Deck 31: Nursing Care of Patients with Cardiac Disorders

Question 1

The nurse is assessing a patient who is demonstrating dyspnea, orthopnea, cyanosis, clammy skin, a productive cough with pink, frothy sputum, and crackles. The nurse realizes that the patient likely has which of the following conditions?

A)chronic heart failure
B)pulmonary edema
C)endocarditis
D)angina

Answer 1

pulmonary edema

Question 2

Blood tests are ordered for a patient who is diagnosed with possible congestive heart failure (CHF). The nurse understands which of the following lab tests indicates heart failure? The most specific test(s) to accurately indicate CHF would be which of the following?

A)liver function
B)urinalysis and blood urea nitrogen (BUN)
C)brain natriuretic peptide (BNF).
D)serum electrolytes

Answer 2

brain natriuretic peptide (BNF).

Question 3

An elderly patient was recently discharged to home after treatment for chronic heart failure. The patient experiences a pulse rate increase from 80 beats per minute (bpm) to 102 bpm when walking from the kitchen to the utility room to do laundry. Which of the following are appropriate nursing actions for the home health nurse?

A)Encourage the patient to complete tasks such as laundry early in the morning before fatigue is an issue.
B)Recommend that the patient ignore the pulse rate and become more active to build stamina.
C)Encourage the patient to rest for 30 minutes between completing each load of laundry.
D)Encourage the patient to rest on a chair in the utility room and sit and rest when the patient feels his pulse rate increase.

Answer 3

Encourage the patient to rest on a chair in the utility room and sit and rest when the patient feels his pulse rate increase.

Question 4

The nurse is caring for a patient who has invasive hemodynamic monitoring. The highest priority of care for this patient is which of the following?

A)Prevent infection at the catheter site by changing the dressing as prescribed.
B)Set alarm limits and turn monitor alarms on.
C)Explain to family members why the monitoring is in use.
D)Coil IV tubing on the bed.

Question 5

A nurse caring for a patient with coronary artery disease hears a murmur during auscultation of the heart. The nurse suspects the a patient has which of the following?

A)valvular heart disease
B)pericarditis
C)cardiac tamponade
D)heart failure

Question 6

The nurse would assess which of the following as clinical signs and symptoms of pericarditis? Select all that apply.

A)pericardial friction rub
B)abdominal discomfort and nausea
C)chest pain
D)bradycardia
E)distended neck veins

Question 7

The nurse is caring for a patient in the critical care area whose fluid volume status needs to be assessed closely. The most likely type of monitoring that will be used is which of the following?

A)arterial pressure monitoring
B)pulmonary artery pressure monitoring
C)central venous pressure monitoring
D)intra-aortic balloon pump monitoring

Question 8

The nurse, caring for a patient diagnosed with cardiac tamponade, realizes treatment would be with which of the following?

A)antidysrhythmic drugs and oxygen
B)oxygen and rest
C)pericardiocentesis
D)antibiotics

Question 9

A pulmonary artery (PA) catheter is used in critical care patients who

A)cannot tolerate hemodynamic monitoring.
B)requires a peripheral intravenous catheter for medication administration.
C)would benefit from having the right ventricle pressures measured each shift.
D)requires evaluation of left ventricular pressures each shift.

Question 10

A nurse caring for a patient with heart failure would expect to find which of the following during assessment of the patient?

A)S1, S2 and flat neck veins
B)S3 and distended neck veins
C)S2 is heard the loudest and followed by S1
D)S4 and flat neck veins

Question 11

The nurse is assessing a patient with chronic heart failure. Which abnormal chest sound would the nurse most likely auscultate?

A)expiratory wheezes
B)friction rub
C)harsh vesicular
D)crackles

Question 12

The nurse should instruct a patient who is prescribed digoxin (Lanoxin) on which of the following information?

A)How to manage nausea that can be associated with taking digoxin.
B)Foods that should be eaten while taking this drug.
C)Do not take the medication and to not take it if the pulse is under 60 beats per minute.
D)Checking the pulse for one minute each day and recording the result on a notepad.

Question 13

The priority nursing action the nurse would implement for the patient who is admitted with pulmonary edema would be to do which of the following?

