Exam Questions | Assessing The Cardiovascular And – Ch.29 - Medical Surgical Nursing 7e | Test Bank by LeMone, Burke, Bauldoff by LeMone, Burke, Gerene Bauldoff. DOCX document preview.
LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)
Chapter 29 Assessing the Cardiovascular and Lymphatic Systems
1) The nurse is reviewing the anatomy of the heart with a patient scheduled for a cardiac catheterization. What should the nurse explain as the primary factor that regulates blood flow through the coronary arteries?
1. Blood pressure in the aorta
2. Blood vessel dilation
3. Low-pressure systemic circulation
4. Draining of blood into the coronary sinus by the coronary veins
Page Ref: 956
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
2) The nurse is explaining cardiac reserve to a patient recovering from a myocardial infarction. Which example should the nurse use to explain this term?
1. Getting on a treadmill and gradually increasing the pace of walking
2. Breathing in through the nose and out the mouth while sitting quietly
3. Sitting in a chair to cool down after completing an exercise routine
4. At the end of systole, approximately 50 mL of blood remaining in the ventricles
Page Ref: 956
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
3) The nurse is reviewing the layers of the heart with a patient with endocarditis. From outermost to innermost, in which order should the nurse review these layers? Place the six steps in the correct order.
Choice 1. Epicardium
Choice 2. Myocardium
Choice 3. Endocardium
Choice 4. Pericardial cavity
Choice 5. Fibrous pericardium
Choice 6. Parietal layer of serous pericardium
Page Ref: 954
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
4) A patient being evaluated for cardiac pathology asks the nurse why sodium, calcium, and potassium are so important in the diet. What is the nurse's best response?
1. "The action potentials of the heart muscle cells are dependent on the diffusion of sodium, potassium, and calcium across the cell membrane."
2. "Because you are on potassium supplements, it is important to monitor electrolytes."
3. "Heart rate is affected by the oxygen levels in your body, which involves the attachment of oxygen molecules to these electrolytes."
4. "It is the pacemaker of your heart that is responsible for the heartbeat."
Page Ref: 957
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
5) The nurse is planning to calculate a patient's cardiac index (CI). What physical assessment data does the nurse need to make this calculation?
1. Weight and height
2. Weight only
3. Weight and waist measurement
4. Waist measurement and height
Page Ref: 957
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
6) The nurse is preparing to analyze a patient's electrocardiogram (ECG) rhythm strip. In which order should the nurse complete this analysis? Place the six steps in the correct order.
Choice 1. Determine rate.
Choice 2. Assess P wave.
Choice 3. Determine regularity.
Choice 4. Identify abnormalities.
Choice 5. Assess P-to-QRS relationship.
Choice 6. Determine interval durations.
Page Ref: 985
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
7) The nurse is reviewing an electrocardiogram (ECG) rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. What should the nurse interpret these findings as indicating?
1. Normal heart function
2. Sick sinus syndrome
3. Sinus bradycardia
4. First-degree heart block
Page Ref: 984
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
8) The nurse is preparing to auscultate a patient's heart sounds. At which location will S1 be heard the loudest?
1. Left midclavicular line at the fifth intercostal space
2. Left sternal border at the fifth intercostal space
3. Right midclavicular line at the fifth intercostal space
4. Right sternal border at the third intercostal space
Page Ref: 971
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
9) The nurse is caring for a patient with hypovolemic shock. In which way will this patient's heart sounds change?
1. Diminished S2
2. Accentuated S2
3. Diminished S1 and S2
4. No change in S1 or S2
Page Ref: 971
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
10) When listening to heart sounds, the nurse hears an S3 sound after S2. What should the nurse suspect is occurring with this patient?
1. Ventricular volume overload
2. Increased resistance to ventricular filling
3. Inflammation of the pericardial sac
4. Stenotic mitral valve
Page Ref: 972
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
11) The nurse is caring for a patient admitted with a grade III heart murmur heard at midsystole. Which heart problem causes this type of murmur? Select all that apply.
1. Aortic stenosis
2. Cardiomyopathy
3. Atrioventricular (AV) valve disease
4. Mitral valve prolapse (MVP)
5. Ventricular septal defect
Page Ref: 972
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
12) The patient's ECG shows the following characteristics: PR interval .08, QRS .08, and isoelectric ST segment. What should the nurse realize these findings indicate?
