Clinical Guidelines in Primary Care 4th Edition Hollier Test Bank chapters 01 to 19 comple, Exams of Medicine

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TEST

BANK

CLINICAL

GUIDELINES IN

PRIMARY CARE

4th Edition, Hollier

TEST

BANK

RATED

Chapter 1: Cardiovascular Disorders Clinical Guidelines in Primary Care 4th Edition Test bank MULTIPLE CHOICE

1. The nurse is aware that the muscle layer of the heart, which is responsible for the hearts contraction, is the: a. endocardium. b. pericardium. c. mediastinum. d. myocardium. ANS: D The myocardium is the specialized muscle layer that allows the heart to contract. 2.The nurse clarifies that the master pacemaker of the heart is the: a. left ventricle. b. atrioventricular (AV) node. c. sinoatrial (SA) node. d. bundle of His. ANS: C The SA node is the master pacemaker of the heart.
2. The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having: a. hepatitis A. b. indigestion. c. urinary infection. d. menopausal complications.

ANS: B

Indigestion, gallbladder attack, anxiety attack, and depression are frequent misdiagnoses for women having an MI.

4. The nurse identifies the LUBB sound of the LUBB/DUBB of the cardiac cycle as the sound of the: a. AV valves closing. b. closure of the semilunar valves. c. contraction of the papillary muscles. d. contraction of the ventricles. ANS: A The LUBB is the first sound of a low pitch heard when the AV valves close. 5.A patient is admitted from the emergency department. The emergency department physician notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV. This indicates the patients condition as: a. moderate heart failure. b. severe heart failure. c. congestive heart failure. d. negligible heart failure. ANS: B Class IV: Severe; patient unable to perform any physical activity without discomfort. Angina or symptoms of cardiac inefficiency may develop at rest.
5. The nurse assesses that the home health patient has no signs or symptoms of heart failure, but does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The nurse is aware that using the American College of Cardiology and the American Heart Association (ACC/AHA) staging, this patient would be a: a. stage A. b. stage B. c. stage C. d. stage D. ANS: A The ACC/AHA staging describes stage A as a person without symptoms of heart failure, but with primary conditions associated with the development of the disease.

d. severe heart failure. ANS: C An ejection factor (cardiac output) of 42% indicates moderate heart failure.

11. The nurse takes into consideration that age-related changes can affect the peripheral circulation because of: a. sclerosed blood vessels. b. hypotension. c. inactivity. d. poor nutrition. ANS: A Aging causes sclerotic changes in the blood vessels that lead to decreased elasticity and narrowing of the vessel lumen.
12. The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this arrhythmia as: a. sinus bradycardia. b. atrial fibrillation. c. sinus tachycardia. d. ventricular tachycardia. ANS: C Sinus tachycardia has a P wave followed by the QRS and the T. All the components of the complex are present and in the correct order, but the rate is over 100 beats a minute.
13. After an influenza-like illness, the patient complains of chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of: a. congestive heart failure. b. heart block. c. aortic stenosis. d. infective endocarditis. ANS: D Collection of subjective data includes noting patient complaints of influenza-like symptoms with recurrent fever, undue fatigue, chest pain, and chills. Objective data may reveal the

significant

c. When nitroglycerin is not relieving the pain, lie down and rest. d. Use oxygen at home to relieve pain when nitroglycerin is not successful. ANS: B Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify the physician. Nitroglycerin administered sublingually usually relieves angina symptoms but does not relieve the pain from an MI. Administering nitroglycerin more than three times will probably not relieve the pain.

18. The patient has been hospitalized for hypertensive episodes three times in the last months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurses immediate course of action would be to: a. reteach him about his medications. b. have a serious talk with him and his family about compliance. c. arrange for home visits after discharge. d. collect more information to identify his reasons for noncompliance. ANS: D Nursing interventions include measures to prevent disease progression and complications. Reteaching about medication will not identify the cause of noncompliance.
19. What is the major cause of cardiac valve disease? a. Rheumatic fever b. Long history of malnutrition c. Drug abuse d. Obesity ANS: A Rheumatic fever, a streptococcal infection, is the major cause of cardiac valve disease.
20. The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low- density lipid (LDL) of 80. The nurses reaction is one of: a. satisfaction. This is good cholesterol control. b. determination. This is evidence that more instruction is necessary. c. inquiry. This needs to clarified as to the cause of noncompliance with the drug protocol. d. regret. This shows very poor cholesterol control. ANS: A

Total cholesterol of less than 200 is desirable. The higher the number of HDLs the better. A high number of LDLs puts the patient at risk for heart disease.

