Chapter 21: Cardiovascular Function My Nursing Test Banks

Chapter 21: Cardiovascular Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. The nurse is teaching cardiovascular risk factors to a group of older adults. The nurse stresses that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers because smoking:

a.

interferes with the development of collateral coronary vessels.

b.

produces coronary artery stricture.

c.

results in carbon monoxide poisoning.

d.

increases platelet aggregation.

ANS: D

Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygen-carrying capacity of the blood. Smoking does not interfere with collateral circulation or produce strictures, but it may contribute to higher levels of carbon monoxide in the blood.

DIF: Understanding (Comprehension) REF: Page 390 OBJ: 21-2

TOP: Teaching-Learning MSC: Health Promotion

2. When assessing an older, female, African American adult, the nurse notes that she has been a type 2 insulin-dependent diabetic 10 years. The nurse notes that the patients greatest risk for developing secondary hypertension is her:

a.

gender.

b.

ethnic origin.

c.

vascular system status.

d.

insulin therapy.

ANS: C

Secondary hypertension identified in the vascular system refers to elevated blood pressure caused by underlying disease such as renal artery disease, renal parenchymal disorders, endocrine and metabolic disorders, central nervous system (CNS) disorders, coarctation of the aorta, and increased intravascular volume. Gender, ethnic origin, and insulin are not diseases that cause hypertension.

DIF: Remembering (Knowledge) REF: Page 392 OBJ: 21-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. When administering Lopressor to an older adult patient with hypertension, the nurse is careful to have the patients care plan include

a.

frequent assessment for dizziness or syncope.

b.

education of the signs and symptoms of thromboembolism.

c.

regular evaluation of the patients muscle strength.

d.

regularly scheduled serum potassium levels.

ANS: A

Dizziness is an adverse reaction to beta-blockers such as Lopressor.

DIF: Remembering (Knowledge) REF: Page 398 OBJ: 21-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. The nurse educates the obese older adult patient that the single most important outcome that will affect cardiac health is:

a.

compliance with drug therapy.

b.

adherence to the DASH diet.

c.

20 minutes of exercise daily.

d.

a 10% reduction in weight.

ANS: D

A 10% reduction of total weight will decrease blood pressure in many overweight individuals. This factor has significance because it underscores the importance of weight reduction in the older adult population. The other factors are important but not as significant to overall cardiac health as is weight loss.

DIF: Understanding (Comprehension) REF: Page 392 OBJ: 21-2

TOP: Teaching-Learning MSC: Health Promotion

5. To evaluate an older patient for possible renal failure as a result of chronic untreated hypertension, nurse prepares to:

a.

schedule an ultrasound.

b.

collect a urine sample.

c.

monitor intake and output.

d.

transport the patient to radiology.

ANS: B

A urinalysis will investigate for proteinuria or other signs of renal failure.

DIF: Remembering (Knowledge) REF: Page 393 OBJ: 21-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

6. The nurse should assess which patient first?

a.

The patient with acute shortness of breath

b.

The patient with epigastric pain

c.

The patient with right arm pain

d.

The patient with persistent indigestion

ANS: A

Older patients often have atypical signs and symptoms of cardiac ischemia, including shortness of breath, fatigue, syncope, confusion, and abdominal or back pain. Shortness of breath requires the most immediate assessment.

DIF: Applying (Application) REF: N/A OBJ: 21-4

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

7. It is suspected that an older adult patient is experiencing severe hypertension. The nurse documents symptoms that support this diagnosis when the patient reports:

a.

difficulty reading the newspapers print.

b.

being fatigued after walking around the block.

c.

noticing that his heart skips a beat frequently.

d.

getting up from a chair too quickly makes him dizzy.

ANS: A

The patient with severe hypertension may experience throbbing occipital headaches, confusion, visual loss, focal deficits, epistaxis, and coma. The other manifestations are not associated with hypertension.

DIF: Remembering (Knowledge) REF: Page 392 OBJ: 21-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. A novice nurse requires additional education on arterial vascular deficiency when suggesting the conditions symptoms include:

a.

2+ edema in calf and foot of left leg.

b.

a 2-cm ulcer between the great and second toe on the left foot.

c.

skin on the left leg is cool to the touch.

d.

toenails on the left foot are thick and brittle.

ANS: A

Edema is not generally observed in cases of arterial deficiency, but rather in venous insufficiency. The other options are manifestations of arterial vascular deficiency.

DIF: Remembering (Knowledge) REF: Page 415 OBJ: 21-5

TOP: Teaching-Learning MSC: Physiologic Integrity

9. The nurse shows an understanding of how anemia symptoms present in the older population when:

a.

questioning the patient about dizziness when turning from side to side in bed.

b.

assessing the patient for pale oral mucous membranes.

c.

asking whether the patient takes supplementary iron tablets.

d.

assessing the patients weekly intake of red meat.

ANS: B

Skin color is not a good indicator of pallor because of varying pigmentation. Oral mucous membranes, as well as conjunctivae and nail beds, are better indicators. The other options are not related to symptoms.

