Perfusion - TopHat Qs

Question 1

Blood passing from the right atrium to the right ventricle passes through which valve?

a. semilunar valve
b. bicuspid valve
c. pulmonic valve
d. tricuspid valve

Answer 1

d. tricuspid

Question 2

Which term accurately describes the amount of resistance within the vasculature the heart pumps against?

a. Preload
b. Afterload
c. Stroke Volume
d. Cardiac Output

Answer 2

b. afterload

Question 3

Which variables contribute to Cardiac Output? Select all that apply.

a. colloid osmotic pressure
b. heart rate
c. stroke volume
d. capillary hydrostatic pressure

Answer 3

b. heart rate

c. stroke volume

Question 4

Which is an example of impaired central perfusion?

a. Angina
b. Deep vein thrombosis
c. Varicose Veins
d. Aneurysms

Answer 4

a. Angina

Question 5

The patient is admitted with a suspected myocardial infarction. Which serum blood test can the nurse anticipate will be ordered to confirm this condition?

a. D-dimer
b. Natriuretic peptide
c. Troponin
d. Homocysteine

Answer 5

c. Troponin

Question 6

Which American Heart Association recommendations should the nurse include in her health promotion class to a group a patients at risk for cardiac disease? Select all that apply.

a. Reduce the amount of tobacco used
b. Maintain blood pressure 120/80 or less
c. Maintain fasting blood glucose less than 180 mg/dL
d. Maintain total cholesterol levels less than 200 mg/dL

Answer 6

b. Maintain blood pressure 120/80 or less

d. Maintain total cholesterol levels less than 200 mg/dL

Question 7

Which cardiac test requires the patient to walk a treadmill while the heart rate and rhythm are being monitored?

a. Stress test
b. Echocardiogram
c. Electrocardiogram
d. Cardiac arteriogram

Answer 7

a. Stress Test

Question 8

The patient is admitted with a myocardial infarction secondary to a blood clot. Which category of medications can the nurse anticipate will be ordered to dissolve this present clot?

a. Anticoagulants
b. Antiplatelets
c. Thrombolytics
d. Lipid lowering agents

Answer 8

c. Thrombolytics

Question 9

The patient is admitted for chest pain. Which diagnostic test will most likely determine the etiology of the chest pain?

a. TEE
b. Stress Test
c. Coronary angiography
d. Chest X-Ray

Answer 9

c. Coronary angiography

Question 10

Which factors can the nurse expect to find in the cardiac system as the patient ages? Select all that apply

a. Stiffening of the arterial walls
b. Increased in cardiac output
c. Widening of the arterial walls.
d. Formation of atherosclerotic plaques

Answer 10

a. Stiffening of the arterial walls

d. Formation of atherosclerotic plaques

Question 11

A patient is a female age 35, who smokes a pack of cigarettes a day, has a total cholesterol of 99 and is obese. Her living father had a heart attack at the age of 52 years. This female patient has how many modifiable risk factors?

a. 1
b. 2
c. 3
d. 4

Answer 11

b. 2

Question 12

A client is admitted with acute HF exacerbation. Assessment reveals tachycardia, hypertension, and crackles in lung bases. The physician orders Lasix IV to be administered immediately. Which patient outcome supports a therapeutic effect of the medications?

A Pulse rate decreases below 100.
B Urine specific gravity is increased
C Sputum is clear and easily expectorated
D Lungs are clear to auscultation

Answer 12

D. Lungs are clear to auscultation

Question 13

A patient with heart failure develops sudden leg pain with pallor, paresthesia and loss of peripheral pulses. Which of the following is the nurse’s initial action?

A Notify the physician
B Elevate the leg to promote venous return
C Wrap the leg in a blanket to promote warmth.
D Perform passive range of motion to stimulate circulation to the leg.

Answer 13

A. Notify the physician

Question 14

The patient is admitted to the medical-surgical for an acute exacerbation of the heart failure (HF) with possible pulmonary edema. Which manifestations would the nurse expect to find in this patient?

