Download 12-1 Test Bank Sole: Introduction to Critical Care Nursing, 5th

Sole: Introduction to Critical Care Nursing, 5th Edition
Chapter 12: Cardiovascular Alterations
Test Bank
MULTIPLE CHOICE
1. Which of the following would most conclusively support that a patient is in the
process of an evolving Q wave myocardial infarction (MI)?
a.
b.
c.
d.
ECG changes (ST elevation) and elevated CPK-MB or troponin levels
Elevated CPK and depressed ST segment
Normal cardiac enzymes and depressed ST segment
Q wave on ECG with normal enzymes and troponin levels
ANS: A
ST segment elevation and elevated cardiac enzymes are seen in Q wave MI.
Incorrect:
B: The non–Q wave MI usually results from a partially occluded coronary vessel, and it
is associated with ST segment depression in two or more leads along with elevated
cardiac enzymes.
C: The non–Q wave MI usually results from a partially occluded coronary vessel, and it
is associated with ST segment depression in two or more leads along with elevated
cardiac enzymes. ST segment elevation and elevated cardiac enzymes are seen in Q
wave MI.
D: ST segment elevation and elevated enzymes are seen in an acute, evolving Q wave
(MI).
DIF: Cognitive Level: Analysis
REF: Page 330
OBJ: Identify specific nursing interventions designed to prevent secondary occurrences
or to minimize complications of cardiac and vascular patients.
TOP: Nursing Process Step: Assessment
MSC:
NCLEX: Physiological
Integrity
2. Which of the following symptoms is most characteristic of left-sided heart failure?
a. Dependent edema
b. Distended neck veins
c. Dyspnea and crackles
d. Nausea and vomiting
ANS: C
In left-sided heart failure, signs and symptoms are related to pulmonary congestion.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-2
Incorrect:
A: Dependent edema is a characteristic of right-sided heart failure.
B: Distended neck veins are a characteristic of right-sided heart failure.
D: Nausea and vomiting are not typically seen in left-sided heart failure.
DIF: Cognitive Level: Analysis
REF: Page 348
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC:
NCLEX: Physiological
Integrity
3. Angiotensin-converting enzymes inhibitors (ACE inhibitors) should be started
within 24 hours of an AMI to reduce the incidence of:
a. myocardial stunning.
b. hibernating myocardium.
c. myocardial remodeling.
d. tachycardia.
ANS: C
Myocardial remodeling is a process mediated by angiotensin II, aldosterone,
catecholamine, adenosine, and inflammatory cytokines, which causes myocyte
hypertrophy and loss of contractile function in the areas of the heart distant from the site
of infarctions. ACE inhibitors reduce the incidence of remodeling.
Incorrect:
A: Myocardial stunning is a temporary loss of contractile function that persists for hours
to days after perfusion has been restored. Myocardial remodeling is a process that
causes myocyte hypertrophy and loss of contractile function in the areas of the heart
distant from the site of infarctions. ACE inhibitors reduce the incidence of
remodeling.
B: Hibernating myocardium is tissue that is persistently ischemic and undergoes
metabolic adaptation to prolong myocyte survival until perfusion can be restored.
Myocardial remodeling is a process that causes myocyte hypertrophy and loss of
contractile function in the areas of the heart distant from the site of infarctions. ACE
inhibitors reduce the incidence of remodeling.
D: Tachycardia would be more effectively treated with beta blockers, which are given to
decrease heart rate, blood pressure, and myocardial oxygen consumption.
DIF: Cognitive Level: Knowledge
REF: Page 338
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-3
4. The patient is a 48-year-old black man who presents to the emergency department
(ED) with chest pain that he has had for the past 2 hours. He is nauseous and
diaphoretic, and his skin is dusky in color. The electrocardiogram shows ST
elevation in leads II, III, and aVF. Comparing the following therapies, which
medical treatment is NOT indicated?
a.
b.
c.
d.
