nrs451 cardi n hema

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CONFIDENTIAL HS/OC T 2009/NRS451

UNIVERSITI TEKNOLOGI M ARAFINAL 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 A LL questions from all two (2) parts:

i) Answ er PA RT A in the OMR M ultiple Choice Answer S heet..

ii) Answ er PA RT B in the Answer Booklet. Start each answer on a new page.3. Do not bring any material into the examination room unless permission is given by the

invigilator.

4. Please che ck to make sure that this examination pack consists o f:

i) the Ques tion Paperii) an Ans wer Booklet - provided by the Facultyiii) an OM R Multiple Choice Answ er Sheet.- provided by the Faculty

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

This examination paper consists of 12 printed pages Hak Cipta Universiti Teknologi MARA C O N F ID E N T IA L


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CONFIDENTIAL 2 HS/OCT 2009/NRS451

PART A (40 marks)

Answer ALL questions.

Choose the MOST appropriate answ er for each question.

1. Which of these wo uld be considered a modifiable risk factor for cardiovascular disease?

A. Menopause.B. Physical inactivity.C. High blood pressure.D. History of chest pain.

2. The nurse notes a client's neck veins are distended when sitting upright which indicates

A. ascites.B. right-sided heart failure.C. decreased renal output.D. pulmonary hypertension.

3. In electrocardiogram (ECG ), represents the electrical impulse as ittravels through the AV node.

A. TwaveB. PwaveC. ST segmentD. QRS complex

4. A heart rate less than 60 beats per minute is called

A. flutter.B. ectopic beat.C. sinus bradycardia.D. asymptomatic bradycardia.

5. The treatment for tachycardia is

A. dependent on the cause.B. administration of atropine.C. administration of epinephrine.D. placement of a permanent pacemaker.

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6. Cardioversion sho uld be done during which part of the EGG wave?

A. Pwave .B. Twave.C. R wave.D. ST segment.

7. Health education for a client who has a pacema ker implanted include

A. resuming a normal diet.B. resuming an active lifestyle, including con tact sports.C. realizing the pacemaker may malfunction without notice.D. wearing a medical alert tag to indicate presence of a pacemaker.

8. The MAINgoal of treatmen t for a client who has rheum atic fever is to

A. treat the inflammation.B. prepare for cardiac rehabilitation.C. prevent spread to o thers in the family.D. alter electrical con duction within the heart.

9. W hich of these m edications are used to treat myocarditis?

A. Diuretics and analgesics.B. Antivirals and antipyretics.C. Anti-inflammatory agents and antifungals.D. D igitalis preparations and broad-spectrum antibiotics.

10. The nursing intervention for a client with pericarditis is

A. use airborne precautions.B. monitor the client's apical and radial pulses.C. prepare the client for pacem aker implantation.D. assess the client for signs of cardiac tampo nade.

1 1 . The MOST common cause of acute myocardial infarction (AMI) is

A. stress.B. hypertension.C. atherosclerosis.D. rheumatic heart disease.

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12. Wh ich of these med ications is used in the initial treatment of AM I?

A. Digoxin and lidocaine.B. Coum adin and corticosteroids.C. Antihypertensives and antiemetics.D. Morphine sulfate and thrombolytic therapy.

13. Com plications of the client receiving thrombolytic therapy are

A. chest and foot pain.B. dysrhythmias and agitation.C. hematemesis and tarry stools.D. fever, dyspnea and tingling in arms and hand s.

1 4. W hich of these sym ptoms is associated with left-sided heart failure?

A. Cyanosis.B. Increased blood pressure.C. Increased sputum production.D. Edema of the ankles an d lower legs.

15. The FIRST step to maintain blood pressure within normal range for a client withhypertension is

A. frequent rest periods during the day.B. use of antihypertensive m edications.C. w eight loss and dietary m odifications.D. have family members checked for hypertension.

