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Chapter 20- Cardiovascular Function, 1
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- 11. Which of the following individuals is likely at the highest risk for orthostatic hypotension? A) A 75-year-old woman who uses a walker B) An 80-year-old man who strains to void when using the bedside commode C) A 60-year-old who has a long leg cast on his right leg D) An 80-year-old woman who is taking PremarinAns: B
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Orthostatic hypotension rises significantly after the age of 75. A risk factor for orthostatic hypotension is doing a Valsalva maneuver while voiding. - 22. Which of the following statements by an older adult indicates the need for further teaching related to cholesterol reduction? A) "I will decrease my intake of food high in polyunsaturated fatty acids." B) "I will increase my intake of soybeans, walnuts, and canola oil." C) "I will eat fish four times a week." D) "I will limit my intake of trans fatty acids and saturated fat."Ans: A
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Nutritional interventions for cholesterol reduction limit foods containing saturated fats and trans fatty acids and increase foods that are high in polyunsaturated fatty acids. - 33. An older adult is admitted to the emergency department with dyspnea and a sudden change in level of consciousness. The nurse should assess first for which of the following disorders? A) Myocarditis B) Aortic aneurysm C) Cor pulmonale D) Myocardial infarctionAns: D
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Compared with younger adults, older adults experiencing a myocardial infarction are more likely to have dyspnea or neurologic symptoms, rather than chest discomfort. Older adults with angina and acute myocardial infarction are more likely to have subtle and unusual manifestations. - 44. Which of the following considerations should a nurse prioritize when assessing an older adult who has arrhythmias? A) Assess the client for adverse medication reactions. B) Check the client's electrolytes immediately. C) Make an assessment in relation to the client's medical history. D) Perform auscultation before collecting the client's history.Ans: C
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Murmurs and arrhythmias may be caused by cardiac diseases, electrolyte imbalances, or adverse medication effects. It is important to make an assessment of underlying causes in relation to the client's medical history. - 55. Which of the following is the most important remediable risk factor for cardiovascular disease in older adults? A) Smoking B) Stress C) Sedentary lifestyle D) Aggressive personalityAns: A
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Smoking is a major risk factor for cardiovascular disease. Benefits of smoking cessation as a secondary prevention intervention begin immediately and are as effective in older adults as they are in younger people. Additional lifestyle interventions that are effective for preventing cardiovascular disease include remaining physically active, managing stress, and maintaining ideal body weight. - 66. Older adults experience a number of changes in the structure or function of their cardiovascular system. Which of the following changes is considered to be a normal, age-related change? A) Veins become thinner and more elastic. B) Regulation of blood pressure and heart rate becomes less efficient. C) Heart valves become atrophied and regurgitation occurs. D) Heart rate becomes slower and ejection fraction increases.Ans: B
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Overall regulation of blood pressure and heart rate becomes less responsive and less efficient with age. Veins become thicker and stiffer. Heart rate does not typically slow with age and valvular regurgitation is considered a pathologic condition at any age. - 77. The nurses who provide care in a long-term care setting are aware of the high prevalence and risks of cardiovascular disease among the older adults who live at the facility. Which of the following measures is most likely to prevent heart disease among older adults? A) Advocating for organic dietary choices for residents B) Establishing an exercise program C) Teaching about the relationships between family history and heart disease D) Teaching residents to reduce their stress levelsAns: B
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Inactivity is among the most salient risk factors for heart disease, exceeding the effects of stress. Knowledge about the role of family history is unlikely to lower individuals' risks of heart disease. An organic diet is not necessary to prevent heart disease. - 88. A 79-year-old client recently experienced a syncopal (fainting) episode after standing up quickly while gardening. Which assessment is the nurse's priority? A) "Did you experience any fatigue or blurred vision?" B) "What did you doctor say about this?" C) "What medications do you take?" D) "When did you last eat a meal?"Ans: C
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Risks for orthostatic hypotension include multiple medications. Orthostatic hypotension can be accompanied by symptoms such as fatigue, lightheadedness, blurred vision, and syncope upon standing or not. Whether orthostatic hypotension is symptomatic or asymptomatic, it can lead to negative functional consequences. Postprandial hypotension is not represented by this scenario. Asking what the primary health care provider said is passing the buck. - 99. A nurse who works on a geriatric long-term care unit is aware that many of the older adult clients on the unit have a documented history of orthostatic hypotension. What measure should the nurse prioritize in order to ensure the safety of such clients? A) Mobilize clients within 2 hours of eating a meal. B) Have clients take several deep breaths before standing to their feet. C) Have clients sit on the edge of their beds for a minute or two before ambulating. D) Encourage clients to use a bedpan or incontinence brief to prevent falls while ambulating to the bathroom.Ans: C
