CH 37 : 38 STUDY QUESTIONS AND ANSWERS NURS MISC

CH 37 : 38 STUDY QUESTIONS AND ANSWERS NURS MISC 1. Why is it important to monitor a patient’s blood pressure when they are on a vasodilator? (A) An adverse effect of vasodilators is hypertension which can harm the patient (B) Vasodilators can cause decreased fluid volume of circulating blood through increased urine output (C) Vasodilators can cause hypotension, especially when a patient rises from a sitting or lying position (D) Vasodilators cause a decreased heart rate by blocking beta receptors, the nurse should monitor this patient closely ANSWER KEY: C 2. A patient is presenting with 120 BPM and BP of 138/96 when checking her am vitals. She are prescribed a calcium channel blocker, how is this medication supposed to improve the patient’s condition? A. The CCB is blocking the calcium from entering the bones to give the heart extra calcium B. Calcium has nothing to do with heart function and is unnecessary, so it blocks it from entering C. Calcium is used for electrical conduction of the heart so by blocking the calcium channels, it slows the HR and dilates arteries to lower BP D. Prevents accumulation of fluid in the pulmonary circulation and body tissues Answer: C 3. A patient with heart failure is prescribed furosemide (Lasix). This will help the symptoms of pulmonary edema by: A. blocking actions of norepinephrine and epinephrine (adrenaline). B. preventing accumulation of excess fluid around the lungs. C. improving contractility of the heart. D. dilating blood vessels. Answer B; furosemide is a loop diuretic which helps reduce the volume of circulating blood and prevents accumulation of fluid in the pulmonary circulation and body tissues. By lessening this restrictive pressure and friction in the thoracic cavity, the heart has less resistance to pump against. 4. The newly licensed nurse reviews discharge instructions on home management for a patient who has a condition of peripheral artery disease. Which statements from the patient indicates that instructions are effective? SATA. A. “I will use a heating pad to promote circulation.” B. “ I will keep my legs below heart level when I am sitting down.” C. “ I will start walking outside with my neighbor friend.” D. “ I will elevate my legs when I am lying in bed.” E. “ I will take my prescribed antiplatelets medication on time.” Correct Answer: B, C, E Rationales: Heating pads must not be used in patients with PAD because of the potential risk for burns. Keeping the extremities warm by wearing socks and insulated shoes improve blood flow and circulation Lowering the extremities below the heart level when sitting or lying down improves arterial blood flow. Walking is a form of exercise which improves circulation & oxygen delivery to body tissues Elevating the legs promotes venous return and therefore does not promote arterial circulation and can lead to increased pain. Take prescribed medications such as antiplatelets, vasodilators to increase blood flow and prevent the development of blood clot. 5. Which of the following systems is the most likely origin of pain the client describes as knife like chest pain that increases in intensity with inspiration? A: Cardiac B: Pulmonary C: Gastrointestinal D: Musculoskeletal Answer: B Pulmonary. Musculoskeletal pain only increases with movement. Cardiac and GI pains don’t change with respiration. 6. You're caring for a patient recovering from a myocardial infarction. They’ve been prescribed Lisinopril, an ACE inhibitor, in which you explain that this drug type promotes circulation by: [Select all that apply] A. Blocking the flow of calcium into the heart and blood vessels B. Tightening the muscles in the walls of arteries and veins C. Reducing systemic vascular resistance, easing the workload of the heart D. Inhibits the angiotensin-converting enzyme Answer: C,D C. ACE inhibitors are vasodilators that reduce systemic vascular resistance D. Angiotensin-converting enzyme (ACE) catalyzes the conversion of angiotensin I into angiotensin II. Angiotensin II is an active vasoconstrictor that narrows the blood vessels and increases systemic blood pressure. 