1. Faster than normal conduction from the SA node to the ventricles, normal conduction through the ventricles, and normal ST segment
2. Faster than normal conduction from the SA node to the ventricles, faster than normal conduction through the ventricles, and normal ST segment
3. Normal conduction from the SA node to the ventricles, normal conduction through the ventricles, and normal ST segment
4. Normal conduction from the SA node to the ventricles, normal conduction through the ventricles, and abnormal ST segment
Page Ref: 984
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
13) The patient is performing a treadmill test. What should the nurse instruct the patient about this test?
1. The patient should wear comfortable shoes.
2. The patient should wear a patient gown and slippers.
3. Smoking is permitted until the time of the test.
4. There are no dietary restrictions prior to the test as long as small meals are planned for the day of the test.
Page Ref: 981
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the cardiovascular and lymphatic systems.
14) The patient is being evaluated for left atrium thrombus due to a dysrhythmia. Which diagnostic test should the nurse expect to be prescribed for this patient?
1. Transesophageal echocardiography (TEE)
2. Pericardiocentesis
3. Cardiac catheterization
4. Computed tomography (CT)
Page Ref: 981
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the cardiovascular and lymphatic systems.
15) A patient is scheduled for a cardiac catheterization. In which order should the nurse describe the events in this diagnostic test? Place the four events in the correct order.
Choice 1. Contrast dye is injected.
Choice 2. Heart activity is filmed.
Choice 3. A catheter is inserted into a vein or artery in the leg.
Choice 4. The catheter is threaded to the heart chamber.
Page Ref: 978
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the cardiovascular and lymphatic systems.
16) A patient is scheduled for a pericardiocentesis. Which health problem is the patient likely experiencing?
1. Cardiac tamponade
2. Slow heart rhythm
3. Chest pain
4. Suspected damage to a heart valve
Page Ref: 980
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the cardiovascular and lymphatic systems.
17) The nurse palpates a thrill on a patient's precordium. With which health problem should the nurse associate this finding?
1. Severe valve stenosis
2. Enlarged heart
3. Stenosis of the carotid arteries
4. Aortic aneurysm
Page Ref: 970
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
18) The nurse is completing the health history of a patient with a suspected cardiac disorder. About which childhood illnesses should the nurse ask the patient?
1. Rheumatic fever and strep throat infections
2. Rubella and chickenpox
3. Asthma and bronchitis
4. Otitis media and respiratory syncytial virus (RSV)
Page Ref: 969
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
19) When auscultating heart sounds, the nurse asks the patient to lie on the left side, then sit up and lean forward. Why is the patient asked to move into these positions?
1. The heart is closer to the chest wall.
2. They diminish the effect of respiratory sounds during auscultation.
3. Use of the stethoscope diaphragm improves auscultation of high-pitched murmurs.
4. Use of the bell side of the stethoscope allows low-pitched sounds to be readily identified.
Page Ref: 971
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
20) A patient recovering from a cardiac catheterization asks to be left alone. What should the nurse explain to this patient?
1. "It is important that you drink fluids after the procedure to protect kidney function. I will bring you some fresh water."
2. "It is important that you ambulate, so I will return in 30 minutes to walk with you."
3. "You are recovering well from the procedure, and rest is a good idea."
4. "You need to do the leg exercises that you practiced before the procedure to maintain good circulation to your legs. After your exercises, you can rest."
Page Ref: 978
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the cardiovascular and lymphatic systems.
21) A patient has a stroke volume (SV) of 80 mL/beat and a heart rate (HR) of 75 beats/minute. What should the nurse calculate this patient's cardiac output to be? ________ mL Record your answer rounding to the nearest whole number.
Page Ref: 956
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
22) A patient has a stroke volume (SV) of 75 mL/beat and end-diastolic volume of 120 mL. What should the nurse calculate this patient's ejection fraction to be? ________% Record your answer rounding to the nearest whole number.
Page Ref: 956
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
23) A patient returns to the care area after a cardiac catheterization. Which nursing intervention is appropriate for this patient? Select all that apply.
1. Assess cardiac rhythm and rate.
2. Assess patient for complaints of shortness of breath.
3. Maintain bed rest as ordered.
4. Assess pulses proximal to the insertion site.
5. Maintain fluid restriction.
Page Ref: 978
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 4. Recognize the purpose of and related nursing interventions for patients undergoing diagnostic tests for assessment of the cardiovascular and lymphatic systems.
