Chapter 18: The Cardiovascular System My Nursing Test Banks

Chapter 18: The Cardiovascular System

MULTIPLE CHOICE

1. The nurse encourages a 65-year-old female patient to get a cholesterol study because the best indicator of possible heart disease in women is:

a.

low levels of high-density lipoprotein.

b.

low levels of triglycerides.

c.

high levels of high-density lipoprotein.

d.

low levels of low-density lipoprotein.

ANS: A

Low levels of good cholesterol are a strong predictor of heart disease in women over 65 years of age.

DIF: Cognitive Level: Comprehension REF: 375 OBJ: 2 (theory)

TOP: Heart Disease in Women: Lipid Studies

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. The nurse explaining blood pressure to a patient instructs that, in a blood pressure of 120/80, the 80 indicates the:

a.

pulse pressure.

b.

pressure in the relaxed ventricles.

c.

relative ejection factor.

d.

stroke volume.

ANS: B

The diastolic pressure of 80 mm Hg is the reading of the pressure during ventricular relaxation.

DIF: Cognitive Level: Comprehension REF: 374 OBJ: 1 (theory)

TOP: Diastolic Pressure: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse is aware that the eventual outcome of angiotensin on the circulatory system is:

a.

vasoconstriction.

b.

release of sodium and water to be excreted.

c.

increase in blood pressure.

d.

decrease in cardiac output.

ANS: C

Angiotensin I is converted to angiotensin II, which causes vasoconstriction. Angiotensin then causes sodium and water to be retained, thus causing an increase in the circulating blood volume, which causes the blood pressure to rise.

DIF: Cognitive Level: Analysis REF: 374 OBJ: 1 (theory)

TOP: Angiotensin: Effect on Circulatory System

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The 85-year-old patient asks the nurse why he has a heart murmur now after all these years. What is the most likely cause of this patients heart murmur?

a.

Hypertension

b.

Atherosclerosis

c.

Insufficient valves

d.

Weakened pacemaker

ANS: C

It is common for systolic murmurs to be present in people over the age of 80. These murmurs are usually related to valvular dysfunction caused by thickening of the valves, especially the mitral and aortic valves.

DIF: Cognitive Level: Application REF: 375 OBJ: 2 (theory)

TOP: Murmur in the Older Adult KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. The nurse is performing a cardiac assessment on the older adult patient and notices an irregular rhythm when listening to the apical pulse. The nurse knows that this is often due to what cause in the elderly patient?

a.

Loss of cells in the sinoatrial (SA) nodes

b.

Increased peripheral resistance

c.

Hypertension

d.

Atherosclerosis

ANS: A

Loss of cells in the SA nodes via age-related changes are the most common cause of dysrhythmias in the older adult. This nurse should, however, document these findings and report the findings to the primary care provider.

DIF: Cognitive Level: Application REF: 375 OBJ: 2 (clinical)

TOP: Dysrhythmia in the Older Adult KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. The nurse warns a group of college students that atherosclerotic plaque begins to occur after the age of:

a.

18.

b.

20.

c.

25.

d.

30.

ANS: B

Plaque begins to occur after the age of 20 years.

DIF: Cognitive Level: Comprehension REF: 375 OBJ: 2 (theory)

TOP: Plaque KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The nurse is outlining a teaching program for diabetic patients. Which teaching point will the nurse stress when educating this population about strategies to prevent heart disease?

a.

Keep blood sugar below 110 mg/dL.

b.

Prevent infections.

c.

Eat meals at regular times.

d.

Use sterile technique in insulin injections.

ANS: A

The diabetic person who maintains the glucose level below 110 mg/dL will avoid the adverse effects of hyperglycemia on the vessels. Preventing infections, eating at regular times, and using sterile technique are all valid teaching points for the diabetic patient, but they do not specifically address prevention of heart disease.

DIF: Cognitive Level: Analysis REF: 377 | Table 18-1

OBJ: 4 (theory) TOP: Prevention of Heart Disease: Diabetics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

8. The nurse explains that a Doppler flow study is done to:

a.

detect a clot in a coronary artery.

b.

visualize obstructions in leg vessels.

c.

assess efficiency of blood flow through heart chambers.

d.

detect a defective heart valve.

ANS: B

The Doppler flow study is used to detect obstructions in the vessels of the lower extremities. The Doppler study may also be performed in other areas of the body, such as the carotid arteries.

DIF: Cognitive Level: Comprehension REF: 381-383 | Table 18-2

OBJ: 5 (theory) TOP: Doppler Flow Study

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9. Following an angiogram, the nurse will assess and record:

a.

allergy to dye.

b.

range of motion of lower limbs.

c.

presence and strength of pedal pulses.

d.

nausea.

ANS: C

The nurse will assess for pedal and popliteal pulses in the leg distal to the puncture site to ensure there is no obstruction of the vessel due to irritation or spasm.

