Exit 18 Flashcards
The nurse is aware of several important tasks that should all be done immediately in order to give Mr. Duffy the care he needs. Which of the following nursing interventions will relieve his current myocardial ischemia?
A. Stool softeners, rest
B. O2 therapy, analgesia
C. Reassurance, cardiac monitoring
D. Adequate fluid intake, low-fat diet
B. O2 therapy, analgesia
Option B: All the nursing interventions listed are important in the care of Mr. Duffy. However, relief of his pain will be best achieved by increasing the O2 content of the blood to his heart and relieving the spasm of coronary vessels.
During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most common following an MI?
A. SGOT, CK, and LDH are all elevated immediately.
B. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
D. CK peaks first and remains elevated for 1 to 2 weeks.
C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
Option C: Although the timing of initial elevation, peak elevation, and duration of elevation vary with sources, current literature favors option letter c.
Serum Glutamic Oxaloacetic Transaminase
Creatine Kinase
Lactate Dehydrogenase
On his second day in CCU, Mr. Duffy suffers a life-threatening cardiac arrhythmia. Considering his diagnosis, which is the most probable arrhythmia?
A. Atrial tachycardia
B. Ventricular fibrillation
C. Atrial fibrillation
D. Heart block
B. Ventricular fibrillation
Option B: Ventricular irritability is common in the early post-MI period, which predisposes the client to ventricular arrhythmias.
Options C and D: Heart block and atrial arrhythmias may also be seen post-MI but ventricular arrhythmias are more common.
Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to this medication?
A. Take his blood pressure
B. Take his radial pulse for one minute
C. Check his serum potassium (K) level
D. Weigh himself every day
B. Take his radial pulse for one minute
Option B: All options have some validity. However, option B relates best to the action of digitalis. If the pulse rate drops below 60 or is markedly irregular, the digitalis should be held and the physician consulted.
Option A: Blood pressure measurement is also helpful; providing the client has the right size cuff and he or she and/or significant other understand the technique and can interpret the results meaningfully.
Option C: Serum potassium levels should be monitored periodically in clients on digitalis and diuretics, as potassium balance is essential for prevention of arrhythmias. However, the client cannot do this at home.
Option D: Daily weights may make the client alert to fluid accumulation, an early sign of CHF.
You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from their care provider?
A. Fluorescein stain
B. Snellen’s test
C. Tonometry
D. Slit lamp
C. Tonometry
Tonometry measures intraocular pressure, which is crucial in diagnosing glaucoma.
Option A: This is most often used to detect corneal lesions;
Option B: This is a test for visual acuity;
Option D: This is used to focus on layers of the cornea and lens looking for opacities and inflammation.
You also explain common eye changes associated with aging. One of these is presbyopia, which is:
A. Refractive error that prevents light rays from coming to a single focus on the retina.
B. Poor distant vision
C. Poor near vision
D. A gradual lessening of the power of accommodation
D. A gradual lessening of the power of accommodation
Presbyopia refers to the age-related loss of the eye’s ability to focus on nearby objects.
Option A: This defines astigmatism.
Option B: This defines myopia.
Option C: This defines hyperopia.
Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During your discussion, you describe the macular area as:
A. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the retina.
B. The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
C. Area where the central retinal artery and vein appear on the retina.
D. Reddish orange in color, sometimes stippled. منقط
B. The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
The macular area is responsible for central vision and is avascular.
Options A and C: These refer to the optic disc.
Option D: This describes the color of the retina.
One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. You explain that this is called:
A. A pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
B. Icterus, which may be due to liver disease.
C. A pterygium, which will interfere with vision.
D. Ciliary flush caused by congestion of the ciliary artery.
A. A pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
Pinguecula is a common, benign growth on the conjunctiva.
Option A: Correct by definition.
You know that all but one of the following may eventually result in uremia. Which option is not implicated?
A. Glomerular disease
B. Uncontrolled hypertension
C. Renal disease secondary to drugs, toxins, infections, or radiations
D. All of the above
D. All of the above
All listed conditions can lead to renal damage and eventually renal failure.
Options A, B and C: These are potential causes of renal damage and eventually renal failure. Individuals can live very well with only one healthy kidney.
You did the initial assessment on Mr. Kaplan when he came to your unit. What classical signs and symptoms did you note?
A. Fruity-smelling breath.
B. Weakness, anorexia, pruritus
C. Polyuria, polydipsia, polyphagia
D. Ruddy complexion
B. Weakness, anorexia, pruritus
These symptoms are associated with progressive renal damage and uremia.
Option B: Weakness and anorexia are due to progressive renal damage; pruritus is secondary to presence of urea in the perspiration.
Option A: Fruity-smelling breath is found in diabetic ketoacidosis.
Option C: Polyuria, polydipsia, polyphagia are signs of DM and early diabetic ketoacidosis. Oliguria is seen in chronic renal failure.
Option D: The skin is more sallow or brown as renal failure continues.
Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him. Regarding his diagnosis and management of his drugs, you know that:
A. The half-life of many drugs is decreased in uremia; thus dosage may have to be increased to be effective.
B. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
C. Drug therapy is not usually affected by this diagnosis
D. Precautions should be taken with prescription drugs, but most OTC medications are safe for him to use.
B. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
Option B: Metabolic changes and alterations in excretion put the client with uremia at risk for development of toxicity to any drug. Thus alteration in drug schedule and dosage is necessary for safe care.
The point of maximal impulse (PMI) is an important landmark in the cardiac exam. Which statement best describes the location of the PMI in the healthy adult?
A. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
B. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
C. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
D. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
C. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
The PMI is located at the apex of the heart, typically at the 5th intercostal space, 7-9 cm from the midsternal line.
Option C: The PMI is the impulse at the apex of the heart caused by the beginning of ventricular systole. It is generally located in the 5th left ICS, 7-9 cm from the MSL or at, or just medial to, the MCL. (Mid Clavicular Line)
During the physical examination of the well adult client, the health care provider auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?
A. Tricuspid
B. Pulmonic
C. Aortic
D. Mitral
A. Tricuspid
Option A: The sound created by closure of the tricuspid valve is heard at the 5th LICS (left intercostal space) at the LSB (left sternal border)
Option B: Pulmonic closure is best heard at the 2nd LICS, LSB.
Option C: Aortic closure is best heard at the 2nd RICS, RSB.
Option D: Mitral valve closure is best heard at the PMI landmark (apex).
The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?
A. S1
B. S2
C. S3
D. S4
B. S2
The S2 sound is caused by the closure of the aortic and pulmonic valves and is best heard at the 2nd left intercostal space.
Option A: S1 is caused by mitral and tricuspid valve closure;
Option B: S2 is caused by the aortic and pulmonic valve closure;
Options C and D: S3 and S4 are generally considered abnormal heart sounds in adults and are best heard at the apex.
The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to the coronary circulation?
A. The right and left coronary arteries are the first of many branches off the ascending aorta
B. Blood enters the right and left coronary arteries during systole only
C. The right coronary artery forms almost a complete circle around the heart, yet supplies only the right ventricle
D. The left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left ventricle
D. The left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left ventricle
The left coronary artery’s branches supply blood to significant portions of the heart, including the left ventricle.
Option D: The right and left coronary arteries are the only branches off the ascending aorta; blood enters these arteries mainly during diastole; the right coronary artery also often supplies a small portion of the left ventricle.
Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are probably due to:
A. Thickening of the pericardium
B. Right heart failure
C. Pulmonary hypertension
D. Left ventricular hypertrophy
C. Pulmonary hypertension
Option C: Pulmonary congestion secondary to left atrial hypertrophy causes these symptoms
Option A: Pericardial thickening does not occur. .
Option D: The left ventricle does not hypertrophy in mitral stenosis.
Option B: Right heart failure would cause abdominal discomfort and peripheral edema.
On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the usual objective findings associated with mitral stenosis?
A. Low-pitched rumbling diastolic murmur, precordial thrill, and parasternal lift
B. Small crepitant rales at the bases of the lungs
C. Weak, irregular pulse, and peripheral and facial cyanosis in severe disease
D. Chest x-ray shows left ventricular hypertrophy
D. Chest x-ray shows left ventricular hypertrophy
Left ventricular hypertrophy is not typically seen in mitral stenosis; rather, left atrial enlargement is observed.
Option D: Evidence of left atrial enlargement may be seen on chest x-ray and ECG.
Options A, B, and C: The other objective findings may be seen in chronic mitral stenosis with episodes of atrial fibrillation and right heart failure.
You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:
A. Ventricular ischemia
B. Dysfunction of the left ventricle
C. Papillary muscle ischemia and dysfunction
D. Cardiac arrhythmias
C. Papillary muscle ischemia and dysfunction
Ischemia and dysfunction of the papillary muscles can cause chest pain in mitral valve prolapse.
Option A: Ventricular ischemia does not occur with prolapsed mitral valve.
Options B and D: These are not painful conditions in themselves.
The most common lethal cancer in males between their fifth and seventh decades is:
A. Cancer of the prostate
B. Cancer of the lung
C. Cancer of the pancreas
D. Cancer of the bowel
B. Cancer of the lung
Lung cancer remains the most common lethal cancer in males within this age group.
Option B: The incidence of lung cancer is also rapidly rising in women.
Of the four basic cell types of lung cancer listed below, which is always associated with smoking?
A. Adenocarcinoma
B. Squamous cell carcinoma (epidermoid)
C. Undifferentiated carcinoma
D. Bronchoalveolar carcinoma
B. Squamous cell carcinoma (epidermoid)
Squamous cell carcinoma is strongly linked to smoking.
Option B: Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat differently. However most agree that squamous cell or epidermoid carcinoma is always associated with cigarette smoking.