16. Which type of medication would be used FIRST in treating hypertension?

A. Diuretics.B. Vasodilators.C. Beta-adrenergic blocking agents.D. Angiotensin-converting enzym e (ACE) inhibitors.

17. W hich of these client's statemen ts MOST closely correlate w ith angina pectoris?

A. "I was cold and hungry".B. "The pain lasted over an hour".C. "After I had dinner, the pain disappeared".D. "It felt like indigestion and a burning sensation in my chest".

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18. is th e MOST accurate indicator of coronary heart diseas e.

A. ECGB. Chest X-rayC. EchocrdiogramD. Coronary angiogram

19. To prevent hematoma following balloon angioplasty, the nurse should

A. assist client to the bathroom to void.B. assess the puncture site every 8 hours.C. elevate the head of the bed 45 degrees.D. prevent flexion of the leg on the affected side of the an gioplasty.

20. Th e PRIORITYnursing diagnosis for a client with chest pain is

A. anxiety.B. ineffective coping .C. activity intolerance.D. ineffective tissue perfusion.

21 . Wh ich of these measures help to reduce the risk of developing cardiac d ysrhythmias inan 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 hemodynamicmonitoring EXCEPT:

A. Set and turn monitoring alarms.B. Measure all pressures between breaths.C. Assess th e catheter insertion site every shift.D. Tightly restrain the affected extremity of the invasive line.

23. pressure indicates hem odynamic functioning of the left ventricle.

A. Intra-arterialB. Central venousC. Intra-ventricularD. Pulmonary artery



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24 . Which of these findings is MOST suggestive of decreased cardiac o utput?

A. Dryskin.B. Warm skin.C. Pink nail beds.D. Diminished pulse.

25 . The nurse should place the client with acute pulmonary edem a in position tofacilitate breathing.

A. proneB. supineC. left-lateralD. high Fowlers

26. How do red blood cells (RBC s) assist the respiratory and circulatory system s?

A. Provide oxygen to body tissues.B. Disperse surfactants within lung tissue.C. Fight infection and assist with immunity.D. Destroy dea d and injured cells and bacteria.

27 . White blood cells (WBCs) are

A. active in the clotting mechanism of the body.B. produced by the liver according to the demand of the body.C. responsible for fighting infection and assisting with immu nity.D. responsible for the exchange of oxygen (02) and carbon dioxide (C02).

28. A client's full blood count result shows an increased number o f W BC s indicating

A. drug toxicity.B. dietary deficien cies.C. bone ma rrow failure.D. infection and inflamma tion.

29. Fresh frozen plasma (FFP) is transfused within

A. 1 0-15 minutes.B. 30 - 4 5 minutes.C. 1 hour.D. 4 hours.



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30. Wha t is the norm al life span of a platelet?

A. A few hours to days.B. 1 0 days.C. 1 20 days.D. 1 0 years.

31 . A universal recipient has a type of blood.

A. AB. BC. ABD. O

32. When a nurse suspects a client is having a blood transfusion reaction, the FIRST actionis to

A. stop the infusion.B. continue to observe the client closely.C. call the blood bank and report findings.D. call the health care provider and report findings.

33. A client with blood transfusion in progress needs frequen t m onitoring of

A. pulse.B. temperature.C. blood pressu re.D. oxygen saturation.

34 . A client who has sickle-cell disease manifests fever, severe pain and swollen joints. Thenurse should recognize that the client's sym ptoms resulted from

A. sickle-cell crisis.B. alcohol ingestion.C. inconsistent blood levels.D. infection such as pneum onia.

35. What is the usual treatment for polycythemia?

A. Phlebotomy.B. Transfusion of RBC s.C. Low-calorie, low-protein diet.D. Adm inistration of oral or parenteraliron.



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36 . Acute lymphocytic leukemia (ALL)

A. is usually fatal, regardless of treatment.B. occurs primarily in children under age 1 5.C. can be cured with stem cell transplantation.D. occurs primarily in adolescence and after age 55.

37. The MOST com mo n cause of death in clients with chronic leukem ia is

A. persistent blood loss.B. aggressive chem otherapy.C. viral and fungal pneum onia.D. bone marrow transplantation.

38 . W hat is the MOST important step whe n caring for a client with leukemia?

