Brunner: Medical-Surgical Nursing, 11th Edition Test Bank, Exams of Nursing

Download Brunner: Medical-Surgical Nursing, 11th Edition Test Bank and more Exams Nursing in PDF only on Docsity! Chapter 28- Management of Patients With Coronary Vascular Disorders Brunner: Medical-Surgical Nursing, 11th Edition Test Bank Chapter 28: Management of Patients With Coronary Vascular Disorders Multiple Choice 1. A patient is diagnosed as having elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of: A) Lipids and fibrous tissue B) WBCs C) Lipoproteins D) High-density cholesterol Ans: A Chapter: 28 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Patient Needs: D-4 Feedback: As T lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls. 2. The coronary arteries are susceptible to development of arteriosclerosis because coronary arteries: A) Are smaller in diameter B) Accumulate more low-density cholesterol C) Have numerous twist and turns D) Have a decreased pulse pressure Ans: C Chapter: 28 Cognitive Level: Knowledge Difficulty: Easy Chapter 28- Management of Patients With Coronary Vascular Disorders Integrated Process: Nursing Process Objective: 1 Patient Needs: D-4 Feedback: Due to the need of the coronary arteries to supply blood to the heart, they have many twists and turns, creating more sites susceptible to developing atheroma. 3. An adult patient who experiences angina pectoris with exertion is informed by the nurse that most often angina is caused by: A) Smoking B) Inadequate cardiac output C) Infarction of the myocardium D) Coronary arteriosclerosis Ans: D Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Patient Needs: D-4 Feedback: In most cases, angina pectoris is due to arteriosclerosis, particularly in older patients. Smoking, hypertension, high cholesterol levels, and diabetes mellitus are all associated with coronary arteriosclerosis. 4. The nurse is teaching a 45-year-old patient about ways to lower elevated cholesterol levels. One method to lower cholesterol levels is to exercise, which: A) Increases HDL and decreases triglycerides B) Increases LDL and decreases triglycerides C) Decreases HDL and increases LDL D) Decreases both HDL and LDL Ans: A Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Patient Needs: B-2 Feedback: Moderate exercise increases HDL levels, which assists in lowering LDL levels. Exercise also decreases triglyceride levels. Chapter 28- Management of Patients With Coronary Vascular Disorders myocardium: A) May have developed an increased area of infarction B) Will probably not have more damage than if he came in immediately C) May be restored in the area of dead cells with proper treatment D) Has been damaged already, so immediate treatment is no longer necessary Ans: A Chapter: 28 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-4 Feedback: When the patient experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated the more likely the treatment will prevent or minimize myocardial tissue necrosis. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage. 10. The nurse notes that there are changes in the ECG of a patient who experienced an MI. Changes may indicate that the occurring ischemia is: A) P wave inversion B) T wave inversion C) Q wave changes with no change in ST or T wave D) P wave enlargement Ans: B Chapter: 28 Cognitive Level: Knowledge Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-4 Feedback: T wave inversion is an indicator of ischemic damage to the myocardium. Typically, there are not many changes to P waves during or after an MI, while Q wave changes with no change in the ST or T wave indicate an old MI. 11. A patient is suspected of experiencing an MI at approximately 6:00 AM, at which time laboratory results show an increase in troponin I. The nurse can expect troponin I to peak at what time: A) 6:00 PM Chapter 28- Management of Patients With Coronary Vascular Disorders B) 1:00 PM C) 8:00 PM the following day D) 10:00 AM Ans: A Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-4 Feedback: Troponin I is a protein found in cardiac muscle, which peaks approximately 10 to 24 hours after onset of myocardial damage. 12. A patient is admitted with pale, cool skin, midsternal chest pain unrelieved with rest, and a history of CAD. The nurse is aware that: A) The symptoms indicate angina and should be treated as such. B) The symptoms indicate anxiety and should be treated as such. C) The symptoms indicate an acute coronary episode and should be treated as such. D) Treatment should be held until an ECG is completed. Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-4 Feedback: Angina and MI have similar symptoms and are considered the same process but are on different points along a continuum. Acute coronary syndrome may be used to represent these diagnoses. Treatment should be initiated immediately regardless of diagnosis. 