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Lewis's Medical-Surgical Nursing, 11th Edition Chapter 31 - 37 Review Questions 2024-205 exam
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Lewis's Medical-Surgical Nursing, 11th Edition Chapter 31 - 37 Review Questions 2024-205 exam
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Lewis's Medical-Surgical Nursing, 11th Edition Chapter 31 - 37Review Questions 2024-205 exam
Which anatomic feature of the heart directly stimulates ventricular contractions?
SA node
AV node
Bundle of His
Purkinje fibers - answer>>>Purkinje fibers
Rationale:
The Purkinje fibers move the electrical impulse or action potential through the walls of both
ventricles triggering synchronized right and left ventricular contraction. The sinoatrial (SA) node
initiates the electrical impulse that results in atrial contraction. The atrioventricular (AV) node
receives the electrical impulse through internodal pathways. The bundle of His receives the
impulse from the AV node.
The patient with chronic heart failure is being discharged from the hospital. What information
should the nurse emphasize in the patient's discharge teaching to prevent progression of the
disease to acute decompensated heart failure (ADHF)?
Take medications as prescribed.
Use oxygen when feeling short of breath.
Direct questions only to the health care provider.
Encourage most activity in the morning when rested. - answer>>>Take medications as
prescribed.
Rationale:
The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking
the medications as prescribed along with nondrug therapies such as alternating activity with
rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will
probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients
are monitored by a care manager or in a transitional program to assess the patient for
medication effectiveness and monitor for patient deterioration and encourage the patient. This
,nurse manager can be asked questions or can contact the health care provider if there is
evidence of worsening HF.
An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes
dyspneic. Before dangling the patient on the bedside, what should the nurse assess first?
Urine output
Heart rhythm
Breath sounds
Blood pressure - answer>>>Blood pressure
Rationale:
The nurse should evaluate the blood pressure before dangling the patient on the bedside
because the blood pressure can decrease as blood pools in the periphery and preload
decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in
the semi-Fowler's position and use other measures to improve gas exchange.
Which aspect of the heart's action does the QRS complex on the ECG represent?
Depolarization of the atria
Repolarization of the ventricles
Depolarization from atrioventricular (AV) node throughout ventricles
The length of time it takes for the impulse to travel from the atria to the ventricles -
answer>>>Depolarization from atrioventricular (AV) node throughout ventricles
Rationale:
The QRS recorded on the ECG represents depolarization from the AV node throughout the
ventricles. The P wave represents depolarization of the atria. The T wave represents
repolarization of the ventricles. The interval between the PR and QRS represents the length of
time it takes for the impulse to travel from the atria to the ventricles.
,A patient with a long-standing history of heart failure recently qualified for hospice care. What
measure should the nurse now prioritize when providing care for this patient?
Taper the patient off his current medications.
Continue education for the patient and his family.
Pursue experimental therapies or surgical options.
Choose interventions to promote comfort and prevent suffering. - answer>>>Choose
interventions to promote comfort and prevent suffering.
Rationale:
The central focus of hospice care is the promotion of comfort and the prevention of suffering.
Patient education should continue, but providing comfort is paramount. Medications should be
continued unless they are not tolerated. Experimental therapies and surgeries are not used in
the care of hospice patients.
An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why
warfarin (Coumadin) has been prescribed to continue at home. What is the best response by
the nurse?
"The medication prevents blood clots from forming in your heart."
"The medication dissolves clots that develop in your coronary arteries."
"The medication reduces clotting by decreasing serum potassium levels."
"The medication increases your heart rate so that clots do not form in your heart." -
answer>>>"The medication prevents blood clots from forming in your heart."
Rationale:
Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway,
especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial
fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an
increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or
anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-
dependent clotting factors.
, The nurse is preparing to administer a nitroglycerin patch to a patient. When providing teaching
about the use of the patch, what should the nurse include?
Avoid drugs to treat erectile dysfunction.
Increase diet intake of high-potassium foods.
Take an over-the-counter H2-receptor blocker.
Avoid nonsteroidal antiinflammatory drugs (NSAIDS). - answer>>>Avoid drugs to treat erectile
dysfunction.
Rationale:
The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and
possibly death. NSAIDs do not pose a risk in combination with nitrates. There is no need to take
an H2-receptor blocker or increase the dietary intake of high-potassium foods.
What should the nurse recognize as an indication for the use of dopamine in the care of a
patient with heart failure?
Acute anxiety
Hypotension and tachycardia
Peripheral edema and weight gain
Paroxysmal nocturnal dyspnea (PND) - answer>>>Hypotension and tachycardia
Rationale:
Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe
heart failure accompanied by hemodynamic instability. Such a state may be indicated by
tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common
signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.
The nurse observes ventricular tachycardia (VT) on the patient's monitor. What evaluation
made by the nurse led to this interpretation?
Unmeasurable rate and rhythm
Rate 150 beats/min; inverted P wave
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