Chapter 12 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 12 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Question 1

Type: MCMA

A patient’s cardiac index will be calculated. What nursing interventions are necessary before this calculation is completed?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Assure that there is an accurate current weight on the medical record.
2. Compare fluid input and output for the last 12 hours.
3. Measure the patient’s height.
4. Figure the patient’s age in years and months.
5. Obtain the patient’s current heart rate.

Correct Answer: 1,3,5

Rationale 1: Weight is a component of cardiac index.

Rationale 2: There is no need to compare fluid intake and output in order to calculate cardiac index.

Rationale 3: Height is used to calculate cardiac index.

Rationale 4: Age is not a consideration when calculating cardiac index.

Rationale 5: Heart rate is a component of cardiac index.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-3

Question 2

Type: MCSA

A patient is scheduled for an echocardiogram with measurement of ejection fraction. The nurse explains to the patient that this test will provide the most information about which cardiac characteristic?

1. The amount of blood the heart pumps every minute
2. The strength of the heartbeat
3. The amount of resistance the heart beats against
4. The amount of blood in the heart before it beats

Correct Answer: 2

Rationale 1: The amount of blood the heart pumps every minute is the cardiac output. Ejection fraction is related to cardiac output, but describing cardiac output does not fully explain ejection fraction.

Rationale 2: Contractility is defined as the force of myocardial contraction and reflects the ability of the heart muscle to work independently of preload and afterload; the ability to function as a pump. Ejection fraction is a measure of the percent of blood ejected with each stroke volume and is used as an index of myocardial function.

Rationale 3: Afterload is the amount of resistance the heart must beat against. Increasing afterload will affect both ejection fraction and cardiac output.

Rationale 4: Preload represents the volume of blood in the ventricle at the end of diastole. A low preload can result in low cardiac output and may also affect ejection fraction.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-3

Question 3

Type: MCMA

Testing indicates that a patient has a high preload. What changes would the nurse expect in this patient’s cardiac function?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Heart rate will decrease.
2. Afterload will increase.
3. Stroke volume will decrease.
4. Stoke volume will increase.
5. Blood pressure will decrease.

Correct Answer: 3,4

Rationale 1: It is not possible to predict what change in heart rate will occur in the face of increased preload. Depending upon the pathophysiology causing the increased preload, the rate may increase, may decrease, or may stay the same.

Rationale 2: Afterload represents the force the heart must overcome to pump blood. It is not affected by preload.

Rationale 3: If the increase in preload is high enough that a critical point is reached stroke volume will decrease.

Rationale 4: The greater the volume of blood in the ventricle, the greater the amount of stretch that the fibers experience. To a point, this increase in stretch will result in an increase in stroke volume.

Rationale 5: It is not possible to determine if an increase in preload will cause a decrease in blood pressure. In most cases, increased preload will result in increased stroke volume which will result in increased blood pressure.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-3