Deck 48: Care of the Patient With a Cardiovascular or a Peripheral Vascular Disorder

Question 1

The nurse clarifies that the master pacemaker of the heart is the:

A) left ventricle.
B) atrioventricular (AV)node.
C) sinoatrial (SA)node.
D) bundle of His.

Answer 1

sinoatrial (SA)node.

Question 2

The nurse assesses that the home health patient has no signs or symptoms of heart failure,but does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus.The nurse is aware that using the American College of Cardiology and the American Heart Association (ACC/AHA)staging,this patient would be a:

A) stage A.
B) stage B.
C) stage C.
D) stage D.

Answer 2

stage A.

Question 3

The patient has been hospitalized for hypertensive episodes three times in the last months.While preparing the discharge teaching plan,the nurse assesses that he does not comply with his medication regimen.The nurse's immediate course of action would be to:

A) reteach him about his medications.
B) have a serious talk with him and his family about compliance.
C) arrange for home visits after discharge.
D) collect more information to identify his reasons for noncompliance.

Answer 3

collect more information to identify his reasons for noncompliance.

Question 4

The nurse identifies the "lub" sound of the "lub/dub" of the cardiac cycle as the sound of the:

A) AV valves closing.
B) closure of the semilunar valves.
C) contraction of the papillary muscles.
D) contraction of the ventricles.

Question 5

The patient has a total cholesterol of 190 with a high-density lipid (HDL)of 110 and a low-density lipid (LDL)of 80.The nurse's reaction is one of:

A) satisfaction.This is good cholesterol control.
B) determination.This is evidence that more instruction is necessary.
C) inquiry.This needs to clarified as to the cause of noncompliance with the drug protocol.
D) regret.This shows very poor cholesterol control.

Question 6

The elderly patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack.The nurse's most helpful response would be:

A) "Continue to take nitroglycerin sublingually at 5-minute intervals until the pain is relieved."
B) "If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals,call your physician and come to the hospital."
C) "When nitroglycerin is not relieving the pain,lie down and rest."
D) "Use oxygen at home to relieve pain when nitroglycerin is not successful."

Question 7

After an influenza-like illness,the patient complains of chills and small petechiae in his mouth and his legs.A heart murmur is detectable.These are characteristic signs of:

A) congestive heart failure.
B) heart block.
C) aortic stenosis.
D) infective endocarditis.

Question 8

The nurse is aware that the muscle layer of the heart,which is responsible for the heart's contraction,is the:

A) endocardium.
B) pericardium.
C) mediastinum.
D) myocardium.

Question 9

The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of:

A) normal heart action.
B) mild heart failure.
C) moderate heart failure.
D) severe heart failure.

Question 10

The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T.The rate is 120.The nurse recognizes this arrhythmia as:

A) sinus bradycardia.
B) atrial fibrillation.
C) sinus tachycardia.
D) ventricular tachycardia.

Question 11

The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient says:

A) "I can ambulate in the hallway with this gadget on."
B) "I always take off the telemetry device when I shower."
C) "My EKG is being watched by one of the nurses in CCU on the home unit."
D) "I am able to sleep just fine with this device on."

Question 12

The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR)at between:

A) 1 and 2.
B) 2 and 3.
C) 3 and 4.
D) 4 and 5.

Question 13

The nurse is aware that the symptoms of an impending myocardial infarction (MI)differ in women because acute chest pain is not present.Women are frequently misdiagnosed as having:

A) hepatitis A.
B) indigestion.
C) urinary infection.
D) menopausal complications.

Question 14

A patient is admitted from the emergency department.The emergency department physician notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA)classification of IV.This indicates the patient's condition as:

A) moderate heart failure.
B) severe heart failure.
C) congestive heart failure.
D) negligible heart failure.

Question 15

What should a person with unstable angina avoid?

A) Walking outside
B) Eating red meat
C) Swimming in warm pool
D) Shoveling snow

Question 16

What do dark or "cold" spots on a thallium scan indicate?