A Apical Pulse of 110 and +3 pitting edema in feet
B Thick white sputum that clear with coughing
C Sleeping prone with only one pillow
D Capillary refill at 3 seconds and intermittent claudication

Answer 14

A Apical Pulse of 110 and +3 pitting edema in feet

Question 15

The patient with acute pericarditis is having a pericardiocentesis. Post-operatively, the nurse should monitor for which complication?

A Pneumonia
B Pneumothorax
C Myocardial Infarction
D Cerebral Vascular Accident

Answer 15

B Pneumothorax

Question 16

The patient hospitalized with infective endocarditis, is now afebrile and being discharged home with antibiotic therapy. Which action by the nurse is most appropriate when planning discharge for patient?

A Plan resources that will meet the patient’s needs while on bedrest
B Encourage the use of diversional activities
C Teach the patient to avoid large crowds
D Assess the home environment and hospital access

Answer 16

D Assess the home environment and hospital access

Question 17

The patient with acute pericarditis has a nursing diagnosis of pain related to pericardial inflammation. Which is the best nursing intervention?

A Administered opioids around the clock
B Promote relaxation exercises with use of deep slow breathing
C Increase the head of the bed with a padded over the bed table for patient to lean
D Encourage the patient to lie supine on the right side

Answer 17

C Increase the head of the bed with a padded over the bed table for patient to lean

Question 18

A new graduate nurse is caring for a patient with a pulse ox of 89% who is experiencing dyspnea due to heart failure. Which nursing action requires intervention by the charge nurse?

A Elevate the head of the bed
B Turn and reposition the client every 1-2 hours
C Teach the client purse-lip breathing
D Weigh the client daily in the morning

Answer 18

B Turn and reposition the client every 1-2 hours

Question 19

The patient with a history of angina is admitted for surgery. The patient reports nausea, pressure in the chest radiating to the left arm, skin is cool and clammy, blood pressure is 150/90, pulse is 100, respiratory rate is 32. What is the priority nursing diagnosis?

A Anxiety
B Ineffective Tissue Perfusion
C Nausea
D Altered Skin Integrity

Answer 19

B Ineffective Tissue Perfusion

Question 20

A patient with a history of stable angina present to the office for a physical exam. Which statement warrants immediate action by the nurse?

A “I take my nitroglycerin before I engage in sex.”
B “I have pain when I am watching TV.”
C “My chest pain is still occurring when I walk up more than one flight of stairs.”
D “I will go to the emergency room, if after 3 nitro pills I still have chest pain.”

Answer 20

B “I have pain when I am watching TV.”

Question 21

A patient is participating in cardiac rehab. Which statements by the patients warrants further teaching by the nurse? (Mark all that apply)

A “I will use my push lawn mower early in the day when it is not so hot”
B “I can change my diet to decrease my intake of fatty foods.”
C “I am looking forward to resuming my skiing activity in a few weeks since it reduces my stress.”
D “I need to take my medication every day to keep my blood pressure under control.”

Answer 21

A “I will use my push lawn mower early in the day when it is not so hot”
pushing activity causes stress on heart
C “I am looking forward to resuming my skiing activity in a few weeks since it reduces my stress.”
high in NATs - takes too much O2

Question 22

The nurse is teamed with an LPN in caring for a group of patients on a cardiac floor. Which action by the LPN indicates the need for the RN to intervene immediately?

A Reminds the patient of his NPO status after returning from a cardiac catheterization
B Checks a patient’s blood pressure before administering Nitroglycerin SL
C Returns a patient back to bed after the patient’s heart rate increases 72 to 96 while ambulating in the hall
D Brings breakfast to a patient scheduled for an echocardiogram later in the morning

Answer 22

A Reminds the patient of his NPO status after returning from a cardiac catheterization

Needs to increase fluids

Question 23

The patient with pericarditis is being charged home. Which intervention should the nurse include in the discharge teaching?

