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MS3 > UNIT 6 > Flashcards

UNIT 6 Flashcards

1
Q

The nurse is explaining to a patient with dysrhythmia how the heart conducts impulses that cause myocardial cells to contract simultaneously. The patient asks what structure allows this conduction from cell to cell. Which structure should the nurse mention?

A) Intercalated disks

B) Nuclei

C) Mitochondria

D) Ribosomes

A

A

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2
Q

A nurse is explaining to a cardiac patient how mechanical contraction takes place in the myocardial cells in the heart. The nurse should explain that which of the following is needed for contraction? Select all that apply.

A) ATP

B) Calcium

C) ADP

D) Phosphorus

E) Iron

F) Zinc

A

A B

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3
Q

Which of the following statements is true of cell membrane depolarization? Select all that apply.

A) In the resting myocardial cell, there are more potassium ions outside than inside the cell.

B) In the depolarized state, the cell membrane is positively charged.

C) Excitability is the term used to describe the ability of a cell to depolarize in response to a given stimulus.

D) Pumps move sodium out of the cell and potassium into the cell.

A

C D

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4
Q

What is the role of the atrioventricular node in a person with normal heart rate (60 to 100 bpm) and why?

A) Acts as primary pacemaker, to establish the heart rate

B) Accelerates conduction of atrial action potentials so that all ventricular cells contract almost simultaneously

C) Delays conduction of atrial action potentials so that all ventricular cells contract almost simultaneously

D) Pumps sodium out of the myocardial cell and potassium into it to cause cell membrane depolarization

A

C

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5
Q

. A nurse is working with a cardiac patient who is anxious about his upcoming surgery. At his request, the nurse hands him his MP3 player. After the patient listens to his MP3 player for a few moments, the nurse notices on the patients heart rate monitor that his heart rate has decreased somewhat. What physiological response would explain this decrease in heart rate?

A) Stimulation of the sympathetic nervous system and the subsequent release of norepinephrine

B) Release of epinephrine from the adrenal medulla

C) Release of norepinephrine from the adrenal medulla

D) Stimulation of the parasympathetic nervous system and the subsequent release of acetylcholine

A

D

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6
Q

The demand for oxygen in heart cells as a result of inotropic action is known as which of the following?

A) Preload

B) Afterload

C) Contractility

D) Automaticity

A

C

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7
Q

Which of the following statements regarding coronary circulation is correct?

A) In about 90% of the population, the right coronary artery is source of blood flow to the atrioventricular node.

B) In about 100% of the population, the left circumflex artery is the source of blood flow to the sinoatrial node.

C) The right coronary artery is the source of blood flow to the bundle branches.

D) The left anterior descending artery is the source of blood to the left atrium.

A

A

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8
Q

A patient has inadequate perfusion to her extremities. Which of the following could explain this phenomenon?

A) Increased diastolic pressure

B) Arteriole dilation

C) Decreased vascular resistance

D) Decreased blood viscosity

A

A

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9
Q

A patient has an irregular heartbeat. What is the most likely cause of this?

A) Excitability in cardiac tissue

B) Contractility in cardiac muscle

C) Automaticity in cardiac muscle cells

D) Conductivity in the AV node

A

C

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10
Q

The double-layered sac that surrounds the heart is known as which of the following?

A) Endocardium

B) Pericardium

C) Myocardium

D) Epicardium

A

B

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11
Q

. A patient has been prescribed calcium blockers. The nurse should expect these medications to have what effect on the patient?

A) Decreased blood volume

B) Irregular heartbeat

C) Decreased arterial pressure

D) Tachycardia

A

C

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12
Q

In evaluating the cardiac function of a patient, the nurse understands that cardiac muscle cells have unique properties that are not found in skeletal muscle. What is the best example of such a unique property?

A) Automaticity

B) Responsiveness

C) Contractility

D) Elasticity

A

A

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13
Q

While teaching a patient, the nurse explains that cardiac functioning has both a mechanical and an electrical component. What is the best way to assess the mechanical function of the heart?

A) Blood pressure

B) Pulse

C) Membrane potential

D) Cardiac monitor pattern

A

B

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14
Q

Part of cardiac function involves the movement of ions in and out of cells, resulting in changes in the polarity of the cell membrane. As part of a teaching plan, the nurse explains that the term depolarized means that the cardiac cell membrane is what?

