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Text Mode – Text version of the exam 1. Which of the following procedures most specifically describes splitting or separating fused cardiac valve leaflets? 2. Which of the following mitral valve conditions generally produces no symptoms? 3. In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? 4. Which of the following patient behaviors, if observed by the nurse, would indicate that the cardiac patient’s level of anxiety has decreased? 5. The patient with which of the follow characteristics is considered high risk for the development of infective endocarditis? 6. Which of the following terms indicates the amount of blood pumped out of the ventricle with each contraction of the heart? 7. When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is measured, the measurement obtained is referred to as the 8. Which of the following medications is categorized as a loop diuretic? 9. When the nurse observes that the patient always has difficulty breathing when lying flat, the nurse records that the patient is demonstrating 10. The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? 11. A classic sign of cardiogenic shock is 12. Vasoactive drugs which cause the arteries and veins to dilate, thereby shunting much of the intravascular volume to the periphery and causing a reduction in preload and afterload include agents such as 13. Which of the following terms refers to a muscular, cramp-like pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? 14. Which of the following observations regarding ulcer formation on the patient’s lower extremity indicate to the nurse that the ulcer is a result of venous insufficiency? 15. A diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is termed 16. The nurse teaches the patient with peripheral vascular disease to refrain from smoking because nicotine causes 17. Which of the following types of aneurysms results in bleeding into the layers of the arterial wall? 18. Which of the following terms refers to enlarged, red, and tender lymph nodes? 19. Which of the following terms is given to hypertension in which the blood pressure, which is controlled with therapy, becomes uncontrolled (abnormally high) with the discontinuation of therapy? 20. Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. 21. The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? 22. Of the following diuretic medications, which conserves potassium? 23. Which of the following adrenergic inhibitors acts directly on the blood vessels, producing vasodilation? 24. Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets? 25. Which of the following terms refers to a form of white blood cell involved in immune response? 26. The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is 27. Of the following hemolytic anemias, which is categorized as inherited? 28. The antidote to heparin is 29. Which of the following terms describes a gastric secretion that combines with vitamin B-12 so that it can be absorbed? 30. When bowel sounds are heard about every 15 seconds, the nurse would record that the bowel sounds are 31. When gastric analysis testing reveals excess secretion of gastric acid, which of the following diagnoses is supported? 32. Which of the following terms is used to describe stone formation in a salivary gland, usually the submandibular gland? 33. Irritation of the lips associated with scaling, crust formation, and fissures is termed 34. Regarding oral cancer, the nurse provides health teaching to inform the patient that 35. The most common symptom of esophageal disease is 36. Halitosis and a sour taste in the mouth are signs and symptoms associated most directly with 37. Which of the following terms refers to the symptom of gastroesophageal reflux disease (GERD) which is characterized by a burning sensation in the esophagus? 38. The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the following measures to manage his disease? 39. Which of the following statements accurately describes cancer of the esophagus? 40. Which of the following venous access devices can be used for no more than 30 days in patients requiring parenteral nutrition? 41. To ensure patency of central venous line ports, dilute heparin flushes are used in which of the following situations? 42. For which of the following medications must the nurse contact the pharmacist in consultation when the patient receives all oral medications by feeding tube? 43. Medium -length nasoenteric tubes are used for: 44. Mercury is typically used in the placement of which of the following tubes? 45. The most significant nursing problem related to continuous tube feedings is 46. When the nurse prepares to give a bolus tube feeding to the patient and determines that the residual gastric content is 150 cc, her best action is to 47. If tube feeding is continuous, the placement of the feeding tube should be checked 48. Decrease in absorption of which of the following vitamins in the geriatric patient results in pernicious anemia? 49. Which of the following terms refers to tarry, black stools? 50. Which of the following statements accurately reflects a rule of thumb upon which the nurse may rely in assessing the patient’s fluid balance?Practice Mode
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Commisurotomy is frequently used for mitral stenosis.
Annuloplasty refers to repair of a cardiac valve’s outer ring.
Chordoplasty refers to repair of the chordae tendonae of atroventricular valve leaflets.
Valvuloplasty is a general term that refers to repair of a stenosed or regurgitant cardiac valve by commisurotomy, annuloplasty, leaflet repair, and/or chordoplasty.
Mitral valve prolpase is a deformity that usually produces no symptoms and has been diagnosed more frequently in recent years, probably as a result of improved diagnostic methods.
