Question 1

Chronic stress may lead directly to cardiovascular disease because of the repeated release of which of the following?

Accepted Answer

The stress response stimulates release of catecholamines from the sympathetic nervous system.This results in increased heart rate and contractility,vasoconstriction,and increased tendency of blood to clot.Cortisol is also released in the stress response,but it is more indirectly related to development of cardiovascular disease through altered glucose,fat,and protein metabolism.

Question 2

The nurse administers sublingual nitroglycerine,a vasodilator,to a patient diagnosed with angina.When the patient's chest pain is not relieved,the nurse prepares to give another nitroglycerine tablet.What is the nurse's priority action prior to administering the next dose of medication?

Accepted Answer

It is most important at this time for the nurse to measure the patient's blood pressure because vasodilating medications can result in a significant drop in blood pressure.There would be no reason to notify the physician unless the patient does not respond by the third dose of nitroglycerine.Elevating the head of the bed would be contraindicated,especially if the patient develops hypotension from vasodilation.Although placing the patient on a monitor is indicated,this is not related to administering the patient's medication.

Question 3

A patient diagnosed with hypertension is taking an angiotensin-converting enzyme (ACE)inhibitor.When planning care,which of the following outcomes would be appropriate for the patient?

Accepted Answer

Goals must be clearly stated so that it is easy to evaluate whether they have been met."BP ...lower than 135/85 ..." is clearly stated and easily evaluated.In contrast,"BP will be normal ..." does not clearly state the desired endpoint.Freedom from dizziness on rising is probably not achievable because ACE inhibitors are vasodilating agents,which may cause vessel dilation and hypotension,especially when the patient arises from a seated or lying position.Patients should be warned of this effect.The expected/desired effect of the ACE inhibitor is to lower the blood pressure; the urine output is minimally relevant in determining that outcome,if at all.

Question 4

The nurse plans to maintain hydration for the patient at risk for thrombus formation.What evaluation finding is an indicator that the intervention is successful?

Accepted Answer

Urine output is the best indicator of hydration,and urine output greater than 1,500 mL would be expected within normal range.Pain in the lower legs is a good indicator that the patient does not have a thrombus in the lower legs,but does not indicate hydration.Absence of chest pain or shortness of breath is a good indicator that the patient doesn't have a significant pulmonary embolism,but does not indicate the patient is hydrated.Weight gain of 5 pounds in 24 hours would indicate overhydration.

Question 5

The nurse is assessing a male patient diagnosed with chronic heart failure 10 years ago.Which finding would indicate poor perfusion to the tissues?

Accepted Answer

Absence of hair on the lower extremities is an indicator of poor perfusion because hair growth requires adequate gas exchange.A blood pressure of 102/64 is lower than the average range,but may be normal for this patient.It would not indicate poor perfusion to the tissues.The patient with heart failure is likely to have a slightly elevated heart rate if not taking medications that slow heart rate because the increased rate compensates for reduced cardiac output.Although shortness of breath may occur with heart failure,this is the result of poor pumping action of the heart,allowing fluid to accumulate in the lungs; it is not an indicator of peripheral circulation.

Question 6

The nurse is teaching a pregnant woman about the increased oxygen demand that develops during pregnancy.The nurse knows the patient comprehends the teaching when she makes the following statement:

Accepted Answer

During pregnancy,oxygen demand increases dramatically.To compensate,the mother's blood volume increases by 30%.The woman requires additional iron to produce this blood as well as to meet fetal requirements.Failure to meet these iron demands can result in maternal anemia,reducing tissue oxygenation of the mother.

Question 7

The patient diagnosed with inadequate closure of the mitral valve is scheduled for surgery and asks the nurse,"Why does it matter if my valve leaks?" What is the nurse's best response to explain why this mitral valve needs to be repaired?

Accepted Answer

The mitral valve is located between the left atrium and left ventricle,so backflow of blood results in reduced cardiac output to the body.The damaged mitral valve does not impact blood flow to the lungs but may impact blood flow from the lungs to the left atrium.The aortic valve is located between the aorta and the left ventricle.The pulmonic valve is located between the pulmonary artery and right ventricle.

Question 8

The nurse analyzes the patient's ECG and compares it with a baseline ECG recorded before the patient began having chest pain.What finding indicates a problem with the ventricle?