A) In transition

B) Electrically neutral

C) Negatively charged

D) Positively charged

A

C

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15
Q

Part of understanding cardiac electrical function is understanding the normal conduction system of the heart. List the following parts in normal functional order.

A) Bundle of His

B) Intranodal pathways

C) Atrioventricular node

D) Left bundle branches

E) Sinoatrial node

F) Purkinje fibers

A

E, B, C, A, D, F

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16
Q

A patient has compromised cardiac output. What parameters would the nurse assess to monitor cardiac output most fully?

A) Stroke volume and blood pressure

B) Heart rate and stroke volume

C) Stroke volume and pulse pressure

D) Heart rate and contractility

A

B

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17
Q

The patient is receiving a beta-receptor antagonist medication. What is the most significant effect on cardiac function that the nurse should be monitoring for?

A) Decreased cardiac output

B) Supraventricular tachycardia

C) Increased stroke volume

D) Increased blood pressure

A

A

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18
Q

The nurse is evaluating a patients cardiac output. What situation would be most indicative of increased preload?

A) Sinus tachycardia

B) Elevated central venous pressure

C) Elevated blood pressure

D) Evidence of myocardial infarction

A

B

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19
Q

The nurse is caring for a patient in cardiac failure who has very high afterload. What is the most direct adverse effect on cardiac function that the nurse would anticipate?

A) Increased cardiac output

B) Decreased heart rate

C) Decreased stroke volume

D) Increased heart rate

A

C

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20
Q

. The patient has been diagnosed with a severe blockage of the proximal left anterior descending artery. What cardiac disturbance does the nurse anticipate as most likely?

A) Arrhythmias from the sinoatrial node

B) Arrhythmias from the atrioventricular node

C) Atrial muscle dysfunction and failure

D) Disturbance in bundle branch conduction

A

D

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21
Q

. A patients heart rate is 45 bpm and regular. What part of the conduction system is most likely initiating the rhythm?

A) Sinoatrial node

B) Atrial muscle tissue

C) Atrioventricular node

D) Purkinje fibers

A

C

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22
Q

The patient has a heart rate of 80 bpm, blood pressure of 140/80 mmHg, and stroke volume of 100 mL/beat. The nurse calculates the patients cardiac output as ____ L/min?

A

8

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23
Q

The patient has a peripheral capillary refill time of less than 2 seconds. What relationship between blood volume and peripheral resistance would the nurse expect to find?

A) Elevated preload and blood pressure measurements

B) Normal preload and blood pressure measurements

C) Diminished preload and blood pressure measurements

D) No relationship between preload and blood pressure

A

B

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24
Q

The patient is complaining of chest pain. The nurse asks several questions to determine the likelihood that this pain is cardiac in origin. What patient response is most likely to indicate cardiac pain?

A) Started suddenly and was at maximum intensity from the start

B) Accompanied by no other symptoms, such as nausea

C) Painful area is the size of a clenched fist and substernal.

D) Described as stabbing and knifelike pain

A

C

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25
Q

As part of the general physical assessment of a patient with cardiac disease, the nurse assesses central and peripheral pulses. What is the most accurate statement about pulse assessment?

A) All pulses should be assessed bilaterally at the same time.

B) A pulse that is weak and thready would be scaled +4.

C) Pulsus alternans varies in intensity with every other beat.

D) Absence of posterior tibial pulses is a normal variant.

A

C

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26
Q

The nurse is auscultating a patients heart sounds. What best describes a normal finding?

A) S2 is heard best at the second intercostal space to the right of the sternum.

B) S2 is heard equally at all areas across the precordium and apex.

C) S1 usually disappears after 25 to 35 years of age.

D) S3 is caused by retrograde blood flow though an incompetent valve.

A

A

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27
Q

A patient has been determined to have a new heart murmur. The best description of the cause of a cardiac murmur is what?

A) The patient had rheumatic heart disease as a child.

B) A murmur is caused by the flow of blood through a narrow or incompetent valve or septum.

C) A murmur indicates a ruptured ventricular septum from myocardial disease or infarction.

D) A murmur occurs normally secondary to turbulent blood flow in children and young adults.

