Chapter 32 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 32

Question 1

Type: MCMA

The nurse is discussing coronary heart disease risk factors with a group of factory employees. Which risk factors would the nurse identify as modifiable?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Hypertension

2. Diabetes mellitus

3. Obesity

4. Age

5. Heredity

Correct Answer: 1,2,3

Rationale 1: Hypertension can be controlled through medications, weight control, diet, and exercise.

Rationale 2: Diabetes mellitus can be controlled through medications, weight control, diet, and exercise.

Rationale 3: Obesity can be modified through medications, weight control, diet, and exercise.

Rationale 4: The role of age in coronary heart disease cannot be changed.

Rationale 5: The role of heredity in coronary heart disease cannot be changed.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-1

Question 2

Type: MCSA

An otherwise healthy patient admitted with chest pain is scheduled for diagnostic testing. The nurse anticipates that the results of which test will provide the best information about the patients coronary artery status?

1. Coronary angiography

2. Stress electrocardiography

3. Echocardiography

4. Nuclear persantine (dipyridamole) stress test

Correct Answer: 1

Rationale 1: The gold standard for evaluating coronary arteries is coronary angiography, which allows visualization of the arteries.

Rationale 2: Stress electrocardiography may be used to detect CAD but does not offer specific information about the arteries.

Rationale 3: Echocardiography reveals structural changes in the heart, but not specific information about the coronary arteries.

Rationale 4: This test is used for patients who are unable to walk on a treadmill. There is no indication that this is the case with this patient.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-5

Question 3

Type: MCSA

Aspirin has been prescribed for a patient following a myocardial infarction. What should the nurse include in teaching about this drug?

1. Watch for signs of bleeding, such as bruising.

2. Report any itching that develops after 7 days of taking the drug.

3. Take aspirin as a substitute for clopidrogrel (Plavix).

4. Do not skip any scheduled appointments to have blood drawn for labs.

Correct Answer: 1

Rationale 1: Aspirin is an antiplatelet agent, so the patient should watch for signs of bleeding.

Rationale 2: Itching is not a common side effect of aspirin therapy.

Rationale 3: Aspirin is not a substitute for clopidrogrel.

Rationale 4: No lab appointments will be made for aspirin monotherapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-4

Question 4

Type: MCSA

The nurse is assessing a patient who is 6 hours postoperative from coronary artery bypass graft (CABG) surgery. The patients heart rate is 120, blood pressure is 90/50, urine output is decreased, chest tube output is decreased, heart sounds are muffled, and peripheral pulses are diminished. What action should the nurse take first?

1. Notify the physician immediately.

2. Recheck vital signs in 15 minutes.

3. Reposition the patient.

4. Increase the intravenous fluids.

Correct Answer: 1

Rationale 1: The patient is exhibiting signs of cardiac tamponade. This is a medical emergency, and the physician must be notified immediately.

Rationale 2: Delaying the response by 15 minutes will be ineffective.

Rationale 3: Repositioning the patient will be ineffective.

Rationale 4: No change in intravenous fluids should be made until a physician order is given to do so.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-7

Question 5

Type: MCSA

Which laboratory test result would the nurse evaluate as indicating increased risk of coronary artery disease (CAD)?

1. Elevated homocysteine

2. Elevated creatinine

3. Elevated high-density lipoprotein (HDL)

4. Elevated INR

Correct Answer: 1

Rationale 1: Elevated levels of homocysteine (Hyc > 17 mol/L) are associated with an increased risk of coronary artery disease (CAD).

Rationale 2: Elevated creatinine indicates kidney disease.

Rationale 3: HDL is the good cholesterol that, when elevated, reduces the risk for the development of CAD.

Rationale 4: INR is a laboratory test that measures blood clotting function, not CAD.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-1

Question 6

Type: MCSA

Which finding from the social and history assessment of a patient admitted for chest pain would the nurse evaluate as carrying the highest risk for heart disease?

1. The patient is overweight and carries the weight around the waist.

2. The patients mother died at age 70 of an acute myocardial infarction.

3. The patient is a single mother of four young children and has a low income.

4. The patient has a desk job and works long hours.

Correct Answer: 1

Rationale 1: Fat accumulation in the upper body, giving the body an appearance of an apple, has been linked to a greater risk of coronary artery disease (CAD) as opposed to a pear shape with body fat accumulation in the gluteofemoral region.