Mitral valve stenosis usually causes progressive fatigue.
Mitral valve regurgitation, in its acute stage, usually presents as severe heart failure.
Mitral valve infection, when acute, will produce symptoms typical of infective endocarditis.
Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling
Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue
Generally, when anxiety begins to increase, the patient will be less likely to want to discuss prognosis.
Open discussion generally indicates some degree of comfort with prognosis.
Verbalization of fears and concerns indicates some degree of comfort with prognosis.
Participation in support groups indicates some degree of comfort with prognosis.
The patient with mitral valve prolapse with valvular regurgitation is at moderate risk for the development of infective endocarditis.
The patient with hypertrophic cardiomyopathy is at moderate risk for the development of infective endocarditis.
The patient with acquired valvular dysfunction is at moderate risk for the development of infective endocarditis.
Stroke volume is the amount of blood pumped out (ejected) with each contraction of the heart (heart beat). Stroke volume times heart rate equals cardiac output.
Afterload is the amount of resistance to ejection of blood from a ventricle.
Cardiac output is the amount of blood pumped out of the heart in one minute.
Preload is the pressure created by a volume of blood within a ventricle before contraction.
When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary arty until it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular end-diastolic pressure.
Central venous pressure is measured in the right atrium.
Pulmonary artery pressure is measured when the balloon tip is not inflated.
Cardiac output is determined through thermodilution involving injection of fluid into the pulmonary artery catheter.
Lasix is commonly used in the treatment of cardiac failure.
Chlorothiazide is categorized as a thiazide diuretic.
Chlorothalidone is categorized as a thiazide diuretic.
Spironolactone is categorized as a potassium-sparing diuretic.
Patients with orthopnea prefer not to lie flat and will need to maintain their beds in a semi- to high Fowler’s position
Dyspnea on exertion refers to difficulty breathing with activity.
Hyperpnea refers to increased rate and depth of respiration.
Paroxysmal nocturnal dyspnea refers to orthopnea that occurs only at night.
Persistent cough may indicate an onset of left-heart failure.
Loss of appetite should be reported immediately.
Weight gain should be reported immediately.
Frequent urination, causing interruption of sleep, should be reported immediately.
Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).
Low blood pressure is a classic sign of cardiogenic shock.
Hypoactive bowel sounds are classic signs of cardiogenic shock.
Decreased urinary output is a classic sign of cardiogenic shock.
Sodium nitroprusside is used in the treatment of cardiogenic shock.
Norepinephrine (Levophed) is a vasopressor that is used to promote perfusion to the heart and brain.
Dopamine (Inotropin) tends to increase the workload of the heart by increasing oxygen demand; thus, it is not administered early in the treatment of cardiogenic shock.
Furosemide (Lasix) is a loop diuretic that reduces intravascular fluid volume.
Intermittent claudication is a sign of peripheral arterial insufficiency.
An aneurysm is a localized sac of an artery wall formed at a weak point in the vessel.
A bruit is the sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel.
Ischemia is a term used to denote deficient blood supply.
The border of an ulcer caused by arterial insufficiency is circular.
Superficial venous insufficiency ulcers cause minimal pain.
The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color.
Venous insufficiency ulcers are usually superficial.
When a thrombus exists, an x-ray image will disclose an unfilled segment of a vein.
Air plethysmography quantifies venous reflux and calf muscle pump ejection.
In lymphangiography, contrast media are injected into the lymph system.
In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.
Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities.
Nicotine has stimulant effects.
Nicotine does not suppress cough. Smoking irritates the bronchial tree, causing coughing.
Nicotine does not cause diuresis.
Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall.
Saccular aneurysms collect blood in the weakened outpouching.
In a false aneurysm, the mass is actually a pulsating hematoma.
An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.
Acute lymphadenitis is demonstrated by enlarged, red and tender lymph nodes.
Lymphangitis is an acute inflammation of the lymphatic channels.
Lymphedema is demonstrated by swelling of tissues in the extremities because of an increased quantity of lymph that results from an obstruction of lymphatic vessels.
Elephantiasis refers to a condition in which chronic swelling of the extremity recedes only slightly with elevation.
Rebound hypertension may precipitate a hypertensive crisis.
Essential or primary hypertension denotes high blood pressure from an unidentified source.
Essential or primary hypertension denotes high blood pressure from an unidentified source.
Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.
