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UNIVERSITI TEKNOLOGI MARA FINAL EXAMINATION

COURSE COURSE CODE EXAMINATION TIME

CARDIOVASCULAR AND HEMATOLOGY NURSING NRS451 OCTOBER 2009 3 HOURS

INSTRUCTIONS TO CANDIDATES 1. This question paper consists of two (2) parts : PART A (50 Questions) PART B (2 Questions) 2. Answer ALL questions from all two (2) parts: i) Answer PART A in the OMR Multiple Choice Answer Sheet.. ii) Answer PART B in the Answer Booklet. Start each answer on a new page. Do not bring any material into the examination room unless permission is given by the invigilator. Please check to make sure that this examination pack consists of: i) ii) iii) the Question Paper an Answer Booklet - provided by the Faculty an OMR Multiple Choice Answer Sheet.- provided by the Faculty

3.

4.

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

This examination paper consists of 12 printed pages
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PART A

(40 marks)

Answer ALL questions. Choose the MOST appropriate answer for each question.

1. Which of these would be considered a modifiable risk factor for cardiovascular disease? A. B. C. D. Menopause. Physical inactivity. High blood pressure. History of chest pain.

2. The nurse notes a client's neck veins are distended when sitting upright which indicates A. B. C. D. ascites. right-sided heart failure. decreased renal output. pulmonary hypertension.

3. In electrocardiogram (ECG), travels through the AV node. A. B. C. D. Twave Pwave ST segment QRS complex

represents the electrical impulse as it

4. A heart rate less than 60 beats per minute is called A. B. C. D. flutter. ectopic beat. sinus bradycardia. asymptomatic bradycardia.

5. The treatment for tachycardia is A. B. C. D. dependent on the cause. administration of atropine. administration of epinephrine. placement of a permanent pacemaker.

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6. Cardioversion should be done during which part of the EGG wave? A. B. C. D. Pwave. Twave. R wave. ST segment.

7. Health education for a client who has a pacemaker implanted include A. B. C. D. resuming a normal diet. resuming an active lifestyle, including contact sports. realizing the pacemaker may malfunction without notice. wearing a medical alert tag to indicate presence of a pacemaker.

8. The MAIN goal of treatment for a client who has rheumatic fever is to A. B. C. D. treat the inflammation. prepare for cardiac rehabilitation. prevent spread to others in the family. alter electrical conduction within the heart.

9. Which of these medications are used to treat myocarditis? A. B. C. D. Diuretics and analgesics. Antivirals and antipyretics. Anti-inflammatory agents and antifungals. Digitalis preparations and broad-spectrum antibiotics.

10. The nursing intervention for a client with pericarditis is A. B. C. D. use airborne precautions. monitor the client's apical and radial pulses. prepare the client for pacemaker implantation. assess the client for signs of cardiac tamponade.

11. The MOST common cause of acute myocardial infarction (AMI) is A. B. C. D. stress. hypertension. atherosclerosis. rheumatic heart disease.

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12. Which of these medications is used in the initial treatment of AMI? A. B. C. D. Digoxin and lidocaine. Coumadin and corticosteroids. Antihypertensives and antiemetics. Morphine sulfate and thrombolytic therapy.

13. Complications of the client receiving thrombolytic therapy are A. B. C. D. chest and foot pain. dysrhythmias and agitation. hematemesis and tarry stools. fever, dyspnea and tingling in arms and hands.

14. Which of these symptoms is associated with left-sided heart failure? A. B. C. D. Cyanosis. Increased blood pressure. Increased sputum production. Edema of the ankles and lower legs.

15. The FIRST step to maintain blood pressure within normal range for a client with hypertension is A. frequent rest periods during the day. B. use of antihypertensive medications. C. weight loss and dietary modifications. D. have family members checked for hypertension.

16. Which type of medication would be used FIRST in treating hypertension? A. B. C. D. Diuretics. Vasodilators. Beta-adrenergic blocking agents. Angiotensin-converting enzyme (ACE) inhibitors.