A

B

28
Q

The patient is to undergo a diagnostic electrophysiology study. The nurse should tell the patient and family that the purpose of this study is what?

A) Identify blockages of coronary arteries.

B) Measure volumes and pressures in cardiac chambers.

C) Evaluate the efficacy of antiarrhythmic drugs and devices.

D) Evaluate patient response to pharmacologically elevated heart rates.

A

C

29
Q

The patient is undergoing an echocardiogram for diagnosis of cardiac valve dysfunction. What factor is most likely to result in an accurate echocardiogram?

A) The patient has chronic obstructive pulmonary disease (COPD).

B) The technologist performing the test is very experienced.

C) The patient is very obese, with large pendulous breasts.

D) The echocardiogram machine is several years old.

A

B

30
Q

The nurse is caring for a patient using a 5-lead continuous cardiac monitor system. To monitor lead V6, where does the nurse place the chest electrode?

A) Fourth intercostal space on right sternal border

B) Right shoulder on muscle tissue close to bone

C) Left shoulder on muscle tissue close to bone

D) Fifth intercostal space on left mid-axillary line

A

D

31
Q

The nurse is applying electrodes to the patients chest for use in continuous cardiac rhythm monitoring. When applying these electrodes, what placement will the nurse use to ensure maximum accuracy?

A) In the fold beneath the breast tissue

B) Directly over the clavicle

C) In the intercostal spaces

D) Over the clavicle/humerus joint

A

C

32
Q

A patient is on continuous cardiac rhythm monitoring. The nurse notices that the low-rate alarm is sounding frequently. What nursing action takes the highest priority?

A) Assess monitor alarm limits for appropriate setting.

B) Check contact with skin for all electrodes.

C) Assess patients level of consciousness and vital signs.

D) Check connections between lead wires and electrodes.

A

C

33
Q

The nurse is using the cardiac monitor tracing to evaluate cardiac function. The QRS interval is 0.14 seconds in width. How does the nurse interpret this finding?

A) Normal rate and rhythm

B) Slowed conduction through the atria

C) Left ventricular bundle branch block

D) Slowed ventricular depolarization

A

D

34
Q

A patient in the CCU is suspected of having coronary artery disease (CAD) following myocardial infarction. Which blood test or tests would be most pertinent in evaluating this patients condition? Select all that apply.

A) Red blood cell count

B) Low-density lipoproteins

C) Prothrombin time

D) Triglycerides

E) White blood cell count

F) High-density lipoproteins

A

D B F

35
Q

A patient in the CCU is suspected to have had a myocardial infarction. His blood work results have arrived, and the nurse is reviewing them. Which results would indicate myocardial infarction? Select all that apply.

A) Elevated troponins

B) CK-MB isoenzyme at 10% of total creatine kinase

C) C-reactive protein serum value of 6 mg/dL

D) Decreased levels of D-dimer

A

A B C

36
Q

A patient is being discharged from the CCU, and the cardiologist would like to monitor her cardiac activity over the coming month. This patient typically experiences infrequent dysrhythmias and is willing to wear electrodes, carry a recorder, and keep a diary. Which type of cardiac monitoring would be most appropriate for this patient?

A) Holter monitoring

B) Event (continuous loop) monitoring

C) Implantable loop monitoring

D) Signal-averaged electrocardiography

A

B

37
Q

A patient in the CCU must perform exercise stress testing. Which of the following would be the most appropriate intervention for the nurse to make in preparing the patient for this test?

A) Provide the patient with a cup of coffee to help him be alert during the testing.

B) Continue the patient on beta blockers throughout the test.

C) Explain to the patient that he may have to continue exercising after angina develops.

D) Feed the patient an hour before the test so that he has plenty of energy.

A

C

38
Q

A patient in the CCU will undergo a diagnostic electrophysiology study. Which complication should the nurse monitor for during this procedure?

A) Bleeding

B) Vascular damage

C) Lethal dysrhythmias

D) Cardiac arrest

A

A

39
Q

A nurse in the CCU must assess a patients cardiac rhythm strip. Which of the following represents the first three steps in this assessment in correct order?

A) Look for P waves, measure the PR interval, evaluate the QRS interval.

B) Evaluate the QRS complex, examine the ST segment, identify the rhythm.

C) Determine atrial and ventricular heart rates, examine the rhythm to see if it is regular, look for P waves.

D) Look for P waves, examine the rhythm to see if it is regular, determine atrial and ventricular heart rates.

A

C

40
Q

A patient in the CCU who is undergoing ECG monitoring has impulses originating at the sinoatrial node at a rate of 75 bpm, a shortest RR interval of 0.69 seconds, and a longest

RR interval of 0.84 seconds. The P wave is regular. Which sinus rhythm does this patient exhibit?

A) Sinus tachycardia

B) Sinus bradycardia

C) Sinus dysrhythmia

D) Sinus arrest

A

C

41
Q

A patient in the CCU has been found on examination by ECG to have a bundle branch block. Which of the following should the nurse expect to see on this patients ECG?

A) Tall, pointed P waves in leads II, III, and aVF

B) Broad, notched P waves in leads I, II, and aVL

C) A tall R wave in V1 and progressively smaller R waves through V6

D) A broad QRS complex with two peaks (RSR)

A

D

42
Q

A patient in the CCU exhibits a tall, narrow, and peaked T wave on ECG. The nurse recognizes that this is most likely an early sign of which of the following?

A) Hypokalemia

B) Hyperkalemia

C) Hypocalcemia

D) Hypercalcemia

A

B

43
Q

A patient in the CCU is undergoing arterial pressure monitoring, and the bedside physiological monitor alarm sounds. Which of the following should the nurse do? Select all that apply.

A) Check to see whether the catheter is kinked.

B) Check to see whether the stopcocks are turned the wrong way.

C) Add IV solution through the arterial pressure monitoring system.

D) Make sure that there is sufficient pressure in the pressure bag.

A

A B D

44
Q

The nurse is working with a patient with suspected acute renal failure. Which of the assessments would provide accurate information about this patients fluid balance? Select all that apply.

A) Daily measure of patients weight at the same time, using same scale

B) Monitoring of intake and output every 1 to 2 hours

C) Monitoring of blood sugar levels hourly

D) Taking x-rays of the kidneys weekly

A

A B

45
Q

A nurse is assessing a patient with acute renal failure for pitting edema. She gently presses her finger into the edematous area on the patients foot. She measures an indention of 8 mm, which slowly returns to baseline after about 3 minutes. Which level of pitting edema does this patient exhibit?

A) 4+ (severe)

B) 3+ (moderate)

C) 2+ (mild)

D) 1+ (trace)

A

A

46
Q

A nurse has just received a clean-catch urine sample from the patient and is about to deliver it to the laboratory for analysis. She observes that it is dark yellow, has a cloudy or turbid appearance, and has an ammonia odor. Which of the following does the nurse suspect about the patients condition based on her observations? Select all that apply.

A) The patient is diabetic.

B) The patient has above-normal creatinine clearance.

C) The patient is dehydrated.

D) The patient has proteinuria.

E) The patient has intrarenal hemorrhaging.

F) The patient has a renal infection

A

C F

47
Q

On auscultating the patients heart, the nurse hears a third heart sound. What condition would this finding be most indicative of?

A) Renal artery stenosis

B) A faulty stethoscope

C) Hypotension

D) Fluid overload

A

D

48
Q

A nurse is examining a patient on dialysis. Which of the following should she especially look for in this patient?

A) The presence of a third heart sound

B) Pitting edema

C) Inflammation or infection near the access site

D) Crackles on auscultation of lungs

A

C

49
Q

A patient in the ICU is found to have a steady glomerular filtration rate (GFR) of 180 L/day. Over the first 3 days following admission, his urine volume averages 1 L per day. On the fourth day, however, his urine volume drops to almost zero, while his GFR remains constant. The nurse recognizes that which of the following is the most likely explanation of this phenomenon?

A) Chronic kidney disease

B) Abdominal compartment syndrome

C) Renal artery stenosis

D) Pulmonary edema

A

B

50
Q

An elderly woman in the ICU has an indwelling urinary catheter and is being treated for a myocardial infarction. She is diabetic but is in the habit of having several glasses of orange juice each day. Her lab test results show that her urinary pH is 7.6. The nurse should suspect which of the following factors as the cause of the elevated pH level?

