NSG 4100 MedSurg III: Exam 3Unit 6:
Complex Perfusion Problems II latest
update with complete solutions
1.
A client with suspected cardiac tamponade develops hypotension, muffled heart sounds, and
jugular venous distention. Which intervention should the nurse anticipate?
A. Administration of a loop diuretic
B. Emergency pericardiocentesis
C. Administration of oral anticoagulants
D. Placement in a prone position
Correct Answer: B. Emergency pericardiocentesis
Rationale: Cardiac tamponade occurs when fluid accumulates in the pericardial space and
compresses the heart, impairing ventricular filling and cardiac output. Pericardiocentesis
removes the pressure-producing fluid and can be lifesaving.
2.
Which assessment finding is most characteristic of cardiac tamponade?
A. Bradycardia, hypertension, and bounding pulses
B. Hypotension, muffled heart sounds, and jugular venous distention
C. Hypertension, crackles, and peripheral edema
D. Fever, tachycardia, and productive cough
Correct Answer: B. Hypotension, muffled heart sounds, and jugular venous distention
Rationale: The classic findings are associated with Beck's triad: hypotension, muffled or
distant heart sounds, and jugular venous distention.
3.
,A client with a large pericardial effusion suddenly becomes hypotensive and dyspneic. Which
finding should concern the nurse most?
A. Heart rate of 82/min
B. New jugular venous distention
C. Mild fatigue
D. Temperature of 37.1°C (98.8°F)
Correct Answer: B. New jugular venous distention
Rationale: Acute jugular venous distention with hypotension and respiratory distress suggests
impaired right-sided cardiac filling and possible progression to tamponade.
4.
Which mechanism primarily causes decreased cardiac output in cardiac tamponade?
A. Increased ventricular filling
B. Reduced ventricular filling during diastole
C. Increased coronary perfusion
D. Increased systemic venous return
Correct Answer: B. Reduced ventricular filling during diastole
Rationale: Pericardial pressure compresses the cardiac chambers, particularly during diastole,
preventing adequate ventricular filling and reducing stroke volume and cardiac output.
5.
A nurse is caring for a client following pericardiocentesis. Which finding requires immediate
intervention?
A. Improved blood pressure
B. Reduced jugular venous distention
C. Sudden recurrence of hypotension
D. Improved respiratory rate
Correct Answer: C. Sudden recurrence of hypotension
Rationale: Recurrent hypotension after pericardiocentesis may indicate reaccumulation of
pericardial fluid, bleeding, or another complication and requires immediate evaluation.
,6.
A client with dilated cardiomyopathy is admitted with worsening heart failure. Which
assessment finding would the nurse expect?
A. Increased ventricular pumping ability
B. Ventricular dilation with reduced contractility
C. Decreased ventricular chamber size
D. Increased cardiac output without congestion
Correct Answer: B. Ventricular dilation with reduced contractility
Rationale: Dilated cardiomyopathy involves enlargement of the cardiac chambers, particularly
the ventricles, with impaired myocardial contractility and reduced pumping efficiency.
7.
Which condition is particularly associated with hypertrophic cardiomyopathy?
A. Excessive ventricular wall thickening
B. Severe ventricular dilation
C. Destruction of the pericardium
D. Decreased myocardial thickness
Correct Answer: A. Excessive ventricular wall thickening
Rationale: Hypertrophic cardiomyopathy involves abnormal thickening of the myocardium,
commonly affecting the interventricular septum. This can impair ventricular filling and, in some
cases, obstruct ventricular outflow.
8.
A client with hypertrophic cardiomyopathy asks why strenuous exercise may be discouraged.
Which response is best?
A. “Exercise permanently decreases your blood volume.”
B. “Strenuous activity can increase the risk of dangerous dysrhythmias and worsen outflow
obstruction.”
C. “Exercise causes your heart valves to close permanently.”
D. “Exercise prevents ventricular filling.”
, Correct Answer: B. “Strenuous activity can increase the risk of dangerous dysrhythmias
and worsen outflow obstruction.”
Rationale: Hypertrophic cardiomyopathy can predispose clients to dysrhythmias and sudden
cardiac deterioration, particularly with intense exertion.
9.
A client with restrictive cardiomyopathy has severe fatigue and peripheral edema. Which
pathophysiologic process contributes most directly to these findings?
A. Excessive ventricular compliance
B. Impaired ventricular filling
C. Increased pulmonary ventilation
D. Increased red blood cell production
Correct Answer: B. Impaired ventricular filling
Rationale: Restrictive cardiomyopathy causes stiff ventricular walls that cannot relax
adequately, limiting diastolic filling and ultimately reducing cardiac output.
10.
Which client with cardiomyopathy should the nurse assess first?
A. Client reporting mild fatigue after walking
B. Client with stable ankle edema
C. Client with new syncope and palpitations
D. Client requesting dietary teaching
Correct Answer: C. Client with new syncope and palpitations
Rationale: Syncope with palpitations can indicate a serious dysrhythmia and possible sudden
cardiac instability.
11.
A client with an aortic aneurysm reports sudden severe abdominal and back pain. What is the
nurse's priority action?