According to the categories of blood pressure levels established by the JNC VI, stage 1 hypertension is demonstrated by a systolic pressure of 140–159 or a diastolic pressure of 90–99.
Pressure of 130 systolic and 80 diastolic falls within the normal range for an adult.
Pressure of 110 systolic and 60 diastolic falls within the normal range for an adult.
Pressure of 120 systolic and 70 diastolic falls within the normal range for an adult.
In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice will meet the daily need for potassium.
The patient should be guided to stop smoking.
The general guideline is to advise the patient to increase aerobic activity to 30 to 45 minutes most days of the week.
In general, alcohol intake should be limited to no more than 1 oz of ethanol per day.
Aldactone is known as a potassium-sparing diuretic.
Lasix causes loss of potassium from the body.
Diuril causes mild hypokalemia.
Hygroton causes mild hypokalemia.
Minipress is a peripheral vasodilator acting directly on the blood vessel. It is not used in angina and coronary artery disease, however, because it induces tachycardia if not preceded by administration of propranolol and a diuretic.
Serpasil impairs synthesis and reuptake of norepinephrine.
Inderal blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the sympathetics to the heart, producing a slower heart reate and lowered blood pressure.
Catapres acts through the central nervous system, apparently through centrally mediated alpha-adrenergic stimulation in the brain, producing blood pressure reduction.
Pancytopenia may be congenital or acquired.
Anemia refers to decreased red cell mass.
Leukopenia refers to a less-than-normal amount of WBCs in circulation.
Thrombocytopenia refers to a lower-than-normal platelet count.
Both B and T lymphocytes respond to exposure to antigens.
Granulocytes include basophils, neutrophils, and eosinophils.
A spherocyte is a red blood cell without central pallor, seen with hemolysis.
A thombocyte is a platelet.
Stem cells may differentiate into myeloid or lymphoid stem cells.
A band cell is a slightly immature neutrophil.
A spherocyte is a red blood cell without central pallor.
A reticulocyte is a slightly immature red blood cell.
Glucose 6-phosphate dehydrogenase deficiency is an inherited abnormality resulting in hemolytic anemia.
Autoimmune hemolytic anemia is an acquired anemia.
Cold agglutinin disease is an acquired anemia.
Hypersplenism results in an acquired hemolytic anemia.
Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin.
Vitamin K is the antidote to warfarin (Coumadin).
Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis.
Ipecac is an emetic used to treat some poisonings.
Lack of intrinsic factor is a common finding in the aged patient.
Amylase is an enzyme that aids in the digestion of starch.
Pepsin is a gastric enzyme important in protein digestion.
Trypsin is an enzyme that aids in the digestion of protein.
Normal bowel sounds are heard every 5-20 seconds.
Hypoactive bowel sounds is the description given to auscultation of one to two bowel sounds in 2 minutes.
Sluggish is not a term a nurse would use to accurately describe bowel sounds.
The nurse records that bowel sounds are absent when no sound is heard in 3-5 minutes.
Patients with duodenal ulcers usually secrete an excess amount of hydrochloric acid.
Patients with chronic atrophic gastritis secrete little or no acid.
Patients with gastric cancer secrete little or no acid.
Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.
Salivary stones are formed mainly from calcium phosphate.
Parotitis refers to inflammation of the parotid gland.
Sialadenitis refers to inflammation of the salivary glands.
Stomatitis refers to inflammation of the oral mucosa.
Leukoplakia is characterized by white patches, usually on the buccal mucosa.
Lichen planus refers to white papules at the intersection of a network of interlacing lesions.
Actinic cheilitis is the result of cumulative exposure to sun.
A chancre is demonstrated as a reddened circumscribed lesion that ulcerates and becomes crusted and is a primary lesion of syphilis.
As the cancer progresses, the patient may complain of tenderness or difficulty in chewing, swallowing, or speaking.
The most frequent symptom of oral cancer is a painless sore that will not heal.
Biopsy is used to diagnose oral cancer.
A typical lesion in oral cancer is a painless hardened ulcer with raised edges.
This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the upper esophagus to acute pain on swallowing.
Nausea is the most common symptom of gastrointestinal problems in general.
Vomiting is a nonspecific symptom that may have a variety of causes.
Odynophagia refers specifically to acute pain on swallowing.
Because the diverticula may retain decomposed food, halitosis and a sour taste in the mouth are frequent complaints.
Achalasia presents as difficulty in swallowing both liquids and solids.
