Chapter 19: Cardiovascular and Respiratory Disorders My Nursing Test Banks

Chapter 19: Cardiovascular and Respiratory Disorders

Test Bank

MULTIPLE CHOICE

1. Which of the following is a true statement about heart disease in older adults?

a.

Myocardial infarction (MI) has many of the same symptoms in older patients as in middle-aged persons.

b.

Both excessive urination at night and decreased urination can be signs of heart failure (HF).

c.

Any exertion on the part of an older adult patient with heart disease can bring on another heart attack.

d.

A person with HF is likely to have trouble breathing, except when lying down.

ANS: B

Because the heart is an ineffective pump in HF, both excessive urination at night and decreased urination can occur when older adults have an MI. Nocturia occurs in HF when the heart is unable to maintain adequate renal blood flow in the performance of daily activities; then, during the night when the patients lower extremities are elevated for sleep, the heart is able to perfuse the kidneys with the assistance of increased venous return owing to the elevated extremities. Inadequate urine production is due to inadequate perfusion from an ineffective pump.

The classic presentation of angina pectoris in older patients is often absent in what is known as a silent MI, with only mild discomfort, perhaps even limited to nausea or heartburn as the only symptom. Failure to engage in cardiac rehabilitation exercises is more likely to result in another MI or be an aggravation of HF than ordinary exertion. A person with HF is more likely to have difficulty breathing except when the trunk is upright (orthopnea).

PTS:1DIF:UnderstandREF:3-8

TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. An older man in a cardiac rehabilitation exercise class refuses to participate in the cool-down phase of the activity; consequently, 2 minutes later, he passes out but quickly regains consciousness. Which instruction does the nurse include in patient teaching to reinforce the importance of cooling down after exercising to this man?

a.

Cardiac output diminishes with age.

b.

Mobility capacity decreases with age.

c.

Baroreceptor function diminishes with age.

d.

Sensory perception diminishes with age.

ANS: C

During exercise, the body shunts blood to the skeletal muscles to supply enough oxygen to meet the increased metabolic demands of the muscles. If the exercise is suddenly withdrawn, however, the blood temporarily pools in the skeletal muscles, and the older adult loses consciousness from transient hypotension. Baroreceptor responsiveness declines with age; therefore the body does not respond as readily to the need for changes in blood pressure. The cool-down period compensates for this effect.

An acute problem such as losing consciousness as a result of decreased cardiac output should appear during the real exercise. The man is mobile enough to participate in the exercise program. Gradual sensory alteration does not account for the acute episode.

PTS: 1 DIF: Apply REF: 3-14 TOP: Teaching/Learning

MSC: Physiological Integrity

3. Which of the following is a true statement about heart disease in older men and women?

a.

More women than men die from MIs.

b.

Cardiac care for men and women is equally aggressive.

c.

Cardiac medications have been tested on men and women equally.

d.

Women generally receive less aggressive treatment than men do.

ANS: D

Women generally receive less aggressive treatment than men; this stereotype has led to a relative neglect of womens cardiac problems. Men usually receive more aggressive treatment. Testing in the past has focused on male patients. Women receive less aggressive treatment and less effective instruction for cardiac disease, which is potentially due to the atypical presentations women have for cardiac disease and MIs.

PTS:1DIF:RememberREF:3-14

TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. Which condition is a COPD?

a.

Bronchial asthma

c.

Bacterial pneumonia

b.

Histoplasmosis

d.

Mycobacterium tuberculosis

ANS: A

COPD includes asthma, chronic bronchitis, and emphysema. Pneumonia, an acute pulmonary infection, is not a chronic obstructive lung disorder.

PTS:1DIF:RememberREF:10-15

TOP: Nursing Process: Assessment MSC: Physiological Integrity

5. An older woman who has COPD wants to perform self-care activities. Which instruction should the nurse include in patient teaching to help her achieve this goal?

a.

Bathe and eat slowly with periodic rest.

b.

Walk short distances without oxygen.

c.

Perform all activities of daily living (ADLs) and then rest.

d.

Bathe right after eating, and then rest.