Rationale 2: If the patients mother had died before age 55, that would be a risk factor.

Rationale 3: Being a single mother is not a specific risk factor for the development of CAD.

Rationale 4: A sedentary lifestyle is a risk factor but is not as significant as another finding.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-1

Question 7

Type: MCSA

The nurse, assessing a middle-aged patient experiencing chest pain, realizes that which symptoms would be most suggestive of an acute myocardial infarction?

1. Substernal pressure-type pain, radiating down the left arm

2. Colic-like epigastric pain

3. Sharp, well-localized unilateral chest and left arm pain

4. Sharp, burning chest pain moving from place to place

Correct Answer: 1

Rationale 1: Terms such as burning, crushing, suffocating, and pressure are typical descriptors of chest pain from myocardial ischemia, often with pain radiating to other areas of the upper torso.

Rationale 2: Cardiac chest pain is not usually described as colic-like or localized to a defined spot such as the epigastric area.

Rationale 3: Cardiac chest pain is not usually described as sharp or localized to a defined spot.

Rationale 4: Cardiac chest pain is not usually described as moving from place to place.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-3

Question 8

Type: MCSA

The nurse, caring for a patient diagnosed with Prinzmetals or variant angina, realizes this is a serious type of chest pain. Why is this so?

1. It indicates the presence of coronary artery spasm.

2. It indicates there is associated renal disease.

3. It indicates there is associated pulmonary disease.

4. It indicates the presence of a myocardial infarction.

Correct Answer: 1

Rationale 1: Variant, Prinzmetals, or vasospastic angina is a serious type of angina. It occurs when single or multiple sites in major coronary arteries and their large branches have vasospasm, thereby cutting off the blood supply to an area of the myocardium.

Rationale 2: Prinzmetals angina is not linked to renal disorders.

Rationale 3: Prinzmetals angina is not linked to pulmonary disorders.

Rationale 4: Prinzmetals angina is not specifically diagnostic for myocardial infarction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-3

Question 9

Type: MCMA

A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient includes which nursing actions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Morphine intravenously and oxygen

2. Aspirin 325 mg orally

3. Preparation for open heart surgery

4. Heparin drip at 100 units per hour

5. Foley catheter insertion

Correct Answer: 1,2

Rationale 1: The mnemonic MONA, cited in the Advanced Cardiac Life Support (ACLS) guidelines, describes a protocol for treatment of patients with suspected myocardial infarction. The mnemonic stands for morphine, oxygen, nitroglycerin, and aspirin.

Rationale 2: The mnemonic MONA, cited in the Advanced Cardiac Life Support (ACLS) guidelines, describes a protocol for treatment of patients with suspected myocardial infarction. The mnemonic stands for morphine, oxygen, nitroglycerin, and aspirin.

Rationale 3: Open heart surgery may be indicated later, but not on admission to the emergency department.

Rationale 4: Heparin is not part of the admission protocol.

Rationale 5: A Foley catheter is not part of the admission protocol.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-2

Question 10

Type: MCSA

Following a transmural myocardial infarction, which ECG change stays with the patient for life?

1. Q wave deepening

2. ST segment elevation

3. ST segment depression

4. P wave inversion

Correct Answer: 1

Rationale 1: The development of an abnormal Q wave is a definitive diagnostic sign of myocardial necrosis and stays with the patient for life.

Rationale 2: ST segment elevation represents myocardial ischemia, which is reversible by increasing the blood flow to the heart.

Rationale 3: ST segment depression occurs when muscle ischemia involves only a portion of the heart wall.

Rationale 4: P wave inversion represents a junctional pacemaker in the heart and is not related to changes that occur with a myocardial infarction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-3

Question 11

Type: MCSA

A patient reports chest pain, nausea, and vomiting off and on for the last 4 days, which the patient interpreted as the flu. Which laboratory tests will provide information about acute cardiac damage for this patient?

1. Troponin I and T

2. Red blood cells

3. CPK-MB

4. Homocysteine and platelets

Correct Answer: 1

Rationale 1: The levels of troponin T begin to rise within 36 hours after myocardial injury and remain elevated 1421 days. Levels of troponin I begin to increase 35 hours after myocardial ischemia, peak at 1418 hours, and remain elevated for 57 days.

Rationale 2: Red blood cells are unaffected by acute cardiac damage.