7. A nurse administered digoxin to a patient with atrial fibrillation. What’s the effective outcome of digoxin? Select all that apply. A. Improve the effectiveness of cardiac output. B. Cure heart failure. C. Dilate the blood vessels. D. Increase the force of myocardial contraction. Answer: A, C & D. 8. Patient is presenting with hypervolemia, what are some signs/symptoms you can expect to find? (Select all that apply) A. hypotension B. distended neck veins C. bounding pulse D. hot, flushed skin E. edema ANSWER: B, C, E 9. You are caring for a 64-year-old male with hypertension, COPD, atrial fibrillation and type II diabetes mellitus. Before you administer his morning dose of metoprolol, the patient asks you, "How will this drug lower my blood pressure?" As the nurse, which of the following responses is most accurate? A. "Metoprolol will lower your blood pressure by removing excess fluid and electrolytes from your body." B. "Metoprolol will block calcium ions from entering the heart cells, which slows heart rate and decreases blood pressure." C. "Metoprolol will inhibit specific hormones that causes the heart to work harder." D. "Metoprolol will dilate the veins to reduce blood pressure." Answer: C Rationale: Metoprolol is a Beta1 selective Beta-Adrenergic Blocker. It will block/"inhibit" adrenergic effects of norepinephrine and epinephrine (hormones) on the heart, reducing the workload and oxygen consumption. (Wilkinson, 2020, p. 1002) Metoprolol will not remove fluid and electrolytes from the body. Calcium channel blockers are drugs that block the flow of calcium into the heart cells. Metoprolol does not dilate veins. 10. Which of the following factors are the baroreceptors responsible for? Select all that apply. A. Regulate ventilation B. Regulate heart rate C. Induce Vasoconstriction D. Maintain Blood Pressure E. Stimulate the parasympathetic nervous system A. False. The chemoreceptors are responsible for ventilation as they detect chemical changes within the body - pH, O2 & CO2. B. True. Baroreceptors regulate the heart rate by stimulating the sympathetic nervous system to increase heart rate and promote vasoconstriction. C. True. Baroreceptors regulate the heart rate by stimulating the sympathetic nervous system to increase heart rate and promote vasoconstriction. D. True. The Baroreceptors detect small changes in blood pressure and stimulate the sympathetic nervous system to increase heart rate and vasoconstriction to maintain blood pressure. E. True. The Baroreceptors stimulate the cardioinhibitory center which controls the parasympathetic nervous system to slow the rate of the heart. They vasomotor center controls the sympathetic nervous system. 11. Why should you manage anxiety in a patient with decreased cardiac output? A. Anxiety activates the SNS and triggers the stress response. B. Blood clots more readily. C. Fluid retention and increase of blood pressure. D. All of the above Answer: D Rationale: All answers “make a cardiac or vascular condition more serious. Therefore, anxiety reduction is a priority intervention (p. 1008)”. 12. A 65-year old female patient arrives at the hospital and is complaining about not sleeping well, fatigue, nausea, and mild intermittent chest pain which occasionally radiates to the back. The nurse would interpret these findings as symptoms of: A). Pancreatic disease B). Normal changes associated with aging C). Signs of anemia D). Cardiac disease Answer: D. Cardiac disease. Women tend to have milder chest pain than men in association with cardiac disease. Other symptoms include nausea, fatigue, jaw or back pains, and shortness of breath (Wilkinson, 2020). Pancreatic disease would cause pain in the abdominal area, Anemia can cause fatigue, but is not associated with nausea or chest pain, theses symptoms are not normal changes in aging. 13. A patient presents in emergency with complaints of pain, at rest and exertion, and says they has “some kind of heart issue with the arteries,” but can’t remember the diagnosis nor the name of the medication taken for the condition. From just this statement, which of the following laboratory values would you most likely recommend in testing this patient for? a) ALT b) WBC c) CRP d) lipid panel e) electrolyte panel Answer: C, D. reasoning: a) ALT - alanine aminotransferase mostly found in liver and kidneys, usually increases with liver damage. (American Association for Clinical Chemistry, 2020) b) WBC - white blood cells, indicating an infection. (Wilkinson et al., 2020) c) CRP - C-reactive protein, increased could indicate arterial inflammation, or a heart attack (American Association for Clinical Chemistry, 2020) d) lipid panel - cholesterol and LDL evaluate cardiovascular risk (Wilkinson et al., 2020) e) electrolyte panel - measures main electrolytes in blood (Na+, K+, Cl-, Bicarbonate), usually testing for fluid balance (American Association for Clinical Chemistry, 2020) 14. A nurse is completing an assessment for a patient who has a history of stable angina. Which of the following findings should the nurse expect? A. Chest pain lasts longer than usual. B. Physical exertion precipitates chest pain. C. Unknown trigger causes angina. D. patient states angina happening more frequently. A - Incorrect - Unstable angina is ischemic chest pain that has worsened in frequency, severity, or duration. pg. 1004 B - Correct - Stable angina is ischemic chest pain that is precipitated by known triggers (e.g activity, large meal, temperature extremes, cigarette smoking, stimulants, sexual activity, strong emotion, circadian rhythm patterns) pg. 1003 C - Incorrect - Stable angina is ischemic chest pain that is precipitated by known triggers (see above) pg. 1003 D - Incorrect - Unstable angina is ischemic chest pain that has worsened in frequency, severity, or duration. pg. 1004 15. A 57 year old male is recovering in the hospital from surgery to repair a deep laceration on his foot. Which interventions will the nurse expect to perform? Select all that apply. A. Administering an anticoagulant medication, such as warfarin B. Help patient to change positions frequently C. Restrict fluid intake. D. Encourage patient to quit smoking. E. Use clean technique for IV therapy Answers: A,B,D A. CORRECT. Patients in hospital setting are at high risk for clot formation, which may lead to DVT and pulmonary embolism, a potentially fatal condition, before signs and symptoms are recognized. Anticoagulant therapy is a priority "safety practice." (Wilkinson, 2020, p.1012) B. CORRECT. Frequent position changes help avoid injury to vessels from prolonged pressure in one area. (Wilkinson, 2020, p. 1012). C. INCORRECT. Adequate hydration is important to keep blood from becoming viscous and more prone to clotting. (Wilkinson, 2020, p.1012). D. CORRECT. Smoking has a constricting effect on vessels and therefore increases risk of clot formation. (Wilkinson, 2020, p. 1012). E. INCORRECT. Strict sterile technique is necessary to prevent infection within blood vessels accessed by the IV. (Wilkinson, 2020, p. 1012). 16. What are the main functions of baroreceptors? Select all that apply A) Causes us to change positions to maintain blood pressure B) Send signal to the brain to accommodate changes in blood pressure C) Regulate heart rate and vascular tone D) Located in the walls of the heart and blood vessels Answer: A, B, C, D? 17. You are a registered nurse checking on one of your patients. You go to the bedside and see the patient is sleeping. What do you know about the heart and the action of its blood vessels at rest? A) the parasympathetic response (rest and digest) causes vasodilation and the patient may become hypotensive. B) Vascular tone maintains blood pressure and blood flow even when a person is resting or asleep. C) The patient needs to be awakened every few hours to ensure adequate blood flow. D) none of the above. Answer: B 18. You are assessing a patient's heart rhythm on a cardiac monitor. Where do you look for on the tracing to identify repolarization of the atria? A) The P wave B) The U wave C) The atria repolarization occurs but it is obscured from being seen due to the timing of the ventricular depolarization occurring at the same time. D) The atria do not repolarize. Correct answer: C 19. Chronic stress may lead to cardiovascular disease because of the repeated release of which of the following? A. Histamine B. Catecholamines C. Cortisol D. Protease Answer: B (The stress response stimulates the release of catecholamines from the sympathetic nervous system which causes increased HR and contractility, vasoconstriction, and increased tendency of blood clotting. Prolonged stimulation of the sympathetic nervous system can lead to cardiovascular disease. Page 1,000 Vol 1.) 20. You're caring for a 60-year old male, who recently experienced a myocardial infarction (MI). He states, "I go walking every day and eat a lot of vegetables. How did this happen to me?" The correct response from the nurse is: A. "It's a very common condition and affects every male once they reach 60." B. "I'm not too sure. Let me have your provider come in to talk with you." C. "As you age, the heart muscle loses strength, heart valves become more thicker and more rigid, and the peripheral vessels become less elastic." D. "The heart becomes more able to respond to decreased oxygen demands, so older adults have a higher exercise tolerance." Answer: C 21. True or False: The electrocardiogram (ECG) reflects what the nerves are telling the heart muscle to do, and what the heart muscle is actually doing in response. Answer: False The ECG illustrates electrical activity but not mechanical activity. This means the ECG does not reflect what the heart muscle is actually doing, but does show what the nerves are telling the heart to do (the impulse). 