Lewis's Medical-Surgical Nursing, 11th Edition Chapter 31 - 37 Review Questions Exam Practice Questions and Answers

Lewis's Medical-Surgical Nursing, 11th Edition Chapter 31 - 37 Review Questions Exam Practice Questions and Answers Which aspect of the heart's action does the QRS complex on the ECG represent? Depolarization of the atria Repolarization of the ventricles Depolarization from atrioventricular (AV) node throughout ventricles The length of time it takes for the impulse to travel from the atria to the ventricles - Ans:- Depolarization from atrioventricular (AV) node throughout ventricles Rationale: The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/117 The patient tells the nurse that he does not understand how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. What is the best response by the nurse? "One coronary vessel curves around and supplies the entire heart muscle." "The LAD supplies blood to the left side of the heart and part of the right ventricle." "The right ventricle is supplied during systole primarily by the right coronary artery." "It is actually on the right side of the heart, but we call it the left anterior descending vessel." - Ans:- "The LAD supplies blood to the left side of the heart and part of the right ventricle." Rationale: The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole. Which anatomic feature of the heart directly stimulates ventricular contractions? SA node AV node Bundle of His ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/117 Purkinje fibers - Ans:-Purkinje fibers Rationale: The Purkinje fibers move the electrical impulse or action potential through the walls of both ventricles triggering synchronized right and left ventricular contraction. The sinoatrial (SA) node initiates the electrical impulse that results in atrial contraction. The atrioventricular (AV) node receives the electrical impulse through internodal pathways. The bundle of His receives the impulse from the AV node. The nurse is providing care for a patient who has decreased cardiac output due to heart failure. As a basis for planning care, what should the nurse understand about cardiac output (CO)? CO is calculated by multiplying the patient's stroke volume by the heart rate. CO is the average amount of blood ejected during one complete cardiac cycle. CO is determined by measuring the electrical activity of the heart and the heart rate. CO is the patient's average resting heart rate multiplied by the mean arterial blood pressure. - Ans:- CO is calculated by multiplying the patient's stroke volume by the heart rate. Rationale: ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/117 Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output. The nurse is performing an assessment for a patient with fatigue and shortness of breath. Auscultation reveals a heart murmur. What does this assessment finding indicate? Increased viscosity of the patient's blood Turbulent blood flow across a heart valve Friction between the heart and the myocardium A deficit in conductivity impairs normal contractility - Ans:-Turbulent blood flow across a heart valve Rationale: Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium. A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? Women are less likely to delay seeking treatment than men. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/117 Women are more likely to have noncardiac symptoms of heart disease. Women are often less ill when presenting for treatment of heart disease. Women have more symptoms of heart disease at a younger age than men. - Ans:-Women are more likely to have noncardiac symptoms of heart disease. Rationale: Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men. A patient is being admitted for valve replacement surgery. Which assessment finding is indicative of aortic valve stenosis? Pulse deficit Systolic murmur Distended neck veins Splinter hemorrhages - Ans:-Systolic murmur ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/117 Rationale: The turbulent blood flow across a diseased valve results in a murmur. Aortic stenosis produces a systolic murmur. A pulse deficit indicates a cardiac dysrhythmia, most commonly atrial fibrillation. Right-sided heart failure may cause distended neck veins. Splinter hemorrhages occur in patients with infective endocarditis. The nurse determines that a patient's pedal pulses are absent. What factor could contribute to this finding? Atherosclerosis Hyperthyroidism Atrial dysrhythmias Arteriovenous fistula - Ans:-Atherosclerosis Rationale: Atherosclerosis can cause an absent peripheral pulse. The feet would also be cool and may be discolored. Hyperthyroidism causes a bounding pulse. Arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm. What position should the nurse place the patient in to auscultate for signs of acute pericarditis? ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 7/117 Supine without a pillow Sitting and leaning forward Left lateral side-lying position Head of bed at a 45-degree angle - Ans:-Sitting and leaning forward Rationale: A pericardial friction rub indicates pericarditis. To auscultate a pericardial friction rub, the patient should be sitting and leaning forward. The nurse will hear the pericardial friction rub at the end of expiration. The blood pressure of an older adult patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? Stenosis of the heart valves Decreased adrenergic sensitivity Increased parasympathetic activity Loss of elasticity in arterial vessels - Ans:-Loss of elasticity in arterial vessels ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 8/117 Rationale: An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results. Valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate. A patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study?IV sedation may be administered to help the patient relax.Food and fluids are restricted for 2 hours before the procedure.Ambulation is restricted for up to 6 hours before the procedure.Contrast medium is injected into the esophagus to enhance images. - Ans:-IV sedation may be administered to help the patient relax. Rationale: IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is susp