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Sitting at the edge of the bed before standing can significantly reduce the risk of falls in individuals with orthostatic hypotension. It is inappropriate to have clients use bedpans or briefs for the sole reason of preventing falls. Mobilizing after meals and deep breathing do not appreciably address orthostatic hypotension. - 1010. A 70-year-old client has been a regular cigarette smoker since late teens and has made several attempts to quit over the years. When the nurse encourages the client to again try to quit, the client responds, "At this point in my life, I think it's probably too late." How should the nurse best respond to the client's statement? A) "You'll be able to avoid having a future heart attack if you quit smoking now." B) "Three months after your quit, you'll have the same risk of heart disease as a lifetime nonsmoker." C) "In a way that's true, but you would feel much better about yourself if you managed to quit." D) "Actually, you'll start to enjoy some health benefits almost as soon as you quit."Ans: D
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Benefits of smoking cessation exist at any age. Complete elimination of smoking-related health threats does not disappear after only 3 months, however. Smoking cessation is not a guarantee against future MI. - 1111. A nurse identifies clients who are at risk for modifiable risk factors for cardiovascular disease. Which of the following clients should the nurse prioritize as having modifiable cardiovascular functional consequences? A) A 54-year-old admitted to the hospital with hepatitis A B) A 72-year-old after her second myocardial infarction. C) A 86-year-old obese woman who has type 2 diabetes D) A 94-year-old with a strong family history of myocardial infarctions at an early ageAns: C
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Modifiable risk factors include obesity, and control of blood glucose levels. Hepatitis A is not a risk factor. Prior myocardial infarction and strong family history are not modifiable. However, those clients are at risk and other risk factors in their life may need to be modified. - 1212. A nurse educates an older adult recently diagnosed with hypertension. Which of the following teaching points should the nurse include? (Select all that apply.) A) Avoid home blood pressure monitoring. B) Increase the daily intake of grains to 8 ounces per day. C) Read labels and limit sodium to 1,500 g/day. D) Walk daily for 30 minutes a day 5 of the 7 days. E) If your blood pressure is higher than 130/80 notify the primary health care provider.Ans: B, C, D
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About 30 to 45 minutes of exercise, such as brisk walking, at least five times weekly is recommended for all people with hypertension. The following nutritional interventions are recommended for all people with hypertension: sodium intake limited to 1.5 g daily; avoidance of processed foods; daily intake of 7 to 8 servings of grains and grain products and 8 to 10 servings of fruits and vegetables.
A person's blood pressure should be measured at least three times before making any decisions about treatment with a goal of systolic blood pressure of <130/80 mm Hg. Home blood pressure monitoring is recommended for initial and ongoing assessment. - 1313. A community nurse develops wellness outcomes for those at highest risk for poor management of cardiovascular disease. Which of the following populations should the nurse target? A) African American woman B) Hindu men C) Immigrant Indian population D) Mentally ill personsAns: A
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Poor people, women, and African Americans have more health disparities based on risk factors and poor health management. American Indians and Alaskan natives have the highest prevalence by population. Religion is not a diversity factor, nor is mental illness. - 1414. A nurse assesses an older adult for dietary habits. Which of the following statements by the client should the nurse identify as a positive dietary habit for cardiovascular functioning? A) "I avoid meat, and eat nuts instead." B) "I don't eat vegetables." C) "I drink 4 glasses of wine a day." D) "I limit my salt to 3,500 grams per day."Ans: A
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Heart-healthy diets include high intake of nuts, fish, fruits, vegetables, and fiber-rich whole grains, less than 1,500 mg of sodium a day, and fruits and vegetables that are rich in essential nutrients, including antioxidants. Excessive use of alcoholic beverages increases the risk. - 1515. A nurse provides education to an 82-year-old woman with postprandial hypotension. Which of the following interventions should be included? (Select all that apply.) A) Avoid sitting still for prolonged periods. B) Drink eight glasses of non-caffeinated beverages daily. C) Eat regularly scheduled meals with breakfast as the largest. D) Engage in regular, but not excessive, exercise. E) Limit alcohol consumption to one drink per evening.Ans: A, B, D, E
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Health promotion measures specific to postprandial hypotension include the following: minimize the risk for postprandial hypotension by taking antihypertensive medications (if prescribed) 1 hour after meals rather than before meals; eat small, low-carbohydrate meals; avoid alcohol consumption; and avoid strenuous exercise, especially for 2 hours after meals.