ANS: A

A person with COPD can perform self-care tasks if allowed plenty of time to accomplish them and to take breaks for rest. The patient can potentially benefit more from longer periods of exercise supplemented with oxygen than from short excursions without oxygen. A plan to rest in the future after the self-care task of performing ADLs or bathing after eating is accomplished does not compensate for the deprivation of rest when she needs it.

PTS: 1 DIF: Apply REF: 42 TOP: Teaching/Learning

MSC: Physiological Integrity

6. Which of the following statements is true about cardiopulmonary disease in older adults?

a.

COPD can be reversed with proper treatment.

b.

Chest radiographic studies are a reliable indicator of whether pneumonia is present in an older patient.

c.

Persons older than 65 years should receive Pneumovax annually.

d.

Mouth hygiene is essential to prevent and treat pneumonia.

ANS: D

Bacteria from the mouth can migrate into the lower respiratory tract and cause infection. COPD cannot be reversed. For a debilitated person at the beginning of the course of infection or in dehydration, the chest x-ray study is often falsely negative. Pneumovax is a one-time vaccine against the pneumococcus bacterium.

PTS:1DIF:RememberREF:10-12

TOP: Nursing Process: Assessment MSC: Physiological Integrity

7. Which of the following is a true statement about tuberculosis (TB) in older adults?

a.

The principal threat from TB is its highly contagious nature.

b.

The tuberculin purified protein derivative (PPD) is a conclusive test for TB.

c.

Antimicrobial drugs have made TB an infection of the past.

d.

Older persons, particularly those in nursing homes, are at risk for TB.

ANS: D

Most reported cases of TB among older adults are from nursing homes. TB is not as contagious as formerly suggested, but drug-resistant forms exist and are a serious risk for older adults who are immunocompromised. A PPD test has a false-negative rate of approximately 30%. When the result is positive, the patient receives a sputum culture and a chest x-ray examination. A positive sputum culture is necessary to confirm the diagnosis. Although medications such as isoniazid (INH) were thought to have eliminated TB, the organism is still present in multidrug-resistant forms. Older adults who contracted TB before the 1940s may suffer reactivation of the bacterium.

PTS:1DIF:UnderstandREF:17-20

TOP: Nursing Process: Assessment MSC: Physiological Integrity

8. An African-American 58-year-old man in good health has a blood pressure at 120/73 mm Hg at his annual physical examination. Which of the following is the best goal for the nurse to use to assist him in maintaining his health and wellness into older age?

a.

Alter modifiable risk factors.

b.

Prevent cardiovascular disease.

c.

Recognize disease in early stage.

d.

Maintain tight glycemic control.

ANS: B

The nurse assists this adult in maintaining health and wellness by helping him prevent cardiovascular disease; as an older African-American man, he has a high risk of stroke, hypertension, and diabetes mellitus. Furthermore, he is more likely to die of a stroke or heart attack than other people in the United States. To help him prevent cardiovascular disease, the nurse assists him with lifestyle modifications. Specific recommendations the nurse can make include getting regular exercise; learning the warning signs of heart attack and stroke; maintaining a normal weight; controlling blood pressure; eating a well-balanced, low-fat, no-added-salt diet; and avoiding smoking.

Altering modifiable risk factors is a subgoal to preventing cardiovascular disease. Learning the early warning signs of disease is a subgoal to preventing cardiovascular disease. Although he has no clinical indicators of hyperglycemia, he is at risk for developing diabetes mellitus, which is an important subgoal of preventing cardiovascular disease for an African-American man.

PTS: 1 DIF: Analyze REF: 17-18 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

9. An older woman has severe ischemic heart disease, hypertension, and low cardiac output. Which medication does the nurse administer to counteract the neurohormonal activation of this patients cardiovascular status?

a.

Loop diuretic

c.

Cardiac glycoside

b.

Nitroglycerin

d.