A)Insert a peripheral intravenous catheter.
B)Seek a prescription to medicate the patient for comfort.
C)Monitor the blood glucose level.
D)Place a pulse oximeter and administer oxygen.

Question 14

The patient in the critical care area has an invasive hemodynamic pressure monitoring line. This position should be marked on the chest wall as a consistent reference point for calibrating and leveling. Indicate on the diagram below, where the chest should be marked by placing an "X" at the appropriate reference point.

Question 15

The nurse recognizes which of the following as a sign of decreased cardiac output and tissue perfusion in a patient with heart failure?

A)decreased mental alertness
B)increased urine output
C)abdominal distention
D)strong peripheral pulses

Question 16

A patient is admitted with acute heart failure. The nurse realizes that acute heart failure is associated with an abrupt onset of which of the following? Select all that apply.

A)cardiomyopathy
B)heart valve disease
C)coronary heart disease (CHD)
D)massive infarction (MI))
E)myocardial injury

Question 17

When caring for a chronic heart failure patient with left-sided failure, the nurse would most likely note the following statement in the physician's written report following cardiac catheterization?

A)"Pressures in the left ventricle and atrium are increased."
B)"Pressures in the left ventricle and atrium are decreased."
C)"Pressures in the right ventricle and atrium match the ventricle pressures."
D)"Pressures in the right ventricle reflect functioning of all heart chambers."

Question 18

When obtaining the health history of a patient who is being assessed for possible congestive heart failure, it is significant when the patient says which of the following?

A)"I break out in a cold sweat when I eat a large meal."
B)"I am sleepy after I eat lunch each day."
C)"I have to prop myself up on three pillows to sleep at night, otherwise I can't breathe."
D)"I feel better with my legs down when I sit in my favorite chair."

Question 19

Which of the following is important to consider when caring for patients with possible endocarditis?

A)Endocarditis does not pose a high risk for damage to affected heart valves.
B)Patients with this disorder can be treated by open heart surgery to clean the heart valves.
C)The condition is unrelated to fever so medicate patients with the prescribed antipyretic and observe.
D)Endocarditis can be prevented in patients at risk by administering antibiotics prior to procedures.

Question 20

The nurse realizes that a patient is experiencing paroxysmal nocturnal dyspnea (PND) when which of the following is assessed? Select all that apply.

A)Symptoms occur at night
B)pulmonary congestion
C)improving cardiac reserve
D)voiding more than one time per night
E)daytime peripheral edema

Question 21

A patient is being started on enalapril (Vasotec). The most common complaint from patients who routinely take this medication is which of the following?

A)increased thirst
B)reduced urine output
C)persistent cough
D)sore throat

Question 22

Which of the following patients should the nurse assess first?

A)the patient with occasional chest pain who has recently been diagnosed with gallbladder disease
B)the elderly patient with heart failure who was admitted with increasing edema of the lower extremities
C)the newly admitted patient complaining of substernal chest pain.Patient has recently had a father die from heart disease
D)the patient complaining of chest pain and is hyperventilating after a family member leaves the room following an argument

Question 23

A patient, newly diagnosed with heart failure, is prescribed 40 mg of furosemide (Lasix) to be given IV push. Knowing that the patient is also prescribed digoxin (Lanoxin), the nurse should review which laboratory result?

A)sodium level
B)digoxin level
C)creatinine level
D)potassium level

Question 24

Home care teaching is being completed by the nurse for a patient recovering from rheumatic fever. Which of the following statements by the patient would indicate that the teaching has been effective?

A)"I will be sure to tell my dentist that I had rheumatic fever."
B)"I will try to focus on eating less protein and more fat, so I will have more energy."
C)"I will avoid brushing my teeth so often and quit using mouth rinse since I have gingivitis."
D)"I know that if my joints start to hurt again, I need to slow down, but I won't have to worry since I'm immune to getting rheumatic fever again."

Question 25

The nurse realizes that which of the following persons are at risk for high-output heart failure?

A)a patient with chronic anemia
B)a person with untreated hypertension
C)an individual with untreated hypothyroidism
D)someone who abuses sedatives and analgesics

Question 26

The nurse suspects that a patient is experiencing the effects of peripheral atherosclerosis. Which of the following did the nurse most likely assess in this patient?