Gastroesophageal reflux presents as burning in the esophagus, indigestion, and difficulty in or pain upon swallowing.
Hiatal hernia presents as heartburn, regurgitation, and dysphagia in many patients while at least 50% are asymptomatic.
Pyrosis refers to a burning sensation in the esophagus and indicates GERD.
Indigestion is termed dyspepsia.
Difficulty swallowing is termed dysphagia.
Pain on swallowing is termed odynophagia.
The patient should not recline with a full stomach.
The patient should be instructed to avoid the listed foods and food components.
The patient should be instructed to elevate the head of the bed on 6- to 8-inch blocks.
The patient is instructed to eat a low-fat diet
In the United States, cancer of the esophagus has been associated with the ingestion of alcohol and the use of tobacco.
In the United States, carcinoma of the esophagus occurs more than three times as often in men as in women.
It is seen more frequently in African Americans than in Caucasians.
It usually occurs in the fifth decade of life.
The subclavian vein is the most common vessel used because the subclavian area provides a stable insertion site to which the catheter can be anchored, allows the patient freedom of movement, and provides easy access to the dressing site.
PICC lines may be used for intermediate terms (3-12 months).
Tunneled central catheters are for long-term use and may remain in place for many years.
Implanted ports are devices also used for long term home IV therapy (eg, Port A Cath, Mediport, Hickman Port, P.A.S. Port).
Daily instillation of dilute heparin flush when a port is not in use will maintain the port.
Continuous infusion maintains the patency of each port. Heparin flushes are used after each intermittent infusion.
Heparin flushes are used after blood drawing in order to prevent clotting of blood within the port.
Heparin flush of ports is not necessary if a line is to be discontinued.
Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by stomach acids. A change of form of medication is required by patients with tube feedings.
Simple compressed tablets may be crushed and dissolved in water for patient receiving oral medications by feeding tube.
Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended to the patient undergoing tube feedings.
The nurse may make an opening in the capsule and squeeze out contents for administration by feeding tube.
Placement of the tube must be verified prior to any feeding.
A gastric sump and nasoenteric tube are used for gastrointestinal decompression.
Nasoenteric tubes are used for gastrointestinal aspiration.
Gastric sump tubes are used to decompress the stomach and keep it empty.
Most nasoenteric tubes use mercury to carry the tube by gravity to its desired location.
A gastric sump is used to decompress and empty the stomach.
Dobbhoff tubes are used for enteric feeding.
Enteraflow tubes are used for enteric feeding.
Because the normal swallowing mechanism is bypassed, consideration of the danger of aspiration must be foremost in the mind of the nurse caring for the patient receiving continuous tube feedings.
Tube feedings preserve GI integrity by intraluminal delivery of nutrients.
Tube feedings preserve the normal sequence of intestinal and hepatic metabolism.
Tube feedings maintain fat metabolism and lipoprotein synthesis.
If the gastric residual exceeds 100 cc 2 hours in a row, the physician should be notified.
One observation of a residual gastric content over 100 cc does not have to be reported to the physician. If the observation occurs two times in succession, the physician should be notified.
If the amount of gastric residual exceeds 100 cc, the tube feeding should be withheld at that time.
If the amount of gastric residual exceeds 100 cc, the tube feeding should be withheld at that time, but not indefinitely.
Each nurse caring for the patient is responsible for verifying that the tube is located in the proper area for continuous feeding.
Checking for placement each hour is unnecessary unless the patient is extremely restless or there is basis for rechecking the tube based on other patient activities.
Checking for placement every 24 hours does not meet the standard of care due the patient receiving continuous tube feedings.
Even though the feedings are continuous, the placement must be assessed.
Vitamin B12 requires the intrinsic factor secreted by the gastric mucosa for absorption.
Lack of vitamin C may cause development of signs and symptoms of scurvy.
Vitamin D deficiency results in an inability to absorb calcium.
Vitamin B6 affects neuromuscular function.
Melena indicates blood in the stool.
Hemarthrosis is bleeding into a joint.
Hematemesis is vomiting blood.
Pyrosis refers to heartburn.
If food and fluids are withheld, IV fluids (3L/day) are usually prescribed.
Minimal urine output may be less than 50 mL/hr.
Minimal urine output must exceed 10 mL/hr.
Minimal intake, as a rule of thumb, is less than 2 liters per day.
Medical-Surgical Nursing Exam 14
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