Chapter 33

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A nurse performs an apical-radial pulse evaluation, with the result of 100/88. Which value represents the pulse deficit?

Which of the following is increased in hypertension that in turn causes an increase in the work of the heart?

Afterload

Which heart sound should the nurse record as normal?

Ventricular gallop in a 20-year-old patient

A patient asks what a transesophageal echocardiogram (TEE) is and what it is expected to do? Which response by the nurse is accurate?

Evaluates the efficiency of the valves

A nurse records the finding of a normal sinus rhythm (NSR) when the P, Q, R, S, and T are all present in the electrocardiographic complex. Which additional information should the nurse document?

Rate of 82 seconds

Which positive outcome should the nurse anticipate that a patient taking Vasotec, an angiotensin-converting enzyme (ACE) inhibitor, should exhibit?

Decreased blood pressure

A 29-year-old patient is to receive cardioversion for a dysrhythmia. Which expectation should the nurse instruct the patient to anticipate?

Administration of a short-acting sedative

A 68-year-old patient is scheduled for open heart surgery in the morning and is crying. Which statement is the most appropriate response by the nurse?

“Tell me what concerns you the most.”

A nurse explains that cardiac rehabilitation lasts from the end of acute care to the return to home and beyond. Which service does this cardiac rehabilitation include?

Telemetry-monitored exercise

On auscultation, a nurse detects a heart murmur. Which physical information should the nurse know that a heart murmur indicates?

Valves that do not close correctly

A physician has ordered continuous pulse oximetry. Which information should the nurse explain to the patient about this procedure?

Measures the amount of oxygen in the blood

A stress test is scheduled for a 41-year-old patient. Which action should the nurse implement to prepare the patient for the examination?

Have the patient sign a consent form.

Which action should a nurse expect to implement when a patient returns from a cardiac catheterization?

Check the puncture site.

A nurse assesses an inverted T wave on the ECG of a patient who had an acute MI two days earlier. Which interpretation of sthis finding is correct?

Abnormal waveform

Laboratory tests are performed to identify damage to the heart muscle. Which test is elevated the earliest with heart damage?

Troponin

A patient is scheduled for a heart catheterization. Which action should the nurse implement in preparation for this examination?

Ask the patient about allergies to seafood or iodine.

A patient has had atropine sulfate that has been administered intravenously to treat a dysrhythmia. Which symptom should the nurse assess this patient for after administration?

Tachycardia

A dopamine infusion is being administered to a patient with shock. Which symptom should the nurse recognize can be caused by this medication?

Sharp spike in blood pressure

A patient with atrial fibrillation is prescribed amiodarone for the dysrhythmia. Which potential adverse reaction should the nurse report

Ataxia

A medication, simvastatin (Zocor), is administered to lower a patient’s cholesterol level. Follow-up lipid levels are reviewed by the nurse. Which level indicates the desired therapeutic range?

HDL, 42 mg/dL; LDL, 98 mg/dL

A diuretic medication, furosemide (Lasix), is being administered for congestive heart failure. Which assessment is not an anticipated consequence of the therapy?

Muscle weakness

A patient is receiving digoxin 0.25 mg/day. Which action should the nurse implement prior to administering this medication?

Hold the dose if the apical rate is 57 beats/min.

A 46-year-old patient is receiving propranolol (Inderal), a nonselective beta-adrenergic blocker, for a heart condition. Which patient teaching is most appropriate?

Never stop taking the drug abruptly.

Which assessment should be immediately addressed in a patient on lidocaine?

Increase in temperature to 102° F

A nurse records a “1” for the pulse quality of the pedal pulse. What interpretation is correct regarding the pulse?

Thready

A patient with an irregular sinoatrial (SA) node conduction has a permanent pacemaker with the code AAIOO and is now going home. The patient asks, “What happens when my real SA node fires on its own?” Which response regarding what the pacemaker should do is correct?

Not fire

Which age-related change in older adults makes them susceptible to cardiovascular disease?

Stiff peripheral vessels

A nurse assesses a patient’s capillary refill time as less than 3 seconds. Which problem does this assessment indicate?

Tissue perfusion

A nurse performs Homans maneuver by flexing the knee and sharply dorsiflexing the foot. Which response indicates a positive Homans sign?

Pain in the calf area

Which technique should the nurse implement when performing the Allen test on a patient to evaluate the adequacy of circulation in the radial artery?

Observes whether the color is returning to the hand, which indicates perfusion

A nurse records that a patient has a 3+ edema to the right foot. Which measurement indicates how deep the nurse’s thumb depresses the edematous area?

To 1 inch

A nurse is caring for a patient who has had an angiogram. Which assessment should the nurse make a point of care to implement and document on this patient?

Peripheral pulses in the affected leg

A nurse is educating a patient regarding a stress test on a treadmill. Teaching includes that this test is a noninvasive procedure. Which additional information is appropriate for the nurse to include?

Is monitored continuously by blood pressure and an electrocardiogram

A patient inquires how something as simple as walking could help his venous vascular disorder. Which information provides the best response by the nurse when explaining the benefits of walking?

Boosts venous circulation through leg muscle activity

Which action is contraindicated for a patient performing Buerger-Allen exercises?

Lying on the stomach

A nurse is performing an intake examination on a patient with peripheral vascular disease (PVD). Which lifestyle information identified by the patient aggravates vascular disease?

Being employed as an air traffic controller

Vascular disease disorders often require the use of elastic stockings. Which action should the nurse implement when caring for a patient with elastic stockings?

Remove the stockings for skin inspection two times a day.

Which instruction is most appropriate for a patient with arterial insufficiency?

Frequently allow the legs to dangle dependently.

A nurse is preparing to administer low-molecular-weight heparin (LMWH). Which major advantage is related to the administration of LMWH ?

It is provided fixed doses.

Which statement made by a patient indicates to the nurse that a teaching plan for the use of warfarin was not effective?

“I’m drinking too much tea. My urine looks like tea.”

Which medication obtained in a patient’s history will lessen the effects of warfarin (Coumadin)?

Yaz (drospirenone/estradiol) as an oral contraceptive

A nurse uses a picture to demonstrate the conduction pathway through the chambers of the heart. Which of the following is the correct sequence of events?

The SA node fires, the atria contract, the AV node fires, conduction occurs through the bundle branches, the Purkinje fibers conduct, and then the ventricles contract.

Which factors affect stroke volume? (Select all that apply.)

Contractility, Preload, Afterload

Which age-related changes in the heart should a nurse take into consideration? (Select all that apply.)

Decrease in contractility, Thickened valves, Stiffened valves, Decreased SA node cells

Which information explains why older persons adapt more slowly to changes in the peripheral vascular system? (Select all that apply.)

Slowing heart rate, Decreasing cardiac output, Stiffening of blood vessels, Thickening of aorta

At rest, the cardiac cells in the myocardium are electrically polarized, with the inside of the cell being more __________ than the outside of the cell.

negative

A nurse explains that the lining of a vessel that allows for smooth blood flow and also reduced resistance in the vessel is the _____________ of the vessel.

intima

A nurse explains that when a patient history reveals a recent episode of vomiting and diarrhea, the nurse anticipates that this fluid loss will cause ________ and increased blood viscosity.

hemoconcentration

A nurse cautions a patient with peripheral vascular disease (PVD) that continued smoking causes detrimental vasoconstriction for up to ____________ after only one cigarette.

1 hour

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