Chapter 56: Management of Clients with Functional Cardiac Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 56: Management of Clients with Functional Cardiac Disorders

MULTIPLE CHOICE

1. The nurse would assess that the individual most at risk for death from coronary heart disease (CHD) is a

a.

30-year-old Hispanic woman.

b.

42-year-old Caucasian woman.

c.

55-year-old Asian man.

d.

62-year-old African American woman.

ANS: D

Symptomatic CHD appears predominantly in clients over age 40. Age influences both the risk for and the severity of CHD. So the older the client, the higher the risk for CHD. CHD rates in women after menopause are 2-3 times higher than those in women who are premenopausal. African-American and Mexican-American women have more risk factors for CHD than do Caucasian women. For people 35-74, the age-adjusted death rate from CHD for African-American women is 72% higher than that for white women and Native Americans.

DIF: Analysis/Analyzing REF: pp. 1410, 1411

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse would explain to a client who smokes that the nicotine in cigarette smoke increases the prevalence of CHD by

a.

causing proliferation of smooth muscle cells.

b.

decreasing the oxygen-carrying capacity of the blood.

c.

increasing fat deposits along the intima of blood vessels.

d.

increasing the heart rate and the risk of dysrhythmia.

ANS: D

Nicotine increases the release of epinephrine and norepinephrine, which results in peripheral vasoconstriction, elevated blood pressure and heart rate, greater oxygen consumption, and increased risk of dysrhythmia.

DIF: Comprehension/Understanding REF: p. 1411 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. In advising a client with higher levels of high-density lipoproteins (HDLs) in proportion to low-density lipoproteins (LDLs), the nurse would suggest that the client

a.

consult the physician for an anticholesterol prescription.

b.

initiate a moderate exercise program.

c.

is less likely to develop CHD.

d.

should consider a reduced-fat diet.

ANS: C

People with high levels of HDLs in proportion to LDLs are at less risk for CHD than those with a low HDL/LDL ratio. High concentrations of HDL seem to protect against the development of CHD.

DIF: Comprehension/Understanding REF: p. 1412 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. The nurse would clarify for a client that the lipoproteins representing the good cholesterol are the

a.

HDLs.

b.

LDLs.

c.

VDRLs.

d.

VLDLs.

ANS: A

The HDLs (high-density lipoproteins) have a lower concentration of cholesterol than the other lipoproteins. LDLs have the highest concentration of cholesterol and transport endogenous cholesterol to body cells. VDRL is a nonspecific test for syphilis. VLDLs mainly transport triglycerides synthesized by the liver.

DIF: Comprehension/Understanding REF: p. 1412 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

5. The nurse would advise a group of diabetic clients that primary prevention for CHD can be achieved by keeping their fasting blood sugar levels below

a.

56 mg/dl.

b.

72 mg/dl.

c.

105 mg/dl.

d.

126 mg/dl.

ANS: D

A fasting blood sugar level of more than 126 mg/dl signals the presence of diabetes and represents another risk factor for developing CHD. Clients with diabetes have a 2-4-fold higher prevalence, incidence, and mortality from all forms of CHD.

DIF: Comprehension/Understanding REF: p. 1413 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

6. To prevent a post-procedure complication, nursing care of a client after a percutaneous transluminal coronary angioplasty (PTCA) generally would include

a.

administering heparin.

b.

assessing for clinical manifestations of shock.

c.

forcing fluids.

d.

maintaining the client flat in bed for 24 hours.

ANS: C

The nurse should force fluids, orally or intravenously, to assist the body in excreting contrast, which causes diuresis and may cause acute tubular necrosis.

DIF: Application REF: p. 1421 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Diagnostic Tests/Treatments/Procedures

7. The nurse would explain the etiology of heart failure after myocardial infarction (MI) as

a.

impairment of the contractile function of the ventricle.

b.

inability of the heart chambers to fill adequately.

c.

increased myocardial workload.

d.

increased oxygen demands of the myocardium.

