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MSN Exam for Myocardial Infarction

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and Heart Failure
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1) The nurse should visit which of the following clients first?

A. The client with diabetes with a blood glucose of 95mg/dL

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B. The client with hypertension being maintained on Lisinopril
C. The client with chest pain and a history of angina MSN Exam for
D. The client with Raynaud’s disease Digestive System
  0

2) A 23 year old patient in the 27th week of pregnancy has been hospitalized on
MSN Exam for
complete bed rest for 6 days. She experiences sudden shortness of breath, Osteoporosis
accompanied by chest pain. Which of the following conditions is the most likely   0
cause of her symptoms?
MSN Exam for
Sensory System
A. Myocardial infarction due to a history of atherosclerosis.
  0
B. Pulmonary embolism due to deep vein thrombosis (DVT).
C. Anxiety attack due to worries about her baby’s health. MSN Exam for Acute
D. Congestive heart failure due to fluid overload. Respiratory Distress
Syndrome
  0
3) What is the primary reason for administering morphine to a client with myocardial
infarction? MSN Exam for
Hyperthyroidism
  0
A. To sedate the client
B. To decrease the client’s pain
C. To decrease the client’s anxiety
D. To decrease oxygen demand on the client’s heart

4) A patient arrives in the emergency department with symptoms of myocardial

infarction, progressing to cardiogenic shock. Which of the following symptoms
should the nurse expect the patient to exhibit with cardiogenic shock?

A. Hypertension.
B. Bradycardia.
C. Bounding pulse.
D. Confusion.

5) In order to be effective, Percutaneous Transluminal Coronary Angioplasty (PTCA)

must be performed within what time frame, beginning with arrival at the emergency
department after diagnosis of myocardial infarction?

A. 60 minutes
B. 30 minutes
C. 9 days
D. 6-12 months

6) Helen, a nurse from the maternity unit is floated to the critical care unit because of
staff shortage on the evening shift. Which client would be appropriate to assign to
this nurse? A client with:

A. Dopamine drip IV with vital signs monitored every 5 minutes

B. a myocardial infarction that is free from pain and dysrhythmias
C. a tracheotomy of 24 hours in some respiratory distress
D. a pacemaker inserted this morning with intermittent capture

7) A female client is brought by ambulance to the hospital emergency room after

taking an overdose of barbiturates is comatose. Nurse Trish would be especially alert

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for which of the following?

A. Epilepsy
B. Myocardial Infarction
C. Renal failure
D. Respiratory failure

8) Tissue plasminogen activator (t-PA) is considered for treatment of a patient who

arrives in the emergency department following onset of symptoms of myocardial
infarction. Which of the following is a contraindication for treatment with t-PA?

A. Worsening chest pain that began earlier in the evening.

B. History of cerebral hemorrhage.
C. History of prior myocardial infarction.
D. Hypertension.

9) A patient admitted to the hospital with myocardial infarction develops severe

pulmonary edema. Which of the following symptoms should the nurse expect the
patient to exhibit?

A. Slow, deep respirations.

B. Stridor.
C. Bradycardia.
D. Air hunger.

10) A 55-year-old client is admitted with chest pain that radiates to the neck, jaw and
shoulders that occurs at rest, with high body temperature, weak with generalized
sweating and with decreased blood pressure. A myocardial infarction is diagnosed.
The nurse knows that the most accurate explanation for one of these presenting
adaptations is:

A. Catecholamines released at the site of the infarction causes intermittent

localized pain.
B. Parasympathetic reflexes from the infarcted myocardium causes diaphoresis.
C. Constriction of central and peripheral blood vessels causes a decrease in blood
pressure.
D. Inflammation in the myocardium causes a rise in the systemic body temperature.

11) Which of the following is the most common symptom of myocardial infarction?

A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations

12) Nursing measures for the client who has had an MI include helping the client to
avoid activity that results in Valsalva’s maneuver. Valsalva’s maneuver may cause
cardiac dysrhythmias, increased venous pressure, increased intrathoracic pressure
and thrombi dislodgement. Which of the following actions would help prevent
Valsalva’s maneuver? Have the client:

A. Assume a side-lying position

B. Clench her teeth while moving in bed
C. Drink fluids through a straw
D. Avoid holding her breath during activity

13) The nurse is giving discharge teaching to a client 7 days post myocardial
infarction. He asks the nurse why he must wait 6 weeks before having sexual
intercourse. What is the best response by the nurse to this question?

A. “You need to regain your strength before attempting such exertion.”

B. “When you can climb 2 flights of stairs without problems, it is generally safe.”
C. “Have a glass of wine to relax you, then you can try to have sex.”
D. “If you can maintain an active walking program, you will have less risk.”

14) Following myocardial infarction, a hospitalized patient is encouraged to practice

frequent leg exercises and ambulate in the hallway as directed by his physician.
Which of the following choices reflects the purpose of exercise for this patient?

A. Increases fitness and prevents future heart attacks.

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B. Prevents bedsores.
C. Prevents DVT (deep vein thrombosis).
D. Prevent constipations.

15) Alzheimer’s disease is the secondary diagnosis of a client admitted with

myocardial infarction. Which nursing intervention should appear on this client’s plan
of care?

A. Perform activities of daily living for the client to decease frustration.

B. Provide a stimulating environment.
C. Establish and maintain a routine.
D. Try to reason with the client as much as possible.

16) Which statement best describes the difference between the pain of angina and
the pain of myocardial infarction?

A. Pain associated with angina is relieved by rest.

B. Pain associated with myocardial infarction is always more severe.
C. Pain associated with angina is confined to the chest area.
D. Pain associated with myocardial infarction is referred to the left arm.

17) Patrick who is hospitalized following a myocardial infarction asks the nurse why
he is taking morphine. The nurse explains that morphine:

A. Decrease anxiety and restlessness

B. Prevents shock and relieves pain
C. Dilates coronary blood vessels
D. Helps prevent fibrillation of the heart

18) An early finding in the EKG of a client with an infarcted mycardium would be:

A. Disappearance of Q waves
B. Elevated ST segments
C. Absence of P wave
D. Flattened T waves

19) A nurse caring for several patients on the cardiac unit is told that one is
scheduled for implantation of an automatic internal cardioverter-defibrillator. Which
of the following patients is most likely to have this procedure?