DIF: Remembering (Knowledge) REF: Page 417 OBJ: 21-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

10. A nurse has provided discharge teaching for an older adult patient who had a pacemaker implanted. Which statement by the patient indicates appropriate understanding of the device?

a.

The battery will need charging every 2 years or so.

b.

Im supposed to call my doctor if my pulse is within 10 beats of my preset rate.

c.

My wife will have to be the one who makes the microwave popcorn.

d.

Ill take my pulse each morning before my first cup of coffee.

ANS: D

The radial pulse should be taken at the same time daily and recorded. The patient should notify the provider if the pulse is lower than the preset lower limit on the pacemaker. Battery life is longer than 2 years. Microwaves are safe to use.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 21-4

TOP: Nursing Process: Evaluation MSC: Health Promotion

11. A 76-year-old patient has been recently diagnosed with cardiac valvular disease. The nurse assesses the patient and recognizes that the medical diagnosis is supported by:

a.

cyanotic fingertips.

b.

weight loss of 10 pounds in 3 months.

c.

angina pain.

d.

shortness of breath with activity.

ANS: D

Individuals with valvular disease may be asymptomatic for many years, but with the deterioration of the valves and hypertrophic changes in the atria or ventricles, symptoms become evident. Exertional dyspnea is frequently the initial symptom. Other symptoms include dizziness, fatigue, weakness, and palpitations. The other signs are not manifestations of valve disease.

DIF: Remembering (Knowledge) REF: Page 406 OBJ: 21-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

12. An older patient is upset with a blood pressure reading of 180/78 mmHg. What response by the nurse is best?

a.

It looks like you need blood pressure medicine now.

b.

Most people get hypertension when they get older.

c.

With age, blood vessels stiffen, raising blood pressure.

d.

Dont worry, there are lots of good medications for this.

ANS: C

With age, elastin in vessel walls decreases, making them stiffer. Systolic blood pressure (SBP) is increased in older adults because of a loss of arterial distensibility resulting from arterial stiffening. The other responses do not offer any useful information on the cause of the patients condition.

DIF: Understanding (Comprehension) REF: Page 389 OBJ: 21-1

TOP: Teaching-Learning MSC: Health Promotion

13. An older patient is overwhelmed at the number of lifestyle changes needed to manage newly diagnosed cardiovascular disease. What action by the nurse will reduce this barrier to teaching?

a.

Tell the patient even tiny changes over time make a big difference.

b.

Tell the patient that smoking is the biggest risk factor and needs to stop.

c.

Help the patient choose a change and incorporate it into daily life.

d.

Educate the patient on the consequences of not making changes.

ANS: C

Although it is true that small changes over time have a great impact, the nurse needs to do more by helping the patient choose a small change to implement. The nurse should help the patient work on the risk factor he or she is most willing to change. Education is important, but it will not enable the patient to make changes.

DIF: Applying (Application) REF: N/A OBJ: 21-5

TOP: Teaching-Learning MSC: Health Promotion

14. A nurse is caring for a patient taking furosemide (Lasix). What assessment finding needs to be reported to the provider immediately?

a.

Weight gain of 1/2 pound (1.1 kg) in 24 hours

b.

2+/4+ pedal and pretibial edema

c.

Potassium level: 2.6 mEq/L

d.

Sodium level: 138 mEq/L

ANS: C

Furosemide is a potassium-wasting diuretic and the patients potassium is low. This finding should be reported. The weight gain should be charted but does not need immediate reporting. Without knowing what the patients baseline edema is, there is no indication this needs to be reported. The sodium level is normal

DIF: Applying (Application) REF: N/A OBJ: 21-5

TOP: Communication and Documentation MSC: Physiologic Integrity

15. An older patient is prescribed nifedipine (Procardia). What teaching topic is most important to discuss with this patient?

a.

Need to monitor blood pressure

b.

Need to follow low-salt diet

c.

Need to change positions slowly

d.

Need to add exercise to daily routine

ANS: C

Calcium channel blockers such as Procardia can cause orthostatic hypotension in older adults. The nurse educates the patient on preventing this by slow position changes. The other topics are appropriate for all patients on this medication.

DIF: Applying (Application) REF: N/A OBJ: 21-4

TOP: Teaching-Learning MSC: Physiologic Integrity

16. A patient had a heart attack and the nurse identifies the diagnosis as activity intolerance. What assessment finding indicates a priority goal for this diagnosis is being met?

a.

Mild chest pain getting into the chair

b.

Feels unsteady when getting out of bed

c.

O2 saturation 98% after using the commode

d.

Less dyspnea when changing positions

ANS: C

Activity intolerance is measured by changes in vital signs, electrocardiogram (ECG), and symptoms such as chest pain or shortness of breath. The oxygen saturation indicates physiologic tolerance to activity. The other options do not show physiologic tolerance.