DIF: Cognitive Level: Comprehension REF: 380-381 | Table 18-2

OBJ: 5 (theory) TOP: Angiogram: Aftercare

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

10. The patient who is to have a stress echocardiogram is instructed that prior to the test she should:

a.

eat a full meal.

b.

limit caffeine drinks to 1 cup.

c.

abstain from smoking for 8 hours.

d.

wear hard-soled shoes.

ANS: C

Patients are to abstain from caffeine and smoking for 8 hours prior to the test. They should eat lightly and wear comfortable walking shoes.

DIF: Cognitive Level: Comprehension REF: 379 | Table 18-2

OBJ: 5 (theory) TOP: Stress Echocardiogram: Preparation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

11. The 65-year-old patient complains of leg pain that disappears on rest after having walked a short distance. The nurse recognizes the description of the patients discomfort as being characteristic of:

a.

muscle spasm.

b.

deep venous thrombosis.

c.

claudication.

d.

angiospasm.

ANS: C

Intermittent claudication, which is cramping pain in the calves, occurs in the presence of arterial insufficiency. This allows the muscles to build up lactic acid and cause pain.

DIF: Cognitive Level: Application REF: 384-385 OBJ: 5 (theory)

TOP: Claudication: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. To hear a murmur best, the nurse should ask the patient to:

a.

take a deep breath.

b.

lean forward.

c.

cough.

d.

bear down.

ANS: B

Asking the patient to learn forward or roll to the left makes the murmur more audible.

DIF: Cognitive Level: Comprehension REF: 386 OBJ: 5 (theory)

TOP: Auscultating for Murmur KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

13. When using a 0 to 4+ scale, the nurse records a normal volume pulse as:

a.

1+.

b.

2+.

c.

3+.

d.

4+.

ANS: C

A normal pulse volume is recorded as a 3+ if using a 0 to 4+ scale. The nurse should be aware of the type of scale used in different facilities.

DIF: Cognitive Level: Comprehension REF: 387 | Box 18-2

OBJ: 5 (theory) TOP: Recording Pulse Quality

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. The nurse has assessed the patient to have a blood pressure of 140/90, an apical pulse of 82, and a radial pulse of 76. The nurse records a pulse pressure of:

a.

6.

b.

56.

c.

82.

d.

90.

ANS: B

The pulse pressure is the difference between the systolic and diastolic pressures. Pulse deficit is the difference between the radial and the brachial pulses.

DIF: Cognitive Level: Application REF: 374 OBJ: 5 (theory)

TOP: Pulse Pressure KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

15. The nurse suspects arterial insufficiency in the 50-year-old patient when the feet and legs exhibit:

a.

equal warmth.

b.

shiny, hairless skin.

c.

thin, brittle nails.

d.

pedal edema.

ANS: B

Skin that is shiny and hairless is an indication of arterial insufficiency. Equal warmth indicates equal and sufficient blood flow to the extremities. The nails would be thick rather than thin with arterial insufficiency, and pedal edema is an indication of venous insufficiency.

DIF: Cognitive Level: Application REF: 388 OBJ: 5 (theory)

TOP: Arterial Insufficiency: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

16. When assessing a patient with the complaint of hypertension, the nurse will inquire if the patient routinely takes:

a.

vitamins.

b.

cold remedies.

c.

laxatives.

d.

antacids.

ANS: B

Cold remedies cause vasoconstriction and increase blood pressure.

DIF: Cognitive Level: Comprehension REF: 384-385 OBJ: 5 (theory)

TOP: Assessing for Causes of Hypertension

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

17. The patient asks if it is harmful for him to drink a glass of wine with dinner on a daily basis. Which is the nurses best response?

a.

As long as it is okay with your physician, moderate alcohol intake can be beneficial to your cardiovascular health.

b.

Drinking wine on a daily basis may lead to you having issues with increased blood pressure.

c.

You may want to be careful because drinking wine with dinner may stimulate your appetite significantly.

d.

This practice may cause your triglyceride level to rise, so I would discourage it.

ANS: A

Alcohol is a mild vasodilator when consumed in moderate amounts, which can be beneficial to heart health, depending on the patients condition.

DIF: Cognitive Level: Application REF: 395 OBJ: 2 (clinical)

TOP: Vasodilation With Alcohol KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

18. The nurse is correct when explaining to the patient that the portion of the heart that is responsible for contracting the muscle layers in order to pump blood is which structure?

a.

Myocardium

b.

Endocardium

c.

Epicardium

d.

Pericardium

ANS: A

The myocardium is the middle layer of muscle fibers of the heart that contract to pump blood. The endocardium is the lining of the inner surface of the heart chambers, the epicardium is the outer layer of the heart muscle, and the pericardium is the membranous sac that surrounds the heart.