A)rubor with extremity elevation
B)normal hair distribution bilaterally over lower extremities
C)peripheral pulses present bilaterally
D)complaints of leg pain upon rest

Question 27

A patient with endocarditis develops sudden leg pain with pallor, tingling, and a loss of peripheral pulses. The initial nursing intervention should be to do which of the following?

A)Notify the physician about these findings.
B)Elevate the leg above the level of the heart.
C)Wrap the extremity in a loose, warm blanket.Apply a foot cradle.
D)Perform passive range of motion (PROM) exercises to stimulate circulation.

Question 28

A patient is admitted with acute pericarditis. When auscultating heart sounds, the nurse should ask the patient to do which of the following?

A)Sit, lean forward, and auscultate at the left lower sternal border.
B)Lay supine and breathe quietly while auscultating for expiratory wheezes.
C)Sit upright and auscultate the outer aspects of the upper lobes for vesicular breath sounds.
D)Sit, lean forward, and auscultate at the second right intercostal space, near the sternal border.

Question 29

The nurse is instructing a patient with hypertension about lifestyle modifications. Which of the following would be appropriate to include in the teaching for this patient? Select all that apply.

A)Review the DASH diet.
B)Begin a walking program, and progress to 30 minutes 5 to 6 days each week.
C)Plan a weight lifting regimen.
D)Eliminate dairy products from the diet.
E)Restrict fluid intake.

Question 30

An elderly patient arrives at the clinic complaining of dyspnea, weight gain, chest pain, and increasing edema of the lower extremities. The patient's blood pressure is elevated. The nurse discovers the patient has a history of heart failure. Which of the following questions by the nurse may best help with determining why the patient is currently having health problems?

A)"Are you married?"
B)"Have you been out of the country lately?"
C)"Do you have grandchildren that you babysit?"
D)"Have you attended any recent family or social gatherings?"

Question 31

A patient is demonstrating signs of ineffective peripheral tissue perfusion. Which of the following interventions would be appropriate for this patient?

A)Encourage patient to reduce level of exercise.
B)Discuss smoking cessation techniques.
C)Keep extremities cool.
D)Assist with pillow placement under knees.

Question 32

A patient is being discharged from the healthcare facility following surgical replacement of a mitral valve with a mechanical valve. The patient asks the nurse how much longer he will need to take warfarin (Coumadin). What is the nurse's best response?

A)"You will be on it for the rest of your life because you have a mechanical valve."
B)"That will depend upon your surgeon.Ask him when you go to your office visit."
C)"You will be on it for the rest of your life because you have a biologic tissue valve."
D)"You will be told when to stop, which means your mechanical prosthetic valve is probably healed and there is minimal risk of clots."

Question 33

The nurse measures a patient's blood pressure as 144/88 mmHg. Which of the following interventions would be most appropriate for this patient?

A)Provide stress-reduction techniques.
B)Inform the physician so antihypertensive medication can be prescribed.
C)Offer the patient a glass of water.
D)Remeasure the blood pressure in a few minutes.

Question 34

The nurse, caring for an elderly patient, realizes that aging adults are at higher risk for development of heart failure due to which of the following? Select all that apply.

A)impaired diastolic filling
B)increased cardiac reserve
C)increased maximal heart rate
D)decreased ventricular compliance
E)high responsiveness to sympathetic nervous system stimulation

Question 35

A patient is having segmental pressure measurements conducted to help diagnose peripheral vascular disease. Which of the following would indicate the presence of this disorder?

A)thigh pressure higher than the arm
B)calf pressure higher than the arm
C)calf pressure lower than the arm
D)no difference between the arm or leg

Question 36

The nurse suspects a patient who is recovering from an abdominal aortic aneurysm repair is experiencing graft leaking. Which of the following are indications of this event? Select all that apply.

A)urine output 45 mL/hr
B)complaint of groin pain
C)abdominal dressing dry and intact
D)respiratory rate 16 and regular
E)complaint of back discomfort

Question 37

A patient's blood pressure continues to be elevated despite being prescribed an ACE inhibitor for several weeks. Which of the following would be most appropriate for the nurse to do at this time?

A)Ask if the patient is taking the prescribed medication.
B)Suggest to the physician that another medication be added.
C)Schedule the patient to have the blood pressure checked again in a week.
D)Realize the patient is anxious because of the diagnosis.