DIF: Analyzing (Analysis) REF: N/A OBJ: 21-5

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

17. An older patient in the internal medicine clinic reports usually being able to walk 1 mile without complaint. However, in the past 2 weeks, after walking just mile, the patients legs begin to ache. The pain goes away with rest. What action by the nurse is most appropriate?

a.

Elevate the patients legs

b.

Assess the pedal pulses

c.

Take the patients blood pressure

d.

Measure the patient for TED hose

ANS: B

This patient has intermittent claudication, a sign of peripheral arterial disease. The nurse assesses the patients pedal pulses. Elevation will further compromise circulation and should be avoided. A blood pressure reading is taken during all health care visits. The patient does not need TED hose at this point.

DIF: Applying (Application) REF: N/A OBJ: 21-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

18. A patient has peripheral vascular disease. What statement by the patient indicates a need for further teaching?

a.

I will have the podiatrist cut my toenails.

b.

I will be sure to wear sturdy shoes.

c.

I can only walk limited distances now.

d.

I will report any injury to my foot or leg.

ANS: C

Patients with venous insufficiency are encouraged to begin a graduated exercise program. The other statements show good understanding.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 21-5

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

MULTIPLE RESPONSE

1. The effect of aging on the cardiovascular system is evidenced by which symptoms in an older adult performing a stress test? (Select all that apply.)

a.

Chest pain during exercise

b.

Slow increase of heart rate in response to stress

c.

Exercise induce dyspnea

d.

Slow decrease of heart rate post exercise

e.

Stress-induced arrhythmias

ANS: B, D

During stress or stimulation, the heart rate increases more slowly; however, once elevated, it takes longer to return to the resting rate. The other manifestations are not related to age-induced physiologic changes.

DIF: Remembering (Knowledge) REF: Page 389 OBJ: 21-1

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. A novice nurse is aware that normal aging can result in changes in the ECG of a 73-year-old patient. The experienced geriatric nurse explains that these changes may include which of the following? (Select all that apply.)

a.

An inverted T wave

b.

A notched P wave

c.

A prolonged PR interval

d.

Decreased amplitude of the QRS complex

e.

A slurred T wave

ANS: B, C, D, E

The number of pacemaker cells located in the sinoatrial node decreases with age, which results in less responsiveness of the cells to adrenergic stimulation. Common aging changes that are reflected by the electrocardiogram (ECG) include a notched P wave, a prolonged PR interval, decreased amplitude of the QRS complex, and a notched or slurred T wave.

DIF: Remembering (Knowledge) REF: Page 389 OBJ: 21-1

TOP: Teaching-Learning MSC: Health Promotion

3. A nurse is planning to teach a senior citizens group heart-healthy lifestyle choices. Which should be included? (Select all that apply.)

a.

Smoking cessation tips

b.

Low-carbohydrate food choices

c.

Stress management techniques

d.

Regular blood pressure monitoring

e.

Strategies to include exercise into daily routine

ANS: A, C, D, E

Heart-healthy lifestyle changes concern smoking cessation, stress management, blood pressure control, exercise, weight loss, and a low-fat, low-sodium diet. Low-carbohydrate foods are not considered part of heart-healthy lifestyles.

DIF: Understanding (Comprehension) REF: Page 389 OBJ: 21-4

TOP: Teaching-Learning MSC: Health Promotion

4. An older adult recovering from a myorcardial infarction (MI) has been taking subcutaneous heparin but is now to receive oral warfarin (Coumadin). The nurse prepares to teach the patient which topics? (Select all that apply.)

a.

Administration of both medications for up to 5 days

b.

Need to use a soft bristle toothbrush

c.

Use of atropine as an antidote for excessive bleeding

d.

Need to continue drawing partial thromboplastin times

e.

Need to drink at least eight cups of fluids daily

ANS: A, B, D

Heparin and warfarin (Coumadin) are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after an MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the international normalized ratio (INR); the antidote is vitamin K. Patients who initially receive heparin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complication. Patients need to be taught bleeding precautions.

DIF: Understanding (Comprehension) REF: Page 398 OBJ: 21-3

TOP: Teaching-Learning MSC: Physiologic Integrity

5. A 77-year-old patient is being treated for cardiac arrhythmia. The nurse determines that the patients cardiac output is adequate with which assessments? (Select all that apply.)

a.

Urine output of 140 cc over 4 hours

b.

Systolic blood pressure that remains within 20 mm of baseline

c.

Denial of substernal pain

d.

Recollection of the birthdays of all of her grandchildren

e.

Absence of rales and crackles

ANS: A, B, D, E

The patient will maintain an adequate cardiac output, as evidenced by heart rate and rhythm within normal range, stable blood pressure, adequate peripheral pulses, mental alertness, urine output of 30 mL/hr, and clear breath sounds. Normal mentation also denotes good cardiac output, but the patient may have too many birthdays to remember, so this is not the best indicator of cognitive status.

DIF: Remembering (Knowledge) REF: Page 403 OBJ: 21-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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