Complex Perfusion Problems II latest
update with complete solutions
1.
A client with suspected cardiac tamponade develops hypotension, muffled heart sounds, and
jugular venous distention. Which intervention should the nurse anticipate?
A. Administration of a loop diuretic
B. Emergency pericardiocentesis
C. Administration of oral anticoagulants
D. Placement in a prone position
Correct Answer: B. Emergency pericardiocentesis
Rationale: Cardiac tamponade occurs when fluid accumulates in the pericardial space and
compresses the heart, impairing ventricular filling and cardiac output. Pericardiocentesis
removes the pressure-producing fluid and can be lifesaving.
2.
Which assessment finding is most characteristic of cardiac tamponade?
A. Bradycardia, hypertension, and bounding pulses
B. Hypotension, muffled heart sounds, and jugular venous distention
C. Hypertension, crackles, and peripheral edema
D. Fever, tachycardia, and productive cough
Correct Answer: B. Hypotension, muffled heart sounds, and jugular venous distention
Rationale: The classic findings are associated with Beck's triad: hypotension, muffled or
distant heart sounds, and jugular venous distention.
3.
,A client with a large pericardial effusion suddenly becomes hypotensive and dyspneic. Which
finding should concern the nurse most?
A. Heart rate of 82/min
B. New jugular venous distention
C. Mild fatigue
D. Temperature of 37.1°C (98.8°F)
Correct Answer: B. New jugular venous distention
Rationale: Acute jugular venous distention with hypotension and respiratory distress suggests
impaired right-sided cardiac filling and possible progression to tamponade.
4.
Which mechanism primarily causes decreased cardiac output in cardiac tamponade?
A. Increased ventricular filling
B. Reduced ventricular filling during diastole
C. Increased coronary perfusion
D. Increased systemic venous return
Correct Answer: B. Reduced ventricular filling during diastole
Rationale: Pericardial pressure compresses the cardiac chambers, particularly during diastole,
preventing adequate ventricular filling and reducing stroke volume and cardiac output.
5.
A nurse is caring for a client following pericardiocentesis. Which finding requires immediate
intervention?
A. Improved blood pressure
B. Reduced jugular venous distention
C. Sudden recurrence of hypotension
D. Improved respiratory rate
Correct Answer: C. Sudden recurrence of hypotension
Rationale: Recurrent hypotension after pericardiocentesis may indicate reaccumulation of
pericardial fluid, bleeding, or another complication and requires immediate evaluation.
,6.
A client with dilated cardiomyopathy is admitted with worsening heart failure. Which
assessment finding would the nurse expect?
A. Increased ventricular pumping ability
B. Ventricular dilation with reduced contractility
C. Decreased ventricular chamber size
D. Increased cardiac output without congestion
Correct Answer: B. Ventricular dilation with reduced contractility
Rationale: Dilated cardiomyopathy involves enlargement of the cardiac chambers, particularly
the ventricles, with impaired myocardial contractility and reduced pumping efficiency.
7.
Which condition is particularly associated with hypertrophic cardiomyopathy?
A. Excessive ventricular wall thickening
B. Severe ventricular dilation
C. Destruction of the pericardium
D. Decreased myocardial thickness
Correct Answer: A. Excessive ventricular wall thickening
Rationale: Hypertrophic cardiomyopathy involves abnormal thickening of the myocardium,
commonly affecting the interventricular septum. This can impair ventricular filling and, in some
cases, obstruct ventricular outflow.
8.
A client with hypertrophic cardiomyopathy asks why strenuous exercise may be discouraged.
Which response is best?
A. “Exercise permanently decreases your blood volume.”
B. “Strenuous activity can increase the risk of dangerous dysrhythmias and worsen outflow
obstruction.”
C. “Exercise causes your heart valves to close permanently.”
D. “Exercise prevents ventricular filling.”
, Correct Answer: B. “Strenuous activity can increase the risk of dangerous dysrhythmias
and worsen outflow obstruction.”
Rationale: Hypertrophic cardiomyopathy can predispose clients to dysrhythmias and sudden
cardiac deterioration, particularly with intense exertion.
9.
A client with restrictive cardiomyopathy has severe fatigue and peripheral edema. Which
pathophysiologic process contributes most directly to these findings?
A. Excessive ventricular compliance
B. Impaired ventricular filling
C. Increased pulmonary ventilation
D. Increased red blood cell production
Correct Answer: B. Impaired ventricular filling
Rationale: Restrictive cardiomyopathy causes stiff ventricular walls that cannot relax
adequately, limiting diastolic filling and ultimately reducing cardiac output.
10.
Which client with cardiomyopathy should the nurse assess first?
A. Client reporting mild fatigue after walking
B. Client with stable ankle edema
C. Client with new syncope and palpitations
D. Client requesting dietary teaching
Correct Answer: C. Client with new syncope and palpitations
Rationale: Syncope with palpitations can indicate a serious dysrhythmia and possible sudden
cardiac instability.
11.
A client with an aortic aneurysm reports sudden severe abdominal and back pain. What is the
nurse's priority action?
