Exam 4- MSN 377 Ch 31-36 QUESTIONS WITH COMPLETE SOLUTIONS

CH 31: A 74-yr-old patient has just arrived in the emergency department. After assessment reveals a pulse deficit of 46 beats, the nurse will anticipate that the patient may require A. emergent cardioversion. B. a cardiac catheterization. C. hourly blood pressure (BP) checks. D. electrocardiographic (ECG) monitoring. correct answer: D. electrocardiographic (ECG) monitoring. Explanation/Rationale:Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are used for diagnosis and/or treatment of cardiovascular disorders but would not be as helpful in determining the immediate reason for the pulse deficit. CH 31: The nurse is reviewing the 12-lead electrocardiograph (ECG) for a healthy 74-yr-old patient who is having an annual physical examination. What finding is of most concern to the nurse? A. A right bundle-branch block. B. The PR interval is 0.21 seconds. C. The QRS duration is 0.13 seconds. D. The heart rate (HR) is 41 beats/min. correct answer: D. The heart rate (HR) is 41 beats/min. Explanation/Rationale:The resting HR does not change with aging, so the decrease in HR requires further investigation. Bundle-branch block and slight increases in PR interval or QRS duration are common in older individuals because of increases in conduction time through the AV node, bundle of His, and bundle branches. CH 31: During a physical examination of an older patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The best follow-up action for the nurse to take will be to A. ask about risk factors for atherosclerosis. B. determine family history of heart disease. C. assess for symptoms of left ventricular hypertrophy. D. auscultate carotid arteries for the presence of a bruit. correct answer: C. assess for symptoms of left ventricular hypertrophy. Explanation/Rationale:The PMI should be felt at the intersection of the fifth intercostal space and left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy (LVH). The other assessments are part of a general cardiac assessment but do not represent follow-up for LVH. Cardiac enlargement is not necessarily associated with atherosclerosis or carotid artery disease. CH 31: To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the A. diaphragm of the stethoscope with the patient lying flat. B. bell of the stethoscope with the patient in the left lateral position. C. diaphragm of the stethoscope with the patient in a supine position. D.bell of the stethoscope with the patient sitting and leaning forward correct answer: B. bell of the stethoscope with the patient in the left lateral position.