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Med Surge Ch. 31: Cardiac Disorders
NCLEX Questions and Answers
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A patient with heart failure has an ejection fraction of 25%. What does this information indicate to the nurse about the patient's health status?
- Ventricular function is severely impaired
- Cardiac output is greater than normal, which overtaxes the heart
- The amount of blood being ejected from the ventricles is within normal limits
- Twenty-five percent of the blood entering the ventricle remains in the ventricle after systole ✔✔1. Normal ejection fraction is 60%. An ejection fraction of 25% indicates severe impairment
of ventricular function; CO is decreased.
A patient admitted 24 hours ago previously with heart failure has lost 1 kg of weight, has a heart rate of 88, which was 105 on admission, and now has crackles only in the bases of the lungs. How should the nurse interpret these assessment findings?
- More aggressive treatment is needed
- The patient's condition unchanged from admissions
- The treatment regimen is achieving the desired effect
- No further treatment is required at this time because the failure has resolved ✔✔3. The main
goals for care of heart failure are to slow its progression, reduce cardiac workload, improve cardiac function, and control fluid retention. A weight loss of 1 kg and crackles in the lung bases indicate control of fluid retention. A HR of 88 indicates reduced cardiac workload and improved cardiac function. The patient's condition has improved since admission. Because the patient continues to have crackles in the lungs, heart failure has not completely resolved.
A patient is diagnosed with left ventricular failure. Which findings should the nurse recognize as being consistent with this diagnosis? (Select all that apply)
- Fatigue
- Substernal chest pain during exercise
- cm jugular vein distention at 30 degrees
- Bilateral inspiratory crackles to midscapulae
- Complaints of shortness of breath with minimal exertion ✔✔1,4,
In left ventricular failure, the CO falls and pressure in the pulmonary vascular system increases. Fatigue is a common early manifestation. Pulmonary congestion causes shortness of breath with minimal exertion. On auscultation of the lungs, inspiratory crackles may be heard in the lung
A patient experiencing acute pulmonary edema is prescribed morphine sulfate 2-5 mg IV as needed for pain and dyspnea. What action should the nurse take with this prescribed medication?
- Administer the drug as ordered, monitoring respiratory status
- Withhold the drug until the patient's respiratory status improves
- Questions the order because no time intervals have been specified
- Administer the drug only when the patient complains of chest pain ✔✔1. Morphine is
administered IV to relieve anxiety and improve the efficacy of breathing. It also is a vasodilator that reduces venous return and lowers left atrial pressure. The nurse should provide the medication and monitor the patient's respiratory status. The medication should not be withheld to wit for the patient's respiratory status to improve. The medication order is correct as written and does not need to be questioned. The medication is not being used to treat chest pain.
The nurse notes a grating heart sound when auscultating the apical pulse of a patient with pericarditis. What should the nurse do with this assessment data?
- Obtain an ECG
- Initiate resuscitation measures
- Immediately notify the physician
- Note the finding in the patient's medical record ✔✔4. A pericardial friction rub, a grating
sound, is a characteristic sign of pericarditis so it is expected, but should be documented in the patient's record. An electrocardiogram is not needed after auscultating this sound. The patient does not need to be resuscitated.
The nurse is planning care for a patient with acute infective endocarditis. What would be an appropriate goal of nursing care for this patient?
- Resume usual activities within 1 week of treatment
- Relate the benign and self-limiting nature of the disease
- Consider cardiac transplantation as a viable treatment option
- State the importance of continuing IV antibiotic therapy as ordered ✔✔4. Antibiotic therapy
effectively treats infective endocarditis in most cases. The goal of therapy is to eradicate the infecting organism from the blood and vegetative lesions in the heart. Since microorganisms may have a fibrin covering that protects them from antibiotic therapy, an extended course of multiple IV antibiotics is required.
The nurse is assessing heart sounds of a patient scheduled for mitral valve replacement surgery. Which sound should the nurse expect to auscultate in this patient?
The parents of a young athlete who collapsed and dies due to hypertrophic cardiomyopathy ask how it is possible that their son had no symptoms of this disorder before experiencing sudden cardiac death. How should the nurse respond to the parents?
- It is likely that your son had symptoms of the disorder before he died, but he may not have thought them important enough to tell someone about.
- In this type of cardiomyopathy, the ventricle does not fill normally. During exercise, heart may not be able to meet the body's needs for blood and oxygen
- Cardiomyopathy results in destruction and scarring of cardiac muscle cells. As a result, the ventricle may rupture during strenuous exercise, leading to sudden death
- Exercise causes the heart to contract more forcefully, and can lead to changes in the heart's rhythm or the outflow of blood from the heart in people with hypertrophic cardiomyopathy.
✔✔4. In hypertrophic cardiomyopathy, manifestations may not develop l the demand for oxygen
increases, such as with athletes during activity, causing sudden death due to a ventricular dysrythmia. Hypertrophic cardiomyopathy is characterized by eased compliance of the left ventricle and hypertrophy of the ventricle muscle mass. This impairs ventricular filling, leading to small end-diastolic volumes and low cardiac output. It may be asymptomatic for many years, but symptoms typically occur when increased oxygen demand causes increased ventricular contractility. They may develop suddenly during or after physical activity; in children and young adults, sudden cardiac death may be the first sign of the disorder. This type of cardiomyopathy does not lead to ventricle rupture during exercise.