ANS: A

Heart failure is a physiologic state in which the heart cannot pump enough blood to meet the metabolic needs of the body. It results from changes in systolic or diastolic function of the left ventricle. After an MI, some of the heart muscle is replaced by noncontracting scar tissue, and the ventricles pump less efficiently.

DIF: Comprehension/Understanding REF: pp. 1430-1431

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

8. The nurse explains that in addition to having a PTCA to clear the artery, the client will also have plaque vaporized by the use of

a.

anticoagulant therapy.

b.

intracoronary stent.

c.

laser ablation.

d.

transmyocardial revascularization.

ANS: C

The laser ablation vaporizes the plaque so that is will not re-occlude the vessel.

DIF: Comprehension/Understanding REF: p. 1420 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

9. The nurse would caution a client with arthritis that this chronic inflammatory disease increases the risk for CHD through the

a.

amount of aspirin taken as a remedy for arthritis.

b.

decreased physical activity relative to arthritic discomfort.

c.

increased level of C-reactive protein.

d.

increased release of histamines.

ANS: C

It is thought that the increased amount of C-reactive protein present from arthritis becomes unstable and breaks off into the circulating volume.

DIF: Comprehension/Understanding REF: p. 1413 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. When a client is admitted to the hospital with clinical manifestations of left ventricular heart failure, the nurse would question the client about

a.

abdominal pain.

b.

breathlessness.

c.

leg swelling.

d.

nausea.

ANS: B

To some degree, exertional dyspnea occurs in all clients. Therefore the nurse should elicit a description of the degree of exertion that results in the sensation of breathlessness from the client with clinical manifestations of heart failure.

DIF: Application/Applying REF: p. 1435 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. When auscultating the respirations of a client in left ventricular heart failure, the nurse would most likely detect

a.

crackling sounds.

b.

diminished sounds.

c.

grunting.

d.

wheezing.

ANS: A

The client coughs because a large amount of fluid is trapped in the pulmonary tree, irritating the lung mucosa. On auscultation, bilateral crackles (rales) may be heard.

DIF: Application/Applying REF: p. 1434 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. A client is admitted to the intensive care unit with severe dyspnea, fear, noisy respirations, sweating, and tachypnea. The nurse would recognize that the client is exhibiting manifestations of

a.

acute pulmonary edema.

b.

acute myocardial infarction.

c.

chronic congestive heart failure.

d.

right ventricular failure.

ANS: A

Acute pulmonary edema, a medical emergency, usually results from left ventricular failure. Typical manifestations include severe dyspnea, orthopnea, pallor, tachycardia, expectoration of large amounts of frothy blood and sputum, fear, wheezing, sweating, bubbling respirations, cyanosis, nasal flaring, use of accessory breathing muscles, tachypnea, vasoconstriction, and hypoxia.

DIF: Application/Applying REF: p. 1437 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

13. When the a client with left ventricular heart failure complains that she has to get up several times during the night to urinate, the nurse would explain that this bothersome event is

a.

a late clinical manifestation of heart failure.

b.

an indication that the right ventricle is being affected.

c.

caused by an increase in blood flow to the kidneys when lying down.

d.

the result of increased secretion of aldosterone at night.

ANS: C

At night, urine formation increases as blood flow to the kidneys improves; this is because the force of gravity does not work to pull blood flow away from the kidneys in a client who is lying down.

DIF: Comprehension/Understanding REF: p. 1437 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

14. When the client who had a myocardial infarction develops dependent edema, the nurse would assess that this could be an early manifestation of

a.

fluid deficit.

b.

left ventricular failure.

c.

renal failure.

d.

right ventricular failure.

ANS: D

Dependent edema is one of the early manifestations of right ventricular failure. Left ventricular failure would be manifested in the lungs.

DIF: Application/Applying REF: p. 1437 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

15. A client with heart failure has been prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse would explain that this drug alleviates manifestations of heart failure by

a.

decreasing circulating volume.

b.

increasing myocardial contractility.

c.

increasing vasodilation.

d.

slowing atrioventricular conduction time.