Beta-adrenergic blocker

ANS: D

A beta-adrenergic blocker is an important part of the standard therapy for patients with HF and is the drug of choice to break the neurohormonal cycle that aggravates HF. Beta-blockers inhibit the action of epinephrine (EPI) and norepinephrine (NE) to decrease myocardial workload and lower the oxygen demands of the myocardial tissue. This womans heart is an ineffective pump because it is ischemic and unable to meet the bodys metabolic demands. An ischemic heart has difficulty obtaining the supply of oxygen it needs to maintain cardiac output. As a result, the hypoxic myocardium stimulates the sympathetic nervous system to release EPI and NE for shunting blood from the periphery to vital organsthe fight-or-flight mechanism. The release of EPI and NE causes vasoconstriction and subsequent hypertension. Both make the work of the heart more difficult because the heart must work harder to pump blood out of the left ventricle against a higher afterload. This extra work increases the oxygen demands of the myocardial tissue and augments the cycle started by the ischemic heart.

A diuretic is a part of the standard therapy for HF for controlling fluid balance, but it does not interrupt neurohormonal activation from HF. Nitroglycerin is a common therapy for an ischemic myocardium to increase myocardial oxygenation, but it does not interrupt the neurohormonal activation from HF. Digoxin, a cardiac glycoside, is a part of the standard HF therapy and acts as an inotropic agent to increase the force of myocardial contractions; however, it does not interrupt neurohormonal activation from HF.

PTS:1DIF:ApplyREF:3-36

TOP: Nursing Process: Implementation MSC: Physiological Integrity

10. Which classic sign of an acute myocardial infarction (AMI) can be absent in an older man with an AMI?

a.

Vague complaints

c.

Crushing chest pain

b.

Epigastric burning

d.

Dyspnea and fatigue

ANS: C

Gripping chest pain, radiating to the shoulder is typically seen in younger adults, but not always in older adults. Instead, an older adult may be experiencing a silent MI. Older adults with an AMI express vague complaints such as fatigue, weakness, and dyspnea. Older adults with an AMI are seen with atypical complaints such as epigastric burning or pain.

PTS:1DIF:UnderstandREF:33

TOP: Nursing Process: Assessment MSC: Physiological Integrity

11. Which of the following is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults who have HF?

a.

Control fluid balance.

c.

Prevent deconditioning.

b.

Control blood pressure.

d.

Maintain patient safety.

ANS: A

The most important goal for keeping a patient who has HF out of the hospital is to control total body fluid; hypervolemia aggravates HF by increasing the blood volume and making the heart work harder. Controlling total body fluid also helps prevent dyspnea and hypertension, maintain physical activity, improve rest and sleep, and promote nutrition for optimal health and wellness.

Controlling the blood pressure is an important part of HF therapy; however, fluid volume status is implicated more often in those hospitalized with HF. Preventing deconditioning is an important yet challenging goal for patients with HF, but it is not frequently implicated in those hospitalized with HF. Maintaining patient safety is an important goal for any patient, but it is not commonly implicated as a cause of hospitalization for those with HF.

PTS: 1 DIF: Understand REF: 17| 6-9 TOP: Nursing Process: Evaluation

MSC:Health Promotion and Maintenance

12. After an acute exacerbation of COPD, the nurse prepares an older adult for discharge to home. Which is the most important patient teaching for the nurse to include for the prevention of hospitalizations for exacerbations of COPD?

a.

Ease breathing by sitting upright.

b.

Use low-flow oxygen for dyspnea.

c.

Avoid sick people and wash hands.

d.

Eat nutrient- and calorie-dense foods.

ANS: C

The nurse helps the patient with COPD maintain health and wellness by preventing infection. To accomplish this, the nurse instructs the patient to avoid people with contagious illnesses to reduce exposure to communicable diseases and to wash hands frequently to reduce exposure to microorganisms as potential pathogens. Following these instructions will help the patient avoid hospitalizations for COPD; a pulmonary infection can have a devastating impact on a patient who has compromised pulmonary reserves. Fluid and exudates accumulate in the lungs to decrease oxygenation and ventilation, and the patient with COPD is less able to cough and expel sputum.

