Chapter 22: Cardiovascular and Cerebrovascular Health and Illness Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition MULTIPLE CHOICE 1. A nurse is auscultating an older patient’s heart and notes a systolic murmur (heard between
the S1 and S2 heart sounds. The first action by the nurse is to: a. question the patient about the presence of the murmur. b. note it in the chart as this is always a normal finding for an older adult. c. contact the medical provider as this is an abnormal finding. d. immediately implement emergency interventions. ANS: A
In normal aging, the heart valves separating the chambers thicken and stiffen as a result of lipid deposits and collagen cross-linking. Mild systolic murmurs (between S1 and S2) are expected findings in the older adult. Aortic and mitral valves are those most commonly affected. If the nurse auscultates a systolic murmur in an asymptomatic older adult, he or she should ask about it. Most older adults will reply that they have had it for a while. If this is not the case, the person is referred to a cardiologist. If the new finding is accompanied by any significant signs or symptoms of distress, it is a medical emergency. Diastolic murmurs (heard between S2 and S1) are always indicative of a serious problem in cardiac hemodynamics and these persons are followed closely by a cardiologist. DIF: Cognitive Level: Understanding REF: pp. 283–284 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 2. A nurse measures an older adult’s blood pressure on the right arm and notes a reading of
150/100. The nurse waits 5 minutes and measures the blood pressure again in the right arm and obtains a reading of 152/100. What is the next action by the nurse? a. Immediately contact the medical provider. b. Measure the blood pressure in the left arm. c. Measure the blood pressure in sitting and standing positions. d. Document the findings in the medical record; elevated blood pressures are normal in older adults. ANS: B
When an abnormal blood pressure reading is obtained, it is necessary to do two measurements, five minutes apart, confirmed in the contralateral arm. Doing orthostatic measurements is not indicated in this situation. A blood pressure reading above 140/90 is considered abnormal for an older adult. DIF: Cognitive Level: Understanding REF: p. 285 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Adaptation 3. A nurse is caring for an older hospitalized patient who recently suffered a myocardial
infarction (MI). The patient asks the nurse, “I didn’t even know that I had a heart attack. I did not have crushing chest pain like you see on television. Why didn’t I?” The best response by the nurse is:
