Cardiac/Vascular Nurse Exam Secrets Study Guide (40 page)

d. a process.

121. A patient receives daily warfarin (Coumadin) after treatment for atrial fibrillation. Which of the following substances may interfere with the drug’s effectiveness?

a. One 4-ounce glass of red wine daily

b. Caffeinated beverages

c. A daily multivitamin

d. Milk products

122. Older adults who must face a change of residence to a long-term care facility
most often
exhibit signs of:

a. abuse.

b. relief.

c. confusion.

d. grief and loss.

123. When considering the use of a translator for a patient who does not speak English, which of the following considerations is most important?

a. The translator has training in medical vocabulary for both languages.

b. The translator speaks both languages well.

c. The translator knows the patient’s history.

d. The translator is available on site.

124. A 40-year old patient who has been diagnosed with severe cardiac hypertrophy says to the nurse, “This is all my fault.” Which of Kübler-Ross’s five stages of grief is the patient probably experiencing?

a. Denial

b. Anger

c. Depression

d. Acceptance

125. Following coronary artery bypass graft (CABG) surgery, a patient exhibits hypotension, which is probably caused by:

a. diuresis.

b. hypokalemia.

c. third spacing.

d. hemolysis.

126. A stress management technique that involves therapeutic imagery is:

a. meditation.

b. visualization.

c. reframing.

d. venting.

127. Physiological changes, the presence or absence of complications, and the extent to which treatment objectives are attained can be considered:

a. physician outcomes.

b. patient outcomes.

c. system outcomes.

d. nurse outcomes.

128. A Hispanic patient is admitted to the hospital, and the nurse attempts to take an admission history; however, the patient speaks very little English. What should the nurse do?

a. Ask the patient’s 12-year old son, who is fluent in English, to translate.

b. Use sign language and pictures to supplement questions.

c. Arrange for a translator.

d. Ask the patient’s wife, who speaks fair English, to answer the questions for her husband.

129. A 58-year old woman who does not drink states she is considering drinking a small glass of wine daily to increase her high-density lipoprotein (HDL) level. Which of the following statements is the most appropriate response by the nurse?

a. She should limit her alcohol intake to two 8-ounce glasses of wine daily.

b. The best strategy is to improve her diet and increase exercise.

c. The American Heart Association recommends that people drink a small glass of red wine daily.

d. There is no evidence that wine increases HDL levels.

130. Using transesophageal Doppler ultrasonography to measure cardiac output, a short waveform with a rounded apex may indicate:

a. decreased preload.

b. increased preload.

c. increased systemic vascular resistance.

d. left ventricular failure.

131. Which enzyme test should be measured 8–12 hours after onset of symptoms for the diagnosis of myocardial infarction?

a. Troponin T and I

b. Myoglobin

c. Lactic dehydrogenase

d. Creatinine kinase /creatinine-myoglobin

132. When assessing for capillary refill and compressing the nail, reperfusion should occur within how many seconds?

a. 0.5 second

b. 1 second

c. 2–3 seconds

d. 4 seconds

133. The nurse remembers that she has forgotten to record a patient’s complaint of headache that occurred 5 hours previously. The nurse should then:

a. document the information between the lines so it is chronologically in the correct place.

b. document the information in the next space available with the current date and time, preceding the entry with “Late entry”

c. document the information in the next space available but draw an arrow indicating where it should have been inserted.

d. document the information in an incident report rather than in the chart.

134. A 48-year old male patient is referred to a cardiac care center for cardiac rehabilitation after a myocardial infarction. The cardiac care center provides:

a. primary care.

b. secondary care.

c. tertiary care.

d. quaternary care.

135. An absolute indication for stopping an exercise test is a:

a. patient complaint of dyspnea that is not noticeable to the observer.

b. downsloping ST segment depression.

c. decrease in systolic blood pressure (BP) of10 mm Hg or less from baseline despite an increased workload but absent evidence of ischemia.

d. decrease in systolic BP of 10 mm Hg or more from baseline despite an increased workload and with evidence of ischemia.

136. When is the best time to assess a patient’s tobacco use?

a. At the initial interview

b. At every visit

c. When patients exhibit tobacco-related symptoms.

d. When patients indicate they smoke.

137. A 76-year old woman with end-stage heart failure was placed on hospice care by her physician 6 months earlier (two 90-day periods), but she is still alive. Her family asks the nurse if the patient will be removed from hospice care. Which response by the nurse is best in this situation?

a. “She will be removed from hospice care until her condition worsens because she has exceeded the 6-month period.”

b. “She has exhausted all of her hospice care benefits and will be removed from hospice care.”

c. “She can continue with hospice care as long as the physician authorizes the care every 60 days.”

d. “She can continue with hospice care if the physician continues to authorize care every 90 days.”

138. Thirty hours after valvular surgery that required cardiopulmonary bypass, a 75-year-old patient, who has been apathetic and forgetful for the previous 12 hours, becomes very disoriented, confused, and combative, pulling out his intravenous lines. He is most likely suffering from:

a. post-pump delirium and psychosis.

b. ischemic stroke.

c. a reaction to drugs.

d. hypoxia.

139. A patient with a total cholesterol of 206, triglycerides of 105, high-density lipoprotein (HDL) of 35, and low-density lipoprotein (LDL) of 150 should have treatment with a goal to:

a. lower total cholesterol and triglyceride levels.

b. lower total cholesterol and HDL levels.

c. lower total cholesterol and raise LDL levels.

d. lower total cholesterol and LDL levels and raise HDL levels.

140. A patient with high cholesterol is advised to stay on the Mediterranean diet, which includes:

a. red meat at least three times weekly.

b. fish at least two to three times weekly.

c. three servings of fruits and vegetables a day.

d. margarine instead of butter.

141. A 60-year old male patient has recently had open-heart surgery. While he is progressing well physically, he becomes upset when asked to make independent decisions and rings the call bell constantly to ask for reassurance that he will get well. This psychological response to stress is an example of:

a. dependence.

b. passivity.

c. depression.

d. confusion.

142. Which members of the health care institution are responsible for identifying quality performance improvement projects?

a. Administrative staff

b. Nursing team leaders

c. All staff

d. Physicians

143. Which rhythm disturbance is most common after cardiac surgery?

a. Ventricular fibrillation

b. Ventricular tachycardia

c. Premature ventricular contractions

d. Atrial fibrillation, flutter, and tachycardia

144. Which self-monitoring skill is essential for a patient with heart failure?

a. Intake of fats

b. Daily weight

c. Degree of edema

d. Exercise

145. According to Selye’s theory of adaptation to stress, a patient whose organs and systems have begun to deteriorate is in which phase?

a. Alarm

b. Resistance

c. Exhaustion

d. Negative

146. A frail 80-year old patient who lives alone requires long-term intravenous (IV) antibiotic therapy for prosthetic valve endocarditis from Staphylococcus epidermidis. His condition is stable at present. The most effective care plan includes:

a. keeping the patient in the acute care hospital until therapy is completed.

b. sending the patient home and having home health nurses provide home intravenous antibiotic therapy.

c. instructing the patient to self-administer the antibiotic therapy.

d. transferring the patient to an extended care facility for continued treatment.

147. A patient with severe pain is receiving pain medication routinely every 6 hours but usually complains of breakthrough pain in 4 hours, requiring an additional injection, which indicates that:

a. the patient has a low pain tolerance and may need to be distracted.

b. the routine pain medication may need to be given every 4 hours or the dosage changed.

c. pain control is adequate with the additional medication.

d. pain may be intractable and cannot be controlled.

148. In the stage-based approach to assessing readiness to change, the stage of “pre-contemplation” is characterized by:

a. an unwillingness to acknowledge the need for change.

b. a patient’s evaluation of advantages and disadvantages of changes.

c. instability and relapse.

d. ambivalence.

149. After percutaneous transluminal coronary angioplasty (PCTA), a bruit is heard near the sheath insertion site. The most likely cause is:

a. bleeding or hematoma.

b. pseudoaneurysm and arteriovenous fistula.

c. thrombus or embolus.

d. retroperitoneal bleeding.

Answer Key

1. A. The Health Insurance Portability and Accountability Act addresses the rights of patients concerning the privacy of health information. Health care professionals must not release any information or documentation about a patient’s condition or treatment without consent; all patients have the right to determine who has access to personal information, which is considered protected health information (PHI); the health history, condition, treatments, and any documentation are considered PHI. Personal information can be shared with spouses, legal guardians, and those with a durable power of attorney.

2. D. Nail polish on the finger used for monitoring of pulse oximetry may give a low reading. Pulse oximetry measures the percentage of hemoglobin saturation and is used to determine oxygenation. Other causes of low readings include circulatory impairment or reduced temperature. Carbon monoxide exposure causes abnormally high readings despite hypoxemia because the hemoglobin binds to the carbon monoxide. Pulse oximetry readings are most effective at a saturation level of 90% or above but are not always reliable at 80% or below.

3. A. Goals are developed from the problem list that is generated as part of the plan of care, based on the patient interview, history, physical exam, and medical records. Goals should be specifically related to the problem, measurable, and attainable. Goals may focus on three areas:

· Resolution: “Pulse rates will not exceed 90 beats/minute at rest.”

· Preventing deterioration or further complications: “Patient will remain at current weight.”

· Palliation/patient comfort: “Patient will not experience breakthrough pain.”