DIF: Cognitive Level: Comprehension REF: 371 OBJ: 1 (theory)

TOP: Structures of the Heart KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. The nurse is explaining to the patient how telemetry will be used during his time in the hospital to help in diagnosing his heart disorder. Which patient statement indicates understanding of teaching?

a.

I will need to stay in bed when the monitor is reading my heart waves.

b.

This test will help determine if I have a blockage in my arteries.

c.

If there is a problem with my heart valves it will show up with telemetry.

d.

The nurses will be able to monitor my heart rate and rhythm.

ANS: D

Telemetry provides monitoring of the hearts rate and rhythm with the use of electrodes and wire leads from a bedside monitor or battery-operated transmitter unit. Patients may ambulate on the unit and still be monitored. Blockage of arteries is usually diagnosed with an arteriogram, and valvular problems may be diagnosed with echocardiography.

DIF: Cognitive Level: Application REF: 384 OBJ: 5 (theory)

TOP: Diagnostic Tests and Procedures KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

20. The nurse outlines behaviors that aid in the prevention of cardiovascular disease, which are: (Select all that apply.)

a.

regular physical activity at least 30 minutes a day.

b.

maintain high-density lipoprotein (HDL) greater than 50 mg/dL.

c.

refrain from smoking.

d.

obtain and maintain healthy weight.

e.

maintain triglycerides above 150 mg/dL.

ANS: A, B, C, D

Triglycerides should be maintained below 150 mg/dL.

DIF: Cognitive Level: Comprehension REF: 375 | Health Promotion, 376-377

OBJ: 4 (theory) TOP: Behaviors Preventing Cardiovascular Disease

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

21. Cardiac output is dependent on: (Select all that apply.)

a.

heart rate.

b.

peripheral pulses.

c.

venous return.

d.

viscosity of the blood.

e.

strength of contraction.

ANS: A, C, D, E

Peripheral pulses are dependent on cardiac output. All other options play a part in the cardiac output. Cardiac output is also dependent on peripheral resistance.

DIF: Cognitive Level: Comprehension REF: 373 OBJ: 1 (theory)

TOP: Cardiac Output KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. The nurse lists modifiable risk factors for a patient at risk for cardiovascular disease, which are: (Select all that apply.)

a.

smoking.

b.

hypertension.

c.

obesity.

d.

sedentary lifestyle.

e.

age.

ANS: A, B, C, D

All options listed are modifiable risk factors for cardiovascular disease except age. Stress is also a modifiable risk factor.

DIF: Cognitive Level: Comprehension REF: 377 | Table 18-1

OBJ: 2 (theory) TOP: Modifiable Risks

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23. During a community presentation on prevention of heart disease, a person asks which disorders are considered congenital. Which responses by the nurse are correct? (Select all that apply.)

a.

Arteriosclerosis

b.

Coarctation

c.

Holes in the septum

d.

Valvular defects

e.

Atherosclerosis

ANS: B, C, D

Congenital defects are those defects that are present at birth, and may include coarctation, septal defects, and valvular defects. Arteriosclerosis and atherosclerosis are considered acquired disorders.

DIF: Cognitive Level: Application REF: 375 OBJ: 1 (theory)

TOP: Disorders of the Heart KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

24. The nurse assessing the heart places the stethoscope between the fifth and sixth ribs at the mid-clavicular line to hear the point of _________.

ANS:

maximal impulse

The placement of the stethoscope will allow the loudest beat at the point of maximal impulse (PMI).

DIF: Cognitive Level: Application REF: 372 OBJ: 1 (clinical)

TOP: Auscultating the PMI KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

25. When the nurse uses the PQRST tool for pain assessment, the R prompts an inquiry about the __________ of the pain.

ANS:

radiation

The tool prompts inquiries about Precipitating events, Quality of pain, Radiation of the pain, Severity of the pain, and Timing of the pain.

DIF: Cognitive Level: Comprehension REF: 386 | Table 18-3

OBJ: 5 (theory) TOP: PQRST Assessment Tool

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

26. The nurse who uses a regular sized adult blood pressure cuff on a large adult will get a blood pressure reading that is falsely __________.

ANS:

elevated

high

The small cuff compresses the artery in a narrow local area and causes a greater compression that a cuff that is better suited. The result is a falsely high reading.

DIF: Cognitive Level: Comprehension REF: 387 OBJ: 5 (theory)

TOP: Blood Pressure: False High KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

27. _________ is the acute symptom most experienced by African Americans when having a myocardial infarction.

ANS:

Dyspnea

Dyspnea is the most common symptom experienced by African Americans during an acute MI rather than the classic MI symptoms. This often causes the African American patient to delay seeking treatment.

DIF: Cognitive Level: Application REF: 385 | Cultural Considerations

OBJ: 5 (theory) TOP: Cultural Considerations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

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