NUR 417 Exam 1 (Module 1-4) | Answered with Rationales
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Module
NUR 417
Institution
NUR 417
NUR 417 Exam 1 (Module 1-4) | Answered with Rationales An older adult patient who has just arrived in the emergency department has a pulse deficit of 46 beats. Which intervention would the nurse anticipate for this patient? 1. Cardiac catheterization 2. Hourly blood pressure checks 3. Electrocar...
An older adult patient who has just arrived in the emergency department has a pulse
deficit of 46 beats. Which intervention would the nurse anticipate for this patient?
Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It
indicates that there may be a cardiac dysrhythmia that would best be detected with
ECG monitoring. Frequent BP monitoring, cardiac catheterization, and emergent
cardioversion are used for diagnosis and/or treatment of cardiovascular disorders but
would not be as helpful in determining the immediate reason for the pulse deficit.
How would the nurse listen to auscultate for S3 or S4 gallops in the mitral area?
1. Use the diaphragm of the stethoscope with the patient lying flat.
2. Use the bell of the stethoscope with the patient in the left lateral position.
3. Use the diaphragm of the stethoscope with the patient in a supine position.
4. Use the bell of the stethoscope with the patient sitting and leaning forward.
Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of
the stethoscope. Sounds associated with the mitral valve are accentuated by turning the
patient to the left side, which brings the heart closer to the chest wall. The diaphragm of
the stethoscope is best to use for the higher pitched sounds such as S1 and S2.
A patient is being treated for heart failure. Which laboratory test result will the nurse
review to determine the effects of the treatment?
Levels of BNP are a marker for heart failure. The other laboratory results would assess
for myocardial infarction (troponin) or the risk for coronary artery disease (Hcy and
LDL).
A patient is scheduled for a cardiac catheterization with coronary angiography. What
information would the nurse provide before the procedure?
,1. It will be important not to move at all during the procedure.
2. A flushed feeling is common when the contrast dye is injected.
3. Monitored anesthesia care will be provided during the procedure.
4. Arterial pressure monitoring will be needed for 24 hours after the test.
A sensation of warmth or flushing is common when the contrast material is injected,
which can be anxiety producing unless it has been discussed with the patient. The
patient may receive a sedative drug before the procedure but monitored anesthesia
care is not used. Arterial pressure monitoring is not routinely used after the procedure to
monitor blood pressure. The patient is not immobile during cardiac catheterization and
may be asked to cough or take deep breaths.
A patient will be evaluated for rhythm disturbances with a Holter monitor. Which
instruction would the nurse provide?
1. Connect the recorder to a computer once daily.
2. Exercise more than usual while the monitor is in place.
3. Remove the electrodes when taking a shower or tub bath.
4. Keep a diary of daily activities while the monitor is worn.
The patient is taught to keep a diary describing daily activities while Holter monitoring is
being accomplished to help correlate any rhythm disturbances with patient activities.
Patients are taught that they should not take a shower or bath during Holter monitoring
and that they should continue with their usual daily activities. The recorder stores the
information about the patient's rhythm until the end of the testing, when it is removed
and the data are analyzed.
How would the nurse document a loud humming sound auscultated over the patient's
abdominal aorta?
1. Thrill
2. Bruit
3. Murmur
4. Normal finding
A bruit is the sound created by turbulent blood flow in an artery. Auscultating a bruit in
an artery is not normal and indicates pathology. Thrills are palpable vibrations felt when
there is turbulent blood flow through the heart or in a blood vessel. A murmur is the
sound caused by turbulent blood flow through the heart.
The standard policy on the cardiac unit states, "Notify the health care provider for mean
arterial pressure (MAP) less than 70 mm Hg." Which patient's status would the nurse
report to the health care provider?
1. Postoperative patient with a BP of 116/42 mm Hg.
, 2. Newly admitted patient with a BP of 150/87 mm Hg.
3. Patient with left ventricular failure who has a BP of 110/70 mm Hg.
4. Patient with a myocardial infarction who has a BP of 140/86 mm Hg.
The mean arterial pressure (MAP) is calculated using the formula MAP = (systolic BP +
2 diastolic BP)/3. The MAP for the postoperative patient is 67. The MAP in the other
three patients is higher than 70 mm Hg.
The nurse is admitting a patient for a cardiac catheterization and coronary angiogram.
Which information is important for the nurse to communicate to the health care provider
before the test?
1. The patient's pedal pulses are +1.
2. The patient is allergic to contrast dye.
3. The patient had a heart attack 1 year ago.
4. The patient has not eaten anything today.
Patients who have allergies to contrast dye will require treatment with medications, such
as corticosteroids and antihistamines before the angiogram. The other information may
be communicated to the health care provider but will not require a change in the usual
pre-cardiac catheterization orders or medications.
The nurse is reviewing the laboratory results for newly admitted patients on the
cardiovascular unit. Which laboratory result is most important to communicate rapidly to
the health care provider?
1. High troponin I level
2. Increased triglyceride level
3. Very low homocysteine level
4. Elevated C-reactive protein level
The elevation in troponin I indicates that the patient has had an acute myocardial
infarction. Further assessment and interventions are indicated. The other laboratory
results indicate increased risk for coronary artery disease but are not associated with
acute cardiac problems that need immediate intervention.
Which hemodynamic parameter most directly reflects the effectiveness of drugs given to
reduce a patient's left ventricular afterload?
SVR reflects the resistance to left ventricular ejection, or afterload. Other parameters
may be monitored but do not reflect left-sided afterload as directly.
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