A. A patient admitted for myocardial infarction without cardiac muscle damage.

B. A post-operative coronary bypass patient, recovering on schedule.
C. A patient with a history of ventricular tachycardia and syncopal episodes.
D. A patient with a history of atrial tachycardia and fatigue.

20) Twenty four hours after admission for an Acute MI, Jose’s temperature is noted at
39.3 C. The nurse monitors him for other adaptations related to the pyrexia, including:

A. Shortness of breath
B. Chest pain
C. Elevated blood pressure
D. Increased pulse rate

21) Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the
ER with a typical description of pain associated with an MI, and is now cold and
clammy, pale and dyspneic. He has an IV of D5W running, and is complaining of chest
pain. Oxygen therapy has not been started, and he is not on the monitor. He is
frightened. During the first three days that Mr. Duffy is in the CCU, a number of
diagnostic blood tests are obtained. Which of the following patterns of cardiac
enzyme elevation are most common following an MI?

A. SGOT, CK, and LDH are all elevated immediately.

B. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours
later.
C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and
then the LDH (peaks 3-4 days).
D. CK peaks first and remains elevated for 1 to 2 weeks.

22) To prevent a valsalva maneuver in a client recovering from an acute myocardial

infarction, the nurse would
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A. Assist the client to use the bedside commode
B. Administer stool softeners every day as ordered
C. Administer antidysrhythmics prn as ordered
D. Maintain the client on strict bed rest

23) A male client with chronic obstructive pulmonary disease (COPD) is recovering
from a myocardial infarction. Because the client is extremely weak and can’t produce
an effective cough, the nurse should monitor closely for:

A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.

24) A 42-year-old client admitted with an acute myocardial infarction asks to see his
chart. What should the nurse do first?

A. Allow the client to view his chart

B. Contact the supervisor and physician for approval
C. Ask the client if he has concerns about his care
D. Tell the client that he isn’t permitted to view his chart.

25) A client with a history of an anterior wall myocardial infarction is being

transferred from the coronary care unit (CCU) to the cardiac stepdown unit (CSU).
While giving report to the CSU nurse, the CCU nurse says, “His pulmonary artery
wedge pressures have been in the high normal range.” The CSU nurse should be
especially observant for:

A. hypertension
B. high urine output
C. dry mucous membranes
D. pulmonary crackles

26) Which patient’s nursing care would be most appropriate for the charge nurse to
assign to the LPN, under the supervision of the RN team leader?

A. A 51-year-old patient with bilateral adrenalectomy just returned from the post-
anesthesia care unit
B. An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary
disease
C. A 38-year-old patient with myocardial infarction who is preparing for discharge
D. A 72-year-old patient admitted from long-term care with mental status changes

27) During the second day of hospitalization of the client after a Myocardial
Infarction. Which of the following is an expected outcome?

A. Able to perform self-care activities without pain

B. Severe chest pain
C. Can recognize the risk factors of Myocardial Infarction
D. Can Participate in cardiac rehabilitation walking program

28) The client with an acute myocardial infarction is hospitalized for almost one
week. The client experiences nausea and loss of appetite. The nurse caring for the
client recognizes that these symptoms may indicate the:

A. Adverse effects of spironolactone (Aldactone)

B. Adverse effects of digoxin (Lanoxin)
C. Therapeutic effects of propranolol (Indiral)
D. Therapeutic effects of furosemide (Lasix)

29) Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client
suffering from myocardial infarction. Which of the following is the most essential
nursing action?

A. Monitoring urine output frequently

B. Monitoring blood pressure every 4 hours
C. Obtaining serum potassium levels daily
D. Obtaining infusion pump for the medication

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30) On the evening shift, the triage nurse evaluates several clients who were brought
to the emergency department. Which in the following clients should receive highest
priority?

A. an elderly woman complaining of a loss of appetite and fatigue for the past week
B. A football player limping and complaining of pain and swelling in the right ankle
C. A 50-year-old man, diaphoretic and complaining of severe chest pain radiating to
his jaw
D. A mother with a 5-year-old boy who says her son has been complaining of
nausea and vomited once since noon

31) Nurse Betty is assigned to the following clients. The client that the nurse would
see first after endorsement?

A. A 34 year-old post operative appendectomy client of five hours who is

complaining of pain.
B. A 44 year-old myocardial infarction (MI) client who is complaining of nausea.
C. A 26 year-old client admitted for dehydration whose intravenous (IV) has
infiltrated.
D. A 63 year-old post operative’s abdominal hysterectomy client of three days
whose incisional dressing is saturated with serosanguinous fluid.

32) After a myocardial infarction, a client is placed on a sodium restricted diet. When
the nurse is teaching the client about the diet, which meal plan would be the most
appropriate to suggest?

A. 3 oz. broiled fish, 1 baked potato, ½ cup canned beets, 1 orange, and milk
B. 3 oz. canned salmon, fresh broccoli, 1 biscuit, tea, and 1 apple
C. A bologna sandwich, fresh eggplant, 2 oz fresh fruit, tea, and apple juice
D. 3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1 orange

33) The greatest danger of an uncorrected atrial fibrillation for a male patient will be
which of the following:

A. Pulmonary embolism
B. Cardiac arrest
C. Thrombus formation
D. Myocardial infarction

34) Jose, who had a myocardial infarction 2 days earlier, has been complaining to the
nurse about issues related to his hospital stay. The best initial nursing response
would be to:

A. Allow him to release his feelings and then leave him alone to allow him to regain
his composure
B. Refocus the conversation on his fears, frustrations and anger about his condition
C. Explain how his being upset dangerously disturbs his need for rest
D. Attempt to explain the purpose of different hospital routines

35) Nurse Patricia finds a female client who is post-myocardial infarction (MI)
slumped on the side rails of the bed and unresponsive to shaking or shouting. Which
is the nurse next action?

