1. 3. The client's ECG changes suggest an anterior-wall myocardial infarction.

The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 2. 2. Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 3. 2. CAD accounts for 30% of all deaths in the United States. Cancer accounts for approximately 20%. Liver failure and renal failure account for less than 10% of all deaths in the United States. CN: Health promotion and maintenance; CNS: None; CL: Analysis 4. 1. Atherosclerosis, or plaque formation, is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD but it isn't the most common cause. Renal failure doesn't cause CAD, but the two conditions are related. MI is commonly a result of CAD. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 5. 2. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can't dilate properly and, therefore, constrict blood flow and oxygen, causing angina. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 6. 3. Because heredity refers to our genetic makeup, it can't be modified. Cigarette smoking cessation is a lifestyle change that involves behavior modification. Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Altering one's diet, exercise, and medication can correct hypertension. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Analysis 7. 4. Cholesterol levels above 240 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk of CAD.

CN: Physiological Comprehension

integrity;

CNS:

Reduction

of

risk

potential;

CL:

8. 2. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but its administration isn't the first priority. Al though educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 9. 3. Oral medication administration is a noninvasive, medical treatment for CAD. Cardiac catheterization isn't a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 10. 3. The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 11. 1. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, commonly seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias. CN: Safe, effective care environment; CNS: Management of care; CL: Analysis 12. 2. The correct landmark for obtaining an apical pulse is the left fifth intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where pulmonic sounds are auscultated. Normally, heart sounds aren't heard in the midaxillary line or the seventh intercostal space in the midclavicular line. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 13. 4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases with movement. Cardiac and GI pains don't change with respiration. 2

CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 14. 3. Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 15. 3. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. LD is present in almost all body tissues and not specific to heart muscle. LD isoenzymes may be useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury. CN: Health promotion and maintenance; CNS: None; CL: Analysis 16. 4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Application 17. 3. Coronary artery thrombosis causes an occlusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Heart failure is usually the result of an MI. Renal failure can be associated with MI but isn't a direct cause. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 18. 3. Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Chloride and sodium aren't lost during diuresis. Digoxin acts to increase contractility but isn't given routinely with furosemide. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Analysis 19. 4. Both glucose and fatty acids are metabolites whose levels increase after an MI. Mechanical changes are those that affect the pumping action of the heart, and electrophysiologic changes affect conduction. Hematologic changes would 3

affect the blood. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 20. 1. Rapid filling of the ventricle causes vasodilation that is auscultated as S 3. Systemic hypertension or increased atrial contraction can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur. CN: Health promotion and maintenance; CNS: None; CL: Analysis 21. 1. The left ventricle is responsible for most of the cardiac output. An anteriorwall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 22. 4. The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction (MI). Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately. Cardiac enzymes are used to diagnose MI but can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Application 23. 2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublingual nitroglycerin are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI. CN: Safe, effective care environment; CNS: Management of care; CL: Analysis 24. 1. Validation of a client's feelings is the most appropriate response. It gives the client a feeling of comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing an MI will feel or get better and, therefore, these responses are inappropriate. CN: Psychosocial integrity; CNS: None; CL: Comprehension 25. 1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve 4

stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Opioids reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload). CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Application 26. 3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after MI. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 27. 2. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein distention isn't a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn't cause jugular vein distention. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 28. 3. Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Increased pressure can't be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). In high Fowler's position, the veins would be barely discernible above the clavicle. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Analysis 29. 1. An apical pulse is essential for accurately assessing the client's heart rate before administering digoxin. The apical pulse is the most accurate pulse point in the body. Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and, therefore, won't always accurately depict the heart rate. Digoxin has no effect on respiratory function. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: 5

Application 30. 1. One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other medications aren't associated with such an effect. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Analysis 31. 1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right- and left-sided heart failure. Hepatic engorgement is associated with right-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 32. 4. The most accurate area on the body to assess dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and chronic kidney disease aren't directly linked to sacral edema. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 33. 3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren't associated with right-sided heart failure. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 34. 4. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Beta adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Application 35. 2. To attempt to convert the rhythm, the nurse should first defibrillate the client with 360 joules. If this is unsuccessful, she would then continue CPR for five cycles and attempt to defibrillate again. Epinephrine and vasopressin may be given but not until after the first two defibrillation attempts. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis

36. 4. Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 37. 2. An increased PR interval is indicative of a 1-degree AV block. NSR and sinus arrhythmia have normal PR intervals. The PR interval (if present) is less than 0.12 second in accelerated junctional rhythm. CN: Physiological integrity; CNS: Reducation of risk potential; CL: Analysis 38. 2. The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn't surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 39. 1. The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastric distention, nor gastritis causes pulsation. CN: Health promotion and maintenance; CNS: None; CL: Application 40. 1. Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Diaphoresis and headache aren't associated with abdominal aortic aneurysm. Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 41. 4. Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is the most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application

42. 2. An aortogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound don't give a direct view of the vessels and don't yield as accurate a diagnosis as the aortogram. CN: Health promotion and maintenance; CNS: None; CL: Application 43. 2. Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Cardiac arrhythmias aren't directly linked to an aneurysm. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but aren't life-threatening. CN: Physiological integrity; CNS: Basic care and comfort; CL: Analysis 44. 1. Thrombolytic agents are declotting agents that place the client at risk for hemorrhage from puncture wounds. All unnecessary needle sticks and invasive procedures should be avoided. The potassium level should be monitored in all cardiac clients, not just those receiving a thrombolytic agent. Although no specific position is required, most cardiac clients seem more comfortable in semiFowler's position. The client's fluid balance must be carefully monitored, so it may be inappropriate to encourage fluids at this time. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Application 45. 3. The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 46. 2. Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Diabetes mellitus doesn't have a direct link to aneurysm. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn't as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. CN: Health promotion and maintenance; CNS: None; CL: Application 47. 2. A bruit is a vascular sound that reflects partial arterial occlusion. It is not a normal finding. Fluid in the lungs is called crackles and inflammation of the peritoneal surface produces a friction rub. CN: Physiological integrity; CNS: Basic care and comfort; CL: Analysis 48. 2. Severe lower back pain indicates an aneurysm rupture, secondary to 8

pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased. The WBC count increases as cells migrate to the site of injury. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 49. 3. Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesn't cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma won't form. CN: Physiological integrity; CNS: Physiological adaptation; CL: Comprehension 50. 3. Marfan's syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aneurysm. Although cystic fibrosis, hemophilia, and sickle cell anemia are all genetic diseases, they haven't been linked to aneurysms. CN: Health promotion and maintenance; CNS: None; CL: Application 51. 4. When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 52. 1. Cardiomyopathy isn't usually caused by plaque in the arteries or atherosclerosis. The etiology in most cases is viral or bacterial infection or cardiotoxic effects of drugs or alcohol. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 53. 1. Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic obstructive cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't a form of cardiomyopathy; it's an inflammation of the cardiac muscle. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 9

54. 3. In hypertrophic obstructive cardiomyopathy, hypertrophy of the ventricular septumnot the ventricle chambersis apparent. This abnormality isn't seen in other types of cardiomyopathy. Congestive isn't a form of cardiomyopathy. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 55. 1. Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. Diabetes mellitus is unrelated to cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in clients with pericarditis. CN: Physiological integrity; CNS: Physiological adaptation; CL: Comprehension 56. 1. Atrial fibrillation is defined as chaotic, asynchronous, electrical activity in the atrial tissue. On an ECG, uneven baseline fibrillating waves appear rather than distinguishable P waves. Ventricular fibrillation is a chaotic rhythm with no QRS complexes. In atrial flutter there are flutter waves that are saw -tooth in appearance. P waves are present in sinus tachycardia. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 57. 4. These are the classic symptoms of heart failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. MI is usually exhibited by chest pain and diaphoresis. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Application 58. 2. Cardiac output isn't affected by hypertrophic obstructive cardiomyopathy because the size of the ventricle remains relatively unchanged. Dilated cardiomyopathy and restrictive cardiomyopathy decrease cardiac output. Obliterative isn't a form of cardiomyopathy. CN: Physiological integrity; CNS: Physiological adaptation; CL: Comprehension 59. 4. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 60. 2. By decreasing the heart rate and contractility, beta-adrenergic blockers 10

improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Anticoagulants may sometimes be used to reduce the risk of emboli, but this practice is considered controversial. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren't as effective as beta-adrenergic blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Comprehension 61. 3. The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible. Cardiac catheterization is an invasive diagnostic procedure for coronary artery disease. CABG is a surgical intervention used for atherosclerotic vessels. An IABP is an invasive treatment that assists the failing heart; however, it's only a temporary solution. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 62. 2. The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Anxiety generally isn't described as painful. Unstable angina doesn't always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at restnot as a result of exertion or stress. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 63. 4. Observing standard precautions is the first priority when dealing with any body fluid. Assessment of the groin site is the second priority. This establishes where the blood is coming from and determines how much blood has been lost. The goal in this situation is to stop the bleeding. The nurse would call for help if it were warranted after the assessment of the situation. After determining the extent of the bleeding, vital signs assessment is important. The nurse should never move the client, in case a clot has formed. Moving can disturb the clot and cause rebleeding. CN: Safe, effective care environment; CNS: Management of care; CL: Analysis 64. 4. Ischemic changes are represented on an ECG by T-wave inversion. An increased QRS duration suggests a bundle-branch block. A shortened PR interval indicates a junctional rhythm. Pathological Q waves are present with myocardial infarction. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 65. 4. Unstable angina progressively increases in frequency, intensity, and 11

duration and is related to an increased risk of MI within 3 to 18 months. Variant angina is related to coronany artery spasm, chronic stable angina is predictable and relieved by rest and nitrates, and microvascular angina is related to impairment of vasodilator reserve in normal coronary arteries. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 66. 3. Nitroglycerin is administered to reduce the myocardial demand, which decreases ischemia and relieves pain. In addition, nitroglycerin dilates the vasculature, thereby reducing preload. Aspirin is administered to reduce the risk of myocardial infarction in patients with unstable angina. Furosemide is a loop diuretic that won't directly reduce pain or prevent angina. Nifedipine is a calcium channel blocker primarily used to decrease coronary artery spasm, as in variant angina. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Analysis 67. 4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 68. 2. Since cardiac catheterization involves the injection of a radiopaque dye, it's most important for the nurse to determine if the client has allergies to iodine or shellfish. The other three parameters are also part of the assessment, but none is the most critical assessment. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Analysis 69. 1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed. Reduction of associated risk factors, such as stress and anxiety, is a progressive, long-term treatment goal that has cumulative effects. Reduction of these factors will decrease the risk for angina but this usually isn't an immediate goal. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 70. 4. PTCA can alleviate the blockage and restore blood flow and oxygenation. Cardiac catheterization is a diagnostic toolnot a treatment. An echocardiogram is a noninvasive diagnostic test. Heart transplantation involves replacing the client's heart with a donor heart and is the treatment for end-stage cardiac disease.

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CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 71. 1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. When the client's condition is stabilized, he can be returned to bed. An ECG can be obtained after the client is sitting down. After the ECG, sublingual nitroglycerin would be administered. CN: Physiological integrity; CNS: Basic care and comfort; CL: Analysis 72. 2. Cardiogenic shock is shock related to reduced cardiac output and ineffective pumping of the heart. Anaphylactic shock results from an allergic reaction. Distributive shock results from changes in the intravascular volume distribution and is usually associated with increased cardiac output. MI isn't a shock state, though a severe MI can lead to shock. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 73. 1. Of all clients with an acute MI, 15% suffer cardiogenic shock secondary to the myocardial damage and decreased function. CAD causes MI. A decreased hemoglobin level is a result of bleeding. Hypotension is the result of a reduced cardiac output produced by the shock state. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Analysis 74. 3. At least 40% of the heart muscle must be involved for cardiogenic shock to develop. In most circumstances, the heart can compensate for up to 25% damage. An infarction involving 90% of the heart would result in death. CN: Physiological integrity; CNS: Physiological adaptation; CL: Comprehension 75. 3. Myocardial oxygen consumption increases as preload, afterload, contractility, and heart rate increase. Cerebral blood flow and renal blood flow don't directly affect myocardial oxygen consumption. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 76. 2. The cardiac index, a figure derived by dividing the cardiac output by the client's body surface area, is used for identifying whether the cardiac output is meeting a client's needs. Heart rate, blood pressure, and decreased cerebral blood flow are less useful in detecting the risk of cardiogenic shock. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 77. 4. Initially, the decrease in cardiac output results in a decrease in cerebral blood flow that causes restlessness, agitation, or confusion. Cyanosis, decreased urine output, and presence of an S4 are all later signs of shock.

