Post by Nursing Board 101 on Aug 18, 2010 13:20:36 GMT -5
1. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride
a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
d. Is an angiotensin-converting enzyme (ACE) inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.
Ans: A – propranolol is -adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
2. The nurse understands that a priority nursing diagnosis for the client with hypertension would be
a. Pain.
b. Deficient Fluid Volume.
c. Impaired skin integrity.
d. Ineffective health maintenance.
Ans: D – managing hypertension is a priority for the client with hypertension. Clients with hypertension frequently do not experience other signs and symptoms such as pain, deficient fluid volume, or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat, because clients may not recognize they are hypertensive or may not perceive the need for aggressive management of the disease.
3. The most important long-term goal for a client with hypertension would be to
a. Learn how to avoid stress.
b. Explore a job change or early retirement.
c. Make a commitment to long-term therapy.
d. Control high blood pressure.
Ans: C – compliance is the most critical element of hypertension therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without during therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.
4. The client with hypertension is prone to long-term complications of the disease. Which of the following is a long-term complication of hypertension?
a. Renal insufficiency and failure.
b. Valvular heart disease.
c. Endocarditis
d. Peptic ulcer disease.
Ans: A – renal disease, including renal insufficiency and failure is a complication of hypertension. effective treatment of hypertension assists in preventing this compliance valvular heart disease, endocarditis, and peptic ulcer disease are not complications of hypertension.
5. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of
a. Cerebrovascular accidents (CVA’s)
b. Liver disease.
c. Myocardial infarction.
d. Pulmonary disease.
Ans: A – hypertension is referred to as the silent killer for adults, because until the adult has significant damage to others systems, the hypertension may go undetected. CVAs can be related to long-term hypertension. Liver or pulmonary disease is not generally associated with hypertension. Myocardial infraction is generally related to coronary artery disease.
6. During the past few months, a 56-year old woman has felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?
a. Visit her friend
b. Rest for at least an hour before climbing the stairs
c. Take a nitroglycerin tablet before climbing the stairs.
d. Lie down once she reaches the friend’s apartment.
Ans: C – nitroglycerin may be used prophylactically before stressful physical activities such as stair-climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.
7. The client who experiences angina pectoris has been told to follow a low-cholesterol diet. Which of the following meals should the nurse tell the client would be best on her low –cholesterol diet?
a. Hamburger, salad, and milkshake.
b. Baked liver, green beans, and coffee.
c. Spaghetti with tomato sauce, salad, and coffee
d. Fried chicken, green beans, and skim milk
Ans: C – pasta, tomato sauce, salad, and coffee would be the best selection for the client following a low-cholesterol diet. Hamburgers, milkshakes, liver, and fried foods tend to be high in cholesterol.
8. Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?
a. A change in the pattern of her pain
b. Pain during sexual activity
c. Pain during an argument with her husband
d. Pain during or after an activity such as lawn mowing
Ans: A – the client should report a change in the pattern of chest pain. It may help increasing severity of coronary artery disease. Pain occurring during stress or sexuality activity would not be unexpected, and the client may be instructed to take nitroglycerin to prevent this pain. Pain during or after an activity such as lawn mowing also would not be unexpected; the client may be instructed to take nitroglycerin to prevent this pain or may be restricted from doing such activities.
9. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:
a. Open and dilate blocked coronary arteries
b. Assess the extent of arterial blockage
c. Bypass obstructed vessels
d. Assess the functional adequacy of the valves and heart muscle
Ans: B – cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage. A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results. Coronary bypass surgery would be used to bypass obstructed vessels. Although cardiac catheterization can be used to assess the functional adequacy of the valves and heart muscle, in this case the client has unstable angina and therefore would need the procedure to assess the extent of arterial blockage.
10. The client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) to treat angina. Priority goals for the client immediately after PTCA would include:
a. Minimizing dyspnea
b. Maintaining adequate blood pressure control
c. Decreasing myocardial contractility
d. Preventing fluid volume deficit
Ans: D – because the contrast medium used in PTCA acts as an osmotic diuretic, the client may experience diuresis with resultant fluid volume deficit after the procedure. Additionally, potassium levels must be closely monitored because the client may develop hypokalemia due to the diuresis. Dyspnea would not be anticipated after this procedure. Maintaining adequate blood pressure control should not be a problem after the procedure. Increased myocardial contractility would be a goal, not decreased contractility.
11. Which of the following is not generally considered to be a risk factor for the development of atheroclerosis?
a. Family history of early heart attack
b. Late onset of puberty
c. Total blood cholesterol level greater than 220 mg/dL
d. Elevated fasting blood sugar concentration
Ans: B – late onset of puberty is not generally considered to be a risk factor of the development of atherosclerosis. Risk factors for atherosclerosis include cigarette smoking, hypertension, high blood cholesterol level, male gender, family history of atherosclerosis, diabetes mellitus, obesity, and physical inactivity.