Rationale 3: The CPK-MB rises within 36 hours after the MI, peaks within 1224 hours, and returns to normal 34 days following the infarction. This patient would likely have normal values 4 days after the onset of symptoms.

Rationale 4: Homocysteine does not change and platelets are unaffected by acute cardiac damage.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-5

Question 12

Type: MCSA

Fifteen hours after admission, a patients CK-MB level is markedly increased. What does this indicate to the treatment team?

1. Cellular necrosis of myocardial tissue has occurred.

2. Lactic acid is present.

3. Thrombolytic therapy is indicated.

4. Cardiac function has returned to normal.

Correct Answer: 1

Rationale 1: CK is the intracellular enzyme that is released when cell damage and death occur. CK-MB becomes elevated when myocardial cell death has occurred.

Rationale 2: The pH is the indicator of lactic acid buildup.

Rationale 3: Thrombolytic therapy is indicated within the first 12 hours after symptoms develop; thus, it is too late for this intervention.

Rationale 4: Cardiac function has not returned to normal.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-5

Question 13

Type: MCSA

The nurse, caring for a patient with myocardial damage, would expect which change on the ECG tracing?

1. ST segment elevation

2. Loss of P waves

3. Bradycardia

4. Widening of the QRS complex

Correct Answer: 1

Rationale 1: Myocardial damage is present with ST segment elevation.

Rationale 2: Loss of P waves occurs with atrial flutter and fibrillation.

Rationale 3: Bradycardia can be a normal or abnormal rhythm. It is not specifically associated with myocardial damage.

Rationale 4: Widening of the QRS complex occurs with bundle branch block. It is not specifically associated with myocardial damage.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-5

Question 14

Type: MCSA

A patient is recovering from an acute myocardial infarction. The nurse realizes that the final extent of cardiac damage depends on which factor?

1. Reperfusion of the ischemic zone

2. Patients ethnicity

3. Patients gender

4. Development of heart block

Correct Answer: 1

Rationale 1: Surrounding the area of infarction are the zone of injury and the zone of ischemia. These zones are made of potentially viable tissues. They can become necrotic and die, or be reperfused and remain functional. The goal of treatment for an AMI is to establish reperfusion as early as possible to prevent necrosis and salvage the myocardium.

Rationale 2: The patients ethnicity does not impact the final extent of cardiac damage.

Rationale 3: The patients gender does not impact the final extent of cardiac damage.

Rationale 4: Developing a heart block does not impact cardiac damage.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-4

Question 15

Type: MCSA

Nursing care of the patient after thrombolytic therapy focuses on the assessment of which common complication?

1. Bleeding

2. Reperfusion chest pain

3. Lethargy

4. Heart block

Correct Answer: 1

Rationale 1: Hemorrhage or bleeding is the most common complication; it can be life threatening.

Rationale 2: Recurrent chest pain is not associated with thrombolytic therapy.

Rationale 3: Lethargy is not associated with thrombolytic therapy.

Rationale 4: Heart block is not associated with thrombolytic therapy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-5

Question 16

Type: MCSA

When auscultating the chest of a 75-year-old patient who recently experienced a myocardial infarction (MI), the nurse hears an S3 and lung crackles. Because of these findings, the nurse would assess for which other condition?

1. Heart failure

2. Extension of the MI

3. Renal failure

4. Liver failure

Correct Answer: 1

Rationale 1: S3 and lung crackles are indications of heart failure.

Rationale 2: Manifestations of MI extension include chest pain and a return of positive laboratory findings (CPK-MB and troponin).

Rationale 3: Renal failure is a late complication of heart failure and is not manifested with an S3 and crackles.

Rationale 4: Liver failure is not manifested with an S3 and crackles.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-4

Question 17

Type: MCSA

The nurse is teaching a patient about coronary artery bypass surgery via the left internal mammary artery. Which information is essential for the patient to understand?

1. You must still reduce or modify cardiac risk factors.

2. This surgery prolongs life an average of 2 years.

3. You have only a minimal chance of functional improvement, even with this surgery.

4. This surgery will cure your atherosclerosis.

Correct Answer: 1

Rationale 1: It is essential that the patient understand that the goal of the surgery is to relieve symptoms and improve quality of life. The patient must still reduce or modify controllable risk factors to retard the underlying process.

Rationale 2: Left internal mammary artery grafts have a 10-year patency rate of 85% to 95%.

Rationale 3: CABG provides nearly complete revascularization and long-term relief of symptoms.