21. A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Characteristic signs and symptoms of angina pectoris include: a. substernal pain that radiates down the left arm. b. epigastric pain that radiates to the jaw. c. indigestion, nausea, and eructation. d. fatigue, shortness of breath, and dyspnea. ANS: A The pain often radiates down the left inner arm to the little finger and also upward to the shoulder and jaw.
22. A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage? a. CK-MB b. Elevated white count c. Elevated sedimentation rate d. Low level of sodium ANS: A The CK-MB is elevated when there is infarcted myocardial muscle. The elevated white count, low sodium, and ESR are nonspecific.
23. The patient, age 26, is hospitalized with cardiomyopathy. While obtaining a nursing history from her, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor(s)? a. Cocaine use b. Viral infections c. Vitamin B 1 deficiencies d. Pregnancy ANS: A Cardiomyopathy caused by cocaine abuse is seen more frequently than ever before. Cocaine also causes high circulating levels of catecholamines, which may further damage myocardial cells, leading to ischemic or dilated cardiomyopathy. The cardiomyopathy produced is difficult to treat. Interventions deal mainly with the HF that ensues.

a. I have to sleep in my recliner and I have this hacking cough. b. I have no appetite and I have lost 3 lb in the last week. c. I have to urinate every 2 hours, even during the night. d. I go barefoot most of the time because my feet are so hot. ANS: A Left ventricular failure; the first is signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough.

28. The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask? a. Do you have a toothache? b. Have you contacted your physician about your dental appointment? c. Is your dentist board certified? d. Do you think you should wait that long for your tooth extraction? ANS: B Patients with endocarditis are put on a protocol of prophylactic antibiotics for any invasive procedure. The dentist and physician should be contacted before the extraction.
29. The home health nurse warns the patient who is taking warfarin (Coumadin) for anticoagulant therapy for thrombophlebitis to stop taking the herbal remedy of ginkgo because ginkgo can: a. cause severe episodes of diarrhea. b. cause a severe skin eruption if taken with Coumadin. c. increase the action of the Coumadin. d. cause the Coumadin to be less effective. ANS: C Herbal remedies such as ginkgo, garlic, angelica, and red clover can increase (potentiate) the action of the Coumadin.
30. What is the difference between primary and secondary hypertension? a. Secondary hypertension is caused by another disorder like renal disease. b. Secondary hypertension is related to hereditary factors. c. Secondary hypertension cannot be treated effectively. d. Secondary hypertension is no real threat to health.

ANS: A

Secondary hypertension is a consistently elevated blood pressure that is caused by another disorder, such as renal disease, diabetes, or Cushing syndrome.

31. The nurse is treating a patient who has had a pacemaker inserted for the correction of atrial fibrillation. Which diagnostic test is no longer available to the patient because of the implanted device? a. MRI b. CT scan c. Thallium scan d. PET ANS: A Because of the large magnets in the MRI cabinet, the pacemaker may be reset to a fixed mode and interfere with the functioning of the pacemaker.
32. Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer? a. Cool dry lower limb b. Edematous, red scaly skin on medial surface of the leg c. Lack of hair and shiny appearance of the lower leg d. Lack of a pedal pulse ANS: B Suggestion of a stasis ulcer in the making is an edematous, dry scaly area on the medial surface of the lower leg that has a darker pigmentation (rubor). Cool hairless limbs with absent or weak pedal pulses are indicative of arterial insufficiency.
33. What is the patient goal of the walking exercise program designed for the rehabilitation of a post-MI patient? a. Walk 2 miles in less than 60 minutes after 12 weeks. b. Jog mile in less than 30 minutes after 12 weeks. c. Fast walk 1 mile in less than 20 minutes after 12 weeks. d. Walk 1 mile in 15 minutes without dyspnea after 12 weeks. ANS: A The goal of the 12-week walking program is that the patient can walk 2 miles in less than 60 minutes.

[email protected] For Nursing Test Banks, Exams & Solution Manuals b. I try to eat more green leafy vegetables, especially broccoli, spinach, and kale. c. I try to eat a well-balanced, low-fat diet. d. I dont drink alcohol or caffeine. ANS: B Avoid marked changes in eating habits, such as dramatically increasing foods high in vitamin K (e.g., broccoli, spinach, kale, greens). Limit alcohol intake to small amounts.