Emergent pacemaker insertion
Emergent percutaneous coronary intervention
Emergent thrombolytic therapy
Immediate coronary artery bypass graft surgery
ANS: A
The goals of management of AMI are to dissolve the lesion that is occluding the
coronary artery and to increase blood flow to the myocardium. Options include
emergent percutaneous intervention, such as angioplasty, emergent coronary artery
bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for
less than 6 hours. No data are noted in this scenario that warrant insertion of a
pacemaker.
Incorrect:
B: The goals of management of AMI are to dissolve the lesion that is occluding the
coronary artery and to increase blood flow to the myocardium. Options include
emergent percutaneous intervention, such as angioplasty, emergent coronary artery
bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for
less than 6 hours. No data are noted in this scenario that warrant insertion of a
pacemaker.
C: The goals of management of AMI are to dissolve the lesion that is occluding the
coronary artery and to increase blood flow to the myocardium. Options include
emergent percutaneous intervention, such as angioplasty, emergent coronary artery
bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for
less than 6 hours. No data are noted in this scenario that warrant insertion of a
pacemaker.
D: The goals of management of AMI are to dissolve the lesion that is occluding the
coronary artery and to increase blood flow to the myocardium. Options include
emergent percutaneous intervention, such as angioplasty, emergent coronary artery
bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for
less than 6 hours. No data are noted in this scenario that warrant insertion of a
pacemaker.
DIF: Cognitive Level: Synthesis
REF: Page 332
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
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Test Bank
12-4
5. Of the following physiological mechanisms, which is thought to cause unstable
angina?
a.
b.
c.
d.
Complete occlusion of a coronary artery
Fatty streak within the intima of a coronary artery
Partial occlusion of a coronary artery with a thrombus
Vasospasm of a coronary artery
ANS: C
In unstable angina, some blood continues to flow through the affected coronary artery;
however, flow is diminished related to partial occlusion. The pain in unstable angina is
more severe, may occur at rest, and requires more frequent nitrate therapy.
Incorrect:
A: Complete occlusion of a coronary artery results in AMI.
B: A fatty streak leads to the presence of fibrotic plaque leading to complicated lesion
formation, which may later cause stable angina, unstable angina, or an MI . It is not
the primary physiological mechanism of unstable angina.
D: Variant, or Prinzmetal’s, angina is caused by coronary artery spasms.
DIF: Cognitive Level: Synthesis
REF: Page 323
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC:
NCLEX: Physiological
Integrity
6. Which of the following therapies is most appropriate to treat an angina attack?
a.
b.
c.
d.
ACE inhibitors and diuretics
Morphine sulfate and oxygen
Nitroglycerin, oxygen, and beta blockers
Statins, bile acid, and nicotinic acid
ANS: C
Conservative intervention for the patient experiencing angina includes nitrates, beta
blockers, and oxygen.
Incorrect:
A: ACE inhibitors and diuretics are first-line medications to treat heart failure.
B: Morphine sulfate and oxygen are administered to manage AMI.
D: Lipid-lowering drugs include statins, bile acid resins, and nicotinic acid; these drugs
are given to prevent and treat coronary artery disease.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-5
DIF: Cognitive Level: Synthesis
REF: Page 324
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Planning
MSC: NCLEX: Physiological Integrity
7. The following diagnostic studies are ordered for the patient with coronary artery
disease. Which best identifies valvular function and measures the size of the cardiac
chambers?
a. 12-lead electrocardiogram
b. Cardiac catheterization
c. Echocardiogram
d. Electrophysiology study
ANS: C
Echocardiography is a noninvasive, acoustic imaging procedure and involves the use of
ultrasound to visualize the cardiac structures and the motion and function of cardiac
valves and chambers.
Incorrect:
A: The 12-lead electrocardiogram is useful in identification of rhythm disturbances and
myocardial ischemia, injury, or infarct.