13. An adult male patient is admitted to emergency following a fall in which he sustained a large laceration to the occipital area of his head. Prior to the fall, he says he developed unrelieved chest pain that had been present for approximately 20 minutes and is still present. The doctor diagnoses the patient with an MI and deep laceration. To minimize cardiac damage, which of the following physician's order will the nurse expect to see for this patient? A) Thrombolytics, oxygen administration, and bed rest B) Morphine sulphate, oxygen administration, and bed rest C) Oxygen administration, anticoagulants and bed rest Chapter 28- Management of Patients With Coronary Vascular Disorders D) Bed rest, albuterol nebulizer treatments, and oxygen administration Ans: B Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: Morphine sulphate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. Thrombolytics and anticoagulants are contraindicated in patients who are bleeding or have a bleeding disorder. Albuterol is a medication used to manage asthma and respiratory conditions and will increase the heart rate. 14. Forty minutes after arrival to the emergency room, a patient suffering an MI is to have emergent percutaneous transluminal coronary angioplasty (PTCA) to: A) Decrease cardiac workload B) Cure elevated cholesterol C) Reperfuse the area of myocardium deprived of oxygen D) Remove the area of ischemia from the myocardium Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-4 Feedback: Emergent PTCA is used to open occluded coronary arteries and allow for reperfusion to the area of myocardium that is deprived of oxygen. 15. The most appropriate expected patient outcome for the nursing diagnosis of deficient knowledge about post-MI self-care would be: A) Relief of angina B) Less anxiety C) Maintenance of adequate tissue perfusion D) Adherence to self-care program Ans: D Chapter 28- Management of Patients With Coronary Vascular Disorders 20. To allow the cardiac surgeon to work in a bloodless surgical field during cardiac surgical procedures and to maintain perfusion of body organs and tissues, a technique often used is: A) CABG B) PTCA C) Atherectomy D) Cardiopulmonary bypass Ans: D Chapter: 28 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing Process Objective: 7 Patient Needs: D-4 Feedback: Cardiopulmonary bypass is often used to circulate and oxygenate blood mechanically while bypassing the heart and lungs. 21. In the preoperative phase of the patient awaiting cardiac surgery, a nurse should: A) Clarify medication regimen preoperatively B) Not alter medication regimen preoperatively C) Save teaching material until after the surgery D) Not discuss fears with the patient to avoid worsening them Ans: A Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication/Documentation Objective: 8 Patient Needs: A-1 Feedback: Clarification of the preoperative medication regimen is required to prepare the patient properly for surgery and avoid patient injuries and delays. Teaching and assessment of psychosocial adaptation/management is essential preoperatively. 22. A 66-year-old patient is admitted for cardiac surgery. The patient states that he is afraid of dying while undergoing the surgery. The nurse is aware that: A) A further assessment of anxiety is required. Chapter 28- Management of Patients With Coronary Vascular Disorders B) A more complete physical examination is required. C) Preoperative fears are normal and if ignored will be alleviated independently. D) Teaching should be initiated immediately to alleviate the fears. Ans: A Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 8 Patient Needs: C-1 Feedback: An assessment of anxiety levels is required in the patient to assist in identifying fears and developing coping mechanisms for those fears. If the patient's anxiety is high, it may interfere with teaching. 23. During the postoperative assessment of a patient who has undergone cardiac surgery, the nurse assesses the peripheral pulses, nail beds, mucosa, and skin temperature. These assessments focus on the patient's: A) Renal function B) Cardiac status C) Peripheral vascular status D) Fluid and electrolyte status Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 8 Patient Needs: D-4 Feedback: Part of the of peripheral vascular status assessment includes peripheral pulses, nail beds, mucosa, and skin temperature. Part of cardiac status assessment includes heart rate and pulmonary artery pressure. Part of renal function assessment includes urinary output and osmolality. Fluid and electrolyte assessment includes alterations in electrolytes and fluid intake and output. 24. The nurse notes that the patient who has undergone cardiac surgery is now nauseated, restless, confused, and experiencing peaked tall T waves in the ECG. The nurse suspects the patient may be experiencing symptoms of: A) Hypocalcemia Chapter 28- Management of Patients With Coronary Vascular Disorders B) Hypercalcemia C) Hyperkalemia D) Hypermagnesemia Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Patient Needs: D-4 Feedback: Hyperkalemia produces symptoms of confusion, restlessness, nausea, and tall peaked changes in T waves in the ECG. Hypocalcemia produces digitalis toxicity and asystole. Hypocalcemia produces symptoms of paresthesias, carpopedal spasm, muscle cramps, and tetany. Hypermagnesemia produces symptoms of vasodilatation, hypotension, hyporeflexia, and slow gastrointestinal motility. 25. The nurse notes a decrease in urine output to less than 25 mL/h and a decrease in blood pressure. These changes in patient condition may indicate: A) Fluid volume overload B) Impaired gas exchange C) Decreased cardiac output D) Impaired cerebral circulation Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Patient Needs: D-4 Feedback: Decreased urine output of less than 25 mL/h and a decrease in blood pressure can indicate a decrease in cardiac output. As cardiac output decreases, glomerular filtration is affected and the volume of urine decreases. 