MSN 377 2023 EXAM VERSION EXPERT QUESTION AND ANSWERS PLUS VERIFIED RATIONALES UPDATED 2023/2024

MSN 377 2023 EXAM VERSION EXPERT QUESTION AND ANSWERS PLUS VERIFIED RATIONALES UPDATED 2023/2024 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. ANS: D Pulse deficit is a difference between simultaneously obtained apical and radial pulses and indicates that there may be a cardiac dysr hythmia 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. 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 coronar y artery disease. c. auscultate both the carotid arteries for the presence of a bruit. d. assess the patient for symptoms of left ventricular hypertrophy. ANS: D The PMI should be felt at the intersection of the 5th intercostal space and the left midcla vicular 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 gal lops 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. ANS: A Gallop rhythms generate low -pitched sounds and are most easily heard with the bell of the steth oscope. 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 de termine 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) 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 aneur ysms. d. Document the finding in the patient chart. 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 ther e 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 in forms 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. mon itored anesthesia care will be provided during the procedure. 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 duri ng cardiac catheterization and may be asked to cough or take deep breaths. While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the n urse take next? a. Use a ruler to measure the level of the JVD. b. Document this finding in the patients record. c. Observe for JVD with the head at 30 degrees. d. Have the patient perform the Valsalva maneuver. ANS: C When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not clinically significant) finding. JVD that persists when the patient is sitting at a 30- to 45 -degree angle or greater is significant. The nurse may use a ruler to determine the level of JVD above the heart if the JVD persists when the patient is at a 30 - to 45 -degree angle or more. JVD is an expected finding when a patient performs the Valsalva maneuver because right atrial pressure increases. The nurse will document the JVD in the record if it persists when the head is elevated. The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to a. exercise more than usual while the monitor is in place. b. remove the electrodes when taking a show er or tub bath. c. keep a diary of daily activities while the monitor is worn. d. connect the recorder to a telephone transmitter once daily. ANS: C The patient is instructed to keep a diary describing daily activities while Holter monitoring is being a ccomplished to help correlate any rhythm disturbances with patient activities. Patients are taught that they should not take a shower or bath during Holter monitoring and that they should continue with their usual daily activities. The recorder stores the information about the patients rhythm until the end of the testing, when it is removed and the data are analyzed. When auscultating over the patients abdominal aorta, the nurse hears a humming sound. The nurse documents this finding as a