Rationale 4: The surgery is not performed to cure atherosclerosis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-7

Question 18

Type: MCMA

A patient, recovering from coronary artery bypass graft (CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which are appropriate responses by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The surgery only relieves the symptoms; it does not cure the disease.

2. You must continue to modify your cardiac risk factors.

3. You are correct; your heart is now normal.

4. You should avoid exercise for at least 6 months after this surgery.

5. There no need to monitor your fat intake any longer.

Correct Answer: 1,2

Rationale 1: Denial is a common coping mechanism among cardiac patients; it is essential that the nurse stress that CABG is not a cure for coronary artery disease (CAD).

Rationale 2: Atherosclerosis is a progressive disease; the patient needs to continue to modify risk factors.

Rationale 3: CABG only relives symptoms; it does not cure the disease.

Rationale 4: The patient should begin a cardiac rehabilitation program with a progressive exercise program.

Rationale 5: The patient must continue to modify risk factors such as fat intake.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-7

Question 19

Type: MCMA

A patient who is recovering from cardiovascular surgery is demonstrating chest tube output of greater than 100 mL per hour. Which nursing interventions are indicated?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Report to the surgeon.

2. Check the hemoglobin and hematocrit.

3. Administer a blood transfusion.

4. Notify the family.

5. Connect pacemaker wires.

Correct Answer: 1,2

Rationale 1: It is abnormal to have greater than 100 mL of drainage in 1 hour. It may indicate bleeding and needs to be assessed by the surgeon.

Rationale 2: Hemoglobin and hematocrit should be checked.

Rationale 3: The patient needs to be assessed along with the laboratory data before it is determined if a blood transfusion is necessary.

Rationale 4: There is no need to notify the family until the patient has been assessed. The finding may be of no significance.

Rationale 5: An increase in chest tube drainage does not indicate the need for a pacemaker.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-7

Question 20

Type: MCSA

The family of a patient who experienced a stroke after CABG surgery asks the nurse what caused the stroke. What is the nurses best response?

1. Stroke is usually caused by a blood clot that breaks loose and travels to the brain.

2. Stroke is usually caused by ruptured plaque inside the coronary artery.

3. Stroke is caused by heart failure.

4. No one knows what causes strokes.

Correct Answer: 1

Rationale 1: Stroke is usually caused by an embolus from the ascending aorta or aortic arch, which travels through the heart into the vessels leading to the brain.

Rationale 2: Plaque inside a coronary artery would travel downstream and lodge in a smaller vessel in the heart.

Rationale 3: Heart failure does not cause strokes.

Rationale 4: The causes of strokes have been identified.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-7

Question 21

Type: MCMA

The nurse would recommend closer evaluation for coronary artery disease (CAD) to a patient with which history?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Diabetes

2. Hyperlipidemia

3. Positive family history

4. Increased C-reactive protein level

5. hypotension

Correct Answer: 1,2,3

Rationale 1: Diabetes is a disease condition that contributes to CAD.

Rationale 2: Hyperlipidemia is a disease condition that contributes to CAD.

Rationale 3: Positive family history in some cases is considered a nonmodifiable risk factor for CAD.

Rationale 4: An increased C-reactive protein level is a contributing factor to the development of CAD.

Rationale 5: Hypotension is not associated with the development of CAD.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-1

Question 22

Type: MCSA

A patient asks the nurse about metabolic syndrome. Which is the most accurate answer for the nurse to provide?

1. Metabolic syndrome is caused by obesity, physical inactivity, and genetic factors.

2. This syndrome is not a concern for females unless they smoke.

3. This problem affects only older adults over the age of 65.

4. Metabolic syndrome can be avoided by taking vitamins daily and drinking 64 fluid ounces of water a day.

Correct Answer: 1

Rationale 1: Metabolic syndrome is caused by obesity, physical inactivity, and genetic factors.

Rationale 2: The syndrome is not directly related to smoking.

Rationale 3: The syndrome is not directly related to age.

Rationale 4: There is no evidence that daily vitamin and fluid consumption affects ones chances of developing metabolic syndrome.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-1

Question 23

Type: MCSA

A patient who is prescribed atorvastatin (Lipitor) should be monitored for which condition?

1. Liver enzyme alteration

2. Blood glucose and uric acid level alteration

3. Renal function alteration

4. Sudden back pain and constipation

Correct Answer: 1

Rationale 1: The nurse should be observing lab work for the current cholesterol level and to ensure that liver enzymes remain normal.

