Chapter 31: Assessment of Cardiovascular System
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1.A 74-yr-old patient has just arrived in the emergency department. After assessment reveals a
pulse deficit of 46 beats, the nurse will anticipate that the patient may require
a. emergent cardioversion.
b.a cardiac catheterization.
c.hourly blood pressure (BP) checks.
d.electrocardiographic (ECG) monitoring.
ANS:D
Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It
indicates that there may be a cardiac dysrhythmia that would best be detected with ECG
monitoring. Frequent BP monitoring, cardiac catheterization, and emergent cardioversion are
used for diagnosis and/or treatment of cardiovascular disorders but would not be as helpful in
determining the immediate reason for the pulse deficit.
DIF:Cognitive Level: Apply (application)REF:668
TOP:Nursing Process: Planning MSC:NCLEX: Physiological Integrity
2.The nurse is reviewing the 12-lead electrocardiograph (ECG) for a healthy 74-yr-old patient
who is having an annual physical examination. What finding is of most concern to the nurse?
a.A right bundle-branch block.c.The QRS duration is 0.13 seconds.
b. The PR interval is 0.21 seconds.d.The heart rate (HR) is 41 beats/min.
ANS:D
The resting HR does not change with aging, so the decrease in HR requires further
investigation. Bundle-branch block and slight increases in PR interval or QRS duration are
common in older individuals because of increases in conduction time through the AV node,
bundle of His, and bundle branches.
DIF:Cognitive Level: Analyze (analysis)REF:662
TOP:Nursing Process: AssessmentMSC:NCLEX: Physiological Integrity
3.During a physical examination of an older patient, the nurse palpates the point of maximal
impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The best
follow-up action for the nurse to take will be to
a.ask about risk factors for atherosclerosis.
b.determine family history of heart disease.
c.assess for symptoms of left ventricular hypertrophy.
d.auscultate carotid arteries for the presence of a bruit.
ANS:C
The PMI should be felt at the intersection of the fifth intercostal space and left midclavicular
line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as
with left ventricular hypertrophy (LVH). The other assessments are part of a general cardiac
assessment but do not represent follow-up for LVH. Cardiac enlargement is not necessarily
associated with atherosclerosis or carotid artery disease.
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