A) A urinary tract infection

B) Ketoacidosis caused by untreated diabetes

C) Consumption of acidic foods

D) Dehydration

A

A

51
Q

A patients lab results include a finding of glucose in the urine (glycosuria). What other lab result should the nurse expect in this patient?

A) Decreased ketones in the urine

B) Alkaline urinary pH

C) Elevated blood glucose

D) Decreased urine volume

A

C

52
Q

A patient in the ICU with chronic renal disease has just received his lab results. The nurse knows that one of the first functions to be lost in renal disease is the ability to concentrate urine. Which of the following lab results would indicate this loss of ability to concentrate the urine?

A) A specific gravity of urine that varies between 1.001 and 1.022, depending on the patients water balance

B) Urine osmolality fixed within 150 mOsm of the simultaneously determined serum osmolality

C) Urinary pH of 6.0

D) Urine volume of 1 L/day

A

B

53
Q

A patient in the ICU is severely dehydrated. Which of the following findings would the nurse expect in this patient?

A) Orthostatic hypotension on standing

B) Third heart sound

C) Pitting edema

D) Rales

A

A

54
Q

The patient is being evaluated for renal disease. During the initial patient history, what system should the nurse focus on in addition to the renal system?

A) Pulmonary and cardiac

B) Neurologic and integumentary

C) Psychological and social support

D) All physical and other systems

A

D

55
Q

A patient with chronic kidney disease has a low body temperature. What is the best nursing response to this finding?

A) Assess for signs of sepsis.

B) Provide extra blankets.

C) Give warm intravenous fluids.

D) Reassess with a different thermometer.

A

B

56
Q

During a routine physical examination, the nurse palpates the patients left kidney just below the costal margins on the posterior aspect of the trunk. What is the most appropriate nursing action?

A) Document this normal finding.

B) Obtain an order for renal diagnostics.

C) Assess for toxic ingestion.

D) Evaluate coagulation studies

A

B

57
Q

During physical examination of an ambulatory patient, the nurse finds elevated blood pressure, pulmonary crackles that do not clear with cough, jugular venous distention, liver congestion and enlargement, an S3 heart sound, and pitting edema of the feet and lower legs. What is the most likely cause of this group of findings?

A) Fluid volume deficit

B) Fluid volume excess

C) Hyponatremia

D) Leukocytosis

A

B

58
Q

A patient has had an arteriovenous graft inserted for dialysis. What nursing physical examination finding indicates patency of the graft?

A) Auscultation of a bruit over the renal artery

B) Palpation of a thrill over the graft

C) Distal pulses are 3+ to palpation

D) Blood pressure within normal limits

A

B

59
Q

A patient with renal impairment is found to have a positive Chvosteks sign. What additional information should the nurse assess for?

A) Hyperkalemia

B) Hyponatremia

C) Hypocalcemia

D) Hypermagnesemia

A

C

60
Q

The patients urinalysis shows proteinuria. What is the significance of this finding?

A) Normal in late pregnancy

B) Intrarenal acute renal failure

C) Diminished glomerular filtration rate

D) Compromised erythropoietin production

A

B

61
Q

The nurse is caring for a patient who was run over by an automobile. The patient has hematuria on admission to the emergency department. What is the most likely cause of the hematuria?

A) Kidney trauma

B) Kidney stones

C) Prostatic disease

D) Toxic damage

A

A

62
Q

What laboratory value is most likely to indicate renal failure?

A) Elevated blood urea nitrogen (BUN)

B) Low hemoglobin and hematocrit

C) Elevated serum creatinine

D) Normal urine osmolarity

A

C

63
Q

A patient has significantly decreased creatinine clearance and an elevated serum creatinine. What does this value indicate to the nurse?

A) Improved renal function

B) Kidney damage from disease

C) Muscle wasting

D) Rhabdomyolysis

A

B

64
Q

After a renal biopsy, what symptom indicates a significant complication of this procedure?

A) Increasing hematuria

B) Increased urine volume

C) Heart rate 60 to 100

D) Mean arterial pressure 85

A

A

65
Q

The nurse is caring for a patient with renal disease and is monitoring fluid balance. What is the most accurate method for assessing fluid balance?

A) Daily weights at same time of day

B) Episodic intake and output totals

C) Heart rate trends

D) Jugular venous volume measurement

A

A

66
Q
A

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