B: Cardiac catheterization is used to confirm and evaluate the severity of lesions within
the coronary arteries, to assess left ventricular function, and to measure pressures in
the chambers of the heart, cardiac output, and blood gas content.
D: An electrophysiology study is an invasive procedure that involves the introduction of
an electrode catheter percutaneously from a peripheral vein or artery into the cardiac
chamber or sinuses and the performance of programmed electrical stimulation of the
heart.
DIF: Cognitive Level: Analysis
REF: Page 317
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
8. Of the following medications, which has been shown to be most effective for the
reduction of serum cholesterol?
a. Bile acid resins
b. Nicotinic acid
c. Nitroglycerin
d. Statins
ANS: D
The statins have been found to lower low-density lipoproteins (LDLs) more than other
types of lipid-lowering drugs.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-6
Incorrect:
A: The bile acid resins combine with cholesterol-containing bile acids in the intestines to
form an insoluble complex that is eliminated through feces. These drugs lower LDLs
by 10% to 20%. The statins have been found to lower LDL more than other types of
lipid-lowering drugs.
B: Nicotinic acid, or niacin, reduces total cholesterol, LDLs, and triglycerides if it is
given in high doses. The statins have been found to lower LDL more than other types
of lipid-lowering drugs.
C: Nitroglycerin is administered to relieve pain associated with angina. It does not affect
cholesterol levels.
DIF: Cognitive Level: Comprehension REF: Page 320
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance
9. The patient is admitted with an MI. Three days later the nurse is concerned that the
patient may have a papillary muscle rupture. Which of the following assessments
may indicate a papillary muscle rupture?
a. Gallop rhythm
b. Murmur
c. S1 heart sound
d. S3 heart sound
ANS: B
The presence of a new murmur warrants special attention, particularly in a patient with
an AMI. A papillary muscle may have ruptured, causing the valve to close incorrectly,
which can be indicative of severe damage and impending complications.
Incorrect:
A: A gallop rhythm is associated with severe heart failure. All four sounds (S4, S1, S2,
and S3) may be heard, producing a “gallop” rhythm.
C: The first heart sound is known as S1. It is a normal sound that is not associated with
pathology.
D: S3 is often heard in patients with heart failure or fluid overload.
DIF: Cognitive Level: Analysis
REF: Page 313
OBJ: Identify specific nursing interventions designed to prevent secondary occurrences
or to minimize complications of cardiac and vascular patients.
TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity
10. Myocardial infarction involves:
a. coronary artery spasm.
b. ischemia.
c. tissue necrosis.
d. transient oxygen imbalance.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-7
ANS: C
Acute myocardial infarction is death (tissue necrosis) of the myocardium that is caused
by lack of blood supply from the occlusion of a coronary artery and its branches.
Incorrect:
A: Coronary artery spasms are common causes of angina.
B: Angina is the chest pain associated with myocardial ischemia; it is transient and does
not cause cell death.
D: Transient oxygen imbalance is associated with angina. Angina is chest pain caused
by myocardial ischemia that results from an imbalance between myocardial oxygen
supply and demand.
DIF: Cognitive Level: Analysis
REF: Page 329
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Diagnosis MSC: NCLEX: Physiological Integrity
11. A 72-year-old woman is brought to the ED by her family. The family states that
she’s “just not herself.” Her respirations are slightly labored, and her heart monitor
shows sinus tachycardia (rate 110) with frequent premature ventricular contractions
(PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her
troponin levels are elevated, and her 12-lead electrocardiogram (ECG) shows
elevated ST segments in leads II, III, and AVF. The most likely diagnosis for this
patient is:
a. hypokalemia.
b. non–Q-wave MI.
c. silent myocardial infarction.
d. unstable angina.
ANS: C
Some individuals may have ischemic episodes without knowing it, thereby having a
“silent” infarction. These can occur with no presenting signs or symptoms.