A) Tissue with adequate blood supply
B) Dilated vessels
C) Areas of neoplastic growth
D) Tissue that has inadequate perfusion

Question 17

A patient,age 72,was admitted to the medical unit with a diagnosis of angina pectoris.Characteristic signs and symptoms of angina pectoris include:

A) substernal pain that radiates down the left arm.
B) epigastric pain that radiates to the jaw.
C) indigestion,nausea,and eructation.
D) fatigue,shortness of breath,and dyspnea.

Question 18

The nurse notes a run of three ventricular contractions (PVC)that are not preceded by a P wave.This particular arrhythmia can progress into:

A) atrial fibrillation and possible emboli.
B) sinus tachycardia and syncope.
C) ventricular tachycardia and death.
D) sinus bradycardia and fatigue.

Question 19

The nurse takes into consideration that age-related changes can affect the peripheral circulation because of:

A) sclerosed blood vessels.
B) hypotension.
C) inactivity.
D) poor nutrition.

Question 20

What is the major cause of cardiac valve disease?

A) Rheumatic fever
B) Long history of malnutrition
C) Drug abuse
D) Obesity

Question 21

How should the nurse advise a patient with an international normalized ratio (INR)of 5.8?

A) Make arrangements to go to the emergency room immediately.
B) Increase fluid intake to 2000 mL/day.
C) Stop taking the anticoagulant and notify health care provider.
D) Add more leafy green vegetables to patient diet.

Question 22

During a health interview by the home health nurse,which patient complaint suggests left-sided heart failure?

A) "I have to sleep in my recliner and I have this hacking cough."
B) "I have no appetite and I have lost 3 lb in the last week."
C) "I have to urinate every 2 hours,even during the night."
D) "I go barefoot most of the time because my feet are so hot."

Question 23

The home health nurse warns the patient who is taking warfarin (Coumadin)for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can:

A) cause severe episodes of diarrhea.
B) cause a severe skin eruption if taken with Coumadin.
C) increase the action of the Coumadin.
D) cause the Coumadin to be less effective.

Question 24

What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient?

A) Walk 2 miles in less than 60 minutes after 12 weeks.
B) Jogmile in less than 30 minutes after 12 weeks.
C) "Fast walk" 1 mile in less than 20 minutes after 12 weeks.
D) Walk 1 mile in 15 minutes without dyspnea after 12 weeks.

Question 25

The nurse making the schedule for the daily dose of furosemide (Lasix)would schedule the administration for which of the following times?

A) Late in the afternoon
B) At bedtime
C) With any meal
D) In the morning

Question 26

What is the difference between primary and secondary hypertension?

A) Secondary hypertension is caused by another disorder like renal disease.
B) Secondary hypertension is related to hereditary factors.
C) Secondary hypertension cannot be treated effectively.
D) Secondary hypertension is no real threat to health.

Question 27

The nurse making a teaching plan for a patient with Buerger disease (thromboangiitis obliterans)will focus on the need for:

A) reduction of alcohol intake.
B) avoiding cold remedies.
C) cessation of smoking.
D) weight reduction.

Question 28

The postsurgical patient has a painful and swollen right calf that appears to be larger than the calf of the left leg.What is the nurse assessing for when she flexes the patient's right leg and dorsiflexes the foot?

A) Pain,which would be a positive Homans' sign
B) Muscular spasm,which would be a sign of hypocalcemia
C) Rigidity,which would be a sign of ankylosis
D) Crepitus,which would be a sign of a joint disorder

Question 29

A patient admitted to the emergency room with a possible myocardial infarction (MI)has reports back from the laboratory.Which laboratory report is specific for myocardial damage?

A) CK-MB
B) Elevated white count
C) Elevated sedimentation rate
D) Low level of sodium

Question 30

Which statement would lead the nurse to offer more instruction about taking warfarin (Coumadin)?

A) "I eat a banana every morning with breakfast."
B) "I try to eat more green leafy vegetables,especially broccoli,spinach,and kale."
C) "I try to eat a well-balanced,low-fat diet."
D) "I don't drink alcohol or caffeine."

Question 31

The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause:

A) hypotension.
B) thrombophlebitis.
C) pulmonary emboli.
D) heart failure.