17. Which of these client's statements MOST closely correlate with angina pectoris? A. B. C. D. "I was cold and hungry". "The pain lasted over an hour". "After I had dinner, the pain disappeared". "It felt like indigestion and a burning sensation in my chest".

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18. A. B. C. D.

is the MOST accurate indicator of coronary heart disease. ECG Chest X-ray Echocrdiogram Coronary angiogram

19. To prevent hematoma following balloon angioplasty, the nurse should A. B. C. D. assist client to the bathroom to void. assess the puncture site every 8 hours. elevate the head of the bed 45 degrees. prevent flexion of the leg on the affected side of the angioplasty.

20. The PRIORITY nursing diagnosis for a client with chest pain is A. B. C. D. anxiety. ineffective coping. activity intolerance. ineffective tissue perfusion.

21. Which of these measures help to reduce the risk of developing cardiac dysrhythmias in an older client? A. Avoid exercise. B. Eliminate smoking. C. Increase salt intake. D. Visit doctor every 2 years.

22. The following are nursing interventions for the client undergoing hemodynamic monitoring EXCEPT: A. B. C. D. Set and turn monitoring alarms. Measure all pressures between breaths. Assess the catheter insertion site every shift. Tightly restrain the affected extremity of the invasive line.

23. A. B. C. D.

pressure indicates hemodynamic functioning of the left ventricle. Intra-arterial Central venous Intra-ventricular Pulmonary artery

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24. Which of these findings is MOST suggestive of decreased cardiac output? A. B. C. D. Dry skin. Warm skin. Pink nail beds. Diminished pulse. position to

25. The nurse should place the client with acute pulmonary edema in facilitate breathing. A. B. C. D. prone supine left-lateral high Fowlers

26. How do red blood cells (RBCs) assist the respiratory and circulatory systems? A. B. C. D. Provide oxygen to body tissues. Disperse surfactants within lung tissue. Fight infection and assist with immunity. Destroy dead and injured cells and bacteria.

27. White blood cells (WBCs) are A. B. C. D. active in the clotting mechanism of the body. produced by the liver according to the demand of the body. responsible for fighting infection and assisting with immunity. responsible for the exchange of oxygen (0 2 ) and carbon dioxide (C0 2 ).

28. A client's full blood count result shows an increased number of WBCs indicating A. B. C. D. drug toxicity. dietary deficiencies. bone marrow failure. infection and inflammation.

29. Fresh frozen plasma (FFP) is transfused within A. B. C. D. 10-15 minutes. 30 - 45 minutes. 1 hour. 4 hours.

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30. What is the normal life span of a platelet? A. B. C. D. A few hours to days. 10 days. 120 days. 10 years.

31. A universal recipient has a A. B. C. D. A B AB O

type of blood.

32. When a nurse suspects a client is having a blood transfusion reaction, the FIRST action is to A. B. C. D. stop the infusion. continue to observe the client closely. call the blood bank and report findings. call the health care provider and report findings.

33. A client with blood transfusion in progress needs frequent monitoring of A. B. C. D. pulse. temperature. blood pressure. oxygen saturation.

34. A client who has sickle-cell disease manifests fever, severe pain and swollen joints. The nurse should recognize that the client's symptoms resulted from A. B. C. D. sickle-cell crisis. alcohol ingestion. inconsistent blood levels. infection such as pneumonia.

35. What is the usual treatment for polycythemia? A. Phlebotomy. B. Transfusion of RBCs. C. Low-calorie, low-protein diet. D. Administration of oral or parenteral iron.

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36. Acute lymphocytic leukemia (ALL) A. is usually fatal, regardless of treatment. B. occurs primarily in children under age 15. C. can be cured with stem cell transplantation. D. occurs primarily in adolescence and after age 55.

37. The MOST common cause of death in clients with chronic leukemia is A. B. C. D. persistent blood loss. aggressive chemotherapy. viral and fungal pneumonia. bone marrow transplantation.

38. What is the MOST important step when caring for a client with leukemia? A. B. C. D. Practice proper hand hygiene. Frequent oral care with a soft toothbrush. Talk to the client about fears and concerns. Administer prescribed vitamins and antiemetics.