22. A nurse answers a call light from the phone that is linked to the call light system. The patient states he want's water with ice. Two minutes later the nurse walks into the room to give the patient water when she notices the roommate is pale and his chest is not rising. When the nurse further assesses the patient, she finds his skin is cool and he has no pulse. What is the proper response the nurse should take? (Select all that apply) A. Check code status B. Activate code blue C. Wait for the code team to start CPR D. Start CPR immediately after activating code blue if the patient is a full code E. Administer 30 chest compressions per minute Answer: a, b, d Rationale A. Correct. The nurse needs to know if CPR is an action the patient wants (pg 1013) B. Correct. Activating code blue will send out an alert for help. Acute care facilities have protocols in place in the event a patient goes into cardiac arrest (ex. Flip the code blue switch on the call light system in the room) (pg 1013) C. Incorrect. A code team could take a few minutes to arrive and every minute it takes to start CPR is time the patient does not have. D. Correct. There is a 4-6-minute window before the patient suffers from a lack of oxygen and brain damage.(pg 1012) E. Incorrect. Administer 30 compressions to 2 breaths (continue chest compressions after the 2 breaths) which is about 100 chest compressions every minute (pg 1013) 23. True or false? If both the SA node and the AV node fail, conduction fibers in the myocardium can initiate impulses, generating at a rate of 100 beats/min. Answer: False Rationale: While the conduction fibers in the myocardium can initiate impulses, they do so at a very slow rate of less than 40 beats/min. Vol 1 Pg 997 24. From your studies of the vascular system, you understand that each vessel plays a role in circulation. What are the characteristics of the capillary vessels within the body? (select all that apply) A. Are microscopic vessels, which branch out from arteries and become smaller and smaller. B. Play a role in returning oxygenated blood to the heart. C. Considered the holding tank for fluctuations in blood volume. D. Facilitate the exchange of gases, nutrients, and wastes between tissue cells and blood. Answer: A and F Correct: "Capillaries are microscopic vessels, created as arterioles branch into smaller and smaller vessels." (Fundamentals, Pg. 997) False: "Oxygenated blood flows from the lungs into left side of the heart and out into arterial circulation." (Fundamentals, Pg. 996) False: The venous system is considered the "holding tank for fluctuations in blood volume." (Fundamentals, Pg 997) True: "Because they are only 1 cell thick, capillaries facilitate the exchange of gases, nutrients, and wastes between the tissue cells and blood." (Fundamentals, Pg 997) 25. Arterial abnormalities affect the flow of oxygenated blood to tissues. What are the signs and symptoms of arterial abnormalities? Select all that apply. A. Edema B. poor capillary refill C. skin discoloration D. weak pulses 26. What is the function of chemoreceptors in regards to circulation and profusion? Check all that apply. A) detect changes in blood pH, oxygen levels, and carbon dioxide levels B) regulate ventilation C) activating sympathetic stimulation D) communicating with the cardioinhibitory center in the brain Correct answer: A,B Rationale: "Chemoreceptors located in the aortic arch and the carotid arteries are sensitive to change blood pH, oxygen levels, and carbon dioxide levels. Their main function is to regulate ventilation, but they also send information to the vasomotor center in response to lack of oxygen. The vasomotor center responds by activating sympathetic stimulation. " (Wilkinson, p 999) Chemoreceptors themselves do not cause sympathetic stimulation, they instead communicate with the vasomotor center in the brain and the vasomotor center causes the sympathetic stimulation. As stated previously, the chemoreceptors do not communicate with the cardioinhibitory center but with the vasomotor center so C and D are incorrect. 27. Atherosclerosis impedes coronary blood flow by and is commonly caused by . A. Plaque build-up in veins; obesity B. Blood clots; smoking C. Plaque buildups in the arteries; a poor fatty diet D. Embolism; pregnancy Correct Answer: C Rationale: (p.1001) Atherosclerosis is a coronary artery disease caused by fatty buildups in the arteries. A diet high in saturated fat is a risk factor 28. Medications classified as Positive Inotropic Agents promote circulation by which of the following actions (select all that apply): A. Dilation of the blood vessels B. Blocking norepinephrine and epinephrine C. Reducing the volume of circulating blood D. Slowing conduction through the AV node E. Automaticity ANSWER: A & E Automaticity and dilation of the blood vessels