Asymptomatic or nontraditional symptoms are more common in elderly persons, in
women, and in diabetic patients.
Incorrect:
A: The elevated troponin levels along with the changes on the 12-lead ECG without
symptoms of chest pain indicate a silent MI.
B: The elevated troponin levels along with the changes on the 12-lead ECG without
symptoms of chest pain indicate a silent myocardial infarction.
D: The elevated troponin levels along with the changes on the 12-lead ECG without
symptoms of chest pain indicate a silent MI.
DIF: Cognitive Level: Synthesis
REF: Page 331
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-8
12. A patient presents to the ED complaining of severe substernal chest pressure
radiating to his left shoulder and back. He is depressed since he just left the hospital
a week ago after having a stroke. His symptoms started about 12 hours ago and he
was hoping that they would go away. The patient’s 12-lead ECG shows ST
depression in all his inferior leads. His troponin and CK-MB are both elevated. The
patient has been in the ED receiving treatment for the last hour and a half and would
like to be admitted to his room because he is so tired. Which of the following
statements regarding thrombolysis is true for this patient scenario?
a.
b.
c.
d.
The patient is not a candidate for thrombolysis.
The patient’s history makes him a good candidate for thrombolysis.
Thrombolysis is appropriate for a candidate having a non–Q-wave MI.
Thrombolysis should be started immediately.
ANS: A
To be eligible for thrombolysis, the patient must be symptomatic for less than 6 hours.
Incorrect:
B: To be eligible for thrombolysis, the patient must be symptomatic for less than 6
hours.
C: To be eligible for thrombolysis, the patient must be symptomatic for less than 6
hours, have pain for 20 minutes that was unrelieved by nitroglycerin, and have an
ECG with an ST segment of greater than or equal to 1 mm in two or more contiguous
ECG leads or 0.5 mm depression.
D: To be eligible for thrombolysis, the patient must be symptomatic for less than 6
hours.
DIF: Cognitive Level: Synthesis
REF: Page 332
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
13. The patient presents to the ED with severe chest discomfort. He is taken for cardiac
catheterization and angiography that shows 80% occlusion of the left main coronary
artery. The nurse will next prep the patient for:
a.
b.
c.
d.
coronary artery bypass graft surgery.
intracoronary stent placement.
percutaneous transluminal coronary angioplasty (PTCA).
transmyocardial revascularization.
ANS: A
Coronary artery bypass graft surgery is indicated for significant left main coronary
occlusion (>50%).
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-9
Incorrect:
B: Coronary artery bypass graft surgery is indicated for significant left main coronary
occlusion (>50%).
C: Coronary artery bypass graft surgery is indicated for significant left main coronary
occlusion (>50%).
D: Transmyocardial revascularization is performed in patients with severe angina who
have no other treatment options.
DIF: Cognitive Level: Synthesis
REF: Page 340
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
14. The patient is admitted with recurrent tachycardia that the cardiologist believes to be
related to an accessory conduction pathway or a reentry pathway. The patient will
most likely be sent to the cardiac catheterization laboratory for which of the
following tests or procedures?
a.
b.
c.
d.
Implantable cardioverter-defibrillator placement
Permanent pacemaker insertion
Radiofrequency catheter ablation
Temporary transvenous pacemaker placement
ANS: C
Radiofrequency catheter ablation is a method of interrupting a supraventricular
tachycardia, a dysrhythmia caused by a reentry circuit, and abnormal conduction
pathway.
Incorrect:
A: Implantable cardioverter-defibrillators are indicated for patients with recurrent lifethreatening ventricular dysrhythmias.
B: A permanent pacemaker is indicated for treatment of symptomatic bradycardia that
continues despite treatment and resolution of the cause.
D: Temporary pacemakers are used on an emergency basis to treat symptomatic
bradycardia or to override tachydysrhythmias.
