1. A nurse is describing the process by which blood is ejected into circulation as the
chambers of the heart become smaller. The instructor categorizes
... [Show More] this action of
the heart as what?
A) Systole
B) Diastole
C) Repolarization
D) Ejection fraction - Ans: A
Feedback:
Systole is the action of the chambers of the heart becoming smaller and ejecting
blood. This action of the heart is not diastole (relaxations), ejection fraction (the
amount of blood expelled), or repolarization (electrical charging).
2. During a shift assessment, the nurse is identifying the clients point of maximum
impulse (PMI). Where will the nurse best palpate the PMI?
A) Left midclavicular line of the chest at the level of the nipple
B) Left midclavicular line of the chest at the fifth intercostal space
C) Midline between the xiphoid process and the left nipple
D) Two to three centimeters to the left of the sternum - Ans: B
Feedback:
The left ventricle is responsible for the apical beat or the point of maximum
impulse, which is normally palpated in the left midclavicular line of the chest wall
at the fifth intercostal space.
3. The nurse is calculating a cardiac patients pulse pressure. If the patients blood
pressure is 122/76 mm Hg, what is the patients pulse pressure?
A) 46 mm Hg
B) 99 mm Hg
C) 198 mm Hg
D) 76 mm Hg - Ans: A
Feedback:
Pulse pressure is the difference between the systolic and diastolic pressure. In
this case, this value is 46 mm Hg.
4. The nurse is caring for a patient admitted with unstable angina. The laboratory
result for the initial troponin I is elevated in this patient. The nurse should
recognize what implication of this assessment finding?
A) This is only an accurate indicator of myocardial damage when it reaches
its peak in 24 hours.
B) Because the patient has a history of unstable angina, this is a poor
indicator of myocardial injury.
C) This is an accurate indicator of myocardial injury.
D) This result indicates muscle injury, but does not specify the source. - Ans:
CFeedback:
Troponin I, which is specific to cardiac muscle, is elevated within hours after
myocardial injury. Even with a diagnosis of unstable angina, this is an accurate
indicator of myocardial injury.
5. The nurse is conducting patient teaching about cholesterol levels. When
discussing the patients elevated LDL and lowered HDL levels, the patient shows
an understanding of the significance of these levels by stating what?
A) Increased LDL and decreased HDL increase my risk of coronary artery
disease.
B) Increased LDL has the potential to decrease my risk of heart disease.
C) The decreased HDL level will increase the amount of cholesterol moved
away from the artery walls.
D) The increased LDL will decrease the amount of cholesterol deposited
on theartery walls. - Ans: A
Feedback:
Elevated LDL levels and decreased HDL levels are associated with a greater
incidence of coronary artery disease.
6. The physician has placed a central venous pressure (CVP) monitoring line in an
acutely ill patient so right ventricular function and venous blood return can be
closely monitored. The results show decreased CVP. What does this indicate?
A) Possible hypovolemia
B) Possible myocardial infarction (MI)
C) Left-sided heart failure
D) Aortic valve regurgitation - Ans: A
Feedback:
Hypovolemia may cause a decreased CVP. MI, valve regurgitation and heart
failure are less likely causes of decreased CVP.
7. While auscultating a patients heart sounds, the nurse hears an extra heart sound
immediately after the second heart sound (S2). An audible S3 would be
considered an expected finding in what patient?
A) An older adult
B) A 20-year-old patient
C) A patient who has undergone valve replacement
D) A patient who takes a beta-adrenergic blocker - Ans: B
Feedback:
S3 represents a normal finding in children and adults up to 35 or 40 years of age.
In these cases, it is called a physiologic S3. It is an abnormal finding in a patient
with an artificial valve, an older adult, or a patient who takes a beta blocker.
8. The physical therapist notifies the nurse that a patient with coronary artery
disease (CAD) experiences a much greater-than-average increase in heart rateduring physical therapy. The nurse recognizes that an increase in heart rate in a
patient with CAD may result in what?
A) Development of an atrial-septal defect
B) Myocardial ischemia
C) Formation of a pulmonary embolism
D) Release of potassium ions from cardiac cells - Ans: B
Feedback:
Unlike other arteries, the coronary arteries are perfused during diastole. An
increase in heart rate shortens diastole and can decrease myocardial perfusion.
Patients, particularly those with CAD, can develop myocardial ischemia. An
increase in heart rate will not usually result in a pulmonary embolism or create
electrolyte imbalances. Atrial-septal defects are congenital.
9. The nurse is caring for a patient who has a history of heart disease. What factor
should the nurse identify as possibly contributing to a decrease in cardiac
output?
A) A change in position from standing to sitting
B) A heart rate of 54 bpm
C) A pulse oximetry reading of 94%
D) An increase in preload related to ambulation - Ans: B
Feedback:
Cardiac output is computed by multiplying the stroke volume by the heart rate.
Cardiac output can be affected by changes in either stroke volume or heart rate,
such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke
volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as
hypoxia can decrease contractility. Transitioning from standing to sitting would
more likely increase rather than decrease cardiac output.
10.The nurse is caring for an 82-year-old patient. The nurse knows that changes in
cardiac structure and function occur in older adults. What is a normal change
expected in the aging heart of an older adult?
A) Decreased left ventricular ejection time
B) Decreased connective tissue in the SA and AV nodes and bundle
branches
C) Thinning and flaccidity of the cardiac values
D) Widening of the aorta - Ans: D
Feedback:
Changes in cardiac structure and function are clearly observable in the aging
heart. Aging results in decreased elasticity and widening of the aorta, thickening
and rigidity of the cardiac valves, increased connective tissue in the SA and AV
nodes and bundle branches, and an increased left ventricular ejection time
(prolonged systole). [Show Less]