12. Many more men than women younger than 50 years of age have coronary artery disease as a result of atherosclerosis. The leading cause of death in women is:
a. Acquired immunodeficiency syndrome
b. Breast cancer
c. Coronary artery disease
d. Chronic obstructive pulmonary disease
Ans: C – coronary artery disease is the leading cause of dearth in women as well as men. Although it is generally agreed that estrogen helps protect women from atherosclerotic changes before menopause, women are still at risk for coronary artery disease. Much attention has been focused on the lack of research studies dealing with cardiac disease in women and minorities, and work is under way to gain a better understanding of cardiac disease in these populations.
13. A client angina asks the nurse, “ What information does an ECG provide?” The nurse would respond that an electrocardiogram (ECG) primarily gives information about the:
a. Electrical conduction of the myocardium
b. Oxygenation and perfusion of the heart
c. Contractile status of the ventricles
d. Physical integrity of the heart muscle
Ans: A – an ECG directly reflects the transmission of electrical cardiac impulses through the heart. This information makes it possible to evaluate indirectly the functional status of the heart muscle and the contractile response of the ventricles. However, these elements are not measured directly. The ECG does not give information about the oxygenation and perfusion of the heart.
14. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg given sublingually. This drug’s principal effects are produced by:
a. Antispasmodic effects on the pericardium
b. Causing an increased myocardial oxygen demand
c. Vasodilation of peripheral vasculature
d. Improved conductivity in the myocardium
Ans: C – nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
15. The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
a. Headache
b. High blood pressure
c. Shortness of breath
d. Stomach cramps
Ans: A – because of its widespread vasodilating effects, nitroglycerin often produces such as side effects as headache, hypotension, and dizziness. The client should sit or lie down to avoid fainting. Nitroglycerin does not cause shortness of breath or stomach cramps.
16. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?
a. Take one tablet every 2 to 5 minutes until the pain stops
b. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes
c. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after these tablets
d. Take one tablet. If pain still persists 5 minutes later, call the physician
Ans: C – the correct protocol for nitroglycerin use involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of three tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes.
17. A client with angina has been taking nifedipine. The client should be taught to:
a. Monitor blood pressure monthly
b. Perform daily weights
c. Inspect gums daily
d. Limit intake of green leafy vegetables
Ans: C – the client taking nifedipine should inspect the gums daily to monitor for gingival hyperplasia. This is an uncommon side effect but one that requires monitoring and intervention if it occurs. The client taking nifedipine might be taught to monitor blood pressure, but more than monthly. These clients would not generally need to perform daily weights or limit intake of green leafy vegetables.
The Client With A Permanent Pacemaker
18. A 74-year-old woman is admitted to the telemetry unit for placement of a permanent pacemaker would be to:
a. Maintain skin integrity
b. Maintain cardiac conduction stability
c. Decrease cardiac output
d. Increase activity level
Ans: B – maintaining cardiac conduction stability to prevent dysrythmias is a priority immediately after artificial pacemaker implantation. The client should have continuous electrocardiographic (ECG) monitoring until proper pacemaker functioning is verified.
19. The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. Outcome criteria include that the client:
a. Selects a low-cholesterol diet to control coronary artery disease
b. States a need for bed rest for 1 week after discharge
c. Verbalizes safety precautions needed to prevent pacemaker malfunction
d. Explain sign and symptoms of myocardial infraction
Ans: C – education is a major component of the discharge plan for a client with an artificial pacemaker. The client with a permanent pacemaker needs to be able to state specific information about safety precautions necessary to maintain proper pacemaker function.
The Client Requiring Cardiopulmonary Resuscitation
20. A rescuer is called to a neighbor’s home after a 56-year-old man collapses. After quickly assessing the victim, the rescuer determines that the victim is unresponsive. To determine unresponsiveness, the rescuer can:
a. Call the victim’s name and gently shake the victim
b. Perform the chin-tilt to open the victim’s airway
c. Feel for any air movement from the victim’s nose or mouth
d. Watch the victim’s chest for respirations
Ans: A – calling the victim’s name and gently shaking the victim is used to establish unresponsiveness. The head-tilt, chin-lift maneuver is used to open the victim’s airway. Feeling for any air movement from the victim’s nose or mouth indicates whether the victim is breathing on his own. The rescuer can watch the victim’s chest for respirations to see if the victim is breathing.
21. Proper hand placement for chest compressions during cardiopulmonary resuscitation (CPR) is essential to reduce the risk of which of the following complications?
a. Gastrointestinal bleeding
b. Myocardial infraction
c. Emesis
d. Rib fracture
Ans: D – proper hand placement during chest compressions is essential to reduce the risk of rib fractures, which may lead to pneumothorax and other internal injuries. Gastrointestinal bleeding and myocardial infarction are generally not considered complications of CPR. Although the victim may vomit during CPR, this is not associated with poor hand placement, but rather with distention of the stomach.