A. Call for help and note the time.

B. Clear the airway
C. Give two sharp thumps to the precordium, and check the pulse.
D. Administer two quick blows.

36) Which of the following actions is the first priority of care for a client exhibiting
signs and symptoms of coronary artery disease?

A. Decrease anxiety
B. Enhance myocardial oxygenation
C. Administer sublingual nitroglycerin
D. Educate the client about his symptoms

37) Medical treatment of coronary artery disease includes which of the following
procedures?

A. Cardiac catherization
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B. Coronary artery bypass surgery
C. Oral medication therapy
D. Percutaneous transluminal coronary angioplasty

38) Which of the following is the most common symptom of myocardial infarction
(MI)?

A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations

39) Which of the following symptoms is the most likely origin of pain the client
described as knifelike chest pain that increases in intensity with inspiration?

A. Cardiac
B. Gastrointestinal
C. Musculoskeletal
D. Pulmonary

40) Which of the following blood tests is most indicative of cardiac damage?

A. Lactate dehydrogenase
B. Complete blood count (CBC)
C. Troponin I
D. Creatine kinase (CK)

41) What is the primary reason for administering morphine to a client with an MI?

A. To sedate the client

B. To decrease the client’s pain
C. To decrease the client’s anxiety
D. To decrease oxygen demand on the client’s heart

42) Which of the following conditions is most commonly responsible for

myocardial infarction?

A. Aneurysm
B. Heart failure
C. Coronary artery thrombosis
D. Renal failure

43) Which of the following complications is indicated by a third heart sound (S3)?

A. Ventricular dilation
B. Systemic hypertension
C. Aortic valve malfunction
D. Increased atrial contractions

44) After an anterior wall myocardial infarction, which of the following problems is
indicated by auscultation of crackles in the lungs?

A. Left-sided heart failure

B. Pulmonic valve malfunction
C. Right-sided heart failure
D. Tricupsid valve malfunction

45) What is the first intervention for a client experiencing MI?

A. Administer morphine
B. Administer oxygen
C. Administer sublingual nitroglycerin
D. Obtain an ECG

46) Which of the following classes of medications protects the ischemic

myocardium by blocking catecholamines and sympathetic nerve stimulation?

A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Narcotics
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D. Nitrates

47) What is the most common complication of an MI?

A. Cardiogenic shock
B. Heart failure
C. arrhythmias
D. Pericarditis

48) With which of the following disorders is jugular vein distention most prominent?

A. Abdominal aortic aneurysm

B. Heart failure
C. MI
D. Pneumothorax

49) Toxicity from which of the following medications may cause a client to see a
green-yellow halo around lights?

A. Digoxin
B. Furosemide (Lasix)
C. Metoprolol (Lopressor)
D. Enalapril (Vasotec)

50) Which of the following symptoms is most commonly associated with left-sided
heart failure?

A. Crackles
B. Arrhythmias
C. Hepatic engorgement
D. Hypotension

51) In which of the following disorders would the nurse expect to assess sacral
edema in a bedridden client?

A. Diabetes
B. Pulmonary emboli
C. Renal failure
D. Right-sided heart failure

52) Which of the following symptoms might a client with right-sided heart failure
exhibit?

A. Adequate urine output

B. Polyuria
C. Oliguria
D. Polydipsia

53) Which of the following classes of medications maximizes cardiac performance

in clients with heart failure by increasing ventricular contractibility?

A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Diuretics
D. Inotropic agents

54) Stimulation of the sympathetic nervous system produces which of the following
responses?

A. Bradycardia
B. Tachycardia
C. Hypotension
D. Decreased myocardial contractility

55) Which of the following conditions is most closely associated with weight gain,
nausea, and a decrease in urine output?

A. Angina pectoris
B. Cardiomyopathy
C. Left-sided heart failure
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D. Right-sided heart failure

56) Which of the following heart muscle diseases is unrelated to other

cardiovascular disease?

A. Cardiomyopathy
B. Coronary artery disease
C. Myocardial infarction
D. Pericardial effusion

57) Which of the following types of cardiomyopathy can be associated with

childbirth?

A. Dilated
B. Hypertrophic
C. Myocarditis
D. Restrictive

58) Septal involvement occurs in which type of cardiomyopathy?

A. Congestive
B. Dilated
C. Hypertrophic
D. Restrictive

59) Which of the following recurring conditions most commonly occurs in clients
with cardiomyopathy?

A. Heart failure
B. Diabetes
C. MI
D. Pericardial effusion

60) Dyspnea, cough, expectoration, weakness, and edema are classic signs and
symptoms of which of the following conditions?

A. Pericarditis
B. Hypertension
C. MI
D. Heart failure

61) In which of the following types of cardiomyopathy does cardiac output remain
normal?

A. Dilated
B. Hypertrophic
C. Obliterative
D. Restrictive

62) Which of the following cardiac conditions does a fourth heart sound (S4)
indicate?

A. Dilated aorta
B. Normally functioning heart
C. Decreased myocardial contractility
D. Failure of the ventricle to eject all of the blood during systole

63) Which of the following classes of drugs is most widely used in the treatment of
cardiomyopathy?

A. Antihypertensives
B. Beta-adrenergic blockers
C. Calcium channel blockers
D. Nitrates

64) If medical treatments fail, which of the following invasive procedures is

necessary for treating cariomyopathy?

A. Cardiac catherization
B. Coronary artery bypass graft (CABG)
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C. Heart transplantation
D. Intra-aortic balloon pump (IABP)

65) Which of the following conditions is associated with a predictable level of pain
that occurs as a result of physical or emotional stress?

A. Anxiety
B. Stable angina
C. Unstable angina
D. Variant angina

66) Which of the following types of angina is most closely related with an impending
MI?

A. Angina decubitus
B. Chronic stable angina
C. Noctural angina
D. Unstable angina

67) Which of the following conditions is the predominant cause of angina?