39. Clotting and hemorrhaging occur alternately in this condition. A. B. C. D. Anemia. Leukemia. Polycythemia vera. Disseminated intravascular coagulapathy (DIC).

40. In DIC, this occurs after microthrombi blocks the arterioles and capillaries. A. B. C. D. The body's fibrinolytic process responds, causing hemorrhaging. Circulation is impeded, causing edema and damage to the peripheral nerves. The body's clotting factors respond, causing breakdown of the circulatory system. Oxygenation is impeded due to the breakdown of association between the arterioles and capillaries.

41. Treatment of DIC includes A. phlebotomy. B. chemotherapy. C. administration of antibiotics. D. administration of platelets and packed cells.

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42. When a client who has Hodgkin's lymphoma is having radiation therapy or chemotherapy it is important for the nurse to A. B. C. D. provide low salt diet. provide high carbohydrate diet. encourage fluid intake of at least 2.5 L. encourage increased activity when possible.

43. Myeloma is A. B. C. D. symptomatically treated. diagnosed with a chest x-ray. usually an initial symptom of chest pain. commonly affects children between the ages of 4 and 18 years.

44. A client with hemophilia experiences pain due to bleeding in the joints. The appropriate nursing intervention would be A. B. C. D. applying ice and pressure to bleeding sites. applying warm compresses to bleeding sites. immobilizing painful joints in an extended position. administering aspirin or nonsteroidal anti-inflammatory drugs.

45.

is administered before blood transfusion. A. Dextrose 5% B. Normal saline C. Dextrose saline D. Lactated Ringer's

46. Which of these nursing interventions is appropriate for the client with sickle-cell anemia to increase tissue perfusion? A. B. C. D. Restrict fluid intake. Monitor for symptoms of electrolyte imbalance. Teach the client to take apical and radial pulses. Elevate head of bed and administer oxygen as needed.

47. A reduction of A. B. D. platelets neutrophils hemoglobin

is associated with a diagnosis of thalassemia.

C. leukocytes
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48. Which of these nursing diagnoses should a nurse address first for a client with a platelet count less than 20,000 uL? A. B. C. D. Risk for bleeding. Risk for infection. Activity intolerance. Body-image disturbance.

49. When caring for a client with thrombocytopenia, the nurse should plan to A. B. C. D. avoid invasive procedures. discourage the use of stool softeners. assess temperature reading six hourly. encourage the use of a hard-bristle toothbrush.

50. Immediately following a bone marrow biopsy and aspiration, the nurse should instruct the client to A. B. C. D. expect to receive a blood transfusion. lie still with a sterile pressure dressing intact. lie with knees slightly bend and head elevated. cleanse the site immediately with providone-iodine.

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PART B

(70 marks)

Answer ALL questions.

QUESTION 1 Mr. Hussin, a 64 year old is admitted for management of chest pain caused by angina pectoris. The doctor prescribed nitroglycerin (GTN) sublingually for Mr. Hussin. a) Define angina pectoris. (2 marks) b) Describe how chronic unstable angina differs from angina associated with myocardial infarction. (6 marks) State the characteristic of chest pain due to angina pectoris. (4 marks) d) Discuss the possible changes in ECG findings and laboratory test. (5 marks) e) Discuss your nursing responsibilities when giving GTN. (4 marks) f) Explain the nursing interventions with rationales for nursing diagnosis "ineffective tissue perfusion due to angina". (8 marks) Explain health education regarding changes in lifestyle. (6 marks)

c)

g)

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QUESTION 2 Julia, a 37-year-old female, is admitted with leukemia. The physician planned for a bone marrow aspiration. a) State FOUR major types of leukemia. (2 marks) b) List FOUR clinical manifestations of leukemia. (4 marks) c) Describe the nursing interventions with rationales for the following nursing diagnoses: i) "Anxiety related to fear of prognosis". (8 marks) ii) "Risk for infection related to altered immune function". d) e) (8 marks) Explain nursing responsibilities before, during and after bone marrow aspiration. (8 marks) Discuss the main priorities of education for a newly diagnosed patient with leukemia. (5 marks)

END OF QUESTION PAPER

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