Question 32

The nurse is treating a patient who had a pacemaker inserted 8 years ago for the correction of atrial fibrillation.Which diagnostic test may no longer be available to the patient because of this older model implanted device?

A) MRI
B) CT scan
C) Thallium scan
D) PET

Question 33

Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply. )

A) Increase the dose of aspirin for better therapy.
B) Take medication at the same time each day.
C) Report to physician cuts that do not stop bleeding with direct pressure.
D) No restrictions for food or drink.
E) Report for prescribed blood tests (PTT,INR,CBC,blood sugar).

Question 34

The nurse caring for a patient recovering from a myocardial infarction (MI)teaches which method to avoid the Valsalva's maneuver during a bowel movement?

A) Mouth breathing
B) Pursing the lips and whistling
C) Taking a deep breath and holding it
D) Breathing rapidly through the nose

Question 35

The nurse would design teaching for a patient with Raynaud disease to include which of the following? (Select all that apply. )

A) Warming hands and feet with a heating pad
B) Using mittens in cold weather
C) Practicing stress-reducing techniques
D) Complete smoking cessation
E) Using caution when cleaning the refrigerator or freezer

Question 36

The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month.Which question is most important for the nurse to ask?

A) "Do you have a toothache?"
B) "Have you contacted your physician about your dental appointment?"
C) "Is your dentist board certified?"
D) "Do you think you should wait that long for your tooth extraction?'

Question 37

The patient,age 26,is hospitalized with cardiomyopathy.While obtaining a nursing history from her,the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)?

A) Cocaine use
B) Viral infections
C) Vitamin B₁ deficiencies
D) Pregnancy

Question 38

Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer?

A) Cool dry lower limb
B) Edematous,red scaly skin on medial surface of the leg
C) Lack of hair and shiny appearance of the lower leg
D) Lack of a pedal pulse

Question 39

The nurse reminds the patient that the American Heart Association recommends a lipid study every _________ years.

A) 2
B) 2 to 3
C) 4
D) 4 to 6

Question 40

The patient has become very dyspneic,respirations are 32,and the pulse is 100.The patient is coughing up frothy red sputum.What should be the initial nursing intervention?

A) Lay the patient flat to reduce hypotension and the symptoms of cardiogenic shock.
B) Place patient in side-lying position to reduce the symptoms of atrial fibrillation.
C) Place patient upright with legs in dependent position to reduce the symptoms of pulmonary edema.
D) Lay the patient flat and elevate the feet to increase venous return in cardiogenic shock.

Question 41

The cardiac marker ___________ rises 3 hours after a myocardial infarct and measures myocardial contractile protein.

Question 42

The process by which a heart is shocked from a persistent arrhythmia back into sinus rhythm is called a ____________.

Question 43

The pain that a person with arterial insufficiency feels on exertion,which is relieved by rest,is ______________ _____________.

Question 44

The patient with congestive heart failure who is on a diuretic drug shows a weight loss of 6.6 lb.The nurse is aware that the patient has lost ______ L of fluid.

Question 45

The nurse explains that the heart has the ability to contract in a rhythmic pattern that is called ____________.

Question 46

What is the transesophageal echocardiogram (TEE)used for? (Select all that apply. )

A) Detect thrombi before a cardioversion.
B) Check for cardiac arrhythmias.
C) Visualize vegetation on the heart valves.
D) Measure effectiveness of diuretic therapy.
E) Visualize abscesses on the heart valves.

Question 47

Following an angiogram with the insertion site of the left groin,the nurse will include in the plan of care provisions for: (Select all that apply. )

A) checking pedal pulses.
B) ambulating with assistance 2 hours after recovery.
C) checking color and warmth of left leg frequently.
D) sandbagging over insertion site.
E) placing patient in semi-Fowler's position.

Question 48

The life support system that uses special techniques,ventilation equipment,and therapies for emergency situations is ________.

Question 49

Which patient teaching would help to prevent venous stasis? (Select all that apply. )

A) Dangle legs when sitting.
B) Avoid crossing the legs at the knee.
C) Elevate legs when lying in bed or sitting.
D) Massage extremities to help maintain blood flow.
E) Wear elastic stockings when ambulating.