Nokea
The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patients stroke volume. The nurse recognizes that afterload is increased when there is what?
- A. Arterial vasoconstriction
- B. Venous vasoconstriction
- C. Arterial vasodilation
- D. Venous vasodilation
Correct Answer: A
Rationale: Arterial vasoconstriction increases the systemic vascular resistance, which increases the afterload. Venous vasoconstriction decreases preload thereby decreasing stroke volume. Venous vasodilation increases preload.
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A nurse is preparing a patient for scheduled transesophageal echocardiography. What action should the nurse perform?
- A. Instruct the patient to drink 1 liter of water before the test
- B. Administer IV benzodiazepines and opioids
- C. Inform the patient that she will remain on bed rest following the procedure
- D. Inform the patient that an access line will be initiated in her femoral artery
Correct Answer: C
Rationale: During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees. The patient must be NPO 6 hours preprocedure. The patient is sedated to make him or her comfortable, but will not be heavily sedated, and opioids are not necessary. Also, the patient will have a peripheral IV line initiated preprocedure.
The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is 122/76 mm Hg, what is the patients pulse pressure?
- A. 46 mm Hg
- B. 99 mm Hg
- C. 198 mm Hg
- D. 76 mm Hg
Correct Answer: A
Rationale: Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg (122 - 76 = 46).
The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult?
- A. Decreased left ventricular ejection time
- B. Decreased connective tissue in the SA and AV nodes and bundle branches
- C. Thinning and flaccidity of the cardiac valves
- D. Widening of the aorta
Correct Answer: D
Rationale: Changes in cardiac structure and function are clearly observable in the aging heart. Aging results in decreased elasticity and widening of the aorta, thickening and rigidity of the cardiac valves, increased connective tissue in the SA and AV nodes and bundle branches, and an increased left ventricular ejection time (prolonged systole).
When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply.
- A. A transducer
- B. A flush system
- C. A leveler
- D. A pressure bag
- E. An oscillator
Correct Answer: A,B,D
Rationale: To perform hemodynamic monitoring, a CVP, pulmonary artery, or arterial catheter is introduced into the appropriate blood vessel or heart chamber. It is connected to a pressure monitoring system that has several components. Included among these are a transducer, a flush system, and a pressure bag. A pressure monitoring system does not have a leveler or an oscillator.
The nurses assessment of an older adult client reveals the following data: Lying BP 144/82 mm Hg; sitting BP 121/69 mm Hg; standing BP 98/56 mm Hg. The nurse should consequently identify what nursing diagnosis in the patients plan of care?
- A. Risk for ineffective breathing pattern related to hypotension
- B. Risk for falls related to orthostatic hypotension
- C. Risk for ineffective role performance related to hypotension
- D. Risk for imbalanced fluid balance related to hemodynamic variability
Correct Answer: B
Rationale: Orthostatic hypotension creates a significant risk for falls due to the dizziness and lightheadedness that accompanies it. It does not normally affect breathing or fluid balance. The patients ability to perform normal roles may be affected, but the risk for falls is the most significant threat to safety.