Chapter 38. Circulation and Perfusion

Chapter 38. Circulation and Perfusion

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

 

____       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?

1)

BP will be lower than 135/85 mm Hg on all occasions.

2)

BP will be normal after 2 to 3 weeks on medication.

3)

Patient will not experience dizziness on rising.

4)

Urine output will increase to at least 50 mL/hr

 

 

ANS:       1

Goals must be clearly stated so that it is easy to evaluate if they have been met. “BP . . . lower than 135/85 mm Hg . . .” 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.

 

PTS:    1                      DIF:    Difficult          REF:    pp. 1372-1373

KEY:   Nursing process: Planning | Client need: PHSI | Cognitive level: Application

 

 

 

____       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?

1)

Decreased Cardiac Output

2)

Impaired Tissue Perfusion

3)

Impaired Cardiac Contractility

4)

Impaired Activity Tolerance

 

 

ANS:       1

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.

 

PTS:    1                      DIF:    Difficult          REF:    p. 1372

KEY:   Nursing process: Diagnosis | Client need: PHSI | Cognitive level: Analysis

 

 

 

____       3.   You are to connect a patient to a cardiac monitor. Which of the following actions should you take to ensure an accurate electrocardiogram tracing?

1)

Select electrode placement sites over bony prominences.

2)

Apply the electrodes immediately after cleansing the skin, before the alcohol evaporates.

3)

Before applying the electrodes, rub the placement sites with gauze until the skin reddens.

4)

Ensure that the gel on the back of the electrodes is dry.

 

 

ANS:       3

Electrodes should be placed over soft tissues or close to bone in order to obtain accurate waveforms. Sites over bony prominences, thick muscles, and skinfolds can produce artifact; therefore, they should not be used. Alcohol removes skin oils that may prevent the electrodes from adhering. However, the alcohol should be allowed to dry before the electrodes are placed. Rubbing the skin with gauze or a washcloth removes dead skin cells and promotes better electrical contact. A dry electrode will not conduct electrical activity; gel should not be dry.

 

PTS:    1                      DIF:    Moderate        REF:    p. 1377

KEY:   Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

 

 

 

____       4.   Chronic stress may lead directly to cardiovascular disease because of the repeated release of which of the following?

1)

Histamine

2)

Catecholamines

3)

Cortisol

4)

Protease

 

 

ANS:       2

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.

 

PTS:    1                      DIF:    Moderate        REF:    p. 1365

KEY:   Nursing process: Assessment | Client need: HPM | Cognitive level: Recall

 

 

 

____       5.   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:

1)

“I may need to drink more fluids in order to make more oxygen.”

2)

“I may need to take an iron supplement so that I am not anemic.”

3)

“I will need a multivitamin supplement for several months.”

4)

“I will need to eat more fruits and vegetables.”

 

ANS:       2

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.

 

PTS:    1                      DIF:    Moderate        REF:    p. 1365-1366

KEY:   Nursing process: Evaluation | Client need: HPM | Cognitive level: Application