Chapter 31: Assessment of Cardiovascular System Lewis: Medical- Surgical Nursing Exam Practice Questions and Answers

Chapter 31: Assessment of Cardiovascular System Lewis: Medical- Surgical Nursing Exam Practice Questions and Answers A 74-yr-old patient has just arrived in the emergency department. After assessment reveals a pulse deficit of 46 beats, the nurse will anticipate that the patient may require a. emergent cardioversion. b. a cardiac catheterization. c. hourly blood pressure (BP) checks. d. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/26 electrocardiographic (ECG) monitoring. - Ans:-d Pulse deficit _________________________ - Ans:-is a difference between simultaneously obtained apical and radial pulses. It indicates that there may be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are used for _____________________ - Ans:-diagnosis and/or treatment of cardiovascular disorders but would not be as helpful in determining the immediate reason for the pulse deficit. The nurse is reviewing the 12-lead electrocardiograph (ECG) for a healthy 74-yr-old patient who is having an annual physical examination. What finding is of most concern to the nurse? a. A right bundle-branch block. c. The QRS duration is 0.13 seconds. b. The PR interval is 0.21 seconds. d. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/26 The heart rate (HR) is 41 beats/min. - Ans:-ANS: D The resting HR does not change with ____________________, so the decrease in HR requires further investigation. - Ans:-aging, Bundle-branch block and slight increases in PR interval or QRS duration are common in older individuals because of ________________ - Ans:-increases in conduction time through the AV node, bundle of His, and bundle branches. During a physical examination of an older patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The best follow-up action for the nurse to take will be to a. ask about risk factors for atherosclerosis. b. determine family history of heart disease. c. assess for symptoms of left ventricular hypertrophy. d. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/26 auscultate carotid arteries for the presence of a bruit. - Ans:-ANS: C The PMI should be felt at the_____________________. - Ans:-intersection of the fifth intercostal space and left midclavicular line A PMI located outside these landmarks indicates possible cardiac enlargement, such as with____________________. The other assessments are part of a general cardiac assessment but do not represent follow-up for LVH. - Ans:-left ventricular hypertrophy (LVH Cardiac enlargement__________ - Ans:-is not necessarily associated with atherosclerosis or carotid artery disease. To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the a. diaphragm of the stethoscope with the patient lying flat. b. bell of the stethoscope with the patient in the left lateral position. c. diaphragm of the stethoscope with the patient in a supine position. d. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/26 bell of the stethoscope with the patient sitting and leaning forward. - Ans:-ANS: B Gallop rhythms generate _________________sounds and are most easily heard with the ____________________of the stethoscope. - Ans:-low-pitched bell Sounds associated with the mitral valve are accentuated by turning the patient to the __________________ side, which brings the heart _____________to the chest wall. - Ans:-left closer The _________________of the stethoscope is best to use for the higher pitched sounds such as S1 and S2. - Ans:-diaphragm To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory test result will the nurse plan to review? a. Troponin c. Low-density lipoprotein (LDL) b. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/26 Homocysteine (Hcy) d. B-type natriuretic peptide (BNP) - Ans:-ANS: D Increased levels of _______________________________ are a marker for heart failure. - Ans:-BNP To assess for myocardial infarction _______________or risk for coronary artery disease ___________________ - Ans:-troponin Hcy and LDL While doing the hospital admission assessment for a thin older adult, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take next? a. Teach the patient about aneurysms.