Accepted Answer

The QRS segment is an indicator of contraction of the ventricle.If there is ischemia to the ventricle,the impulse will travel more slowly,especially if there are damaged or dead cells along the impulse pathway; therefore,the QRS segment would be prolonged.The P wave is an indicator of atrial activity,not ventricular activity.The T wave is an indication of repolarization of the cardiac tissue,so it would not indicate ventricular ischemia.The PR interval measures the time it takes for the impulse to move from the atria to the ventricles and is not a measure of ventricular ischemia.

Question 9

You are preparing the nursing care plan for a middle-aged patient admitted to the intensive care unit for an acute myocardial infarction (heart attack).His symptoms include tachycardia,palpitations,anxiety,jugular vein distention,and fatigue.Which of the following nursing diagnoses is most appropriate?

Accepted Answer

The patient's symptoms reflect altered cardiac preload,a component of cardiac output.Acute myocardial infarction is often associated with decreased cardiac output as a result of altered cardiac pumping ability.Although the other nursing diagnoses might be associated with Decreased Cardiac Output,these diagnoses cannot be determined from the symptoms presented.Additionally,Impaired Cardiac Contractility is not a NANDA-I nursing diagnosis.

Question 10

The nurse administers a beta-adrenergic agent to a patient with congestive heart failure.What assessment findings would indicate the drug was working?

Accepted Answer

Beta-adrenergic blockers reduce heart rate and myocardial oxygen demand,and improve contractility of the heart.Therefore,the patient's reduced rate would be an expected finding that indicates the drug is working.Beta blockers would not alter the movement of the electrical impulse through the ventricle,so there should be no change in QRS appearance.There would be no expectation of tingling in the hands and feet after taking a beta blocker.Increased urine output would be anticipated with use of diuretics,but the only improvement in urine output with beta blockers would be indirect if the patient had reduced kidney perfusion.This would not be a primary anticipated effect.

Question 11

The nurse is providing teaching for a weight loss group on the cardiac dangers of obesity.Which statement,if made by the nurse,would be incorrect?

Accepted Answer

It is a correct statement that obesity increases the risk of atherosclerosis,particularly if obesity results from excess sugar or saturated fat intake.Obesity does increase the risk of hypertension; even young children should be monitored for hypertension if they are obese.Fat builds up around the heart of obese individuals,resulting in reduced pumping action of the heart.In obesity,the workload of the heart is increased in an attempt to perfuse excess body tissue; however,tissue perfusion is not diminished until the heart is damaged and can no longer adequately perfuse the tissues.

Question 12

The nurse is assessing a patient who is complaining of chest pain,clutching his chest,and is short of breath.Which assessment question would be appropriate for the nurse to ask?

Accepted Answer

In a situation in which breathing and/or circulation are inadequate,questions should be phrased to allow short (e.g.,yes or no)answers that do not tax the patient's ability to breathe and talk.Asking the patient to describe the pain,location,and self-treatment would require an extended verbal response from a patient who is having trouble breathing.It would stress the patient to try to respond.Although a list of medications is important to determine,the patient with compromised breathing and circulation is unlikely to be able to provide this information.The patient who is having difficulty answering is unlikely to be able to supply information about past medical history,despite its importance.Asking a spouse or close relative is likely to yield a more complete reply.

Question 13

Three days ago,a patient had cardiac surgery to bypass three occlusions of his coronary arteries.Veins for the bypass were harvested from his right leg.He informs the nurse that his leg is warm and tender in his right calf.The nurse notes a 3-cm periwound erythema and swelling at the distal end of the incision.Staples are intact along the incision,and there is no drainage.Vital signs are stable.The nurse would suspect that the patient has what kind of complication?

Accepted Answer

Deep vein thrombosis (DVT)is a clot in the veins that are deep under the muscles of the leg.DVT can occur after surgery,after lengthy bedrest,or after trauma.Symptoms include pain,warmth,redness,and swelling of the leg.Dorsiflexion of the foot (pulling toes forward)and Pratt's sign (squeezing calf to trigger pain)have not been found to be reliable in diagnosing DVT.Dehiscence is the rupture of a suture line,whereas evisceration is the protrusion of internal organs through the rupture.Internal bleeding is a wound-healing complication associated with hematoma formation,pain,hypotension,and tachycardia.Infection is a complication of wound healing that causes warmth,pain,inflammation of the affected area,and changes in vital signs (i.e.,elevated pulse and temperature).

