization.The patientisanxiousandasksthereasonforthistest.Whatisthebestresponse? A)

Cardiaccatheterizationisusuallydonetoassesshowblockedoropenapatientscoronaryarteries are.

B)

Cardiaccatheterizationismostcommonlydonetodetecthowefficientlyapatientsheartmuscle contracts.

C)

Cardiaccatheterizationisusuallydonetoevaluatecardiovascularresponsetostress.

D)

Cardiaccatheterizationismostcommonlydonetoevaluatecardiacelectricalactivity.

Ans:

A Feedback: Cardiaccatheterizationisusuallyusedtoassesscoronaryarterypatencytodetermineifrevascularization proceduresarenecessary.Athalliumstresstestshowsmyocardialischemiaafterstress.AnECGshows theelectricalactivityoftheheart.

19. ThecriticalcarenurseiscaringforapatientwhohashadanMI.Thenurseshouldexpecttoassistwith establishingwhathemodynamicmonitoringproceduretoassessthepatientsleftventricularfunction? A)

Centralvenouspressure(CVP)monitoring

B)

Pulmonaryarterypressuremonitoring(PAPM)

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Systemicarterialpressuremonitoring(SAPM)

D)

Arterialbloodgases(ABG)

Ans:

B

499

Feedback: PAPMisusedtoassessleftventricularfunction.CVPisusedtoassessrightventricularfunction;SAPM isusedforcontinualassessmentofBP.ABGareusedtoassessforacidicandalkaloticlevelsinthe blood. 20. AcriticallyillpatientisadmittedtotheICU.Thephysiciandecidestouseintra-arterialpressure monitoring.Afterthisinterventionisperformed,whatassessmentshouldthenurseprioritizeintheplan ofcare? A)

Fluctuationsincorebodytemperature

B)

Signsandsymptomsofesophagealvarices

C)

Signsandsymptomsofcompartmentsyndrome

D)

Perfusiondistaltotheinsertionsite

Ans:

D Feedback: Theradialarteryistheusualsiteselected.However,placementofacatheterintotheradialarterycan furtherimpedeperfusiontoanareathathaspoorcirculation.Asaresult,thetissuedistaltothe cannulatedarterycanbecomeischemicornecrotic.Vigilantassessmentisthusnecessary.Alterationsin temperatureandthedevelopmentofesophagealvaricesorcompartmentsyndromearenothighrisks.

21. Thenurseiscaringforanacutelyillpatientwhohascentralvenouspressuremonitoringinplace.What interventionshouldbeincludedinthecareplanofapatientwithCVPinplace? A)

Applyantibioticointmenttotheinsertionsitetwicedaily.

B)

Changethesitedressingwheneveritbecomesvisiblysoiled.

C)

Performpassiverange-of-motionexercisestopreventvenousstasis.

D)

AspiratebloodfromthedeviceoncedailytotestpH.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

500

B Feedback: Gauzedressingsshouldbechangedevery2daysortransparentdressingsatleastevery7daysand wheneverdressingsbecomedamp,loosened,orvisiblysoiled.PassiveROMexerciseisnotindicated anditisunnecessaryandinappropriatetoaspiratebloodtotestitforpH.Antibioticointmentsare contraindicated.

22. ApatientisbroughtintotheEDbyfamilymemberswhotellthenursethepatientgrabbedhischestand complainedofsubsternalchestpain.Thecareteamrecognizestheneedtomonitorthepatientscardiac functioncloselywhileinterventionsareperformed.Whatformofmonitoringshouldthenurse anticipate? A)

Left-sidedheartcatheterization

B)

Cardiactelemetry

C)

Transesophagealechocardiography

D)

HardwirecontinuousECGmonitoring

Ans:

D Feedback: TwotypesofcontinuousECGmonitoringtechniquesareusedinhealthcaresettings:hardwirecardiac monitoring,foundinEDs,criticalcareunits,andprogressivecareunits;andtelemetry,foundingeneral nursingcareunitsoroutpatientcardiacrehabilitationprograms.Cardiaccatheterizationand transesophagealechocardiographywouldnotbeusedinemergentsituationstomonitorcardiacfunction.

23. Thenurseisperforminganintakeassessmentonapatientwithanewdiagnosisofcoronaryartery disease.Whatwouldbethemostimportantdeterminationtomakeduringthisintakeassessment? A)

Whetherthepatientandinvolvedfamilymembersunderstandtheroleofgeneticsintheetiologyof thedisease

B)

Whetherthepatientandinvolvedfamilymembersunderstanddietarychangesandtheroleof nutrition

C)

Whetherthepatientandinvolvedfamilymembersareabletorecognizesymptomsofanacute cardiacproblemandrespondappropriately

D)

Whetherthepatientandinvolvedfamilymembersunderstandtheimportanceofsocialsupportand communityagencies

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

501

C Feedback: Duringthehealthhistory,thenurseneedstodetermineifthepatientandinvolvedfamilymembersare abletorecognizesymptomsofanacutecardiacproblem,suchasacutecoronarysyndrome(ACS)orHF, andseektimelytreatmentforthesesymptoms.Eachoftheotherlistedtopi...