A Allow for uninterrupted rest and sleep
B Refer the patient to outpatient therapy
C Maintain oxygen via nasal cannula at 2 liters/min
D Discuss upcoming valve replacement surgery

Answer 23

A Allow for uninterrupted rest and sleep

Question 24

Which patient with a history of cardiac disease should the nurse assess first?

A Patient A has a history of angina and ran out of his medications
B Patient B has a BP of 140/85 and is complaining of chest pain when he walks
C Patient C is complaining of indigestion and is diaphoretic
D Patient D is complaining of chest discomfort only when he is lying down

Answer 24

C Patient C is complaining of indigestion and is diaphoretic

Question 25

The nurse is admitting an older adult with decompensated congestive heart failure. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. The nurse should question which doctor’s order? A Furosemide (Lasix) 20 mg po now B Oxygen via face mask at 2 L C KCl 20 mEq PO two times per day D Intravenous (IV) 500 mL of 0.9% NaCl at 125 mL/hr

Answer 25

D Intravenous (IV) 500 mL of 0.9% NaCl at 125 mL/hr

Question 26

A patient is inquiring about having sex after having a heart attack. Which instructions are appropriate for the nurse to provide to the patient regarding sexual activity after a myocardial infarction? (MARK ALL THAT APPLY) A Avoid anal intercourse B Talk to your doctor regarding taking NTG before sexual activity C To relax - consume alcohol before sexual activity D To reduce anxiety and added stress to the heart- avoid any foreplay.

Answer 26

A Avoid anal intercourse B Talk to your doctor regarding taking NTG before sexual activity Want to encourage foreplay because it is stress relieving and increases demand of heart slowly No anal because anal stimulation impact cranial nerves (Vagus) which makes them pass out/die - HR drops

Question 27

Besides monitoring Carlos for decreased perfusion to the heart, which test would best confirm if heart failure is present? A electrocardiogram B echocardiogram C serum troponin D holter monitor