Rationale 2: Changes in blood glucose and uric acid levels are generally not associated with the use of this drug.

Rationale 3: Renal function alteration is generally not associated with the use of this drug.

Rationale 4: Constipation and sudden back pain are generally not associated with the use of this drug.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-1

Question 24

Type: MCMA

The nurse is instructing a patient who has been prescribed nitroglycerin (NTG) tablets to treat angina. Which statements should be included in the nurses instructions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Take a second dose if the angina is not relieved within 5 minutes.

2. If you need to take nitroglycerin, you should also stop what you are doing and rest.

3. If your pain is not relieved by nitroglycerin taken as directed, you should call 911.

4. If the pain does not go away after taking one pill, try using the spray.

5. Call your doctor immediately if you develop a headache when taking this drug.

Correct Answer: 1,2,3

Rationale 1: A second dose of nitrates is recommended within 5 minutes if the first dose does not relieve the angina.

Rationale 2: Resting is an essential component of reducing oxygen demand.

Rationale 3: Unrelieved pain indicates ischemia is continuing. The patient should call 911 to receive additional treatment.

Rationale 4: Typically patients are provided either the pill form or the spray form of NTG and would not be instructed to use alternate forms.

Rationale 5: A transient headache may occur when taking this medication and will diminish over time.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-2

Question 25

Type: MCSA

The nurse is reviewing a new prescription for propranolol (Inderal) for a patient with coronary artery disease (CAD). The nurse would call the physician and question this prescription if the patient has which history?

1. History of asthma

2. Also taking antioxidants

3. Also taking simvastatin (Zocor)

4. History of bleeding disorders

Correct Answer: 1

Rationale 1: Class II beta-blockers such as propranolol are used to reduce heart rate and myocardial contractility and in the treatment of supraventricular tachycardia. These drugs may cause bronchospasm and are contraindicated for patients with asthma.

Rationale 2: Antioxidants may be taken concurrently.

Rationale 3: Simvastatin may be taken concurrently.

Rationale 4: Bleeding disorders are not a contraindication for propranolol use.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-2

Question 26

Type: MCSA

The nurse considers which information when planning care for a patient with left anterior descending (LAD) artery occlusion?

1. An occlusion in the LAD often results in death.

2. The patient may have atrial dysrhythmias.

3. Occlusion of this vessel will result in an inferior wall MI.

4. Occlusion of this vessel damages the aorta.

Correct Answer: 1

Rationale 1: The LAD supplies over 70% of the left ventricle. Destruction of this tissue can cause serious consequences, including death.

Rationale 2: The circumflex artery supplies the area of the SA node in 40% of the population. The right coronary artery supplies the SA node in 60% of the population.

Rationale 3: The inferior wall is supplied by the right coronary artery.

Rationale 4: There is no indication that occlusion of the LAD damages the aorta.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-3

Question 27

Type: MCMA

A patient is scheduled for cardiac catheterization this morning. Which information should the nurse communicate to the treatment team?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The night nurse reports the patient was confused and combative throughout the night.

2. The patients potassium is 4.1 mEq/L.

3. The patients serum creatinine is 1.6 mg/dL this morning.

4. The patients previous S3 heart sound is not audible this morning.

5. The patient required intravenous morphine sulfate for pain control on one occasion during the night.

Correct Answer: 1,3

Rationale 1: The patient must be able to offer some cooperation for this test to be safe and effective.

Rationale 2: This is a normal potassium level and does not indicate increased risk for this procedure.

Rationale 3: Serum creatinine greater than or equal to 1.5 mg/dL is a relative contraindication for this procedure.

Rationale 4: The presence of a third heart sound can indicate congestive heart failure. The absence of this heart sound is a good indicator.

Rationale 5: One episode of pain controlled by morphine is not a contraindication for this procedure.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-6

Question 28

Type: MCMA

A patient is about to have a balloon angioplasty. The nurse would evaluate that the patient does not understand the procedure when the patient makes which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. They may put in a stent to help keep my artery open.

2. I expect to be up walking in the hall an hour after the procedure.

3. If they put a stent in, I will have to come back to have it removed in about 3 months.

4. I may feel a hot flush during this procedure.

5. My family should be prepared for this procedure to take several hours.

Correct Answer: 2,3,5

Rationale 1: This statement indicates an understanding of this portion of the procedure.

