Clinical Guidelines in Primary Care: Comprehensive Test Bank, Exams of Medicine

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TEST BANK FOR CLINICAL GUIDELINES IN PRIMARY CARE

5TH EDITION HOLLIER ALL

CHAPTERS

Clinical Guidelines in Primary Care 5th Edition Hollier Test Bank All

Chapters

Chapter 1 Cardiovascular Disorders MULTIPLE CHOICE When taking a nursing history from a hospitalized 26 - year-old patient with cardiomyopathy, the nurse realizes that the rising occurrence of cardiomyopathy in young adults with minimal cardiovascular risk factors is primarily associated with which factor(s)? a. Cocaine use b. Viral infections c. Vitamin B1 deficiencies d. Pregnancy Answer: A RATIONALE-Cardiomyopathy induced by cocaine abuse is increasingly common. Cocaine elevates catecholamine levels, potentially causing further myocardial cell damage and leading to ischemic or dilated cardiomyopathy. Managing this cardiomyopathy is challenging, with interventions primarily addressing ensuing heart failure.

Answer: C RATIONALE-Signs and symptoms of pulmonary edema include restlessness, agitation, severe dyspnea, coughing up frothy blood-tinged sputum, and audible wheezing and crackles. Keeping the legs in a dependent position decreases venous return, easing pulmonary edema. In teaching a patient recovering from a myocardial infarction (MI) to avoid the Valsalva maneuver during bowel movements, which method should the nurse suggest? a. Mouth breathing b. Pursing the lips and whistling c. Taking a deep breath and holding it d. Breathing rapidly through the nose Answer: A RATIONALE-Mouth breathing reduces straining severity and minimizes the Valsalva maneuver's impact on intrathoracic pressure. How often does the National Heart, Lung, and Blood Institute recommend a lipid study?

a. 2 years b. 3 years c. 4 years d. 5 years Answer: D

c. "Is your dentist board-certified?" d. "Do you think you should wait that long for your tooth extraction?" Answer: B RATIONALE-Patients with endocarditis require prophylactic antibiotics before invasive procedures. Therefore, it's crucial to contact both the dentist and physician before the extraction.

The home health nurse advises a patient taking warfarin (Coumadin) for thrombophlebitis to avoid taking ginkgo herbal remedy because ginkgo can: a. Cause severe episodes of diarrhea. b. Cause a severe skin eruption if taken with Coumadin. c. Increase the action of Coumadin. d. Decrease the effectiveness of Coumadin. Answer: C RATIONALE-Herbal remedies like ginkgo can potentiate the action of Coumadin, leading to increased anticoagulant effects. What distinguishes primary from 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.

b. CT scan c. Thallium scan d. PET Answer: A RATIONALE-The large magnets in MRI machines can interfere with pacemaker functioning, necessitating caution. What assessment would prompt the nurse to closely examine the leg for evidence of a stasis ulcer? a. Cool dry lower limb b. Edematous, red scaly skin on the medial surface of the leg c. Lack of hair and shiny appearance of the lower leg d. Lack of a pedal pulse Answer: B

RATIONALE-An edematous, dry, scaly area on the lower leg's medial surface with dark pigmentation suggests an impending stasis ulcer. What is the patient goal of the walking exercise program designed for post-MI rehabilitation? a. Walk 2 miles in less than 60 minutes after 12 weeks. b. Jog a mile in less than 30 minutes after 12 weeks.

How should the nurse advise a patient with an international normalized ratio (INR) of 5.8? a. Make arrangements to go to the emergency room immediately b. Increase fluid intake to 2000 mL/day c. Stop taking the anticoagulant and notify the healthcare provider d. Add more leafy green vegetables to the patient's diet

Answer: C RATIONALE-An INR of 5.8 puts the patient at risk of hemorrhage. Therefore, stopping the anticoagulant and seeking further instructions from the physician is essential. When making a teaching plan for a patient with Buerger's disease (thromboangiitis obliterans), the nurse will emphasize the need for: a. Reducing alcohol intake. b. Avoiding cold remedies. c. Cessation of smoking. d. Weight reduction. Answer: C RATIONALE-Smoking cessation

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. 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.

7. The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient says: a. I can ambulate in the hallway with this gadget on. b. I always take off the telemetry device when I shower. c. My EKG is being watched by one of the nurses in CCU on the home unit. d. I am able to sleep just fine with this device on. ANS: B Remote telemetry allows the patient to be on a separate unit, but be monitored in a central location. The patients can be ambulatory and can sleep with the monitor on. They should not remove the monitor to shower.
8. The nurse assesses pitting edema that can be depressed approximately inch and refills in 15 seconds. The nurse would document this assessment as: a. +1 edema. b. +2 edema. c. +3 edema. d. +4 edema. ANS: B A +2 edema can be documented if the skin can be depressed inch and respond within 15 seconds.
9. What do dark or cold spots on a thallium scan indicate? a. Tissue with adequate blood supply b. Dilated vessels c. Areas of neoplastic growth d. Tissue that has inadequate perfusion ANS: D Thallium scans show adequate perfused areas by the collection of thallium. Dark spots or cold spots indicate tissues that have inadequate perfusion.

10. The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of: a. normal heart action. b. mild heart failure. c. moderate heart failure.