Question 14

The nurse is planning care for an elderly patient diagnosed with end-stage heart failure and a nursing diagnosis of Decreased Cardiac Output secondary to ineffective left ventricular function.What outcome would the nurse plan for this patient to measure improvement in cardiac output?

Accepted Answer

Left-sided failure causes blood to back up into the lungs and can result in pulmonary edema; therefore,clear breath sounds with no shortness of breath would be an effective outcome.When the right ventricle is compromised by heart failure,venous return is slowed and peripheral edema results; however,this patient has left-sided failure.Medications to treat heart failure are meant to alter heart rate,so this would not be the best indicator of improvement in the patient's condition.A patient with heart failure may have a regular rhythm even before treatment,so this is not the best choice for an indication of improved cardiac output.

Question 15

The nurse is caring for a patient with reduced perfusion to the extremities.The nurse evaluates the patient and finds the response to therapy is not optimal.What lifestyle change does the nurse suspect is contributing to the lack of response?

Accepted Answer

1,500 mL of fluid is lower than optimal and the patient should be encouraged to increase fluid intake to 2,000 mL per day.This could have a negative impact on perfusion if the patient is dehydrated,even mildly so.A vegetarian diet is usually low in cholesterol and fat,so this is an appropriate lifestyle change that would not reduce response to therapy.Further assessment of diet may be needed.Daily exercise promotes perfusion,so this would not be the anticipated cause of reduced response to therapy.Quitting smoking should improve response to therapy and would not be the likely cause of the patient's failure to respond to treatment.

Question 16

The nurse is preparing to apply a cardiac monitor to a patient.Where should the nurse place the electrodes?

Accepted Answer

Electrodes should be placed over muscle and skin between ribs to improve electrical pattern.Electrodes should not be placed over bony areas,which will reduce conduction of electrical pattern.Leads are placed on the chest,which is not soft and spongy in most patients,so the arms and legs are not an appropriate choice.Leads placed on the abdomen would not provide a useful recording of electrical activity in the heart,so it would not be the best choice.

Question 17

A patient with heart failure has BP 120/60,HR 64,R 18,T 97.6°F,coarse crackles bilaterally,and 3+ edema to the lower extremities.An appropriate nursing diagnosis for this patient is:

Accepted Answer

Excess Fluid Volume is an appropriate nursing diagnosis for someone demonstrating increased isotonic fluid retention,as demonstrated by adventitious breath sounds (crackles bilaterally)and edema.There is no indication that this patient is experiencing impaired gas exchange or inefficient tissue perfusion based on the information provided.Although the patient may have knowledge deficit,this is not a priority at this time.

Question 18

The nurse is reviewing the results of the patient's laboratory findings and notes an elevated C-reactive protein (CRP).What does this indicate?

Accepted Answer

An elevated CRP indicates the presence of inflammation in the body.This may,but does not necessarily,include arterial inflammation or a myocardial infarction.Many conditions can cause an elevated CRP,so a CRP is not specific to a myocardial infarction,as is a troponin or CPK-MB level.CRP is not related to measuring cardiac output.CRP elevations are not an indication of elevated cholesterol levels or a diet high in cholesterol.

Question 19

For which patient might the nurse use the nursing diagnosis of Risk for Ineffective Renal Tissue Perfusion?

Accepted Answer

The patient with hypertension who is not taking medications as prescribed can risk damage to tiny arterioles in the kidney,resulting in poor renal tissue perfusion; this would be an appropriate diagnosis.Nitroglycerine is a vasodilator that improves perfusion rather than risking poor perfusion.The patient with pneumonia requires an oxygenation diagnosis and does not risk ineffective renal perfusion unless the heart is damaged.When the body suffers blood loss,perfusion to the internal organs is not affected because the body compensates by reducing blood flow to the periphery and the quantity of blood loss in the brain is limited by the enclosed compartment.

Question 20

A nurse is performing cardiopulmonary resuscitation on an infant.When performing chest compressions,the nurse understands that the compression rate is at least:

Accepted Answer

The prompt initiation of effective chest compressions is a fundamental aspect of cardiac arrest resuscitation.CPR improves the victim's chance of survival by providing heart and brain circulation.Rescuers should perform chest compressions for all victims in cardiac arrest,regardless of rescuer skill level,victim characteristics,or available resources. Rescuers should focus on delivering high-quality CPR providing chest compressions of adequate rate (at least 100 compressions per minute).

Quiz 37: Circulation