Rationale 2: The patient will likely be on bed rest for at least 4 to 6 hours after the procedure is completed. This statement indicates the patient does not understand the postprocedure treatment.

Rationale 3: The stent is put in permanently and is not removed. This statement indicates the patient does not understand the postprocedure treatment plan.

Rationale 4: When contrast dye is injected, patients often report a hot, flushed feeling. The patient understands this potential effect.

Rationale 5: The procedure itself is generally done quickly and the patient is taken to a specialized nursing care unit for postprocedure care. The family would be notified that the procedure is complete. This statement indicates the patient does not understand the expected length of the procedure.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 32-6

Question 29

Type: FIB

After a percutaneous coronary intervention (PCI), a patient develops a pseudoaneurysm. The nurse would anticipate conservative management if testing proves the pseudoaneurysm to be less than ______ centimeters in diameter as long as the patient is asymptomatic.

Standard Text:

Correct Answer: 2

Rationale : If the pseudoaneurysm is small (less than 2 cm in diameter) and the patient is asymptomatic, watchful waiting begins. If the pseudoaneurysm begins to enlarge or the patient becomes symptomatic, intervention will be rapid.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 32-6

Question 30

Type: MCSA

A patient was admitted this morning for an elective percutaneous coronary intervention. The nurse would alert the health care provider if the patient makes which statement?

1. My blood sugar was high yesterday, so I took my metformin as prescribed last night.

2. I have not had anything to eat or drink since midnight last night.

3. I am eager to get this procedure over with so I can go to my grandsons baseball game next week.

4. I did not sleep well last night.

Correct Answer: 1

Rationale 1: Metformin has been associated with an increased risk of lactic acidosis after contrast administration. The drug is generally held for several days prior to contrast administration. A different form of blood glucose control is prescribed if indicated.

Rationale 2: This is a standard NPO regimen and does not require special notification of the health care provider.

Rationale 3: If all goes well during the procedure, there should be no contraindication to the patients plan.

Rationale 4: The patient may be anxious about the procedure, which would interfere with sleep. The nurse should ask additional questions to determine if notification of the health care provider is indicated.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-6

Question 31

Type: FIB

The nurse would suspect conversion of a patients stable angina to unstable angina if the patient reports angina lasting over _______ minutes at rest.

Standard Text:

Correct Answer: 20

Rationale : If the patient has angina for over 20 minutes while at rest, it is likely the angina is unstable.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-3

Question 32

Type: MCMA

A patients electrocardiogram (ECG) reveals evidence of a myocardial infarction (MI), although this event is not recorded in the patients history. The nurse teaches the patient that silent ischemia and silent MI are more common in which people?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Women

2. African Americans

3. People with diabetes

4. People in high-stress occupations.

5. People younger than 45

Correct Answer: 1,3

Rationale 1: Silent ischemia is more common in women.

Rationale 2: There is no indication that race plays a part in determining who is at greater risk for silent ischemia.

Rationale 3: People who have diabetes are more likely to experience silent ischemia.

Rationale 4: There is no indication that living with high stress increases the risk for silent ischemia.

Rationale 5: Older adults are more likely to experience silent ischemia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 32-4

Question 33

Type: MCMA

A patient is being discharged after having balloon angioplasty. Which teaching should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Take aspirin for any minor discomfort at the procedure site.

2. Call the hospital immediately if there is any bright red bleeding from the procedure site.

3. Because the access site is in your groin, you should avoid bending over or straining for at least 48 hours.

4. You may shower or bathe as usual.

5. Keep a pressure dressing over the site for 24 hours and then replace it with a light dressing for the next 24 hours.

Correct Answer: 3,4

Rationale 1: Tylenol should be used for pain control, as aspirin may increase bleeding tendencies.

Rationale 2: The patient should first lie down and have someone apply direct pressure to the site. If the bleeding continues after 20 minutes, someone should call 911.

Rationale 3: Bending over or straining may cause disruption of the clot, which would lead to bleeding from the site.

Rationale 4: The patient is allowed to shower or bathe with no special restrictions.

Rationale 5: No special dressings are required.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 32-6

Question 34

Type: FIB

A patients activity is progressing after an acute myocardial infarction (AMI). The nurse would determine that the patient is deconditioned if getting up in a chair decreases systolic blood pressure by _______ mmHg or more.

Standard Text:

Correct Answer: 20

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