Download Saunders practice questions

Chapter 51 Cardiovascular Disorders
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PRACTICE QUESTIONS
1. A postcardiac surgery client with a blood urea nitrogen (BUN) level of 45mg/dL and a
serum creatinine level of 2.2mg/dL has a total 2-hour urine output of 25 mL. The nurse
understands that the client is at risk for which?
A.
B.
C.
D.
Hypovolemia
Acute kidney injury
Glomerulonephritis
Urinary tract infection
2. The nurse is preparing to ambulate a postoperative client after cardiac surgery. The nurse
plans to do which to enable the client to best tolerate the ambulation?
A.
B.
C.
D.
Provide the client with a walker.
Remove the telemetry equipment.
Encourage the client to cough and deep breathe.
Premedicate the client with an analgesic before ambulating.
3. A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse’s
station. The nurse sees no electrocardiographic complexes on the screen. The nurse
should do which first?
A.
B.
C.
D.
Call a code blue.
Call the health care provider.
Check the client status and lead placement.
Press the recorder button on the ECG console.
4. The nurse in a medical unit is caring for a client with heart failure. The client suddenly
develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects
pulmonary edema. The nurse immediately notifies the registered nurse and expects which
interventions to be prescribed? Select all that apply.
A.
B.
C.
D.
E.
F.
Administering oxygen
Inserting a Foley catheter
Administering furosemide (Lasix)
Administering morphine sulfate intravenously
Transporting the client to the coronary care unit
Placing the client in a low Fowler’s side-lying position
5. The nurse is caring for a client on a cardiac monitor who is alone in a room at the end of
the hall. The client has a short burst of ventricular tachycardia (VT), followed by
ventricular fibrillation (VF). The client suddenly loses consciousness. Which intervention
should the nurse do first?
A. Go to the nurse’s station quickly and call a code.
B. Run to get a defibrillator from an adjacent nursing unit.
C. Call for help and initiate cardiopulmonary resuscitation (CPR).
D. Start oxygen by cannula at 10L/minute and lower the head of the bed.
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6. The nurse is monitoring a client following cardioversion. Which observations should be
of highest priority to the nurse?
A.
B.
C.
D.
Blood pressure
Status of airway
Oxygen flow rate
Level of consciousness
7. To use an external cardiac defibrillator on a client, which action should be performed to
check the cardiac rhythm?
A. Holding the defibrillator paddles firmly against the chest
B. Applying the adhesive patch electrodes to the skin and moving away from the client
C. Connecting standard electrocardiographic electrodes to a transtelephonic monitoring
device
D. Applying standard electrocardiographic monitoring leads to the client and observing
the rhythm
8. The nurse is assisting in caring for the client immediately after insertion of a permanent
demand pacemaker via the right subclavian vein. The nurse prevents dislodgement of the
pacing catheter by implementing which intervention?
A.
B.
C.
D.
Limiting movement and abduction of the left arm
Limiting movement and abduction of the right arm
Assisting the client to get out of bed and ambulate with a walker
Having the physical therapist do active range of motion to the right arm
9. A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain
and shortness of breath, and the client is visibly anxious. The nurse understands that a
life-threatening complication of this condition is which?
A.
B.
C.
D.
Pneumonia
Pulmonary edema
Pulmonary embolism
Myocardial infarction
10. A 24-year-old man seeks medical attention for complaints of claudication in the arch of
the foot. The nurse also notes superficial thrombophlebitis of the lower leg. The nurse
should check the client for which next?
A.
B.
C.
D.
Smoking history
Recent exposure to allergens
History of recent insect bites
Familial tendency toward peripheral vascular disease
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11. The nurse has reinforced instructions to the client with Raynaud’s disease about selfmanagement of the disease process. The nurse determines that the client needs further
teaching if the client states which?
A.
B.
C.
D.
“Smoking cessation is very important.”
“Moving to a warmer climate should help.”
“Sources of caffeine should be eliminated from the diet.”
“Taking nifedipine (Procardia) as prescribed will decrease vessel spasm.”
12. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air
hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath
sounds, expecting to hear which breath sounds bilaterally?
A.
B.
C.
D.
Rhonchi
Crackles
Wheezes
Diminished breath sounds
13. The nurse is collecting data on a client with a diagnosis of right-sided heart failure. The
nurse should expect to note which specific characteristic of this condition?
A.
B.
C.
D.
Dyspnea
Hacking cough
Dependent edema
Crackles on lung auscultation
14. The nurse is checking the neurovascular status of a client who returned to the surgical
nursing unit 4 hours ago after undergoing an aortoiliac bypass graft. The affected leg is
warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged
from admission. The nurse interprets that the neurovascular status is which?
A.
B.
C.
D.
Moderately impaired, and the surgeon should be called
Normal, caused by increased blood flow through the leg
Slightly deteriorating, and should be monitored for another hour
Adequate from an arterial approach, but venous complications are arising
15. A client with a diagnosis of rapid rate atrial fibrillation asks the nurse why the health
care provider is going to perform carotid massage. The nurse responds that this procedure
may stimulate which?
A.
B.
C.
