Nokea
The nurse is treating a patient who had a pacemaker inserted 8 years ago for the correction of atrial fibrillation. Which diagnostic test may no longer be available to the patient because of this older model implanted device?
- A. MRI
- B. CT scan
- C. Thallium scan
- D. PET
Correct Answer: A
Rationale: Patients who have pacemakers placed in the last several years can have MRI testing without difficulty. A model that has been in place for some time might be affected by the large magnets in the MRI cabinet. In either case, the patient should always report the use of a pacemaker before having an MRI.
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A patient with atrial fibrillation may experience decreased cardiac output, due to
Correct Answer: Incomplete ventricular filling
Rationale: Since the atria quiver, rather than contract, the normal atrial kick is lost, leading to a decrease in the cardiac output.
The nurse caring for a patient recovering from a myocardial infarction (MI) administers stool softeners for which reason?
- A. Prevent enema dependence in the hospitalized patient
- B. Prevent fecal impactions which can lead to bowel obstruction
- C. Stool softeners reduce the need for laxatives once the patient is discharged
- D. Reduce the necessity to strain at the stool to lessen the effect of Valsalva's maneuver
Correct Answer: D
Rationale: Stool softeners will lessen the severity of straining and will decrease the effect of the Valsalva's maneuver on intrathoracic pressure.
The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient makes which statement?
- A. I can ambulate in the hallway with this gadget on.'
- B. I always take off the telemetry device when I shower.'
- C. My EKG is being watched by one of the nurses in CCU on the home unit.'
- D. I am able to sleep just fine with this device on.'
Correct Answer: B
Rationale: Remote telemetry allows the patient to be on a separate unit, but be monitored in a central location. The patients can be ambulatory and can sleep with the monitor on. They should not remove the monitor to shower.
The nurse would assess closely for which sign of right-sided heart failure?
- A. cough.
- B. increasing abdominal girth.
- C. shortness of breath.
- D. edema of feet and ankles.
- E. distended jugular veins.
- F. orthopnea.
Correct Answer: B,D,E
Rationale: Indicators of right-sided heart failure are distended jugular veins, anorexia, abdominal distention from ascites, liver enlargement with right upper quadrant pain, and edema of feet and ankles.
During a health interview by the home health nurse, which patient report suggests left-sided heart failure?
- A. I have to sleep in my recliner and I have this hacking cough.'
- B. I have no appetite and I have lost $3 \mathrm{lb}$ in the last week.'
- C. I have to urinate every 2 hours, even during the night.'
- D. I go barefoot most of the time because my feet are so hot.'
Correct Answer: A
Rationale: Left ventricular failure is often among the first of signs and symptoms of decreased cardiac output. The second is pulmonary congestion. Signs and symptoms of this condition include dyspnea, orthopnea, pulmonary crackles, hemoptysis, and cough.