A. Increased preload
B. Decreased afterload
C. Coronary artery spasm
D. Inadequate oxygen supply to the myocardium

68) Which of the following tests is used most often to diagnose angina?

A. Chest x-ray
B. Echocardiogram
C. Cardiac catherization
D. 12-lead electrocardiogram (ECG)

69) Which of the following results is the primary treatment goal for angina?

A. Reversal of ischemia
B. Reversal of infarction
C. Reduction of stress and anxiety
D. Reduction of associated risk factors

70) Which of the following interventions should be the first priority when treating a
client experiencing chest pain while walking?

A. Sit the client down

B. Get the client back to bed
C. Obtain an ECG
D. Administer sublingual nitroglycerin

71) Myocardial oxygen consumption increases as which of the following parameters

increase?

A. Preload, afterload, and cerebral blood flow

B. Preload, afterload, and renal blood flow
C. Preload, afterload, contractility, and heart rate.
D. Preload, afterload, cerebral blood flow, and heart rate.

72) Which of the following positions would best aid breathing for a client with acute
pulmonary edema?

A. Lying flat in bed

B. Left side-lying
C. In high Fowler’s position
D. In semi-Fowler’s position

73) Which of the following blood gas abnormalities is initially most suggestive of
pulmonary edema?

A. Anoxia
B. Hypercapnia
C. Hyperoxygenation
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D. Hypocapnia

74) Which of the following is a compensatory response to decreased cardiac

output?

A. Decreased BP
B. Alteration in LOC
C. Decreased BP and diuresis
D. Increased BP and fluid retention

75) Which of the following actions is the appropriate initial response to a client
coughing up pink, frothy sputum?

A. Call for help

B. Call the physician
C. Start an I.V. line
D. Suction the client

76) Which of the following terms describes the force against which the ventricle
must expel blood?

A. Afterload
B. Cardiac output
C. Overload
D. Preload

77) Acute pulmonary edema caused by heart failure is usually a result of damage to
which of the following areas of the heart?

A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle

78) An 18-year-old client who recently had an URI is admitted with suspected
rheumatic fever. Which assessment findings confirm this diagnosis?

A. Erythema marginatum, subcutaneous nodules, and fever

B. Tachycardia, finger clubbing, and a load S3
C. Dyspnea, cough, and palpitations
D. Dyspnea, fatigue, and synocope

79) A client admitted with angina compains of severe chest pain and suddenly
becomes unresponsive. After establishing unresponsiveness, which of the following
actions should the nurse take first?

A. Activate the resuscitation team

B. Open the client’s airway
C. Check for breathing
D. Check for signs of circulation

80) A 55-year-old client is admitted with an acute inferior-wall myocardial infarction.

During the admission interview, he says he stopped taking his metoprolol (Lopressor)
5 days ago because he was feeling better. Which of the following nursing diagnoses
takes priority for this client?

A. Anxiety
B. Ineffective tissue perfusion; cardiopulmonary
C. Acute pain
D. Ineffective therapeutic regimen management

81) A client comes into the E.R. with acute shortness of breath and a cough that
produces pink, frothy sputum. Admission assessment reveals crackles and wheezes,
a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The
client’s medical history included DM, HTN, and heart failure. Which of the following
disorders should the nurse suspect?

A. Pulmonary edema
B. Pneumothorax
C. Cardiac tamponade
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D. Pulmonary embolus

82) The nurse coming on duty receives the report from the nurse going off duty.
Which of the following clients should the on-duty nurse assess first?

A. The 58-year-old client who was admitted 2 days ago with heart failure, BP of
126/76, and a respiratory rate of 21 breaths a minute.
B. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a
DNR order.
C. The 62-year-old client who was admitted one day ago with thrombophlebitis and
receiving IV heparin.
D. A 76-year-old client who was admitted 1 hour ago with new-onset atrial
fibrillation and is receiving IV diltiazem (Cardizem).

83) When developing a teaching plan for a client with endocarditis, which of the
following points is most essential for the nurse to include?

A. “Report fever, anorexia, and night sweats to the physician.”

B. “Take prophylactic antibiotics after dental work and invasive procedures.”
C. “Include potassium rich foods in your diet.”
D. “Monitor your pulse regularly.”

84) A nurse is conducting a health history with a client with a primary diagnosis of
heart failure. Which of the following disorders reported by the client is unlikely to play
a role in exacerbating the heart failure?

A. Recent URI
B. Nutritional anemia
C. Peptic ulcer disease
D. A-Fib

85) A nurse is preparing for the admission of a client with heart failure who is being
sent directly to the hospital from the physician’s office. The nurse would plan on
having which of the following medications readily available for use?

A. Diltiazem (Cardizem)
B. Digoxin (Lanoxin)
C. Propranolol (Inderal)
D. Metoprolol (Lopressor)

86) A nurse caring for a client in one room is told by another nurse that a second
client has developed severe pulmonary edema. On entering the 2nd client’s room, the
nurse would expect the client to be:

A. Slightly anxious
B. Mildly anxious
C. Moderately anxious
D. Extremely anxious

87) A client with pulmonary edema has been on diuretic therapy. The client has an
order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that
the client also will be started on Digoxin (Lanoxin), a nurse checks the client’s most
recent:

A. Digoxin level
B. Sodium level
C. Potassium level
D. Creatinine level

88) A client who had cardiac surgery 24 hours ago has a urine output averaging 19
ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output
for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea
nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the
client is at risk for:

A. Hypovolemia
B. UTI
C. Glomerulonephritis
D. Acute renal failure

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89) A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery.
The nurse would plan to do which of the following to enable the client to best tolerate
the ambulation?

A. Encourage the client to cough and deep breathe

B. Premedicate the client with an analgesic
C. Provide the client with a walker
D. Remove telemetry equipment because it weighs down the hospital gown.