38. The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause: a. hypotension. b. thrombophlebitis. c. pulmonary emboli. d. heart failure. ANS: D Heart failure can result from rapid infusion of intravenous fluids in older adults.
39. The nurse making the schedule for the daily dose of furosemide (Lasix) would schedule the administration for which of the following times? a. Late in the afternoon b. At bedtime c. With any meal d. In the morning ANS: D Diuretics should be scheduled for morning administration to avoid causing the patient nocturia.

Chapter 2: Dermatologic Disorders Clinical Guidelines in Primary Care 4th Edition Test bank MULTIPLE CHOICE 1.What should the nurse do when administering a therapeutic bath to a patient who has severe pruritus? a. Use Burows solution to help promote healing b. Rub the skin briskly to decrease pruritus c. Limit bathing to 3 times a week d. Ensure that bath area is at least 85 degrees and dehumidified ANS: A Pruritus is responsible for most of the discomfort. Wet dressings and using Burows solution help promote the healing process. A cool environment with increased humidity decreases the pruritus. Give daily baths with an application to cleanse the skin. 2.A frail, older adult home health patient who had chickenpox as a child has been exposed to varicella (chickenpox) several days ago. What should the nurse do? a. Assess frequently for herpes zoster b. Be aware of the patients immunity to chickenpox c. Encourage the patient to have a pneumonia vaccine d. Arrange for the patient to receive gamma globulin ANS: A Herpes zoster is caused by the same virus that causes chickenpox (Herpes varicella). The greatest risk occurs to patients who have a lowered resistance to infection, such as those on chemotherapy, aging, or receiving large doses of prednisone, in whom the disease could be fatal because of the patients compromised immune system. 3.A patient has herpes zoster (shingles) and is being treated with acyclovir (Zovirax). What should the nurse do when administering this drug? a. Apply lightly, being careful not to completely cover the lesion b. After application, wrap in warm wet dressings c. Use gloves d. Rub medication into lesions ANS: C The topical application requires that the nurse uses gloves, completely covers the lesion gently, then leaves it open to the air.

7. The home health nurse assessing skin lesions uses the PQRST mnemonic as a guide. What does the S in this guide indicate? a. Severity of the symptoms b. Site of the lesions c. Symptomatology of the lesions d. Surface area of the lesions ANS: A The mnemonic PQRST stands for Provocative factors (causes), Quantity, Region of the body, Severity of the symptoms, Time (length of time the disorder has been present).
8. What would the nurse stress to the 17-year-old girl who has been prescribed Accutane for her acne? a. Avoid alcoholic beverages b. Drink at least 1000 mL of fluid daily c. Use dependable birth control to avoid pregnancy d. Avoid exposure to the sun ANS: C Accutane has a destructive effect on fetal development. Dependable birth control is important to avoid a pregnancy. 9.A 30-year-old African American had surgery 6 months ago and the incision site is now raised, indurated, and shiny. This is most likely which type of tissue growth? a. Angioma b. Keloid c. Melanoma d. Nevus ANS: B Keloids, which originate in scars, are hard and shiny and are seen more often in African Americans than in whites.
9. A patient, age 37, sustained partial- and full-thickness burns to 26% of the body surface area. When would the greatest fluid loss resulting from the burns occur? a. Within 12 hours after burn trauma b. 24 to 36 hours after burn trauma

c. 24 to 48 hours after burn trauma d. 48 to 72 hours after burn trauma ANS: A In a burn injury, usually the greatest fluid loss occurs within the first 12 hours.

11. Most of the deaths from burn trauma in the emergent phase that require a referral to a burn center result from: a. infection. b. arrhythmias with cardiac arrest. c. hypovolemic shock and renal failure. d. adrenal failure. ANS: C Hypovolemic shock is frequently lethal in the emergent period of a severe burn because of the transfer of fluids into the interstitial tissue from the circulating volume.
12. The nurse takes into consideration that carbon monoxide intoxication secondary to smoke inhalation is often fatal because carbon monoxide: a. binds with hemoglobin in place of oxygen. b. interferes with oxygen intake. c. is a respiratory depressant. d. is a toxic agent. ANS: A Carbon monoxide poisoning is likely if the patient has been in an enclosed area. Carbon monoxide displaces oxygen by binding with hemoglobin.
13. A nurse arrives at an accident scene where the victim has just received an electrical burn. What is the nurses primary concern? a. The extent and depth of the burn b. The sites of entry and exit c. The likelihood of cardiac arrest d. Control of bleeding ANS: C Most electrical burns result in cardiac arrest, and the patient will require CPR or acute cardiac monitoring.