Chapter 37 Circulation

Chapter 37  Circulation

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A patient diagnosed with hypertension is taking an angiotensin-converting enzyme (ACE) inhibitor. When planning care, which of the following outcomes would be appropriate for the patient?
a)
BP will be lower than 135/85 on all occasions.
b)
BP will be normal after 2 to 3 weeks on medication.
c)
Patient will not experience dizziness on rising.
d)
Urine output will increase to at least 50 mL/hr.

ANS: A
Goals must be clearly stated so that it is easy to evaluate whether they have been met. “BP . . . lower than 135/85 . . .” is clearly stated and easily evaluated. In contrast, “BP will be normal . . .” does not clearly state the desired endpoint. Freedom from dizziness on rising is probably not achievable because ACE inhibitors are vasodilating agents, which may cause vessel dilation and hypotension, especially when the patient arises from a seated or lying position. Patients should be warned of this effect. The expected/desired effect of the ACE inhibitor is to lower the blood pressure; the urine output is minimally relevant in determining that outcome, if at all.

Difficulty: Difficult
Nursing Process: Planning
Client Need: PHSI
Cognitive Level: Application

PTS: 1

2. You are preparing the nursing care plan for a middle-aged patient admitted to the intensive care unit for an acute myocardial infarction (heart attack). His symptoms include tachycardia, palpitations, anxiety, jugular vein distention, and fatigue. Which of the following nursing diagnoses is most appropriate?
a)
Decreased Cardiac Output
b)
Impaired Tissue Perfusion
c)
Impaired Cardiac Contractility
d)
Impaired Activity Tolerance

ANS: A
The patient’s symptoms reflect altered cardiac preload, a component of cardiac output. Acute myocardial infarction is often associated with decreased cardiac output as a result of altered cardiac pumping ability. Although the other nursing diagnoses might be associated with Decreased Cardiac Output, these diagnoses cannot be determined from the symptoms presented. Additionally, Impaired Cardiac Contractility is not a NANDA-I nursing diagnosis.

Difficulty: Difficult
Nursing Process: Diagnosis
Client Need: PHSI
Cognitive Level: Analysis

PTS: 1

3. Chronic stress may lead directly to cardiovascular disease because of the repeated release of which of the following?
a)
Histamine
b)
Catecholamines
c)
Cortisol
d)
Protease

ANS: B
The stress response stimulates release of catecholamines from the sympathetic nervous system. This results in increased heart rate and contractility, vasoconstriction, and increased tendency of blood to clot. Cortisol is also released in the stress response, but it is more indirectly related to development of cardiovascular disease through altered glucose, fat, and protein metabolism.

Difficulty: Moderate
Nursing Process: Assessment
Client Need: HPM
Cognitive Level: Knowledge

PTS: 1

4. The nurse is teaching a pregnant woman about the increased oxygen demand that develops during pregnancy. The nurse knows the patient comprehends the teaching when she makes the following statement:
a)
“I may need to drink more fluids to make more oxygen.”
b)
“I may need to take an iron supplement so that I am not anemic.”
c)
“I will need a multivitamin supplement for several months.”
d)
“I will need to eat more fruits and vegetables.”

ANS: B
During pregnancy, oxygen demand increases dramatically. To compensate, the mother’s blood volume increases by 30%. The woman requires additional iron to produce this blood as well as to meet fetal requirements. Failure to meet these iron demands can result in maternal anemia, reducing tissue oxygenation of the mother.

Difficulty: Moderate
Nursing Process: Evaluation
Client Need: HPM
Cognitive Level: Application

PTS: 1

5. Three days ago, a patient had cardiac surgery to bypass three occlusions of his coronary arteries. Veins for the bypass were harvested from his right leg. He informs the nurse that his leg is warm and tender in his right calf. The nurse notes a 3-cm periwound erythema and swelling at the distal end of the incision. Staples are intact along the incision, and there is no drainage. Vital signs are stable. The nurse would suspect that the patient has what kind of complication?
a)
Deep vein thrombosis
b)
Dehiscence of the wound
c)
Internal bleeding
d)
Infection at the incisional site

ANS: A
Deep vein thrombosis (DVT) is a clot in the veins that are deep under the muscles of the leg. DVT can occur after surgery, after lengthy bedrest, or after trauma. Symptoms include pain, warmth, redness, and swelling of the leg. Dorsiflexion of the foot (pulling toes forward) and Pratt’s sign (squeezing calf to trigger pain) have not been found to be reliable in diagnosing DVT. Dehiscence is the rupture of a suture line, whereas evisceration is the protrusion of internal organs through the rupture. Internal bleeding is a wound-healing complication associated with hematoma formation, pain, hypotension, and tachycardia. Infection is a complication of wound healing that causes warmth, pain, inflammation of the affected area, and changes in vital signs (i.e., elevated pulse and temperature).

Difficulty: Moderate
Nursing Process: Assessment
Client Need: PHSI
Cognitive Level: Application

PTS: 1