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CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 78. 1. ABG levels reflect cellular metabolism and indicate hypoxia. A CBC is performed to determine various constituents of venous blood. An ECG shows the electrical activity of the heart. A lung scan is performed to view functionality of the lungs. CN: Health promotion and maintenance; CNS: None; CL: Analysis 79. 4. A balance must be maintained between oxygen supply and demand. In a shock state, the myocardium requires more oxygen. If it can't get more oxygen, the shock worsens. Increasing the oxygen will also play a large role in correcting metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention isn't an appropriate goal for this condition. CN: Physiological integrity; CN: Physiological adaptation; CL: Analysis 80. 1. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a betaadrenergic blocker that slows heart rate and lowers blood pressure; neither is a desired effect in the treatment of cardiogenic shock. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Application 81. 4. A pulmonary artery catheter is used to give accurate pressure measurements within the heart, which aids in determining the course of treatment. An arterial line, an indwelling urinary catheter, and an ECG monitor all provide valuable information related to the severity of a shock state but aren't the most important instrument. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Analysis 82. 3. According to the JNC 7, a systolic blood pressure of 140 to 159 mm Hg or a diastolic pressure of 90 to 99 mm Hg represents stage 1 hypertension. A systolic pressure greater than or equal to 160 mm Hg or diastolic pressure greater than or equal to 100 mm Hg represents stage 2 hypertension. A systolic pressure of 120 to 139 mm Hg or diastolic pressure of 80 to 89 mm Hg represents prehypertension. A systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg are considered normal. CN: Health promotion and maintenance; CNS: None; CL: Application 83. 2. In phase I, auscultation produces a faint, clear tapping sound that 14

gradually increases in intensity. Phase II produces a murmur sound, and precedes Phase III, the phase marked by an increased intensity of sound. Phase IV produces a muffling sound that gives a soft blowing noise. Phase V, the final phase, is marked by the disappearance of sounds. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 84. 4. Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Baroreceptors are nerve endings that are embedded in the blood vessels and respond to the stretching of vessel walls. They don't directly affect diastolic blood pressure. Cardiac output determines systolic blood pressure. Renal function helps control blood volume and indirectly affects diastolic blood pressure. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 85. 2. The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic blood pressure by regulating blood volume. Sodium or water retention would only further increase blood pressure. Sodium and water travel together across the membrane in the kidneys; one can't travel without the other. CN: Physiological integrity; CNS: Physiological adaptation; CL: Application 86. 1. Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Decreases in pulsatile pressure cause a reflex increase in heart rate. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 87. 2. Angiotensin II is a potent vasoconstrictor, thereby promoting venous return. Angiotensin I is a precursor that is converted in the pulmonary vasculature to angiotensin II. Neither thyroid hormone nor insulin has vasoconstrictive properties. CN: Physiological integrity; CNS: Physiological adaptation; CL: Analysis 88. 3. Characterized by a progressive, usually asymptomatic blood pressure increase over several years, primary hypertension is the most common type. Malignant hypertension, also known as accelerated hypertension, is rapidly progressive, uncontrollable, and causes a rapid onset of complications. Secondary hypertension occurs secondary to a known, correctable cause. CN: Physiological integrity; CNS: Reduction of risk potential; CL: Analysis

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89. 3. An occipital headache is typical of hypertension secondary to continued increased pressure on the cerebral vasculature. Blurred vision can result from hypertension due to the arteriolar changes in the eye. Epistaxis (nose-bleed) occurs far less frequently than a headache but can also be a diagnostic sign of hypertension. Peripheral edema can also occur from an increase in sodium and water retention but is usually a latent sign. CN: Health promotion and maintenance; CNS: None; CL: Application 90. 1. The brachial artery is most commonly used due to its easy accessibility and location. The brachiocephalic artery isn't accessible for blood pressure measurement. The radial and ulnar arteries can be used in extraordinary circumstances, but the measurement may not be as accurate. CN: Physiological integrity; CNS: Basic care and comfort; CL: Application 91. 4. Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop of Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action on angiotensin.

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