D.
Vagus nerve to slow the heart rate
Vagus nerve to increase the heart rate
Diaphragmatic nerve to slow the heart rate
Diaphragmatic nerve to increase the heart rate
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ANSWERS & RATIONALES
1. B
Rationale: The client who undergoes cardiac surgery is at risk for acute kidney injury
from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy.
Kidney injury is signaled by a decreased urine output and increased BUN and creatinine
levels. The client may need medications to increase renal perfusion and could need
peritoneal dialysis or hemodialysis.
2. D
Rationale: The nurse should encourage regular use of pain medication for the first 48 to
72 hours after cardiac surgery, because analgesia will promote rest, decrease myocardial
oxygen consumption caused by pain, and allow better participation in activities such as
coughing, deep breathing, and ambulation.
3. C
Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole
or possible electrode displacement. Checking of the client and equipment is the first
action by the nurse.
4. A, B, C, D
Rationale: Pulmonary edema is a life-threatening event that can result from severe heart
failure. In pulmonary edema the left ventricle fails to eject sufficient blood, and pressure
increases in the lungs because of the accumulated blood. Oxygen is always prescribed,
and the client is placed in a high Fowler’s position to ease the work of breathing.
Furosemide, a rapid-acting diuretic, will eliminate accumulated fluid. A Foley catheter is
inserted to accurately measure output. Intravenously administered morphine sulfate
reduces venous return (preload), decreases anxiety, and reduces the work of breathing.
Transporting the client to the coronary care unit is not a priority intervention. In fact, this
may not be necessary at all if the client’s response to treatment is successful.
5. C
Rationale: When ventricular fibrillation occurs, the nurse remains with the client and
initiates CPR until a defibrillator is available and attached to the client. Options A, B and
D are incorrect.
6. B
Rationale: Nursing responsibilities after cardioversion include maintenance of a patent
airway, oxygen administration, assessment of vital signs and level of consciousness, and
dysrhythmia detection. Airway is the priority.
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7. B
Rationale: The nurse or rescuer puts two large adhesive patch electrodes on the client’s
chest in the usual defibrillator position. The nurse stops cardiopulmonary resuscitation
and orders anyone near the client to move away and not touch the client. The defibrillator
then analyzes the rhythm, which may take up to 30 seconds. The machine then indicates
if it is necessary to defibrillate. Although automatic external defibrillation can be done
transtelephonically, it is done through the use of patch electrodes (not standard
electrocardiographic electrodes) that interact via telephone lines to a base station that
controls any actual defibrillation. It is not necessary to hold defibrillator paddles against
the client’s chest with this device.
8. B
Rationale: In the first several hours after insertion of either a permanent or temporary
pacemaker, the most common complication is pacing electrode dislodgment. The nurse
helps prevent this complication by limiting the client’s activities.
9. C
Rationale: Pulmonary embolism is a life-threatening complication of deep vein
thrombosis and thrombophlebitis. Chest pain is the most common symptom, which is
sudden in onset and may be aggravated by breathing. Other signs and symptoms include
dyspnea, cough, diaphoresis, and apprehension.
10. A
Rationale: The mixture of arterial and venous manifestations (Claudication and phlebitis,
respectively) in the young male client suggests thromboangiitis obliterans (Buerger’s
disease). This is a relatively uncommon disorder, characterized by inflammation and
thrombosis of smaller arteries and veins. This disorder is typically found in young men
who smoke. The cause is unknown but is suspected to have an autoimmune component.
11. B
Rationale: Raynaud’s disease responds favorably to the elimination of nicotine and
caffeine. Medications such as calcium channel blockers may inhibit vessel spasm and
prevent symptoms. Avoiding exposure to cold through a variety of means is very
important. However, moving to a warmer climate may not necessarily be beneficial
because the symptoms could still occur with the use of air conditioning and during
periods of cooler weather.
12. B
Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air
hunger, and production of frothy, pink-tinged sputum. Auscultation of the lungs reveals
crackles. Wheezes, rhonchi, and diminished breath sounds are not associated with
pulmonary edema.
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13. C
Rationale: Right-sided heart failure is characterized by signs of systemic congestion that
occurs as a result of right ventricular failure, fluid retention, and pressure buildup in the
venous system. Edema develops in the lower legs and ascends to the thighs and
abdominal wall. Other characteristics include jugular (neck vein) congestion, enlarged
liver and spleen, anorexia and nausea, distended abdomen, swollen hands and fingers,
polyuria at night, and weight gain. Left-sided heart failure produces pulmonary signs.
These include dyspnea, crackles on lung auscultation, and a hacking cough.
14. B
Rationale: An expected outcome of surgery is warmth, redness, and edema in the
surgical extremity caused by increased blood flow. Options A, C and D are incorrect.
15. A
Rationale: Carotid sinus massage is one maneuver used for vagal stimulation to decrease
a rapid heart rate and possibly terminate a tachydysrhythmia. The other maneuvers are
the Valsalva maneuver of inducing the gag reflex and asking the client to strain or bear
down. Medication therapy is often needed as an adjunct to keep the rate down or maintain
the normal rhythm.