90) A client’s electrocardiogram strip shows atrial and ventricular rates of 80

complexes per minute. The PR interval is 0.14 second, and the QRS complex
measures 0.08 second. The nurse interprets this rhythm is:

A. Normal sinus rhythm

B. Sinus bradycardia
C. Sinus tachycardia
D. Sinus dysrhythmia

91) A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A
nurse is most concerned with this dysrhythmia because:

A. It is uncomfortable for the client, giving a sense of impending doom.

B. It produces a high cardiac output that quickly leads to cerebral and myocardial
ischemia.
C. It is almost impossible to convert to a normal sinus rhythm.
D. It can develop into ventricular fibrillation at any time.

92) A home care nurse is making a routine visit to a client receiving digoxin
(Lanoxin) in the treatment of heart failure. The nurse would particularly assess the
client for:

A. Thrombocytopenia and weight gain

B. Anorexia, nausea, and visual disturbances
C. Diarrhea and hypotension
D. Fatigue and muscle twitching

93) A client with angina complains that the angina pain is prolonged and severe and
occurs at the same time each day, most often in the morning, On further assessment
a nurse notes that the pain occurs in the absence of precipitating factors. This type
of anginal pain is best described as:

A. Stable angina
B. Unstable angina
C. Variant angina
D. Nonanginal pain

94) The physician orders continuous intravenous nitroglycerin infusion for the client
with MI. Essential nursing actions include which of the following?

A. Obtaining an infusion pump for the medication

B. Monitoring BP q4h
C. Monitoring urine output hourly
D. Obtaining serum potassium levels daily

95) Aspirin is administered to the client experiencing an MI because of its:

A. Antipyrectic action
B. Antithrombotic action
C. Antiplatelet action
D. Analgesic action

96) Which of the following is an expected outcome for a client on the second day of
hospitalization after an MI?

A. Has severe chest pain

B. Can identify risks factors for MI
C. Agrees to participate in a cardiac rehabilitation walking program
D. Can perform personal self-care activities without pain

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97) Which of the following reflects the principle on which a client’s diet will most
likely be based during the acute phase of MI?

A. Liquids as ordered
B. Small, easily digested meals
C. Three regular meals per day
D. NPO

98) An older, sedentary adult may not respond to emotional or physical stress as
well as a younger individual because of:

A. Left ventricular atrophy

B. Irregular heartbeats
C. peripheral vascular occlusion
D. Pacemaker placement

99) Which of the following nursing diagnoses would be appropriate for a client with
heart failure? Select all that apply.

A. Ineffective tissue perfusion related to decreased peripheral blood flow secondary

to decreased cardiac output.
B. Activity intolerance related to increased cardiac output.
C. Decreased cardiac output related to structural and functional changes.
D. Impaired gas exchange related to decreased sympathetic nervous system
activity.

100) Which of the following would be a priority nursing diagnosis for the client with
heart failure and pulmonary edema?

A. Risk for infection related to stasis of alveolar secretions

B. Impaired skin integrity related to pressure
C. Activity intolerance related to pump failure
D. Constipation related to immobility

101) Captopril may be administered to a client with HF because it acts as a:

A. Vasopressor
B. Volume expander
C. Vasodilator
D. Potassium-sparing diuretic

102) Furosemide is administered intravenously to a client with HF. How soon after
administration should the nurse begin to see evidence of the drugs desired effect?

A. 5 to 10 minutes
B. 30 to 60 minutes
C. 2 to 4 hours
D. 6 to 8 hours

103) Which of the following foods should the nurse teach a client with heart failure
to avoid or limit when following a 2-gram sodium diet?

A. Apples
B. Tomato juice
C. Whole wheat bread
D. Beef tenderloin

104) The nurse finds the apical pulse below the 5th intercostal space. The nurse
suspects:

A. Left atrial enlargement

B. Left ventricular enlargement
C. Right atrial enlargement
D. Right ventricular enlargement
Answers and Rationales

1. C. The client with chest pain and a history of angina . The client with chest pain
should be seen first because this could indicate a myocardial infarction. The
client in answer A has a blood glucose within normal limits. The client in answer

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B is maintained on blood pressure medication. The client in answer D is in no
distress.
2. B. Pulmonary embolism due to deep vein thrombosis (DVT). In a hospitalized
patient on prolonged bed rest, he most likely cause of sudden onset shortness of
breath and chest pain is pulmonary embolism. Pregnancy and prolonged
inactivity both increase the risk of clot formation in the deep veins of the legs.
These clots can then break loose and travel to the lungs. Myocardial infarction
and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart
failure due to fluid overload. There is no reason to suspect an anxiety disorder in
this patient. Though anxiety is a possible cause of her symptoms, the
seriousness of pulmonary embolism demands that it be considered first.
3. D. To decrease oxygen demand on the client’s heart . Morphine is administered
because it decreases myocardial oxygen demand. Morphine will also decrease
pain and anxiety while causing sedation, but isn’t primarily given for those
reasons.
4. D. Confusion. Cardiogenic shock severely impairs the pumping function of the
heart muscle, causing diminished blood flow to the organs of the body. This
results in diminished brain function and confusion, as well as hypotension,
tachycardia, and weak pulse. Cardiogenic shock is a serious complication of
myocardial infarction with a high mortality rate.
5. A. 60 minutes . The sixty minute interval is known as “door to balloon time” for
performance of PTCA on a diagnosed MI patient.
6. B. a myocardial infarction that is free from pain and dysrhythmias. This client is
the most stable with minimal risk of complications or instability. The nurse can
utilize basic nursing skills to care for this client.
7. D. Respiratory failure . Barbiturates are CNS depressants; the nurse would be
especially alert for the possibility of respiratory failure. Respiratory failure is the
most likely cause of death from barbiturate over dose.
8. B. History of cerebral hemorrhage. A history of cerebral hemorrhage is a
contraindication to tPA because it may increase the risk of bleeding. TPA acts by
dissolving the clot blocking the coronary artery and works best when
administered within 6 hours of onset of symptoms. Prior MI is not a
contraindication to tPA. Patients receiving tPA should be observed for changes in
blood pressure, as tPA may cause hypotension.
9. D. Air hunger. Patients with pulmonary edema experience air hunger, anxiety, and
agitation. Respiration is fast and shallow and heart rate increases. Stridor is
noisy breathing caused by laryngeal swelling or spasm and is not associated
with pulmonary edema.
10. D. Inflammation in the myocardium causes a rise in the systemic body
temperature. . Temperature may increase within the first 24 hours and persist as
long as a week.
11. A. Chest pain . The most common symptom of an MI is chest pain, resulting
from deprivation of oxygen to the heart. Dyspnea is the second most common
symptom, related to an increase in the metabolic needs of the body during an MI.
Edema is a later sign of heart failure, often seen after an MI. Palpitations may
result from reduced cardiac output, producing arrhythmias.
12. D. Avoid holding her breath during activity
13. B. “When you can climb 2 flights of stairs without problems, it is generally
safe.” “When you can climb 2 flights of stairs without problems, it is generally
safe.” There is a risk of cardiac rupture at the point of the myocardial infarction
for about 6 weeks. Scar tissue should form about that time. Waiting until the
client can tolerate climbing stairs is the usual advice given by health care
providers.
14. C. Prevents DVT (deep vein thrombosis). Exercise is important for all
hospitalized patients to prevent deep vein thrombosis. Muscular contraction
promotes venous return and prevents hemostasis in the lower extremities. This
exercise is not sufficiently vigorous to increase physical fitness, nor is it intended
to prevent bedsores or constipation.
15. C. Establish and maintain a routine. Establishing and maintaining a routine is
essential to decreasing extraneous stimuli. The client should participate in daily
care as much as possible. Attempting to reason with such clients isn’t
successful, because they can’t participate in abstract thinking.
16. A. Pain associated with angina is relieved by rest. Pain associated with angina is
relieved by rest. Answer B is incorrect because it is not a true statement. Answer
Pain associated with angina is confined to the chest area is incorrect because
pain associated with angina can be referred to the jaw, the left arm, and the back.
Pain associated with myocardial infarction is referred to the left arm is incorrect
because pain from a myocardial infarction can be referred to areas other than the
left arm.