26. When a patient has been extubated from the ventilator after cardiac surgery, the nurse encourages the patient to: A) Deep breathe and cough at least every 1 to 2 hours B) Deep breathe and cough once every 6 hours C) Lie flat as often as possible Chapter 28- Management of Patients With Coronary Vascular Disorders Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-3 Feedback: ECG monitoring should be started as soon as possible; life-threatening arrhythmias are the leading cause of death in the first hours after MI. Obtaining information about family history of heart disease and whether the patient smokes aren't immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation, and pain control needs are met. 31. The nurse provides care for a patient who experienced an extensive myocardial infarction (MI). The patient exhibits behavior characteristic of the denial stage of the grieving process. How should the nurse approach the patient's denial? A) Reinforce and support the patient's denial. B) Let the patient know that the nurse is available to talk. C) Point out other patients with MIs who are doing well. D) Explain to the patient that he needs to accept his diagnosis. Ans: B Chapter: 28 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: C-1 Feedback: Letting the patient know that the nurse is available to talk acknowledges the patient's feelings. It may help the patient cope until he's ready to move on to the next stage of the grieving process. Pointing out other patients with MI who are doing well offers false reassurance to this patient and disregards his feelings. The patient shouldn't be forced to face reality. Denial is a protective mechanism that enables the patient to cope with crisis until he can use more effective coping behaviors. 32. A patient comes to the emergency department with an acute myocardial infarction. An electrocardiogram shows a heart rate of 116 beats/minute with frequent premature ventricular contractions. The patient experiences ventricular tachycardia and becomes unresponsive. After resuscitation, the patient moves to the intensive care unit. What is the priority nursing diagnosis for this patient? A) Impaired physical mobility related to complete bed rest B) Deficient knowledge related to emergency interventions Chapter 28- Management of Patients With Coronary Vascular Disorders C) Social isolation related to restricted family visits D) Anxiety related to the threat of death Ans: D Chapter: 28 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: C-1 Feedback: Anxiety related to the threat of death is an appropriate nursing diagnosis. Anxiety can adversely affect the patient's heart rate and rhythm by stimulating the autonomic nervous system. The threat of death is an immediate and real concern for the patient. The other options are valid, but their priority is less urgent. 33. The nurse in the emergency department is assessing a 64-year-old patient experiencing substernal chest pain. The patient's electrocardiogram shows evidence of myocardial ischemia. Which statement indicates to the nurse that the patient may be a candidate for thrombolytic therapy? A) "I have had chest pain for 2 days." B) "My chest pain started 3 hours ago." C) "My chest pain stops when I take a nitroglycerin pill." D) "I have had chest pain on and off all week." Ans: B Chapter: 28 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: Because it takes 4 to 6 hours for myocardial cells to die, thrombolytic therapy should be given within 6 hours of the onset of chest pain to achieve the best results in an acute myocardial infarction. The patient who has waited 2 days to be treated for chest pain won't benefit from thrombolytic therapy. Chest pain that's relieved by nitroglycerin is most likely due to angina and not an indication for thrombolytic therapy. Chest pain for 1 week is also beyond the 6-hour time limit. 34. The nurse is teaching a patient about the use of sublingual nitroglycerin. Which statement indicates understanding of the teaching plan? Chapter 28- Management of Patients With Coronary Vascular Disorders A) "I must swallow the tablet whole without chewing." B) "I should take a tablet about 45 minutes before initiating a strenuous activity that causes angina." C) "I'll keep the nitroglycerin in its original dark, airtight container." D) "I'll take a tablet every 5 minutes until my chest pain stops." Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Patient Needs: D-2 Feedback: To maintain potency, nitroglycerin should be kept in its original dark, airtight container. Sublingual nitroglycerin tablets should be placed under the tongue and allowed to dissolve; they shouldn't be chewed or swallowed. Tablets may be placed under the tongue about 5 to 10 minutes before an activity known to cause angina. If angina occurs, one tablet should be placed under the tongue every 5 minutes until pain is relieved, up to a total of three tablets in 15 minutes. If the angina still isn't relieved, the patient should seek immediate treatment. 35. The nurse is caring for a nonsmoking female patient with the diagnosis of coronary atherosclerosis who has been admitted to the hospital with angina. The patient states that she never experiences chest pain, the most common manifestation of myocardial ischemia. The nurse is not surprised at this statement and explains to the patient that: A) Women who have ischemia are usually totally asymptomatic. B) Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. C) Chest pain occurs only with strenuous exercise. D) Cigarette smoking is usually the contributing factor to chest pain. Ans: B Chapter: 28 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Patient Needs: B-2 Feedback: Ischemia of the heart muscle may produce pain varying in severity from mild indigestion to a heavy sensation or agonizing pain in the upper chest. The most common manifestation is chest pain or pressure that may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, usually the left arm. A woman may have different symptoms than a man, because coronary disease in women tends to be more diffuse and affects long segments of the artery rather than discrete segments. Factors such as physical exertion and exposure to cold Chapter 28- Management of Patients With Coronary Vascular Disorders Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Patient Needs: B-2 Feedback: Any activity or exercise that causes dyspnea and chest pain should be stopped in the patient with CAD. Heart rate rather than respiratory rate determines the parameters for exercise. An increase in BP more than 20 mm Hg and ST-segment ECK changes also indicate it is time to stop exercising, but cannot be self-monitored. 