Nokea
If Mrs. Payer's pulmonary capillary wedge pressure (PCWP) is rising above normal values, this would indicate
- A. right ventricular failure
- B. hypovolemia
- C. left ventricular failure
- D. ventricular irritability
Correct Answer: C
Rationale: Elevated PCWP reflects left ventricular dysfunction.
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When teaching about methyldopa, it is important for the patient to know that it
- A. decreases cardiac output
- B. may produce mental confusion
- C. may produce drowsiness initially
- D. blocks the release of norepinephrine
Correct Answer: C
Rationale: Initial drowsiness is a common side effect of methyldopa.
The nurse is giving the client digoxin for heart failure and recognizes that the drug has what type of effect on the heart?
- A. Negative inotropic, negative chronotropic effect
- B. Positive inotropic, negative chronotropic effect
- C. Negative inotropic, positive chronotropic effect
- D. Positive inotropic, positive chronotropic effect
Correct Answer: B
Rationale: The correct answer is B: Positive inotropic, negative chronotropic effect. Digoxin is a positive inotrope, meaning it increases the force of myocardial contraction, which helps improve cardiac output in heart failure. It has a negative chronotropic effect, meaning it decreases the heart rate by slowing down the electrical conduction in the heart, which can be beneficial in certain heart conditions.
Choice A (Negative inotropic, negative chronotropic effect) is incorrect because digoxin is a positive inotrope, not a negative inotrope. Choice C (Negative inotropic, positive chronotropic effect) is incorrect because digoxin does not have a positive chronotropic effect. Choice D (Positive inotropic, positive chronotropic effect) is incorrect because digoxin has a negative chronotropic effect, not a positive one.
Therefore, the correct choice is B due to the combination of positive inotropic effect and negative chronotropic effect of digoxin on the heart
What term refers to the degree of myocardial fiber stretch before contraction, related to the volume of blood distending the ventricles at the end of diastole, and determined by the amount of venous return?
- A. Preload
- B. Afterload
- C. Contractility
- D. Ejection fraction
Correct Answer: A
Rationale: Rationale:
1. Preload refers to myocardial fiber stretch before contraction.
2. It is related to the volume of blood in ventricles at end of diastole.
3. Preload is determined by the amount of venous return to the heart.
4. It influences the force of contraction and stroke volume.
5. Afterload (B) is the resistance the heart must overcome to pump blood.
6. Contractility (C) is the intrinsic strength of the heart muscle.
7. Ejection fraction (D) is the percentage of blood ejected from ventricles.
Summary:
- Preload is correct as it specifically relates to fiber stretch and volume of blood.
- Afterload, contractility, and ejection fraction do not directly relate to ventricular volume and venous return.
During hemodynamic monitoring, the nurse finds that the patient has a decreased CO with unchanged pulmonary artery wedge pressures, HR, and SVR. The nurse identifies that the patient has a decrease in
- A. SV
- B. Preload
- C. Afterload
- D. Contractility
Correct Answer: D
Rationale: CO is dependent on the heart rate and stroke volume, and stroke volume is determined by preload, afterload and contractility. If CO is decreased and heart rate is unchanged, stroke volume is the variable factor.
What does the nurse teach the client who has had a mechanical valve placed?
- A. The PT must remain below 1.5 times the control value.
- B. The PTT must be higher than 2.5 times the control value.
- C. The INR must be maintained between 2.5 and 3.5 for anticoagulant monitoring
- D. The INR must be maintained below 2.5 for anticoagulant monitoring.
Correct Answer: C
Rationale: Mechanical valves require precise anticoagulation management, with an INR target range of 2.5-3.5 to prevent clotting.