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17. B. Prevents shock and relieves pain. Morphine is a central nervous system
depressant used to relieve the pain associated with myocardial infarction, it also
decreases apprehension and prevents cardiogenic shock.
18. B. Elevated ST segments . This is a typical early finding after a myocardial infarct
because of the altered contractility of the heart. The other choices are not typical
of MI.
19. C. A patient with a history of ventricular tachycardia and syncopal episodes. . An
automatic internal cardioverter-defibrillator delivers an electric shock to the heart
to terminate episodes of ventricular tachycardia and ventricular fibrillation. This
is necessary in a patient with significant ventricular symptoms, such as
tachycardia resulting in syncope. A patient with myocardial infarction that
resolved with no permanent cardiac damage would not be a candidate. A patient
recovering well from coronary bypass would not need the device. Atrial
tachycardia is less serious and is treated conservatively with medication and
cardioversion as a last resort.
20. D. Increased pulse rate . Fever causes an increase in the body’s metabolism,
which results in an increase in oxygen consumption and demand. This need for
oxygen increases the heart rate, which is reflected in the increased pulse rate.
Increased BP, chest pain and shortness of breath are not typically noted in fever.
21. C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours)
and then the LDH (peaks 3-4 days). Although the timing of initial elevation, peak
elevation, and duration of elevation vary with sources, current literature favors
letter c.
22. B. Administer stool softeners every day as ordered . Administering stool
softeners every day will prevent straining on defecation which causes the
Valsalva maneuver. If constipation occurs then laxatives would be necessary to
prevent straining. If straining on defecation produced the valsalva maneuver and
rhythm disturbances resulted then antidysrhythmics would be appropriate.
23. C. Atelectasis. In a client with COPD, an ineffective cough impedes secretion
removal. This, in turn, causes mucus plugging, which leads to localized airway
obstruction — a known cause of atelectasis. An ineffective cough doesn’t cause
pleural effusion (fluid accumulation in the pleural space). Pulmonary edema
usually results from left-sided heart failure, not an ineffective cough. Although
many noncardiac conditions may cause pulmonary edema, an ineffective cough
isn’t one of them. Oxygen toxicity results from prolonged administration of high
oxygen concentrations, not an ineffective cough.
24. C. Ask the client if he has concerns about his care
25. D. pulmonary crackles . High pulmonary artery wedge pressures are diagnostic
for left-sided heart failure. With leftsided heart failure, pulmonary edema can
develop causing pulmonary crackles. In leftsided heart failure, hypotension may
result and urine output will decline. Dry mucous membranes aren’t directly
associated with elevated pulmonary artery wedge pressures.
26. B. An 83-year-old patient with type 2 diabetes and chronic obstructive
pulmonary disease . The 83-year-old patient has no complicating factors at the
moment. Providing care for stable and uncomplicated patients is within the
LPN’s educational preparation and scope of practice, with the care always being
provided under the supervision and direction of the RN. The RN should assess
the newly post-operative patient and the new admission. The patient who is
preparing for discharge after MI may need some complex teaching. Focus:
Delegation/supervision, assignment
27. A. Able to perform self-care activities without pain . By the 2nd day of
hospitalization after suffering a Myocardial Infarction, Clients are able to perform
care without chest pain
28. B. Adverse effects of digoxin (Lanoxin) . Toxic levels of Lanoxin stimulate the
medullary chemoreceptor trigger zone, resulting in nausea and subsequent
anorexia.
29. D. Obtaining infusion pump for the medication . Administration of Intravenous
Nitroglycerin infusion requires pump for accurate control of medication.
30. C. A 50-year-old man, diaphoretic and complaining of severe chest pain
radiating to his jaw . These are likely signs of an acute myocardial infarction (MI).
An acute MI is a cardiovascular emergency requiring immediate attention. Acute
MI is potentially fatal if not treated immediately.
31. B. A 44 year-old myocardial infarction (MI) client who is complaining of
nausea. Nausea is a symptom of impending myocardial infarction (MI) and
should be assessed immediately so that treatment can be instituted and further
damage to the heart is avoided.
32. D. 3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1
orange . Canned fish and vegetables and cured meats are high in sodium. This
meal does not contain any canned fish and/or vegetables or cured meats
33. C. Thrombus formation