DIF: Cognitive Level: Synthesis
REF: Page 343
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-10
15. The patient presents to the ED with sudden severe sharp chest discomfort radiating
to his back and down both arms, as well as numbness in his left arm. While taking
the patient’s vital signs, the nurse notices a 30-point discrepancy in systolic blood
pressure between the right and left arm. The nurse should:
a.
b.
c.
d.
contact the physician that the cardiac enzyme results are back.
contact the physician and prepare the patient for thrombolytic therapy.
contact the physician immediately and begin prepping the patient for surgery.
give the patient aspirin and heparin.
ANS: C
These symptoms indicate the possibility of acute aortic dissection. Symptoms often
mimic those of AMI or pulmonary embolism. Aortic dissection is a surgical emergency.
Signs and symptoms include chest pain and arm paresthesia.
Incorrect:
A: These symptoms indicate the possibility of acute aortic dissection. Symptoms often
mimic those of AMI or pulmonary embolism.
B: These symptoms indicate the possibility of acute aortic dissection. Symptoms often
mimic those of AMI or pulmonary embolism. Thrombolytic therapy is not indicated.
D: These symptoms indicate the possibility of acute aortic dissection. Symptoms often
mimic those of AMI or pulmonary embolism. Aspirin and heparin are not indicated
and may increase the risk for bleeding during and after surgery to repair the
aneurysm.
DIF: Cognitive Level: Evaluation
REF: Page 364
OBJ: Identify specific nursing interventions designed to prevent secondary occurrences
or to minimize complications of cardiac and vascular patients.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
1. The 45-year-old patient has been in chronic heart failure for the past 10 years. He
has been on beta blockers and angiotensin-converting enzyme inhibitors as well as
diuretics. His symptoms have recently worsened, and he presents to the ED with
severe shortness of breath and crackles throughout his lung fields. His respirations
are labored and his arterial blood gases show that he is at risk for respiratory failure.
Which of the following therapies may be used for acute, short-term management of
the patient (choose all that apply)?
a. Dobutamine
b. Intra-aortic balloon pump
c. Nesiritide (Natrecor)
d. Ventricular assist device
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-11
ANS: A, B, C
This patient is showing signs and symptoms of an acute exacerbation of heart failure.
Dobutamine and nesiritide are medications administered for acute short-term
management; mechanical assist with an intra-aortic balloon pump may also be
warranted.
Incorrect:
D: Ventricular assist devices (VADs) are capable of partial to complete circulatory
support for short- to long-term support for the failing heart. They assist the failing
heart and maintain adequate circulatory pressure. The left VAD is therapy for
patients with terminal heart failure and has been used in patients who are not eligible
for heart transplantation. Although a VAD may be indicated, the other therapies will
provide more immediate treatment for the patient to relieve symptoms.
DIF: Cognitive Level: Synthesis
REF: Page 358
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
2. Which of the following are priorities in the treatment and nursing management of the
patient with an acute myocardial infarction (AMI) (choose all that apply)?
a.
b.
c.
d.
Administer thrombolytic therapy if indicated
Diurese aggressively and monitor daily weight
Keep oxygen saturation levels below 89%
Provide adequate pain control to reduce myocardial oxygen demands
ANS: A, D
Medical treatment of AMI is aimed at relieving pain, providing adequate oxygenation to
the myocardium, preventing platelet aggregation, and restoring blood flow to the
myocardium through thrombolytic therapy or acute interventional therapy such as
angioplasty.
Incorrect:
B: This is the treatment for congestive heart failure.
C: The goal is to maintain oxygen saturation above 90%.
DIF: Cognitive Level: Analysis
REF: Page 332
OBJ: Discuss the nursing care responsibilities related to the cardiac and vascular
patient.
TOP: Nursing Process Step: Assessment
MSC:
NCLEX: Physiological
Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-12
3. Priority interventions for managing symptoms of an AMI in the ED include which of
the following (choose all that apply)?
a.
b.
c.
d.