Answer 27

B echocardiogram

Question 28

``` Carlos has the following lipid levels... HDL: 32 mg/dL LDL: 190 mg/dL Total Cholesterol: 250mg/dL Carlos inquires about these levels. Which statement is most appropriate by the nurse? ``` A Total cholesterol below 300mg/dL is normal B As long as the LDL is below 200 mg/dL no medications are needed C A HDL level below 40 mg/dL is a risk factor for heart disease D These levels are borderline and given your risk factors, diet and activity changes need to be made.

Answer 28

C A HDL level below 40 mg/dL is a risk factor for heart disease

Question 29

Carlos is placed on an ACE inhibitor for his hypertension. Which statement by Carlos requires intervention by the nurse? A "I will remember to take this medication every day in the morning before I leave for work" B "I am going to limit the fatty snacks and eat more fruits such as cantaloupes and bananas." C "This medication may make me urinate more since it works with the kidney." D "I may develop a cough with this medication and will notify the doctor if one develops".

Answer 29

B "I am going to limit the fatty snacks and eat more fruits such as cantaloupes and bananas."

Question 30

Carlos is instructed to report to the cardiology center the next day for a stress echo test. Which instruction should the nurse provide to Carlos? A The dye that is inserted may cause a warm flushing sensation. B It is important to keep a record of activities while you are wearing the monitor C You will need to be NPO after midnight D It is important to return to the table immediately following exercising

Answer 30

D It is important to return to the table immediately following exercising

Question 31

Carlos 's stress test reflects angina and he is ordered Nitroglycerin SL prn for pain and nitroglycerin transdermal patch apply in am and remove at bedtime. Which instruction should the nurse provide regarding these medications? A Change position slowly B Chew the nitroglycerin tab to enhance absorption C Store the Nitroglycerin patches in the refrigerator D You cannot take both the patch and tablets at the same time.

Answer 31

A Change position slowly Pt vasodilates and can cause orthohyper

Question 32

Carlos just finished arguing with Eleanor (mother-in-law) regarding taking over the TV and smoking in the house. (Carlos is trying to quit smoking again). Shortly after he approaches Debbie and states that his head and chest hurts. He reported taking one Nitro tab 5 minutes ago. Which actions should Debbie take first? A Take Carlos's blood pressure, tell him to avoid Eleanor and sit down B Inquire if Carlos administered his nitroglycerin patch and take a 2nd sublingual tab C Given him an Aspirin and another sublingual Nitro tab and call 911 D Discuss the possibility of Eleanor living somewhere else and tell Carlos to ignore her.

Answer 32

C Given him an Aspirin and another sublingual Nitro tab and call 911

Question 33

Carlos is admitted to the ER. Which question will be most appropriate for the nurse to ask in order to determine if Carlos is experiencing angina or myocardial infarction? A "Why did the pain start?" B "How did you get to the hospital?" C "Do you have any other symptoms?" D "Did you follow your diet and exercise?"

Answer 33

C "Do you have any other symptoms?"

Question 34

It appears Carlos may be having an myocardial infarction. Which test would best confirm the this diagnosis? A Homocysteine B CK-BB C Troponin D LDL

Answer 34

C Troponin

Question 35

The nurse administered Morphine IV to Carlos with a suspected MI after reporting a pain rating of 9 (0-10 scale). When evaluating the response 5 minutes after giving the medication, which data would indicate a need for immediate further action? A The blood pressure decreases from 114/65 to 106/58 B The respiratory rate drops from 18 to 12 breaths/minute C Carlos complains of feeling dizzy and lightheaded D Carlos complains has chest pain at a level of 2 (0-10 level)

Answer 35

D Carlos complains has chest pain at a level of 2 (0-10 level) Chest pain = lack of O2 in the heart This is subjective, but the pt is still reporting chest pain so nurse needs to act b/c it means the heart is still being deprived of O2

Question 36

It is determined that Carlos now needs to undergo a cardiac catheterization with possible percutaneous transluminal coronary angioplasty. Which action is most appropriate by the nurse when Carlos returns back to the floor? A Obtain lung sounds and apical pulse every 15 minutes B Instruct Carlos to stay in bed and keep leg immobilized C Limit one visitor per hour and monitor Carlos 's temperature D Check the gag reflex before starting fluids

Answer 36

B Instruct Carlos to stay in bed and keep leg immobilized Should be checking pedal pulse, not apical TEE requires checking gag reflex

Question 37

Carols is found to have mild heart failure and is treated with low dose Digoxin and Lasix. To prevent possible complications of this drug combination, the nurse should take which action? A Keep an accurate measure of intake and output B Teach the patient about dietary restriction of sodium C Take the apical pulse and withhold the heart medication if the heart rate is irregular D Monitor the serum potassium levels

Answer 37

D Monitor the serum potassium levels

Question 38

Which finding indicates to the nurse that treatment plan for Carlos's heart failure is effective? A Peripheral pulse has changed from +3 to +4 B Lungs are clear to auscultation C Minimal jugular vein distention D Carlos reports completing ADL without dyspnea

Answer 38

D Carlos reports completing ADL without dyspnea

Question 39

The nurse on the 3-11 shift received report and is caring for three patents in addition to Carlos. Which patient should the nurse see first? A Carlos scheduled for discharge tomorrow, reported vomiting a few minutes ago and is complaining of muscle weakness B Mike newly diagnosed with hypertension, is awaiting medication teaching and needs an echocardiogram C Rocco 3 days post MI is constipated, anxious and demanding that the doctor be notified. D Ann admitted with acute coronary syndrome received her first dose of propranolol (Inderal) and aspirin this morning.

Answer 39

A Carlos scheduled for discharge tomorrow, reported vomiting a few minutes ago and is complaining of muscle weakness