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34. B. Refocus the conversation on his fears, frustrations and anger about his
condition . This provides the opportunity for the client to verbalize feelings
underlying behavior and helpful in relieving anxiety. Anxiety can be a stressor
which can activate the sympathoadrenal response causing the release of
catecholamines that can increase cardiac contractility and workload that can
further increase myocardial oxygen demand.
35. A. Call for help and note the time. Having established, by stimulating the client,
that the client is unconscious rather than sleep, the nurse should immediately
call for help. This may be done by dialing the operator from the client’s phone and
giving the hospital code for cardiac arrest and the client’s room number to the
operator, of if the phone is not available, by pulling the emergency call button.
Noting the time is important baseline information for cardiac arrest procedure.
36. B. Enhance myocardial oxygenation. Enhancing myocardial oxygenation is
always the first priority when a client exhibits signs or symptoms of cardiac
compromise. Without adequate oxygenation, the myocardium suffers damage.
Sublingual nitroglycerin is administered to treat acute angina, but administration
isn’t the first priority. Although educating the client and decreasing anxiety are
important in care delivery, neither are priorities when a client is compromised.
37. C. Oral medication therapy. Oral medication administration is a noninvasive,
medical treatment for coronary artery disease. Cardiac catherization isn’t a
treatment, but a diagnostic tool. Coronary artery bypass surgery and
percutaneous transluminal coronary angioplasty are invasive, surgical
treatments.
38. A. Chest pain. The most common symptom of an MI is chest pain, resulting from
deprivation of oxygen to the heart. Dyspnea is the second most common
symptom, related to an increase in the metabolic needs of the body during an MI.
Edema is a later sign of heart failure, often seen after an MI. Palpitations may
result from reduced cardiac output, producing arrhythmias.
39. D. Pulmonary. Pulmonary pain is generally described by these symptoms.
Musculoskeletal pain only increases with movement. Cardiac and GI pains don’t
change with respiration.
40. C. Troponin I. Troponin I levels rise rapidly and are detectable within 1 hour of
myocardial injury. Troponin I levels aren’t detectable in people without cardiac
injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not
specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury.
CBC is obtained to review blood counts, and a complete chemistry is obtained to
review electrolytes. Because CK levels may rise with skeletal muscle injury, CK
isoenzymes are required to detect cardiac injury.
41. D.To decrease oxygen demand on the client’s heart. Morphine is administered
because it decreases myocardial oxygen demand. Morphine will also decrease
pain and anxiety while causing sedation, but it isn’t primarily given for those
reasons.
42. C. Coronary artery thrombosis . Coronary artery thrombosis causes an inclusion
of the artery, leading to myocardial death. An aneurysm is an outpouching of a
vessel and doesn’t cause an MI. Renal failure can be associated with MI but isn’t
a direct cause. Heart failure is usually a result from an MI.
43. A.Ventricular dilation. Rapid filling of the ventricle causes vasodilation that is
auscultated as S3. Increased atrial contraction or systemic hypertension can
result in a fourth heart sound. Aortic valve malfunction is heard as a murmur.
44. A. Left-sided heart failure. The left ventricle is responsible for most of the
cardiac output. An anterior wall MI may result in a decrease in left ventricular
function. When the left ventricle doesn’t function properly, resulting in left-sided
heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs
and causes crackles. Pulmonic and tricuspid valve malfunction causes right
sided heart failure.
45. B. Administer oxygen. Administering supplemental oxygen to the client is the
first priority of care. The myocardium is deprived of oxygen during an infarction,
so additional oxygen is administered to assist in oxygenation and prevent further
damage. Morphine and nitro are also used to treat MI, but they’re more
commonly administered after the oxygen. An ECG is the most common
diagnostic tool used to evaluate MI.
46. A. Beta-adrenergic blockers. Beta-adrenergic blockers work by blocking beta
receptors in the myocardium, reducing the response to catecholamines and
sympathetic nerve stimulation. They protect the myocardium, helping to reduce
the risk of another infarction by decreasing myocardial oxygen demand. Calcium
channel blockers reduce the workload of the heart by decreasing the heart rate.
Narcotics reduce myocardial oxygen demand, promote vasodilation, and
decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing
left ventricular end-diastolic pressure (preload) and systemic vascular resistance
(afterload).