Administration of morphine
Administration of nitroglycerin (NTG)
Dopamine infusion
Oxygen therapy
ANS: A, B, D
The initial pain of AMI is treated with morphine sulfate administered intravenously.
NTG may be given to reduce the ischemic pain of AMI. NTG increases coronary
perfusion because of its vasodilatory effects. Oxygen administration is important for
assisting the myocardial tissue to continue its pumping activity and for repairing the
damaged tissue around the site of the infarct.
Incorrect:
C: Dopamine is indicated for the treatment of hypotension refractory to fluid
administration.
DIF: Cognitive Level: Synthesis
REF: Page 332
OBJ: Develop a research-related care plan for the acutely ill cardiovascular patient.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
4. Which are the true statements regarding the symptoms of an AMI (choose all that
apply)?
a.
b.
c.
d.
Dysrhythmias are common occurrences.
Men have more atypical symptoms than women.
Midsternal chest pain is a common presenting symptom.
Some patients are asymptomatic.
ANS: A, C, D
Chest pain is a common presenting symptom in AMI. Dysrhythmias are commonly seen
in AMI. Some individuals may have ischemic episodes without knowing it, thereby
having a “silent” infarction. Women are more likely to have atypical signs and
symptoms, such as shortness of breath, nausea and vomiting, and back or jaw pain.
Incorrect:
B: Women are more likely to have atypical signs and symptoms, such as shortness of
breath, nausea and vomiting, and back or jaw pain.
DIF: Cognitive Level: Analysis
REF: Page 331
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-13
5. AMI can be classified as (choose all that apply):
a. angina.
b. nonischemic.
c. non–Q wave.
d. Q wave.
ANS: C, D
AMI can be classified as Q wave or non–Q wave.
Incorrect:
A: AMI can be classified as Q wave or non–Q wave.
B: AMI can be classified as Q wave or non–Q wave.
DIF: Cognitive Level: Knowledge
REF: Page 330
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC:
NCLEX: Physiological
Integrity
6. Which of the following are complications of AMI (choose all that apply)?
a. Cardiac dysrhythmias
b. Heart failure
c. Pericarditis
d. Ventricular rupture
ANS: A, B, C, D
All are potential complications of AMI.
DIF: Cognitive Level: Knowledge
REF: Page 331
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
COMPLETION
1. The ____________________ covers the heart valves and the small muscles
associated with the opening and closing of the heart valves.
ANS: endocardium
The inner endothelial layer, or endocardium, covers the heart valves and the small
muscles associated with the opening and closing of those valves.
DIF: Cognitive Level: Knowledge
REF: Page 309
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-14
2. The ____________________ nervous system lowers heart rate and blood pressure.
ANS: parasympathetic
The parasympathetic nervous system releases acetylcholine through stimulation of the
vagus nerve. It causes a decrease in the sinus node discharge and slows conduction
through the AV node.
DIF: Cognitive Level: Knowledge
REF: Page 310
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
3. Heart murmurs are usually a caused by a malfunction of a heart
____________________.
ANS: valve
A heart murmur is a sound caused by turbulence of blood flow through the valves of the
heart. Murmurs are audible when a septal defect is present; when a valve (usually aortic
or mitral) is narrow, inflamed, stenosed, or incompetent; or when the valve leaflets fail
to approximate (valve insufficiency).
DIF: Cognitive Level: Knowledge
REF: Page 313
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
4. When taking a history on a patient who has NTG ordered, it is important for the
nurse to note the use of medications to treat ____________________.
ANS: erectile dysfunction
A history of the patient’s use of sildenafil citrate (Viagra) or similar medications taken
for erectile dysfunction is necessary to know when considering NTG administration.
These medications potentiate the hypotensive effects of nitrates; thus concurrent use is
contraindicated. It is also important to determine whether the patient has any food or
drug allergies.