Question 38

During the abdominal assessment of an elderly patient, the nurse palpates a mass in the mid-abdomen. Which of the following should the nurse do next?

A)Percuss the mass.
B)Ask the patient to cough.
C)Notify the physician.
D)Auscultate the mass.

Question 39

The nurse caring for patients on a cardiac unit should plan to see which of the following assigned patients first?

A)a patient with hypertrophic cardiomyopathy who is reporting dyspnea
B)a patient who had a cardiac catheterization and will be ambulating for the first time
C)a patient receiving antibiotics for bacterial endocarditis who is reporting anxiety and chest pain
D)a patient who is recovering from coronary artery bypass grafting (CABG) surgery with a temperature of 101° F.

Question 40

A patient with diabetes is beginning treatment for hypertension. The nurse shares with the patient that a desirable blood pressure would be which of the following?

A)140/90 mmHg
B)135/85 mmHg
C)130/80 mmHg
D)120/80 mmHg

Question 41

A patient is seen for increasing edema in his left lower extremity, erythema, and pain in the limb with ambulation. Which of the following disorders do these symptoms suggest?

A)arterial occlusion
B)deep vein thrombosis
C)superficial vein thrombosis (SVT)
D)varicose veins

Question 42

A patient who is being treated for a deep vein thrombosis (DVT) complains of chest pain and shortness of breath. Which of the following should the nurse do first?

A)Elevate the head of the bed and begin oxygen therapy.
B)Obtain a 12-lead EKG and notify the physician.
C)Measure the patient's blood pressure.
D)Assess the extremity with the thrombosis and heart sounds.
E)Assess the pulses on the extremity with the thrombosis and check the PT/INR level .

Question 43

The nurse is preparing to assess a patient's hematologic, peripheral vascular, and lymphatic systems. Which of the following assessment techniques is not typically utilized for this assessment?

A)inspection.
B)palpation
C)percussion
D)auscultation

Question 44

A patient is diagnosed with thromboangiitis obliterans. Appropriate teaching for this patient includes which of the following?

A)Medications are the only cure.
B)Surgical procedures can be performed to cure this disorder.
C)Management depends upon the patient's willingness to stop smoking.
D)Management strategies have no effect on disorder.

Question 45

A patient is being discharged on long-term oral anticoagulant therapy for arterial thrombus formation in the lower extremity. Which of the following should be included in this patient's discharge instructions?

A)Slight bleeding from the nose is expected.
B)Contact the physician's office for follow-up laboratory studies.
C)Pain in the limb is a sign of healing.
D)Take two doses of the prescribed anticoagulant if a dose is missed one day.

Question 46

A patient with a deep vein thrombosis (DVT) is going to be weaned from intravenous heparin. The nurse anticipates that oral warfarin sodium should be prescribed

A)the same day the heparin is discontinued.
B)the day before the heparin is discontinued.
C)four to five days before the heparin is discontinued.
D)the day the patient is discharged.

Question 47

An elderly patient is prescribed elastic graduated compression stockings. The nurse should instruct this patient to do which of the following?

A)Wear the stockings continuously, except when showering.
B)Expect areas of skin breakdown under the stockings.
C)Wear the stockings primarily while sleeping.
D)Remove the stockings once per day and while sleeping.

Question 48

A 75-year-old patient is diagnosed with chronic venous insufficiency. Which of the following instructions are appropriate for this patient?

A)Keep legs in a dependent position as much as possible.
B)Avoid the use of knee-high hose or girdles.
C)Limit ambulation.
D)Dangle legs over the side of the bed several times per day.

Question 49

A patient is demonstrating signs of thrombophlebitis. With this disorder, the nurse realizes that which three mechanisms occur to cause this condition? Select all that apply.

A)pooling of blood in the vessel
B)blood hypercoagulation
C)sluggish blood flow
D)elevated systemic blood pressure
E)vessel damage

Question 50

The nurse is planning care for a patient who was diagnosed with deep vein thrombosis (DVT). Which of the following should be included in the patient's plan of care?

A)activity as tolerated
B)measure and apply graduated compression stockings
C)encourage patient to sit out of bed several hours every day
D)assist patient with putting on tight-fitting pants