Chapter 13: Cardiovascular Alterations

Chapter 13: Cardiovascular Alterations

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The patient is admitted with a suspected acute myocardial infarction (AMI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction (MI)?

a.	ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b.	Depressed ST-segment on ECG and elevated total CPK
c.	Depressed ST-segment on ECG and normal cardiac enzymes
d.	Q wave on ECG with normal enzymes and troponin levels

 

 

ANS:  A

ST segment elevation and elevated cardiac enzymes are seen in Q wave MI.

 

DIF:    Cognitive Level: Analyze/Analysis                                   REF:   p. 313 | Nursing Care Plan

OBJ:   Identify specific nursing interventions designed to prevent secondary occurrences or to minimize complications of cardiac and vascular patients.

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

2. The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find?

a.	Dependent edema
b.	Distended neck veins
c.	Dyspnea and crackles
d.	Nausea and vomiting

 

 

ANS:  C

In left-sided heart failure, signs and symptoms are related to pulmonary congestion. Dependent edema and distended neck veins are related to right-sided heart failure.

 

DIF:    Cognitive Level: Analyze/Analysis                                   REF:   p. 326 | Box 13-13

OBJ:   Contrast the pathological cause and effect mechanisms that produce acute cardiac disturbances.

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

3. A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzyme (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process?

a.	Myocardial stunning
b.	Hibernating myocardium
c.	Myocardial remodeling
d.	Tachycardia

 

 

ANS:  C

Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines; it causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors reduce the incidence of remodeling.

 

DIF:    Cognitive Level: Analyze/Analysis                                   REF:   p. 328 | Table 13-13

OBJ:   Compare and contrast pharmacological, operative, and electrical treatment modalities used in treatment of cardiac disease.                    TOP:              Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

4. A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. The patient is nauseated and diaphoretic, with dusky skin color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question?

a.	Emergent pacemaker insertion
b.	Emergent percutaneous coronary intervention
c.	Emergent thrombolytic therapy
d.	Immediate coronary artery bypass graft surgery

 

 

ANS:  A

The goals of management of AMI are to dissolve the lesion that is occluding the coronary artery and to increase blood flow to the myocardium. Options include emergent percutaneous intervention, such as angioplasty, emergent coronary artery bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for less than 6 hours. No data in this scenario warrant insertion of a pacemaker.

 

DIF:    Cognitive Level: Analyze/Analysis                                   REF:   p. 312

OBJ:   Compare and contrast pharmacological, operative, and electrical treatment modalities used in treatment of cardiac disease.                    TOP:              Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity