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Test Bank for Gerontologic Nursing 4th Edition by Meiner Chapter 23: Cardiovascular Function Test Bank MULTIPLE CHOICE 1. When preparing information concerning cardiovascular risk factors for a group of older adults, the nurse stresses that cigarette smokers are four times more likely to die of sudden cardiac death than nonsmokers because smoking: a. interferes with the development of collateral coronary vessels. b. produces coronary artery stricture. c. results in carbon monoxide poisoning. d. increases platelet aggregation. ANS: d Smoking increases platelet aggregation and causes coronary artery spasms. Nicotine increases blood pressure and cardiac demands. Carbon monoxide in tobacco smoke decreases the oxygencarrying capacity of the blood. DIF: Application (Apply) OBJ: Nursing Process: Implementation MSC: Physiological Integrity TOP: Cardiovascular REF: p. 402 2. When assessing an older, female African American adult, the nurse notes that she has been a type 2 insulin-dependent diabetic 10 years. The nurse notes that the client’s greatest risk for developing secondary hypertension is her: a. gender. b. ethnic origin. c. vascular system status. d. insulin therapy. ANS: c Secondary hypertension refers to elevated blood pressure caused by underlying disease DIF: Analysis (Analyze) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 404
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3. When administering Lopressor to an older adult client with hypertension, the nurse is careful to have the client’s care plan include: a. frequent assessment for dizziness and/or syncope. b. education of the signs and symptoms of thromboembolism. c. regular evaluation of the client’s muscle strength. d. regularly scheduled serum potassium levels. ANS: a Dizziness is an adverse reaction to beta-blockers such as Lopressor. DIF: Analysis (Analyze) OBJ: Nursing Process: Planning MSC: Physiological Integrity TOP: Drug-related responses REF: p. 406 4. The nurse educates the obese older adult client that the single most important outcome that will affect cardiac health is: a. compliance with antihypertensive drug therapy. b. adherence to the DASH diet. c. inclusion of 20 minutes of low impact exercise daily. d. a 10% reduction in weight. ANS: d A 10% reduction of total weight will decrease blood pressure in many overweight individuals. This factor has significance because it underscores the importance of weight reduction in the older adult population DIF: Application (Apply) OBJ: Nursing Process: Implementation MSC: Health Promotion and Maintenance TOP: Cardiovascular REF: p. 404 5. In order to evaluate an older client for possible renal failure as a result of chronic untreated hypertension, nurse prepares to: a. draw a blood sample. b. collect a urine sample. c. monitor intake and output. d. transport the client to radiology. ANS: b A urinalysis will investigate for proteinuria or other signs of renal failure. DIF: Application (Apply) OBJ: Nursing Process: Implementation MSC: Physiological Integrity TOP: Cardiovascular and Renal
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REF: p. 404 6. a. b. c. d.
The nurse recognizes that the symptoms that have priority for care are: acute confusion observed in a 78-year-old female. epigastric pain reported by a 70-year-old male. severe left shoulder pain in a 68-year-old male. persistent indigestion reported by a 69-year-old female.
ANS: a Neuropathies and changes recognition in older adults also limit the use of chest pain as a diagnostic sign for older adults. Atypical symptoms include shortness of breath, fatigue, syncope, confusion, and abdominal or back pain. Women, especially older women, may not exhibit the classic signs of CAD, and the nurse needs to be aware of this to adequately assess female clients. DIF: Analysis (Analyze) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 409 7. It is suspected that an older adult client is experiencing severe hypertension. The nurse documents symptoms that support this diagnosis when the client reports: a. difficulty reading the newspaper’s print. b. being very fatigued after walking around the block. c. noticing that his heart “skips a beat” frequently. d. getting up from a chair too quickly makes him dizzy. ANS: a In severe hypertension the client may experience throbbing occipital headaches, confusion, visual loss, focal deficits, epistaxis, and coma. DIF: Analysis (Analyze) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 404 8. A novice nurse requires additional education on the assessment findings reflective of arterial vascular deficiency when suggesting the condition’s symptoms include: a. 2+ edema in calf and foot of left leg. b. a 2-cm ulcer between the great and second toe on the left foot. c. skin on the left leg is cool to the touch. d. toenails on the left foot are thick and brittle. ANS: a Edema is not generally observed in cases of arterial deficiency. DIF: Application (Apply) OBJ: Nursing Process: Assessment
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MSC: Physiological Integrity TOP: Cardiovascular REF: p. 422 9. The nurse shows an understanding of how anemia symptoms present in the older population when: a. questioning the client about dizziness when turning from side-to-side in bed. b. assessing the client for pale oral mucous membranes. c. asking whether the client takes supplementary iron tablets. d. assessing the client’s weekly intake of red meat. ANS: b Skin color is not a good indicator of pallor because of varying pigmentation. Oral mucous membranes, as well as conjunctivae and nail beds, are better indicators. DIF: Application (Apply) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 428 10. When evaluating the effectiveness of discharge teaching for an older adult client who had a pacemaker implanted, the nurse determines the client has an appropriate understanding of the device when stating: a. “The battery will need charging every 2 years or so.” b. “I’m supposed to call my doctor if my pulse is within 10 beats of my preset rate.” c. “My wife will have to be the one who makes the microwave popcorn.” d. “I’ll take my pulse each morning before my first cup of coffee.” ANS: d The radial pulse should be taken at the same time daily and recorded. DIF: Application (Apply) OBJ: Nursing Process: Evaluation MSC: Health Promotion and Maintenance TOP: Cardiovascular REF: p. 415 11. A 76-year-old client has been recently diagnosed with cardiac valvular disease. The nurse assesses the client and recognizes that the medical diagnosis is supported by: a. cyanotic fingertips. b. weight loss of 10 pounds over a 3-month period just before diagnosis. c. angina pain. d. the client’s report that, “walking around the block makes me short of breath.” ANS: d Individuals with valvular disease may be asymptomatic for many years, but with the deterioration of the valves and hypertrophic changes in the atria or ventricles, symptoms become
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evident. Exertional dyspnea is frequently the initial symptom. Other symptoms include dizziness, fatigue, weakness, and palpitations. DIF: Analysis (Analyze) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 418 MULTIPLE RESPONSE 1. a. b. c. d. e.
The effect of aging on the cardiovascular system is evidenced when the nurse notes that an older adult performing a stress test experiences which of the following? Select all that apply. Chest pain during exercise Slow increase of heart rate in response to stress Exercise induce dyspnea Slow decrease of heart rate post exercise Stress-induced arrhythmias
ANS: b, d During stress or stimulation, the heart rate increases more slowly; however, once elevated, it takes longer to return to the resting rate. DIF: Application (Apply) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 401 2. A novice nurse is aware that normal aging can result in changes in the ECG of a 73-year-old client. The experienced geriatric nurse explains that these changes may include which of the following? Select all that apply. a. An inverted T wave b. A notched P wave c. A prolonged PR interval d. Decreased amplitude of the QRS complex e. A slurred T wave ANS: b, c, d, e The number of pacemaker cells located in the SA node decreases with age, which results in less responsiveness of the cells to adrenergic stimulation. Common aging changes that are reflected by the electrocardiogram (ECG) include a notched P wave, a prolonged PR interval, decreased amplitude of the QRS complex, and a notched or slurred T wave. DIF: Application (Apply) OBJ: Nursing Process: Implementation MSC: Physiological Integrity TOP: Cardiovascular REF: p. 401
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3. When a nurse prepares an educational fact sheet on cardiovascular disease (CVD) for distribution to a senior citizens group, the lifestyle choices included are which of the following? Select all that apply. a. Smoking cessation tips b. Low-carbohydrate food choices c. Stress management techniques d. Importance of regular blood pressure monitoring e. Strategies for including exercise into daily routine ANS: a, c, d, e Many forms of CVD can be accelerated by unhealthy lifestyle choices such as smoking, physical inactivity, high-risk dietary behaviors (i.e. high fat), obesity, stress, and hormonal use by women. Chronic diseases such as hypertension and diabetes mellitus also play a role in accelerating changes. DIF: Application (Apply) OBJ: Nursing Process: Implementation MSC: Health Promotion and Maintenance TOP: Cardiovascular REF: p. 401 4. An older adult recovering from an MI has been prescribed subcutaneous heparin but is now to receive oral warfarin (Coumadin). The nurse prepares a client teaching plan that includes information regarding which of the following? Select all that apply. a. Administration of both medications for up to 5 days b. Need to use a soft bristle toothbrush c. Use of atropine as an antidote for excessive bleeding d. Need to continue drawing partial thromboplastin times e. Need to drink at least 8 cups of fluids daily ANS: a, b, d Heparin and warfarin (Coumadin) are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the international normalized ratio (INR); the antidote is vitamin K. Clients who initially receive heparin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complication. Clients need to be taught bleeding precautions. DIF: Application (Apply) OBJ: Nursing Process: Planning MSC: Health Promotion and Maintenance TOP: Cardiovascular REF: p. 410
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5. A 77-year-old client is being treated for cardiac arrhythmia. The nurse determines that the client’s cardiac output is adequate when assessment confirms which of the following? Select all that apply. a. Urine output of 140 cc over 4 hours b. Systolic blood pressure that remains within 20 mm of baseline c. Denial of substernal pain d. Recollection of the birthdays of all of her grandchildren e. Absence of rales and crackles ANS: a, b, d, e The client will maintain an adequate cardiac output, as evidenced by heart rate and rhythm within normal range, stable blood pressure, adequate peripheral pulses, mental alertness, urine output of 30 mL/hr, and clear breath sounds. DIF: Application (Apply) OBJ: Nursing Process: Assessment MSC: Physiological Integrity TOP: Cardiovascular REF: p. 415
Test Bank for Gerontologic Nursing 4th Edition by Meiner