ANS: C

ACE inhibitors are now considered first-line therapy for heart failure. ACE inhibitors interfere with the production of angiotensin, a potent vasoconstrictor. Diuretics work to decrease circulating volume. Inotropes increase myocardial contractility. Digoxin has as one of its effects slowing the AV conduction time.

DIF: Comprehension/Understanding REF: p. 1440 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

16. When a client with heart failure is receiving loop diuretics, the nurse would be sure to monitor serum

a.

calcium levels.

b.

enzyme levels.

c.

potassium levels.

d.

sodium levels.

ANS: C

With the use of loop diuretics, potassium is lost through the kidneys, which can lead to dysrhythmias and electrolyte imbalances. Hypokalemia sensitizes the myocardium to digitalis and therefore predisposes the client to digitalis toxicity.

DIF: Application/Applying REF: p. 1439 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

17. The nurse would clarify to a client considering a MIDCABG that this procedure is less invasive and does not utilize

a.

anticoagulants.

b.

cardiopulmonary bypass.

c.

long-term anesthesia.

d.

mammary arteries.

ANS: B

The MIDCABG is less invasive, using the mammary arteries. The cardiopulmonary bypass machine is not needed, but the standard anticoagulant therapies and anesthesia are used.

DIF: Comprehension/Understanding REF: pp. 1421-1422

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

18. A nurse is speaking to a group of high school girls about not smoking. The nurse would caution them that the risk of CHD in women who smoke is greater than that for nonsmoking women by

a.

two times.

b.

three times.

c.

four times.

d.

five times.

ANS: B

The risk of CHD in smoking women is three times greater than that for nonsmokers.

DIF: Comprehension/Understanding REF: p. 1411 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

19. Reporting that a clients total cholesterol reading is 230, the nurse would know this result indicates a reading that is

a.

low.

b.

borderline high.

c.

high.

d.

very high.

ANS: B

A total cholesterol reading of 240 is considered high and a reading of 200 to 239 borderline high.

DIF: Comprehension/Understanding REF: p. 1412 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

20. The nurse would recognize that the client at greatest risk for CHD is a

a.

35-year-old man who is 15 pounds overweight.

b.

40-year-old woman who repeatedly gains and loses 15 pounds.

c.

45-year-old man who lost 30 pounds by following a strenuous diet.

d.

50-year-old man 20 pounds overweight but a lifelong swimmer.

ANS: B

Losing and regaining weight puts the client at greater risk for CHD.

DIF: Application/Applying REF: p. 1413 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

21. A nurse is caring for a client in the intensive care unit who underwent a CABG earlier this morning. Which nursing diagnosis takes priority?

a.

Decreased Cardiac Output

b.

Impaired Gas Exchange

c.

Pain

d.

Risk for Hemorrhage

ANS: B

Using the ABCs (airway, breathing, circulation), Impaired Gas Exchange would be the priority followed by Decreased Cardiac Output. Pain would be third because it is an actual, not a risk for, diagnosis.

DIF: Analysis/Analyzing REF: pp. 1426-1429

OBJ: Diagnosis

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

22. A nurse is preparing to administer IV digoxin to an elderly client in heart failure. Which nursing action takes priority?

a.

Ask the client if he/she has ever had digoxin before.

b.

Assess the clients pulse rate and hold the medication if it is less than 60 beats/min.

c.

Prepare the client for any side effects of the medication.

d.

Provide instruction to the client on the medications expected effects.

ANS: B

Digoxins actions include slowing the heart rate to allow more effective filling. However, with its narrow therapeutic range, toxicity is common. One manifestation of toxicity is bradycardia. Nearly all health care institutions have policies that require nurses to check the clients pulse rate before administering digoxin and to hold the dose and notify the physician if the pulse rate is less than 60 beats/min. While all options are appropriate nursing interventions, option b takes priority.

