Stimulation of the sympathetic nervous system produces which of the following responses?
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Solution
Tachycardia
Option B: Stimulation of the sympathetic nervous system causes tachycardia and increased contractility.
Options A, C, and D: The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.
Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility?
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Solution
Inotropic agents
Option D: Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output.
Options A and B: Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart.
Option C: Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.
Which of the following symptoms might a client with right-sided heart failure exhibit?
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Solution
Oliguria
Option C: Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria.
Options A, B, and D: Adequate urine output, polyuria, and polydipsia aren’t associated with right-sided heart failure.
In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?
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Solution
Right-sided heart failure
Option D: The most accurate area of 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.
Options A, B, and C: Diabetes mellitus, pulmonary emboli, and renal disease aren’t directly linked to sacral edema.
Which of the following symptoms is most commonly associated with left-sided heart failure?
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Solution
Crackles
Option A: 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.
Option B: Arrhythmias can be associated with both right and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.
Toxicity from which of the following medications may cause a client to see a green halo around lights?
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Solution
Digoxin
Option A: One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign.
Options B, C, and D: The other medications aren’t associated with such an effect.
Which of the following parameters should be checked before administering digoxin?
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Solution
Apical pulse
Option A: An apical pulse is essential for accurately assessing the client’s heart rate before administering digoxin. The apical pulse is the most accurate point in the body.
Option B: Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin.
Option C: The radial pulse can be affected by cardiac and vascular disease and therefore, won’t always accurately depict the heart rate.
Option D: Digoxin has no effect on respiratory function.
What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention?
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Solution
Raised 30 degrees
Option C: 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.
Options B and D: Inclined 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).
Option A: In high-Fowler’s position, the veins would be barely discernible above the clavicle.
With which of the following disorders is jugular vein distention most prominent?
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Solution
Heart failure
Option B: Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump.
Options A and D: Jugular vein distention isn’t a symptom of abdominal aortic aneurysm or pneumothorax.
Option C: An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention.
What is the most common complication of a myocardial infarction?
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Solution
Arrhythmias
Option C: Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI.
Option A: 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.
Option B: Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication.
Option D: Pericarditis most commonly results from a bacterial or viral infection but may occur after MI.