The nurse teaches the patient to sit upright to ease breathing for transient dyspnea that occurs after exertion or while eating. This technique, however, is unlikely to prevent a hospitalization for the patient with an exacerbation of COPD. The patient with COPD regularly uses oxygen for dyspnea as prescribed. Oxygen provides symptomatic relief of dyspnea but does not prevent hospitalizations for exacerbated COPD. Eating nutrient- and calorie-dense food is also important. Patients with COPD work very hard at breathing; therefore the patient needs the calories and nutrition to supply fuel for the work of breathing. In addition, patients with COPD should eat these foods because eating them in sufficient quantities to meet their needs is often difficult; therefore the food they do eat must contain many calories and nutrients. Nutritional issues are not the most important aspect of preventative therapy for patients with COPD; an infection is more likely to cause a more devastating problem.

PTS: 1 DIF: Analyze REF: 42-43 TOP: Teaching/Learning

MSC:Health Promotion and Maintenance

13. The nurse notices that an older female nursing home resident is not eating and that her heart rate is faster than usual. Which should the nurse do to determine if pneumonia is a potential cause of the change in her status?

a.

Obtain a specimen for aerobic blood cultures.

b.

Promptly send the resident for a chest x-ray examination.

c.

Analyze sputum for color, texture, and volume.

d.

Compare tympanic temperature to the baseline.

ANS: C

Sputum cultures are indicated to assess a resident for pneumonia. Sputum is a sensitive and specific clinical indicator of pneumonia for older adults in nursing homes. If pneumonia is causing this residents anorexia and tachycardia, then her sputum should be cloudy, colored, and thick, especially if the resident is dehydrated, which indicates an infection.

Blood cultures are likely to show no growth unless the resident has severe sepsis. A chest x-ray study is a nonsensitive, nonspecific diagnostic tool for determining the presence of pneumonia in an older adult. Fever can be a late indicator of infection for an older adult.

PTS:1DIF:ApplyREF:13-19| 41| 43

TOP: Nursing Process: Implementation MSC: Physiological Integrity

MULTIPLE RESPONSE

1. Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.)

a.

Carotid stenosis

b.

Diabetes mellitus

c.

Renal insufficiency

d.

Coronary artery disease

e.

Isolated systolic hypertension

f.

Familial hypercholesterolemia

ANS: A, C, D

Carotid stenosis refers to the occlusion of the carotid artery from atherosclerotic plaque and can be a result of chronic hypertension. Older adults with carotid stenosis are at high risk for strokes because of the risk of a thromboembolic event from the plaque. Renal dysfunction can occur as a result of chronic hypertension; the intimal lining of the renal arteries is damaged over time, which leads to renal artery stenosis and decreased renal perfusion. Coronary artery disease is a common result of chronic hypertension.

Diabetes mellitus (DM) is not a result of end-organ damage from chronic hypertension; however, when it accompanies hypertension, DM accelerates the process of end-organ damage and greatly increases the risk of cardiovascular disease. Isolated systolic hypertension is a common consequence of aging but not a result of end-organ damage. Genetic factors determine familial hypercholesterolemia and cannot be caused by end-organ damage.

PTS:1DIF:UnderstandREF:4

TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. An older man who has HF complains of increasing dyspnea over 2 days. Which of the following should the nurse assess to help determine whether the patient has adhered to his therapy? (Select all that apply.)

a.

Check for peripheral edema.

b.

Ask about his bowel pattern.

c.

Auscultate the lungs bilaterally.

d.

Compare his weight to baseline.

e.

Determine coughing frequency.

f.

Assess his diet over last 48 hours.

ANS: A, C, D, F

Standard HF therapy includes taking medications as prescribed with a low-sodium diet to control total body fluids. Usually, dyspnea in a patient with HF is due to hypervolemia, which occurs after a lapse in adherence to the standard HF therapy. The nurse checks the patients extremities for edema because peripheral edema is a clinical indicator of hypervolemia. If the patient is nonadherent with therapy, then the nurse is more likely to find peripheral edema than with an adherent patient. Hypervolemia can also be due to worsening HF. The nurse listens to the patients lungs to assess for pulmonary edema as a cause for the patients dyspnea. Pulmonary edema can be caused by hypervolemia from nonadherence to therapy or from worsening HF. The nurse compares the patients weight to his baseline to determine whether the patient has experienced a sudden weight gain, which would be indicative of hypervolemia. Assessing the patients diet over the last 48 hours can provide clues about a potential cause of the patients dyspnea. If the patient increases the dietary sodium by eating pizza, pickles, and processed food, among others, the patient is likely to experience a sudden increase in total body fluid, which can cause the patients dyspnea.