DIF: Application/Applying REF: p. 1447 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

23. A client who is grossly overweight tells the nurse I just cant lose a bunch of weight to prevent a disease I might not get. The best response by the nurse takes into consideration that

a.

even a small weight loss is beneficial.

b.

even overweight, women do not get coronary heart disease at high rates.

c.

obesity is not one of the major risk factors for coronary heart disease.

d.

the client really does need to lose substantial weight.

ANS: A

Coronary heart disease is the number one killer of both men and women. Obesity is a major risk factor not only because the heart has to work harder in an obese person but also because obesity is often associated with other risk factors. However, even losing 10-20 pounds significantly reduces ones risk.

DIF: Comprehension/Understanding REF: p. 1413 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

24. A nurse is conducting worksite health education classes. The nurse informs the participants that in order to prevent heart disease, the American Heart Association recommends which amount of exercise?

a.

10-20 minutes every day.

b.

20-30 minutes three to five times a week.

c.

30-60 minutes every day.

d.

30-60 minutes on most days of the week.

ANS: D

25% of Americans report no leisure time physical activity. The AHA recommends that to prevent heart and blood vessel diseases, individuals get 30-60 minutes of exercise on most days of the week.

DIF: Comprehension/Understanding REF: p. 1413 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

25. A client is scheduled to have CABG surgery next week. To best meet the clients need for psychosocial support, which intervention by the nurse would be best?

a.

Ask the client and family to relay fears and questions.

b.

Discuss the possible need for blood products during or after the operation.

c.

Provide written and oral instructions along with contact phone numbers.

d.

Refer the client to the preoperative educational classes at the hospital.

ANS: D

All options are appropriate. However, since the psychological preparation of the client before surgery is so important, many hospitals have instituted preoperative educational classes. These classes greatly reduce client and family fear and apprehension.

DIF: Application/Applying REF: p. 1424 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Stress Management

26. A client is being discharge after successful CABG surgery. Despite the positive prognosis, the nurse cautions the client and family that

a.

a heart attack could happen at any time.

b.

heart disease can always return.

c.

postoperative depression is common.

d.

the real results of the operation are not yet known.

ANS: C

Postoperative depression, fatigue, incisional discomfort, dyspnea, and anorexia are common. By the fourth or fifth week, clients are feeling much better, and by 1 year after the operation, 93% report improved quality of life.

DIF: Application/Applying REF: p. 1430 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Quality of Life

MULTIPLE RESPONSE

1. A client had a PTCA with stent placement. Nursing care that can be delegated to the unlicensed assistive personnel (UAP) after the procedure includes (Select all that apply)

a.

assessing the distal pulses every 15-30 minutes.

b.

calling for an ECG immediately if the client has angina.

c.

monitoring vital signs every 15-30 minutes.

d.

providing the client with plenty of fluids to drink.

e.

reminding the client to remain flat in bed.

ANS: C, D, E

All options are appropriate care for the client after a PTCA and stent placement. However, the registered nurse must assess pulses. If the client complains of angina to the UAP, that person should let the nurse know. The nurse must assess the client before anyone calls for an ECG.

DIF: Analysis/Analyzing REF: p. 1421 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

2. A client is scheduled to have a PTCA. The nurse brings the consent forms and the client questions why he/she has to sign a consent form for possible coronary artery bypass grafting too. The nurses response should be based on understanding that (Select all that apply)

a.

a separate consent must be signed for each procedure.

b.

education will only have to be done one time if the client signs both now.

c.

in case of a complication, there may not be time to have a consent signed.

d.

the client will be sedated during the PTCA and cannot sign another consent form.

ANS: A, C, D

Complications of PTCA can include perforation of the artery or acute occlusion. In that case, CABG would be required. The client or family would need to sign a separate consent form for that procedure. In case of emergency, there might not be time to do so. The client who is sedated for the PTCA cannot sign another consent. It is standard procedure to have clients sign consents for both PTCA and CABG.

DIF: Analysis/Analyzing REF: p. 1421 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Informed Consent

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

Leave a Reply