22. The American Heart Association guidelines urge greater availability of automated external defibrillators (AEDs) and people trained to use them. AEDs are used in cardiac arrest situations for:
a. Early defibrillation in cases of atrial fibrillation
b. Cardioversion in cases of atrial fibrillation
c. Pacemaker placement
d. Early defibrillation in cases of ventricular fibrillation
Ans: D – AEDs are used for early defibrillation in cases of ventricular fibrillation. The American Heart Association places major emphasis on early defibrillation for ventricular fibrillation and use of the AED as a toll to increase sudden cardiac arrest survival rates.
23. A client who has been given CPR is transported by ambulance to the hospital’s emergency department, where the admitting nurse quickly assesses the client’s condition. Of the following observations, the one most often recommended for determining the effectiveness of CPR is noting whether the:
a. Pulse rate is normal
b. Pupils are reacting to light
c. Mucous membranes are pink
d. Systolic blood pressure is at least 80 mmHg
Ans: B – Pupillary reaction is the best indication of whether oxygenated blood has been reaching the client’s brain. Pupils that remain widely dilated and do not react to light probably indicate that serious brain damage has occurred. The pulse rate may be normal, mucous membranes may still be pink, and systolic blood pressure may be 80 mmHg or higher, and serious brain damage may still have occurred.
24. The client receives epinephrine during resuscitation in the emergency department. This drug is administered primarily because of its ability to:
a. Dilate bronchioles
b. Constrict arterioles
c. Free glycogen from the liver
d. Enhance myocardial contractility
Ans: D. Epinephrine is administered during resuscitation efforts primarily for its ability to improve cardiac activity. Epinephrine has great affinity for adrenergic receptors in cardiac tissue and acts to strengthen and speed the heart rate as well as to increase impulses conduction from atria to ventricles. Epinephrine dilates bronchioles and constricts arterioles, but these are not the primary reasons for administering it during resuscitation. Epinephrine is not associated with freeing glycogen from the liver.
25. The rescuer understands that the compression-to-ventilation ratio for one-rescuer adult CPR is:
a. 5:1
b. 15:1
c. 5:2
d. 15:2
Ans: D – With one-rescuer CPR, the compression to ventilation ratio is 15:2.
26. During CPR, the xiphoid process at the lower end of the sternum should not be compressed when performing cardiac compressions. Which of the following organs would be most likely at risk for laceration by forceful compressions over the xiphoid process?
a. Lung
b. Liver
c. Stomach
d. Diaphragm
Ans: B Because of its location near the xiphoid process, the liver is the organ most easily damaged from pressure exerted over the xiphoid process during CPR. The pressure on the victim’s chest wall should be sufficient to compress the heart but not so great as to damage internal organs. Injury may result, however, even when CPR is performed properly.
27. When performing external chest compressions on an adult during CPR, the rescuer should depress the sternum.
a. 0.5 to 1 inch
b. 1 to 1.5 inches
c. 1.5 to 2 inches
d. 2 to 2.5 inches
Ans: C – an adult’s sternum must be depressed 1.5 to 2 inches with each compression to ensure adequate heart compression.
28. The American Heart Association guidelines for Basic Cardiac Life Support recommend that the rescuer after first establishing unresponsiveness, should:
a. Perform CPR for 2 minutes on the adult victim then place a call for emergency assistance
b. Place a call for emergency assistance immediately
c. Begin rescue breathing for the victim
d. Begin CPR on the adult victim and wait until help comes on the scene
Ans: B – the American Heart Association guidelines for Basic Cardiac Life Support now recommends that the rescuer call for emergency assistance immediately after establishing unresponsiveness in the adult victim. A call for emergency assistance takes places precedence over initiating CPR in the adult victim, in an effort to get emergency personnel and an AED to the scene. Early defibrillation and prompt bystander CPR have increased sudden cardiac arrest survival rates.
29. If the victim’s chest wall fails to rise with each inflammation when rescue breathing is administered during CPR, the most likely reason is that the:
a. Airway is not opened properly
b. Victim is beyond resuscitation
c. Inflations are being given at too rapid a rate
d. Rescuer is using inadequate force for cardiac compression
Ans: A – if the airway is not opened properly, it is impossible to inflate the lungs during CPR. A common signs of airway obstruction is failure of the victim’s chest wall to rise with each inflation. The victim should not be considered beyond resuscitation; rather the airway should be opened properly. Inflations may be being given too rapidly. However, this is not the usual cause of not being able to adequately ventilate the victim. If the rescuer is using inadequate force for cardiac compression, it should not interfere with how ventilations are delivered.
30. During rescue breathing in CPR, the victim with exhale by:
a. Normal relaxation of the chest
b. Gentle pressure of the rescuer’s hand on the upper chest
c. The presence of cardiac compressions
d. Turning the head to the side
Ans: A – the exhalation phase of ventilation is a passive activity that occurs during CPR as part of the normal relaxation of the victim’s chest. No action by the rescuer is necessary.