Question 1

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

Accepted Answer

The sinoatrial (SA) node is known as the master pacemaker of the heart because it generates electrical impulses that initiate the heartbeat, setting the pace for the rest of the heart's electrical conduction system.

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:

Accepted Answer

Stage A in the ACC/AHA framework for heart failure includes patients at high risk for developing heart failure but without structural heart disease or symptoms of heart failure. A history of rheumatic fever and a recent diagnosis of diabetes mellitus place the patient at high risk, fitting the criteria for 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:

Accepted Answer

Collecting more information to identify the reasons for noncompliance is crucial for addressing the root cause of the issue and developing a tailored intervention plan.

Question 4

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

Accepted Answer

The "lub" sound in the "lub/dub" of the cardiac cycle is caused by the closure of the atrioventricular (AV) valves, which occurs at the beginning of ventricular systole when the ventricles start to contract and increase pressure, forcing the AV valves to close to prevent backflow of blood into the atria.

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:

Accepted Answer

The patient's cholesterol levels indicate good control. An HDL (high-density lipoprotein) level of 110 is considered very good, as HDL is known as "good" cholesterol that helps remove other forms of cholesterol from the bloodstream. An LDL (low-density lipoprotein) level of 80 is also within a desirable range, as LDL is known as "bad" cholesterol, with lower levels being associated with a reduced risk of heart disease. The total cholesterol level of 190 is within the recommended range (below 200 mg/dL). Therefore, the nurse's reaction of satisfaction is appropriate.

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:

Accepted Answer

The correct guidance for taking nitroglycerin during an angina attack is to take it at 5-minute intervals for a maximum of three doses. If the pain is not relieved after these three doses, it is important to seek medical attention immediately, as this could indicate a more serious condition such as a myocardial infarction.

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:

Accepted Answer

These symptoms are indicative of infective endocarditis, which is an infection of the heart's inner lining (endocardium) typically involving the heart valves. The presence of fever, petechiae, a new or changed heart murmur, and a recent history of a flu-like illness suggest this diagnosis.

Question 8

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

Accepted Answer

The myocardium is the muscular layer of the heart wall responsible for its contraction, allowing the heart to pump blood throughout the body.

Question 9

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

Accepted Answer

An ejection fraction of 42% indicates moderate heart failure, as normal ejection fraction ranges from 55% to 70%.

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:

Accepted Answer

The presence of a P wave followed by a QRS and a T wave in each cardiac complex indicates a normal sinus rhythm. The rate of 120 beats per minute is above the normal resting heart rate range (60-100 bpm), classifying this rhythm as sinus 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:

Accepted Answer

Telemetry devices are designed to be worn continuously to monitor the heart's activity, including during sleep and while moving around, such as ambulating in the hallway. However, they are electronic devices and should not be taken off for showers or come into contact with water, as this could damage the device and interrupt the continuous monitoring necessary for a patient recovering from a myocardial infarct.

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:

Accepted Answer

The ideal INR for a patient on Coumadin (warfarin), especially for the treatment of atrial fibrillation, is typically between 2 and 3. This range helps balance the risk of clot formation against the risk of bleeding.

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:

Accepted Answer

Women experiencing a myocardial infarction (MI) may present with symptoms that are less typical than the classic chest pain often seen in men. Symptoms in women can include indigestion, nausea, shortness of breath, back or jaw pain, and fatigue, which can lead to misdiagnosis.

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:

Accepted Answer

The New York Heart Association (NYHA) classification IV indicates severe heart failure, where symptoms occur at any level of physical activity or even at rest.

Question 15

What should a person with unstable angina avoid?

Accepted Answer

Shoveling snow can be a strenuous activity that increases the heart rate and blood pressure, potentially exacerbating the condition of someone with unstable angina.

Question 16

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

Accepted Answer

Dark or "cold" spots on a thallium scan indicate areas of the heart that are not receiving an adequate blood supply, often due to blockages in the coronary arteries.

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:

Accepted Answer

Angina pectoris typically presents as substernal chest pain that may radiate to the left arm, neck, jaw, or back.

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:

Accepted Answer

A run of three or more premature ventricular contractions (PVCs) without preceding P waves can indicate ventricular tachycardia, which is a potentially life-threatening arrhythmia that can progress to ventricular fibrillation and result in sudden cardiac death if not treated promptly.

Question 19

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

Accepted Answer

Sclerosed blood vessels are a common age-related change that affects peripheral circulation. As people age, their blood vessels can become more rigid and narrow, leading to decreased blood flow.

Question 20

What is the major cause of cardiac valve disease?

Accepted Answer

Rheumatic fever is a major cause of cardiac valve disease, particularly in developing countries. It results from an autoimmune response to infection by group A Streptococcus bacteria, which can lead to inflammation and scarring of the heart valves.

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