24) The nurse is assessing an adult patient's heart sounds. In which order should the nurse hear the sounds?
1. S1, then S2
2. S2, then S3
3. S3, then S4
4. S2, then S1
Page Ref: 971
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
25) The nurse determines that a patient has tachycardia. What does this information suggest about the patient's heart rate?
1. Greater than 100 beats per minute
2. Less than 60 beats per minute
3. 60-90 beats per minute
4. 90 beats per minute
Page Ref: 971
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
26) When auscultating the chest of an older patient who recently experienced a myocardial infarction (MI), the nurse hears an S3 heart sound immediately following S2. For which other health problems should the nurse assess this patient?
1. Heart failure
2. Extension of the MI
3. Renal failure
4. Liver failure
Page Ref: 972
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
27) The nurse is listening to the heart of a healthy young adult. How many beats per minute should the nurse expect to assess in this patient?
1. 60-100
2. 30-60
3. 100-130
4. 130-160
Page Ref: 953
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.1 Describe the anatomy, physiology, and functions of the cardiovascular and lymphatic systems.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
28) An older patient is being treated for sepsis. What intervention should the nurse include in this patient's plan of care to adjust for age-related changes in cardiovascular status? Select all that apply.
1. Restricting fluids
2. Monitoring for tachycardia
3. Encouraging increased physical activity
4. Planning rest periods between physical activities
5. Maintaining the head of the bed at a 30-degree angle
Page Ref: 986
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 29.4 Differentiate considerations for assessing the cardiovascular and lymphatic systems of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
29) During an assessment the nurse determines that an older patient is demonstrating age-related changes in the tunica intima layer of the vascular system. What did the nurse assess to make this clinical determination? Select all that apply.
1. Tachycardia
2. Postural hypotension
3. Weak peripheral pulses
4. Prominent neck and hand veins
5. Elevated systolic blood pressure
Page Ref: 986
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.4 Differentiate considerations for assessing the cardiovascular and lymphatic systems of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
30) An older patient asks why she always feels so cold. What should the nurse's response include? Select all that apply.
1. "Heat sensors in the blood vessels lose sensitivity with aging."
2. "Your body metabolism is slowing the amount of blood flow."
3. "Blood vessels don't constrict as quickly with aging."
4. "Aging causes a layer of the blood vessels to stiffen."
5. "One layer of the blood vessels gets thinner with aging."
Page Ref: 986
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.4 Differentiate considerations for assessing the cardiovascular and lymphatic systems of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
31) The nurse is planning care for an older patient who exhibits low blood pressure. What should the nurse include in this plan that addresses age-related vascular changes? Select all that apply.
1. Monitoring hemoglobin level
2. Monitoring the effects of medications
3. Encouraging frequent position changes
4. Monitoring lower extremities for edema
5. Assessing skin for evidence of inflammation
Page Ref: 986
Cognitive Level: Applying
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 29.4 Differentiate considerations for assessing the cardiovascular and lymphatic systems of older adults, veterans, individuals in the LGBTQI population, and adults with sequelae of childhood/congenital conditions.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
32) Through genetic testing, parents learn that their adolescent child has long QT syndrome. What instruction regarding health protection should the nurse provide to this family? Select all that apply.
1. Avoid loud music.
2. Limit the intake of citrus fruits.
3. Avoid foods with extra sodium.
4. Practice caution when exercising.
5. Restrict the intake of dairy products.
Page Ref: 968
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
33) The nurse is preparing to assess a patient with Gaucher disease. What findings should the nurse expect when assessing this patient? Select all that apply.
1. Pain
2. Nausea
3. Fatigue
4. Jaundice
5. Hypotension
Page Ref: 968
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.2. Recognize the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness, using a constructed pedigree from collected family history information as well as standardized symbols and terminology | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
34) The nurse is participating in a health fair in a major metropolitan city park. For which community member should screening for thalassemia be suggested? Select all that apply.
1. 21-year-old male from Hong Kong
2. 55-year-old female who recently visited India
3. 32-year-old male who emigrated from Nigeria
4. 45-year-old female whose mother is from Italy
5. 68-year-old female returning from a trip to Croatia
Page Ref: 968
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Screening
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
35) A patient has a genetic history of disorders. The nurse decides to include in the plan of care measures to protect the patient's cardiovascular health. What finding supported the nurse's clinical decision making? Select all that apply.
