TEST BANK CLINICAL REASONING CASES IN NURSING, 7TH EDITION BY HARDING| SNYDER

The nurse is explaining to a student nurse about impaired central perfusion. The nurse knows the student understands this problem when the student states, Central perfusion a. Is monitored only by the physician. b. Involves the entire body. c. Is decreased with hypertension. d. Is toxic to the cardiac system. ANS: B Central perfusion does involve the entire body as all organs are supplied with oxygen and vital Nutrients. The physician does not control the bodys ability for perfusion. Central perfusion is not decreased with hypertension. Central perfusion is not toxic to the cardiac system. 2. A patient was diagnosed with hypertension. The patient asks the nurse how this disease could have happened to them. The nurses best response is Hypertension a. Happens to everyone sooner or later. Dont be concerned about it. b. Can happen from eating a poor diet, so change what you are eating. c. Can happen from arterial changes that impede the blood flow. d. Happens when people do not exercise, so you should walk every day. ANS: C Hardening of the arteries from atherosclerosis can cause hypertension in the patient. Hypertension does not happen to everyone. Changing the patients diet and exercising may be a positive life change, but these answers do not explain to the patient how the disease could have happened. 3. The patient asks the nurse to explain the sinoatrial node in the heart. The nurses best response would be, The sinoatrial node a. Provides the heart with the stimulation to beat in a normal rhythm. b. Protects the heart from atherosclerotic changes. c. Provides the heart with oxygenated blood. d. Protects the heart from infection. ANS: A The sinoatrial node is the natural pacemaker of the heart, and it assists the heart to beat in a Normal rhythm. The sinoatrial node does not protect from atherosclerotic changes or infection, and it does not directly provide the heart with oxygenated blood. 4. The patient is brought to the emergency department after a motor vehicle accident. The patient is diagnosed with internal bleeding. The nurses primary concern is to monitor for a. Mental alertness. b. Perfusion. c. Pain. d. Reaction to medications. ANS: B Perfusion is the correct answer, because with internal bleeding, the nurse should monitor vital Signs to be sure perfusion is happening. Mental alertness, pain, and medication reactions are important but not the primary concern. 5. A patients serum electrolytes are being monitored. The nurse notices that the potassium level is low. The nurse knows that the patient should be observed for a. Tissue ischemia. b. Brain malformations. c. Intestinal blockage. d. Cardiac dysthymia. ANS: D Cardiac dysthymia is a possibility when serum potassium is high or low. Tissue ischemia, brain Malformations, or intestinal blockage do not have a direct correlation to potassium irregularities. 6. A nurse is explaining to a student nurse about perfusion. The nurse knows the student understands the concept of perfusion when the student states, Perfusion