MSN 377 - Exam 1 Practice Questions and correct answers 2023/2024

MSN 377 - Exam 1 Practice Questions Chapter 32: Cardiovascular System - ANSWER After noting a pulse deficit when assessing a patient who has just arrived in the emergency department, the nurse will anticipate that the patient may require a. a 2-D echocardiogram. b. a cardiac catheterization. c. hourly blood pressure (BP) checks. d. electrocardiographic (ECG) monitoring. - ANSWER ANS: D Pulse deficit is a difference between simultaneously obtained apical and radial pulses and indicates that there may be a cardiac dysrhythmia that would be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and echocardiograms are used for diagnosis of other cardiovascular disorders but would not be as helpful in determining the immediate reason for the pulse deficit. When reviewing the 12-lead electrocardiograph (ECG) for a healthy 86-year-old patient who is having an annual physical examination, which of the following will be of most concern to the nurse? a. The heart rate (HR) is 43 beats/minute. b. The PR interval is 0.21 seconds. c. There is a right bundle-branch block. d. The QRS duration is 0.13 seconds. - ANSWER ANS: A 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, the bundle of His, and the bundle branches. During a physical examination of a patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appropriate action for the nurse to take next will be to a. document that the PMI is in the normal anatomic location. b. ask the patient about risk factors for coronary artery disease. c. auscultate both the carotid arteries for the presence of a bruit. d. assess the patient for symptoms of left ventricular hypertrophy. - ANSWER ANS: D The PMI should be felt at the intersection of the 5th intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with coronary or carotid artery disease. To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the a. bell of the stethoscope with the patient in the left lateral position. b. bell of the stethoscope with the patient sitting and leaning forward. c. diaphragm of the stethoscope with the patient in a reclining position. d. diaphragm of the stethoscope with the patient lying flat on the left side. - ANSWER ANS: A Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher-pitched sounds such as S1 and S2. To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review? a. Myoglobin b. Homocysteine (Hcy) c. Low-density lipoprotein (LDL) d. B-type natriuretic peptide (BNP) - ANSWER ANS: D Increased levels of BNP are a marker for heart failure. The other laboratory results would be used to assess for myocardial infarction (myoglobin) or risk for coronary artery disease (Hcy and LDL). While doing the admission assessment for a thin 72-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take? a. Notify the hospital rapid response team. b. Instruct the patient to remain on bed rest. c. Teach the patient about aortic aneurysms. d. Document the finding in the patient chart. - ANSWER ANS: D Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals and the nurse should simply document the finding in the admission assessment. Unless there are other abnormal findings (such as a bruit, pain, or hyper/hypotension) associated with the pulsation, the other actions are not necessary. 7. A patient is scheduled for a cardiac catheterization with coronary angiography. Before the test, the nurse informs the patient that a. electrocardiographic (ECG) monitoring will be required for 24 hours after the test. b. it will be important to lie completely still during the procedure. c. a warm feeling may be noted when the contrast dye is injected. d. monitored anesthesia care will be provided during the procedure. - ANSWER ANS: C A sensation of warmth or flushing is common when the iodine-based contrast material is injected, which can be anxiety-producing unless it has been discussed with the patient. The patient may receive a sedative drug before the procedure, but monitored anesthesia care is not used. ECG monitoring is used during the procedure to detect dysrhythmias, but there is not a risk for dysrhythmias after the procedure. The patient is not immobile during cardiac catheterization and may be asked to cough or take deep breaths