1. The patient's sister developed high cholesterol at age 32.
2. The patient's father had a myocardial infarction at age 50.
3. The patient's brother broke a leg while skiing in the winter.
4. The patient's uncle has cirrhosis of the liver and pancreatitis.
5. The patient's mother was diagnosed with high blood pressure at age 45.
Page Ref: 968
Cognitive Level: Analyzing
Client Need & Sub: Health Promotion and Maintenance: Health Screening
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
36) While conducting a physical assessment the nurse detects atrophic changes on a patient's lower extremities. What physical finding did the nurse assess in this patient? Select all that apply.
1. Thick toenails
2. Skin ulcerations
3. Dilated leg veins
4. Skin discolorations
5. Absence of hair on the lower legs
Page Ref: 973
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
37) While assessing a patient's lymph nodes, the nurse suspects that the patient has a malignancy. What did the nurse assess to make this clinical decision? Select all that apply.
1. Painful nodes in the neck
2. Lymph nodes adhering to the chest wall
3. Rubbery lymph nodes in the femoral region
4. Hard, nodular lymph nodes in the axillary region
5. Warm lymph nodes along the upper chest
Page Ref: 977
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
38) While conducting an abdominal assessment, the nurse percusses a dull sound below the tenth rib at the left midaxillary line. What should the nurse suspect is occurring with this patient? Select all that apply.
1. Cancer
2. Hemophilia
3. Viral infection
4. Blood dyscrasia
5. Bacterial infection
Page Ref: 977
Cognitive Level: Analyzing
Client Need & Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 29.3 Outline the components of the assessment of the cardiovascular and lymphatic systems including topics for the health assessment interview, techniques for physical assessment, and the diagnostic tests used in the assessment.
MNL Learning Outcome: 3. Interpret abnormal findings of the cardiovascular and lymphatic systems collected during assessment.
39) The nurse is discussing arterial circulation with a group of new colleagues. Which should the nurse explain is a factor that determines peripheral vascular resistance (PVR)? Select all that apply.
1. Blood pressure
2. Blood viscosity
3. Chemoreceptors
4. Length of the vessel
5. Diameter of the vessel
Page Ref: 961
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.2 Describe the anatomy, physiology, and functions of the peripheral vascular system.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
40) A patient with lower extremity edema asks why fluid accumulates in the feet. What should the nurse explain about the lymphatic system? Select all that apply.
1. Lymph vessels return the fluid to the heart.
2. Lymph vessels return lymph fluid through the arterial system.
3. Lymph vessels operate through a low-pressure system without a pump.
4. Lymph vessels transport fluid through the contraction of smooth muscle.
5. Lymph vessels collect excess fluid that leaks from the cardiovascular system.
Page Ref: 963
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Techniques of Physical Assessment
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.2 Describe the anatomy, physiology, and functions of the peripheral vascular system.
MNL Learning Outcome: 1. Utilize appropriate techniques to perform a health history and physical assessment of the cardiovascular and lymphatic systems.
41) A patient with a blood pressure of 124/82 mmHg is prescribed lifestyle modifications. What should the nurse instruct to help reduce this patient's blood pressure? Select all that apply.
1. Stop smoking.
2. Reduce sodium intake.
3. Lose weight if overweight.
4. Engage in aerobic exercise for 30 minutes 4 days a week.
5. Limit alcohol intake to no more than 2 oz. of ethanol per day.
Page Ref: 989
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.5 Summarize topics that nurses teach to promote cardiovascular and lymphatic health across the lifespan.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
42) A patient with hypertension is prescribed the Dietary Approaches to Stop Hypertension (DASH) diet. What should the nurse teach the patient about this eating plan? Select all that apply.
1. Limit grains to six servings per day.
2. Eat four to five servings of fruit per day.
3. Eat two to three servings of fats and oils per day.
4. Limit sweets to five low-fat servings per week.
5. Limit meat to two or fewer 3 oz servings per day.
Page Ref: 989
Cognitive Level: Applying
Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning
Learning Outcome: 29.5 Summarize topics that nurses teach to promote cardiovascular and lymphatic health across the lifespan.
MNL Learning Outcome: 2. Recognize normal findings of the cardiovascular and lymphatic systems collected during assessment and health promotion activities to support the health of these body systems.
Document Information
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