Chapter 35: Cardiac Disorders MULTIPLE CHOICE 1. The nurse performs an apical-radial pulse evaluation, with the result of 100/88. This pulse deficit assessment is: 1. 12. 2. 24. 3. 76. 4. 88. ANS: 1 To detect an apical radial pulse deficit, the rates should be counted simultaneously and com-pared for differences. If there is a difference between the apical rate and radial rate, a pulse deficit is present. For example, in atrial fibrillation, a pulse deficit exists. PTS: 1 DIF: Cognitive Level: Application REF: 633 OBJ: 1 TOP: Vital Sign Assessment: Pulse Deficit KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. The nurse explains that hypertension increases the work of the heart because of increasing: 1. preload. 2. stroke volume. 3. contractility. 4. afterload. ANS: 4 An increase blood pressure creates an increase in afterload because the heart must work harder to push the blood out of the left ventricle into the circulating volume. PTS: 1 DIF: Cognitive Level: Analysis REF: 631 OBJ: 7 TOP: Hypertension Effect on Afterload KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 3. The heart sound the nurse would record as normal would be: 1. ventricular gallop in a 20-year-old. 2. atrial gallop in a 25-year-old. 3. friction rub in a 45-year-old. 4. medium diastolic murmur in a 50-year-old. ANS: 1 Ventricular gallops are considered normal in persons under 30. All other options are patho-logic. PTS: 1 DIF: Cognitive Level: Application REF: 633 OBJ: 7 TOP: Heart Sound Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
4. A 49-year-old patient has multiple risk factors for coronary artery disease. A modifiable risk factor that the patient can focus on is: 1. family history. 2. age. 3. smoking. 4. male gender. ANS: 3 Smoking, a high-fat diet, hypertension, sedentary lifestyle, and stress are considered modifi-able risk factors. PTS: 1 DIF: Cognitive Level: Application REF: 632 and 653, Health Promotion Considerations OBJ: 7 TOP: Coronary Artery Disease Risk Factors KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. When the patient asks what a TEE is and what it is expected to do, the nurse explains that the TEE is a transesophageal echocardiogram, which: 1. measures conductivity. 2. records force of contraction. 3. evaluates efficiency of the valves. 4. checks volume of the preload. ANS: 3 A TEE evaluates the valve efficiency. PTS: 1 DIF: Cognitive Level: Application REF: 635, Diagnostic Tests and Procedures table, and 637 OBJ: 6 TOP: TEE KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 6. The nurse records the finding of normal sinus rhythm (NSR) when the P, Q, R, S, and T are all present in the electrocardiographic complex and a(an): 1. rate of 82.
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