40. The nurse caring for an elderly patient with CAD is teaching her about the clinical manifestations of an acute MI. The nurse emphasizes that she may not exhibit the typical pain profile because the presenting symptom in the elderly often is: A) Dyspnea B) Back pain C) Nausea D) Diaphoresis Ans: A Chapter: 28 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Patient Needs: A-1 Feedback: An older adult often has altered responses to CAD and MI, resulting in atypical symptoms and sudden dyspnea and profound weakness. Pain perception is blunted because of diminished responses of neurotransmitters that occur with aging. Nausea and diaphoresis are often not present. 41. The nurse taking care of a patient with high cholesterol and triglyceride values teaches him about therapeutic lifestyle changes such as diet and exercise. The nurse is aware that the desired goal for cholesterol levels is: A) High HDL values and high triglyceride values B) Low soluble fiber C) Elevated blood lipids, fasting glucose less than 100 D) Low LDL values and high HDL values Ans: D Chapter: 28 Chapter 28- Management of Patients With Coronary Vascular Disorders Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Patient Needs: B-2 Feedback: The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver where it is excreted. Triglyceride, another fatty substance made up of fatty acids, is transported through the blood. Elevated triglyceride is also a major risk factor for cardiovascular disease as well as insulin resistance (fasting glucose over 100). The goal is to keep triglyceride levels less than 150 mg/dL and fasting glucose less than 100mg/dL. Soluble dietary fiber is not a value measured in the bloodstream; it is found in fresh fruits, cereal grains, and vegetables and has been known to enhance the excretion of metabolized cholesterol. 42. The nurse who is teaching about cardiovascular disease promotes cessation of cigarette smoking and healthy lifestyle, diet, and exercise to correct cholesterol abnormalities. In addition, the nurse explains that there are two modifiable conditions that have been cited as major risk factors for CAD and its complications. These two conditions receive much attention in health promotion and control. They are: A) Obesity and hypertension B) Diabetes mellitus and hypertension C) Bradycardia and hypertension D) Depression and hypertension Ans: B Chapter: 28 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Patient Needs: B-2 Feedback: Four modifiable risk factors have been cited as major risk factors for CAD and its complications. They are cholesterol abnormalities, cigarette smoking, diabetes, and hypertension. As a result, they receive much attention in health promotion programs. Early detection of hypertension and adherence to a therapeutic regimen can prevent serious consequences. Proper control of diabetes mellitus has also been shown to reduce CAD. 43. The nurse caring for a patient with cardiovascular disease is aware of the many types of Chapter 28- Management of Patients With Coronary Vascular Disorders pharmacologic therapy used of treat CAD that decrease the oxygen demand of the myocardium and increase the oxygen supply. The doctor has ordered Norvasc, a calcium channel blocking agent, for this patient. The nurse knows that calcium channel blockers have a variety of effects. One of the therapeutic effects is: A) Decrease in sinoatrial node and atrioventricular node conduction and decrease in workload of the heart B) Prevention of platelet aggregation and subsequent thrombosis C) Reduction of myocardial oxygen consumption by blocking beta-adrenergic stimulation to the heart D) Reduction of myocardial oxygen consumption, thus decreasing ischemia and relieving pain Ans: A Chapter: 28 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: A-1 Feedback: Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. They are also used to prevent and treat vasospasm. Antiplatelet and anticoagulation medications are administered to prevent platelet aggregation and subsequent thrombosis which impeded blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and, in higher doses, the arteries. 44. The nurse is caring for a patient with cardiovascular disease who has a nursing diagnosis of anxiety related to perceived threat of death. Stress reduction methods and providing information about the illness, its treatment, and prevention of its progression have been implemented by the nurse. The nurse evaluates her goal in reducing anxiety and determines that the goal has been met when the patient states: A) “I know you are doing everything possible to save my life and help me.” B) “When can I resume all my normal activities again?” C) “I am going to take my recovery one day at a time.” D) “I feel fine now and I am ready to go on with my previous life activities.” Ans: C Chapter: 28 Cognitive Level: Application Difficulty: Moderate