Chapter 27 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 27  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. The nurse is caring for a patient who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what?

  1. A)  Lipids and fibrous tissue
  2. B)  White blood cells
  3. C)  Lipoproteins
  4. D)  High-density cholesterol

Ans: A

Feedback:

As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls. These plaques do not consist of white cells, lipoproteins, or high-density cholesterol.

2. A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause?

  1. A)  Decreased cardiac output
  2. B)  Decreased cardiac contractility
  3. C)  Infarction of the myocardium
  4. D)  Coronary arteriosclerosis

Ans: D

Feedback:

In most cases, angina pectoris is due to arteriosclerosis. The disease is not a result of impaired cardiac output or contractility. Infarction may result from untreated angina, but it is not a cause of the disease.

3. The nurse is caring for an adult patient who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina?

  1. A)  Ineffective breathing pattern related to decreased cardiac output
  2. B)  Anxiety related to fear of death
  3. C)  Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)
  4. D)  Impaired skin integrity related to CAD

Ans: C

Feedback:

Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin integrity is not impaired by the effects of angina.

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4. The triage nurse in the ED assesses a 66-year-old male patient who presents to the ED with complaints of midsternal chest pain that has lasted for the last 5 hours. If the patient’s symptoms are due to an MI, what will have happened to the myocardium?

  1. A)  It may have developed an increased area of infarction during the time without treatment.
  2. B)  It will probably not have more damage than if he came in immediately.
  3. C)  It may be responsive to restoration of the area of dead cells with proper treatment.
  4. D)  It has been irreparably damaged, so immediate treatment is no longer necessary.

Ans: A

Feedback:

When the patient experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated, the more likely the treatment will prevent or minimize myocardial tissue necrosis. Delays in treatment equate with increased myocardial damage. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage. Dead cells cannot be restored by any means.

5. Family members bring a patient to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data?

  1. A)  The symptoms indicate angina and should be treated as such.
  2. B)  The symptoms indicate a pulmonary etiology rather than a cardiac etiology.
  3. C)  The symptoms indicate an acute coronary episode and should be treated as such.
  4. D)  Treatment should be determined pending the results of an exercise stress test.

Ans: C

Feedback:

Angina and MI have similar symptoms and are considered the same process, but are on different points along a continuum. That the patient’s symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.

6. An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what?

  1. A)  Brachial artery
  2. B)  Brachial vein
  3. C)  Femoral artery
  4. D)  Greater saphenous vein

Ans: D

Feedback:

The greater saphenous vein is the most commonly used graft site for CABG. The right and left internal mammary arteries, radial arteries, and gastroepiploic artery are other graft sites used, though not as frequently. The femoral artery, brachial artery, and brachial vein are never harvested.

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