Latest questions and Answers for Nur 107 Chapters 21-27 Cardiovascular/ Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition 2023

A client with a history of right-sided heart failure lives in a long-term care facility. In the daily assessment, the nurse is required to record the level of this client's peripheral edema. Which would be the main area for examination? - Correct Answer-Correct response: feet and ankles Explanation: Edema occurs when blood is not pumped efficiently or plasma protein levels are inadequate to maintain osmotic pressure. When blood has nowhere else to go, the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. The area over, not below, the sacrum is another area prone to edema. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 21: Assessment of Cardiovascular Function, Assessment of the Skin and Extremities, p. 664. Chapter 21: Assessment of Cardiovascular Function - Page 664 It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur: - Correct Answer-Correct response: Right ventricular pressure must be higher than pulmonary arterial pressure. Explanation: For the right ventricle to pump blood in need of oxygenation into the lungs via the pulmonary artery, right ventricular pressure must be higher than pulmonary arterial pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 21: Assessment of Cardiovascular Function, Cardiac Hemodynamics, p. 655. Chapter 21: Assessment of Cardiovascular Function - Page 655 For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which data is necessary to collect if the client is experiencing chest pain? - Correct Answer-description of the pain Explanation: If the client is experiencing chest pain, a history of its location, frequency, and duration is necessary. A description of the pain is also needed, including if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the client and measures vital signs. The nurse may measure blood pressure in both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 21: Assessment of Cardiovascular Function, Assessment of the Cardiovascular System, Health History, p. 658. Chapter 21: Assessment of Cardiovascular Function - Page 658 The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? - Correct Answer-Count the heart rate at the apex. Explanation: The nurse determines the pulse deficit by counting the heart rate through auscultation at the apex while a second nurse simultaneously palpates and counts the radial pulse for a full minute. The difference, if any, is the pulse deficit. The pulse quality refers to its palpated volume. Pulse rhythm is the pattern of the pulsations and the pauses between them. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 21: Assessment of Cardiovascular Function, Pulse Rhythm, p. 666. Chapter 21: Assessment of Cardiovascular Function - Page 666 Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue? - Correct Answer-The inner layer, the endocardium, is composed of a thin, smooth layer of endothelial cells. Folds of endocardium form the heart valves. The middle layer, the myocardium, consists of muscle tissue and is the force behind the heart's pumping action. The pericardium is a saclike structure that surrounds and supports the heart. The outer layer, the epicardium, is composed of fibrous and loose connective tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 21: Assessment of Cardiovascular Function, Anatomy of the Heart, p. 651. Chapter 21: Assessment of Cardiovascular Function - Page 651 The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document? - Correct Answer-ventricular tachycardia Explanation: The dysrhythmia shown is ventricular tachycardia because it has more than 3 premature ventricular contractions. The ventricular rate is 100 to 200 bpm; the atrial rate depends on the underlying rhythm (e.g., sinus rhythm). The QRS duration is 0.12 seconds or more and has an abnormal shape. . Ventricular asystole is characterized by absent QRS complexes; this rhythm is referred to as flatline. Normal sinus rhythm is regular with with a ventricular and atrial rate of 60 to 100 bpm. The P-wave has a consistent shape and is always in front of the QRS. The PR interval is a consistent interval between 0.12 and 0.20 seconds, and the P:QRS ratio is 1:1. A junctional rhythm not caused by a complete heart block has a ventricular rate of 40 to 60 bpm and, if P waves are discernible, an atrial rate of 40 to 60 bpm. The ventricular and atrial rhythm are regular. If the P-wave is in front of the QRS, the PR interval is less than 0.12 seconds. The P:QRS ratio is 1:1 or 0:1. Atrial fibrillation is indicated by an atrial rate of 300 to 600 bpm; the ventricular rate is usually 120 to 200 bpm if untreated. Both the ventricular and atrial rhythm are highly irregular. P-waves will not be discernible; irregular undulating waves that vary in amplitude and shape are referred to as fibrillatory or f waves. The PR interval cannot be measured, and the P:QRS ratio is Many:1. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 22: Management of Patients with Arrhythmias and Conduction Problems, Types of Arrhythmias, p. 707. The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? - Correct Answer-Explanation: Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes. The rhythms look different on the electrocardiogram strip. The QRS is wide and bizarre or undefined in ventricular fibrillation. The P-R interval is not present in the ventricular dysrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 22: Management of Patients with Arrhythmias and Conduction Problems, Types of Arrhythmias, pp. 706-707. Chapter 22: Management of Patients with Arrhythmias and Conduction Problems - Page 706-707 The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? - Correct Answer-Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 22: Management of Patients with Arrhythmias and Conduction Problems, Types of Arrhythmias, p. 708. Chapter 22: Management of Patients with Arrhythmias and Conduction Problems - Page 708 A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia? - Correct Answer-heart rate of 118 bpm Explanation: The sinus node creates an impulse at a faster-than-normal rate. The PR interval of 0.1 seconds, QRS duration of 0.16 seconds and Q wave of 0.04 seconds are consistent with a normal sinus rhythm. Sinus tachycardia occurs when the heart rate is over 100 bpm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 22: Management of Patients with Arrhythmias and Conduction Problems, Types of Arrhythmias, p. 696. Chapter 22: Management of Patients with Arrhythmias and Conduction Problems - Page 696 A client asks the nurse about complications associated with use of a cardiac pacemaker. What does the nurse include in their response? Select all that apply. - Correct Answer-Twiddler syndrome Hiccupping Localized infection Explanation: Complications associated with pacemakers include infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability. A positive Kernig's sign is an indication of meningitis. A positive Babinski reflex is normal in neonates, but indicates a central nervous system disorder in adults. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 22: Management of Patients with Arrhythmias and Conduction Problems, Pacemaker Therapy, p. 718. The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain? - Correct Answer-a lack of oxygen in the heart muscle cells Explanation: Angina pectoris refers to chest pain that is brought about by myocardial ischemia. It is the result of cardiac muscle cells being deprived of oxygen due to the progressive symptoms of coronary artery disease. Artery blockage or closure leads to myocardial death. The destroyed part of the heart (death of heart tissue) is a myocardial infarction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders, Angina Pectoris, p. 732. A client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina? - Correct Answer-Stable Explanation: Angina is usually caused by atherosclerotic disease and most often is associated with a significant obstruction of at least one major coronary artery. Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet its continuous demands. When demand increases, flow through the coronary arteries needs to be increased. When there is a blockage in a coronary artery, flow cannot be increased and ischemia results. There are different types of angina. Stable angina is predictable and consistent pain that occurs on exertion and is relieved by rest or nitroglycerin. This is the type of angina the client is describing. Variant angina is pain at rest with reversible ST-segment elevation and is thought to be caused by a spasm of a coronary artery. In unstable angina, the symptoms increase in frequency and severity and may not be relieved with rest or nitroglycerin. Intractable angina pectoris causes severe incapacitating chest pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders, Angina Pectoris, p. 733. The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? - Correct Answer-potassium level of 6 mEq/L Explanation: Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain is not significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders, Surgical Procedures: Coronary Artery Revascularization, p. 759. When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? - Correct Answer-"The pain occurred while I was mowing the lawn." Explanation: Decreased oxygen supply to the myocardium causes angina pectoris. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate this chest pain. Anginal pain typically is self-limiting, lasting 5 to 15 minutes. Food consumption doesn't reduce angina pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders, angina pectoris, p. 732. The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? - Correct Answer-Avoid situations that contribute to ischemic episodes. Explanation: Teaching for clients with Raynaud syndrome and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders. After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? - Correct Answer-Apply manual pressure at the site of the insertion of the sheath. Explanation: The immediate nursing action would be to apply pressure to the femoral site. Reviewing blood studies will not stop the bleeding. The nurse cannot decrease anticoagulation therapy independently. If the bleeding does not stop, the health care provider needs to be notified. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders, Percutaneous Coronary Interventions, p. 747. When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? - Correct Answer-Unstable Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular Disorders, Angina Pectoris, p. 733. When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? - Correct Answer-Inadequate fluid volume Explanation: Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific g