Chapter 19: Care of Patients with Cardiac Disorders deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. The nurse is caring for a patient with suspected right-sided heart failure. Which manifestation best supports this potential diagnosis? a. Wheezing b. Orthopnea c. Edema d. Pallor ANS: C Right-sided heart failure leads to edema from systemic backup. Wheezing, orthopnea, and pallor are indicative of left-sided failure. PTS:1 DIF: Cognitive Level: Comprehension REF: 426, Table 19-2 OBJ:1 (theory) TOP: Heart Failure: Right Side KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. The nurse is caring for a patient with a history of left-sided congestive heart failure (CHF). Which finding leads the nurse to suspect that the patient could be experiencing an acute exacerbation of this condition? a. The abdomen is tight and shiny. b. Wheezes are present during lung auscultation. c. The pupils react sluggishly to light. d. The heart rate is irregularly irregular. ANS: B Left-sided heart failure causes increased pressure on the lungs and may manifest in wheezing. A tight and shiny abdomen is consistent with ascites, a manifestation of right-sided CHF. Sluggish pupillary reaction is consistent with a neurologic problem, and an irregularly irregular heart rate is consistent with a cardiac arrhythmia like atrial fibrillation. PTS:1 DIF: Cognitive Level: Application REF: 426, Table 19-2 OBJ:1 (theory) TOP: CHF: Signs KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The statement indicates that the nurse’s teaching about the purpose of an implanted cardioverter-defibrillator (ICD) has been successful? a. “The ICD will detect bad rhythms and shock my heart into normal rhythm.” b. “I should avoid handheld security devices at the airport.” c. “I should ask my doctor how often I should have my ICD checked.” d. “I should avoid working on the alternator of my boat.” ANS: A All statements are accurate, but the question asks about the purpose of the ICD. ICDs are devices indicated for patients with repeated episodes of life-threatening dysrhythmias and for some patients with cardiomyopathy. This device monitors the heartbeat and provides an electrical shock similar to that delivered in cardiac defibrillation or cardioversion when a life-threatening rhythm is detected. Most ICDs have the ability to pace as well as defibrillate. The patient is warnedto avoid exposure to strong magnetic fields such as: microwave towers, transformers and electrical transmitters, electrical generators, handheld security devices at airports, and arc welding equipment. The patient should not lean over the alternator of a running car or boat motor. A magnetic field will temporarily inactivate the device. Moving away from the magnetic source will restore normal function. PTS:1 DIF: Cognitive Level: Analysis REF: 441 OBJ:2 (clinical) TOP: ICD KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 4. The nurse is caring for a patient with severe congestive heart failure (CHF) who denies pain and is fearful of taking prescribed morphine. Which explanation best works to alleviate the patient’s anxiety about risk of addiction? a. “Many people with CHF use morphine for pain control.” b. “We can treat your pain with aspirin or ibuprofen.” c. “Morphine has properties that help relieve air hunger in CHF patients.” d. “You can refuse to take it.”