Chapter 37. Circulation

Chapter 37. Circulation

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient diagnosed with hypertension is taking an angiotensin-converting enzyme (ACE) inhibitor. When planning care, which of the following outcomes would be appropriate for the patient?

a)	BP will be lower than 135/85 on all occasions.
b)	BP will be normal after 2 to 3 weeks on medication.
c)	Patient will not experience dizziness on rising.
d)	Urine output will increase to at least 50 mL/hr.

 

 

ANS:  A

Goals must be clearly stated so that it is easy to evaluate whether they have been met. “BP . . . lower than 135/85 . . .” is clearly stated and easily evaluated. In contrast, “BP will be normal . . .” does not clearly state the desired endpoint. Freedom from dizziness on rising is probably not achievable because ACE inhibitors are vasodilating agents, which may cause vessel dilation and hypotension, especially when the patient arises from a seated or lying position. Patients should be warned of this effect. The expected/desired effect of the ACE inhibitor is to lower the blood pressure; the urine output is minimally relevant in determining that outcome, if at all.

 

Difficulty: Difficult

Nursing Process: Planning

Client Need: PHSI

Cognitive Level: Application

 

PTS:   1

 

2. You are preparing the nursing care plan for a middle-aged patient admitted to the intensive care unit for an acute myocardial infarction (heart attack). His symptoms include tachycardia, palpitations, anxiety, jugular vein distention, and fatigue. Which of the following nursing diagnoses is most appropriate?

a)	Decreased Cardiac Output
b)	Impaired Tissue Perfusion
c)	Impaired Cardiac Contractility
d)	Impaired Activity Tolerance

 

 

ANS:  A

The patient’s symptoms reflect altered cardiac preload, a component of cardiac output. Acute myocardial infarction is often associated with decreased cardiac output as a result of altered cardiac pumping ability. Although the other nursing diagnoses might be associated with Decreased Cardiac Output, these diagnoses cannot be determined from the symptoms presented. Additionally, Impaired Cardiac Contractility is not a NANDA-I nursing diagnosis.

 

Difficulty: Difficult

Nursing Process: Diagnosis

Client Need: PHSI

Cognitive Level: Analysis

 

PTS:   1

 

3. Chronic stress may lead directly to cardiovascular disease because of the repeated release of which of the following?

a)	Histamine
b)	Catecholamines
c)	Cortisol
d)	Protease

 

 

ANS:  B

The stress response stimulates release of catecholamines from the sympathetic nervous system. This results in increased heart rate and contractility, vasoconstriction, and increased tendency of blood to clot. Cortisol is also released in the stress response, but it is more indirectly related to development of cardiovascular disease through altered glucose, fat, and protein metabolism.

 

Difficulty: Moderate

Nursing Process: Assessment

Client Need: HPM

Cognitive Level: Knowledge

 

PTS:   1

 

4. The nurse is teaching a pregnant woman about the increased oxygen demand that develops during pregnancy. The nurse knows the patient comprehends the teaching when she makes the following statement:

a)	“I may need to drink more fluids to make more oxygen.”
b)	“I may need to take an iron supplement so that I am not anemic.”
c)	“I will need a multivitamin supplement for several months.”
d)	“I will need to eat more fruits and vegetables.”

 

 

ANS:  B

During pregnancy, oxygen demand increases dramatically. To compensate, the mother’s blood volume increases by 30%. The woman requires additional iron to produce this blood as well as to meet fetal requirements. Failure to meet these iron demands can result in maternal anemia, reducing tissue oxygenation of the mother.

 

Difficulty: Moderate

Nursing Process: Evaluation

Client Need: HPM

Cognitive Level: Application