Although older adults with HF complain of anorexia, bowel habits are not as likely to be affected by hypervolemia as is the appetite. Coughing is a nonspecific, nonsensitive indicator of pulmonary edema.

PTS:1DIF:AnalyzeREF:39| 41

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

3. The nurse understands that heart disease risk factors are which of the following? (Select all that apply.)

a.

Age

c.

Diabetes

b.

Hypertension

d.

Macular degeneration

ANS: A, B, C

Age, hypertension, cigarette smoking, obesity, inactivity, dyslipidemia, and diabetes are all risk factors for the development of heart disease. Macular degeneration is a disease.

PTS:1DIF:UnderstandREF:32

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

4. The nurse should instruct a patient on which of the following modifiable risk factor(s) for essential hypertension? (Select all that apply.)

a.

Tobacco use

c.

Stress management

b.

Alcohol

d.

Adequate rest

ANS: A, B, C

Tobacco use, alcohol, and stress management are modifiable risk factors. Although adequate rest helps with general health and wellness, it has not been identified as a modifiable risk factor for essential hypertension.

PTS: 1 DIF: Understand REF: 36 TOP: Teaching and Learning

MSC:Health Promotion and Maintenance

OTHER

1. The exercise tolerance of an older adult is impaired after a MI because of a low ejection fraction. Rank the following interventions that the nurse should use to assist this individual to restore baseline functional status in order of importance, beginning with the first intervention.

A. Provide a well-balanced diet.

B. Assist with range of motion.

C. Sit in chair four times daily.

D. Keep arterial oxygen saturation (SaO2) above 95%.

ANS:

D, A, B, C

The nurse first helps the patient maintain myocardial oxygenation by keeping the patients SaO2 above 95%; if it drops below that level, then the arterial blood lacks sufficient oxygen to meet tissue oxygen demands. Second, the nurse provides a well-balanced diet for tissue building and repair. The patient has little hope of resuming baseline functioning without adequate food for fuel and maintaining muscle bulk. Third, to help maintain muscle bulk and joint flexibility, the nurse helps the patient perform range-of-motion exercises in preparation for more strenuous physical activity. Last, before ambulation, the nurse ensures that the patient is able to sit in the chair four times a day as progress toward restoring baseline functioning.

PTS: 1 DIF: Analyze REF: 39-41 TOP: Nursing Process: Planning

MSC:Health Promotion and Maintenance

2. After noticing an older mans extremities are cool and the cardiac monitor is showing a heart rate of 120 bpm, the nurse determines that these findings warrant further investigation. Rank the patient parameters the nurse should examine to assess cardiac output in order of importance, beginning with the first assessment the nurse should complete.

A. Hypoxemia

B. Hypotension

C. Irregular rhythm

D. Low urine output

ANS:

A, C, B, D

The nurse assesses the SaO2 because airway and breathing are the two most basic human needs on Maslows Hierarchy of Human Needs. Assessing the SaO2 is also the first step for this individual because hypoxemia can explain the cool extremities and tachycardia with an adequate cardiac output. The nurse then examines the hearts rhythm; with adequate oxygenation, the cool extremities and increased heart rate can be explained by a low cardiac output as a result of dysrhythmia; the heart becomes an ineffective pump when it beats too quickly, too slowly, or in an irregular pattern. Next, the nurse examines the blood pressure; hypotension as a result of low cardiac output and with adequate oxygen and a regular heart rhythm can explain the cool extremities and tachycardia as the body tries to compensate by shunting blood to the vital organs and increasing the heart rate. Finally, the nurse examines the urine output to assess renal perfusion. With adequate oxygenation and a regular heart rhythm, urine output will drop with a low cardiac output because it decreases renal perfusion. The kidneys need a minimum systolic blood pressure of 80 mm Hg to produce urine.

PTS:1DIF:AnalyzeREF:8-10

TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance

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