Chapter 28 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition


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Chapter 28  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition



Complete Chapter Questions And Answers

Sample Questions


1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm?

  1. A)  Ventricular fibrillation (VF)
  2. B)  Ventricular tachycardia (VT)
  3. C)  Atrial fibrillation
  4. D)  Sinus bradycardia

Ans: C


In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.

2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?

  1. A)  Exposure to immunocompromised individuals
  2. B)  Future hospital admissions
  3. C)  Dental procedures
  4. D)  Live vaccinations

Ans: C


Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.

3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurse’s admission interview, the patient states that she takes over-the- counter “water pills” on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics?

  1. A)  Encourage the patient to drink at least 2 liters of fluid daily.
  2. B)  Increase the patient’s oral sodium intake.
  3. C)  Inform the care provider because diuretics are contraindicated.
  4. D)  Ensure that the patient’s fluid balance is monitored vigilantly.

Ans: C


Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware. Adjusting the patient’s sodium or fluid intake or fluid monitoring does not address this important contraindication.

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4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond?

  1. A)  Azathioprine decreases the risk of thrombus formation.
  2. B)  Azathioprine ensures adequate cardiac output.
  3. C)  Azathioprine increases the number of white blood cells.
  4. D)  Azathioprine minimizes rejection of the transplant.

Ans: D


After heart transplant, patients are constantly balancing the risk of rejection with the risk of infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf), azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.

5. A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs?

  1. A)  Enoxaparin (Lovenox)
  2. B)  Metoprolol (Lopressor)
  3. C)  Azathioprine (Imuran)
  4. D)  Amoxicillin (Amoxil)

Ans: D


Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high- risk patients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.

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6. A patient with pericarditis has just been admitted to the CCU. The nurse planning the patient’s care should prioritize what nursing diagnosis?

  1. A)  Anxiety related to pericarditis
  2. B)  Acute pain related to pericarditis
  3. C)  Ineffective tissue perfusion related to pericarditis
  4. D)  Ineffective breathing pattern related to pericarditis

Ans: B


The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Anxiety is highly plausible and should be addressed, but chest pain is a nearly certain accompaniment to the disease. Breathing and tissue perfusion are likely to be at risk, but pain is certain, especially in the early stages of treatment.

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