health alterations week 2

Question 1

Heart failure is cardiac dysfunction leading to what?

Answer 1

Inadequate perfusion of tissues with oxygenated blood

Question 2

What proportion of patients with heart failure also have a history of coronary heart disease and acute myocardial infarction?

Answer 2

Approximately two thirds

Question 3

What is another name for left heart failure?

Answer 3

Congestive heart failure

Question 4

What increases afterload

Answer 4

Arteriole vasoconstriction,Increased peripheral vascular resistance,Hypertension

Question 5

What are the clinical manifestations of systolic heart failure?

Answer 5

decreased urine output

Question 6

What are the signs of right heart failure?

Answer 6

Hepatomegaly,Jugular vein distension,Peripheral oedema

Question 7

What symptoms does a person with class 2 heart failure experience according to the New York Heart Association?

Answer 7

ordinary physical activity results in fatigue, dyspnoea, palpitations or anginal pain

Question 8

When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, which foods would you explain require restriction?

Answer 8

yogurt and milk products.
Yogurt and milk products (e.g., cheese) naturally contain a significant amount of sodium, and the intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily

Question 9

What is the role of diuretics in managing systolic heart failure?

Answer 9

Decrease preload

Question 10

What is a haemorrhagic stroke?

Answer 10

Bleeding from the cerebral vessels into brain tissue

Question 11

What are the two types of ischaemic stroke?

Answer 11

Thrombotic & embolic

Question 12

What proportion of strokes are ischaemic?

Answer 12

75-85%

Question 13

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the nurse to address?

Answer 13

The patient’s usual blood pressure (BP) is 170/94 mm Hg.

Hypertension is the single most important modifiable risk factor.

Question 14

The clinical manifestations of stroke are…

Answer 14

Facial drooping
Unilateral arm weakness
Speech disturbance (expressive and receptive)

Question 15

Intracerebral haemorrhage is …

Answer 15

Related to hypertension and ruptured aneurysm

Question 16

Why does a stroke on one side of the brain affect contralateral motor function

Answer 16

Pyramidal nerve pathways cross at the medulla

Question 17

What is the purpose of an urgent non-contrast CT or MRI scan of the brain for a person suspected of stroke?

Answer 17

Rapidly distinguish between an ischaemic and haemorrhagic stroke.The results will determine treatment options

Question 18

What is the rationale for screening stoke patient’s ability to swallow and keeping them nil by mouth until a swallow assessment is completed by a speech therapist?

Answer 18

Risk of dysphagia

Question 19

Why are long-term indwelling catheters not recommended for stroke patients?

Answer 19

Urinary tract infections and delayed bladder re-training

Question 20

What is the maximal duration a stoke patient with hemiparesis can be positioned on their affected side?

Answer 20

30 minutes

Question 21

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse?

Answer 21

Oxygen saturation of 88%

Question 22

Baroreceptors in the central circulation activate what system in response to decreased perfusion?

Answer 22

Sympathetic nervous system

Question 23

What process occurs within arteries entering the brain, or within the brain, resulting a thrombotic stroke?

Answer 23

Atherosclerosis

Question 24

What is the clinical manifestation of atherosclerosis?

Answer 24

Partial vessel obstruction may lead to transient ischaemic events, associated with stress or exercise.
Transient ischaemic attack
Angina pectoris

Question 25

Lacunar infarcts involve

Answer 25

Small, deep arterial blood vessels thromboses causing focal deficits

Question 26

How is a thrombotic stroke different from an embolic stoke?

Answer 26

thrombotic stroke is the result of atherosclerosis in arteries supplying the brain, while an embolic stroke is the result of a fragment that travels to the brain blocking arteries.

Question 27

What are the two type of left heart failure?

Answer 27

Systolic heart failure and diastolic heart failure

Question 28

Why do the signs and symptoms associated with transient ischaemic attack resolve quickly?

Answer 28

A temporary reduction in blood flow within the brain that is caused by low blood pressure.

Question 29

Differentiate between systolic and diastolic heart failure.

Answer 29

Systolic heart failure occurs when the left ventricle is unable to contract adequately, diastolic heart failure occurs due to the inability of the left ventricle to properly relax

Question 30

What is the key feature of systolic heart failure?

Answer 30

Decreased contractility of the heart muscle and increased end diastolic volume

Question 31

What does the renin-angiotensin-aldosterone system do?

Answer 31

Increases peripheral vascular resistance and increase sodium and water retention

Question 32

Nurses in change-of-shift report are discussing the care of a patient with a stroke who has progressively increasing weakness and decreasing level of consciousness. Which patient problem do they determine has the highest priority for the patient?

Answer 32

Risk for aspiration related to inability to protect airway

Question 33

Tissue plasminogen activator is recommended for…

Answer 33

Patients with an ischaemic stroke (proven by imaging) within 4.5 hours of symptom onset

Question 34

During the initial evaluation of a stroke patient, what is the single most important point in the patient’s history?

Answer 34

Time of onset of symptoms

Question 35

A patient is being admitted with a possible stroke. Which information from the assessment indicates that you should consult with the doctor before administering the prescribed aspirin?

Answer 35

The patient reports that symptoms began with a severe headache

Question 36

The nurse is caring for a patient who is receiving IV frusemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnoea. Which clinical finding is the best indicator that the treatment has been effective?

Answer 36

Reduced dyspnoea with the head of bed at 30 degrees

Question 37

Several weeks after a stroke, a 50-yr-old male patient has impaired awareness of bladder fullness, resulting in urinary incontinence. Which nursing intervention should be planned to begin an effective bladder training program?

Answer 37

Assist the patient onto the bedside commode every 2 hours. | Developing a regular voiding schedule will prevent incontinence and may increase patient awareness of a full bladder.

Question 38

During the change of shift report, a nurse is told that a patient has an occluded left posterior cerebral artery. The nurse will anticipate that the patient may have

Answer 38

visual deficits.

Question 39

What are some raised intracranial pressure (ICP) management strategies that can improve venous drainage of the brain?

Answer 39

Elevating the head of the bed 30%, maintaining head and neck alignment & avoiding hip flexion

Question 40

The headache from haemorrhagic stroke is due to…

Answer 40

Irritation of meningeal membranes by blood

Question 41

What medications can reduce peripheral vascular resistance?

Answer 41

ACE inhibitors, ARBs, short acting B-adrenergic blockers

Question 42

What is a TIA?

Answer 42

A thrombotic stroke lasting less than 24 hours

Question 43

A patient with a history of chronic heart failure is admitted to the emergency department with severe dyspnoea and a dry, hacking cough. After completing the primary survey, which action should the nurse do first?

Answer 43

Auscultate the breath sounds. This patient’s severe dyspnoea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary oedema, which should be detected and treated immediately to prevent ongoing hypoxaemia and cardiac/respiratory arrest.

Question 44

A patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find?

Answer 44

Difficulty comprehending instructions