DIF: Cognitive Level: Synthesis
REF: Page 314
OBJ: Discuss the nursing care responsibilities related to the cardiac and vascular
patient.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
5. If a patient is unable to walk on a treadmill for an exercise stress test, the nurse
would expect the physician to order a(n) ____________________ stress test.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-15
ANS: adenosine
If a patient is unable physically to perform the exercise, a pharmacological stress test
can be done. Adenosine is preferred over dobutamine because of its short duration of
action and because reversal agents are not needed.
DIF: Cognitive Level: Analysis
REF: Page 316
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
6. Following a ____________________ test, the patient’s NPO status must be
continued until the gag reflex returns.
ANS: transesophageal echocardiogram
In transesophageal echocardiography, an ultrasound probe is fitted on the end of a
flexible gastroscope, which is inserted into the posterior pharynx and advanced into the
esophagus. After the procedure, the patient is unable to eat until the gag reflex returns.
DIF: Cognitive Level: Synthesis
REF: Page 317
OBJ: Discuss the nursing care responsibilities related to the cardiac and vascular
patient.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
7. The ____________________ laboratory test has a greater specificity than CK-MB in
the diagnosis of AMI.
ANS: troponin
Troponin I has a greater specificity than CK-MB in the diagnosis of AMI at 7 to 14
hours after the onset of chest pain.
DIF: Cognitive Level: Analysis
REF: Page 319
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
8. When teaching the patient who is taking a statin medication, it is important for the
nurse to inform the patient about possible side effects related to
____________________ function and the need for periodic laboratory tests.
ANS: liver
Statins are associated with liver damage; it is important to ensure that the patient has
liver enzymes measured periodically to assess liver function.
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-16
DIF: Cognitive Level: Synthesis
REF: Page 322
OBJ: Discuss the nursing care responsibilities related to the cardiac and vascular
patient.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
9. ____________________ is caused by myocardial ischemia that does not result in
cell death.
ANS: Angina
Angina is chest pain or discomfort caused by myocardial ischemia that results from an
imbalance between myocardial oxygen supply and demand. It is transient and does not
cause cell death.
DIF: Cognitive Level: Synthesis
REF: Page 323
OBJ: Contrast the pathological cause and effect mechanisms that produce acute cardiac
disturbances.
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
10. The nurse must be vigilant and watch for signs of intracranial hemorrhage if a
patient is administered ____________________ therapy.
ANS: thrombolytic
The worst possible complication of fibrinolytic therapy is intracranial hemorrhage.
DIF: Cognitive Level: Synthesis
REF: Page 333
OBJ: Discuss the nursing care responsibilities related to the cardiac and vascular
patient.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
11. Percutaneous coronary intervention is contraindicated for patients with lesions in the
____________________ artery.
ANS: left mainstem
Stenosis of the left mainstem artery is considered unacceptable for percutaneous
intervention.
DIF: Cognitive Level: Synthesis
REF: Page 339
OBJ: Compare and contrast pharmacological, operative, and electrical treatment
modalities used in treatment of cardiac disease.
TOP: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.
Test Bank
12-17
12. The patient has undergone open chest surgery for coronary artery bypass grafting.
One of the nurse’s responsibilities is to monitor the patient for atrial fibrillation and
flutter. These are examples of cardiac ____________________.
ANS: dysrhythmias
Atrial fibrillation and flutter are dysrhythmias common after cardiac surgery.
DIF: Cognitive Level: Synthesis
REF: Page 343
OBJ: Discuss the nursing care responsibilities related to the cardiac and vascular
patient.
TOP: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
13. The left ventricular assist device (VAD) is a therapy for patients with terminal heart
failure and has been used in patients who are not eligible for
____________________.
ANS: heart transplant
At present, the left VAD is therapy for patients with terminal heart failure and has been
used in patients who are not eligible for heart transplant.
DIF: Cognitive Level: Synthesis
REF: Page 358
TOP: Nursing Process Step: Assessment
MSC:
Integrity
NCLEX: Physiological
Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.