A. Practice proper hand hygiene.B. Frequent oral care with a soft toothbrush.C. Talk to the client about fears and concerns.D. Adm inister prescribed vitamins and antiemetics.

39 . Clotting and hem orrhaging occur alternately in this condition.

A. Anemia.B. Leukemia.C. Polycythemia vera.D. Disseminated intravascular coagulapathy (DIC).

40. In DIC, this occurs after m icrothrombi blocks the arterioles and capillaries.

A. The body's fibrinolytic process responds, causing hem orrhaging.B. Circulation is imped ed, causing edema and damage to the peripheral nerves.C. The body's clotting factors respond, causing breakdown of the circulatory system .

D. Oxygena tion is imp eded due to the breakdown of association between the arteriolesand capillaries.

4 1 . Treatment of DIC includes

A. phlebotomy.B. chemotherapy.C. adm inistration of antibiotics.D. adm inistration of platelets and packed cells.



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42. When a client who has Hodgkin's lymphoma is having radiation therapy orchemotherapy it is important for the nurse to

A. provide low salt diet.B. provide high carbohydrate diet.C. enco urage fluid intake of at least 2.5 L.D. encourage increased activity when possible.

43. Myeloma is

A. symptom atically treated.B. diagnosed with a chest x-ray.C. usually an initial symp tom of chestpain.D. comm only affects children between the ages of 4 and 18 years.

44. A client with hemophilia experiences pain due to bleeding in the joints. The appropriatenursing intervention would be

A. applying ice and pressure to bleeding sites.B. applying wa rm compresses to bleeding sites.C. immo bilizing painful joints in an extended position.D. adm inistering aspirin or nonsteroidal anti-inflammatory drugs.

45. is administered before blood transfusion.

A. Dextrose 5%B. Normal salineC. Dextrose salineD. Lactated Ringer's

46. Which of these nursing interventions is appropriate for the client with sickle-cell anemiato increase tissue perfusion?

A. Restrict fluid intake.B. Monitor for symptom s of electrolyte imbalance.C. Teach the client to take apical and radial pulses.D. Elevate head of bed and administer oxygen as needed .

47. A reduction of is associated with a diagnosis of thalassem ia.

A. plateletsB. neutrophilsC. leukocytesD. hemoglobin



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48. Wh ich of these nursing diagnoses should a nurse address first for a client with a plateletcount less than 20,000 uL?

A. Risk for bleeding.B. Risk for infection .C. Activity intolerance.D. Body-image disturbance.

49. W hen caring for a client with thrombocytopenia, the nu rse should p lan to

A. avoid invasive procedures.B. discourage the use of stool softeners.C. assess temp erature reading six hourly.D. encourage the use of a hard-bristle toothbrush.

50 . Immediately following a bone marrow biopsy and as piration, the nurse should instruct theclient to

A. expect to receive a blood transfusion.B. lie still with a sterile pressu re dressing intact.C. lie with knees slightly bend and head elevated.D. 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 anginapectoris. The doctor prescribed nitroglycerin (GTN) sublingually for Mr. Hussin.

a) Define angina pecto ris.(2 marks)

b) Describe how chronic unstable angina differs from angina associated with m yocardialinfarction.

(6 marks)

c) State the characteristic of chest pain due to angina pectoris.(4 marks)

d) Discuss the poss ible changes in ECG findings and laboratory test.(5 marks)

e) Discuss your nursing responsibilities when giving GT N.(4 marks)

f) Explain the nursing interventions with rationales for nursing diagn osis "ineffective tissueperfusion due to angina".

(8 marks)

g) Explain health edu cation regarding changes in lifestyle.(6 marks)



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QUESTION 2

Julia, a 37-year-old female, is admitted with leukemia. The physician planned for a bonemarrow 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".(8 marks)

d) Explain nursing respons ibilities before, during and after bone marrow aspiration.(8 marks)

e) Discuss the main priorities of educa tion for a newly diagnose d patient with leukemia.(5 marks)

END OF QUESTION PAPER

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nrs451 cardi n hema

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