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47. C. arrhythmias. Arrhythmias, caused by oxygen deprivation to the myocardium,
are the most common complication of an MI. Cardiogenic shock, another
complication of an MI, is defined as the end stage of left ventricular dysfunction.
This condition occurs in approximately 15% of clients with MI. Because the
pumping function of the heart is compromised by an MI, heart failure is the
second most common complication. Pericarditis most commonly results from a
bacterial or viral infection but may occur after the MI.
48. B. Heart failure. Elevated venous pressure, exhibited as jugular vein distention,
indicates a failure of the heart to pump. JVD isn’t a symptom of abdominal aortic
aneurysm or pneumothorax. An MI, if severe enough, can progress to heart
failure, however, in and of itself, an MI doesn’t cause JVD.
49. A. Digoxin. One of the most common signs of digoxin toxicity is the visual
disturbance known as the “green-yellow halo sign.” The other medications aren’t
associated with such an effect.
50. A. Crackles. Crackles in the lungs are a classic sign of left-sided heart failure.
These sounds are caused by fluid backing up into the pulmonary system.
Arrhythmias can be associated with both right- and left-sided heart failure. Left-
sided heart failure causes hypertension secondary to an increased workload on
the system.
51. D. Right-sided heart failure. The most accurate area on the body to assess
dependent edema in a bed-ridden client is the sacral area. Sacral, or dependent,
edema is secondary to right-sided heart failure.
52. C. Oliguria. Inadequate deactivation of aldosterone by the liver after right-sided
heart failure leads to fluid retention, which causes oliguria.
53. D. Inotropic agents. Inotropic agents are administered to increase the force of
the heart’s contractions, thereby increasing ventricular contractility and ultimately
increasing cardiac output.
54. B. Tachycardia. Stimulation of the sympathetic nervous system causes
tachycardia and increased contractility. The other symptoms listed are related to
the parasympathetic nervous system, which is responsible for slowing the heart
rate.
55. D. Right-sided heart failure. Weight gain, nausea, and a decrease in urine output
are secondary effects of right-sided heart failure. Cardiomyopathy is usually
identified as a symptom of left-sided heart failure. Left-sided heart failure causes
primarily pulmonary symptoms rather than systemic ones. Angina pectoris
doesn’t cause weight gain, nausea, or a decrease in urine output.
56. A. Cardiomyopathy. Cardiomyopathy isn’t usually related to an underlying heart
disease such as atherosclerosis. The etiology in most cases is unknown. CAD
and MI are directly related to atherosclerosis. Pericardial effusion is the escape
of fluid into the pericardial sac, a condition associated with Pericarditis and
advanced heart failure.
57. A. Dilated. Although the cause isn’t entirely known, cardiac dilation and heart
failure may develop during the last month of pregnancy or the first few months
after birth. The condition may result from a preexisting cardiomyopathy not
apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal
symmetry of the ventricles that has an unknown etiology but a strong familial
tendency. Myocarditis isn’t specifically associated with childbirth. Restrictive
cardiomyopathy indicates constrictive pericarditis; the underlying cause is
usually myocardial.
58. C. Hypertrophic. In hypertrophic cardiomyopathy, hypertrophy of the ventricular
septum—not the ventricle chambers—is apparent. This abnormality isn’t seen in
other types of cardiomyopathy.
59. A. Heart failure. Because the structure and function of the heart muscle is
affected, heart failure most commonly occurs in clients with cardiomyopathy. MI
results from prolonged myocardial ischemia due to reduced blood flow through
one of the coronary arteries. Pericardial effusion is most predominant in clients
with pericarditis.
60. D. Heart failure. These are the classic signs of failure. Pericarditis is exhibited by
a feeling of fullness in the chest and auscultation of a pericardial friction rub.
Hypertension is usually exhibited by headaches, visual disturbances, and a
flushed face. MI causes heart failure but isn’t related to these symptoms.
61. B. Hypertrophic. Cardiac output isn’t affected by hypertrophic cardiomyopathy
because the size of the ventricle remains relatively unchanged. All of the rest
decrease cardiac output.
62. D. Failure of the ventricle to eject all of the blood during systole. An S4 occurs as
a result of increased resistance to ventricular filling after atrial contraction. The
increased resistance is related to decreased compliance of the ventricle. A
dilated aorta doesn’t cause an extra heart sound, though it does cause a murmur.
Decreased myocardial contractility is heard as a third heart sound. An S4 isn’t
heard in a normally functioning heart.

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63. B. Beta-adrenergic blockers. By decreasing the heart rate and contractility, beta-
blockers improve myocardial filling and cardiac output, which are primary goals
in the treatment of cardiomyopathy. Antihypertensives aren’t usually indicated
because they would decrease cardiac output in clients who are already
hypotensive. Calcium channel blockers are sometimes used for the same
reasons as beta-blockers; however, they aren’t as effective as beta-blockers and
cause increased hypotension. Nitrates aren’t used because of their dilating
effects, which would further compromise the myocardium.
64. C. Heart transplantation. The only definitive treatment for cardiomyopathy that
can’t be controlled medically is a heart transplant because the damage to the
heart muscle is irreversible.
65. B. Stable angina. The pain of stable angina is predictable in nature, builds
gradually, and quickly reaches maximum intensity. Unstable angina doesn’t
always need a trigger, is more intense, and lasts longer than stable angina.
Variant angina usually occurs at rest—not as a result of exercise or stress.
66. D. Unstable angina. Unstable angina progressively increases in frequency,
intensity, and duration and is related to an increased risk of MI within 3 to 18
months.
67. D. Inadequate oxygen supply to the myocardium. Inadequate oxygen supply to
the myocardium is responsible for the pain accompanying angina. Increased
preload would be responsible for right-sided heart failure. Decreased afterload
causes increased cardiac output. Coronary artery spasm is responsible for
variant angina.
68. D.12-lead electrocardiogram (ECG). The 12-lead ECG will indicate ischemia,
showing T-wave inversion. In addition, with variant angina, the ECG shows ST-
segment elevation. A chest x-ray will show heart enlargement or signs of heart
failure, but isn’t used to diagnose angina.
69. A. Reversal of ischemia. Reversal of the ischemia is the primary goal, achieved
by reducing oxygen consumption and increasing oxygen supply. An infarction is
permanent and can’t be reversed.
70. A. Sit the client down. The initial priority is to decrease the oxygen consumption;
this would be achieved by sitting the client down. An ECG can be obtained after
the client is sitting down. After the ECGm sublingual nitro would be administered.
When the client’s condition is stabilized, he can be returned to bed.
71. C. Preload, afterload, contractility, and heart rate. Myocardial oxygen
consumption increases as preload, afterload, renal contractility, and heart rate
increase. Cerebral blood flow doesn’t directly affect myocardial oxygen
consumption.
72. C. In high Fowler’s position. A high Fowler’s position promotes ventilation and
facilitates breathing by reducing venous return. Lying flat and side-lying positions
worsen the breathing and increase workload of the heart. Semi-Fowler’s position
won’t reduce the workload of the heart as well as the Fowler’s position will.
73. D. Hypocapnia. In an attempt to compensate for increased work of breathing due
to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the
condition persists, CO2 retention occurs and hypercapnia results.
74. D. Increased BP and fluid retention. The body compensates for a decrease in
cardiac output with a rise in BP, due to the stimulation of the sympathetic NS and
an increase in blood volume as the kidneys retain sodium and water. Blood
pressure doesn’t initially drop in response to the compensatory mechanism of
the body. Alteration in LOC will occur only if the decreased cardiac output
persists.
75. A. Call for help. Production of pink, frothy sputum is a classic sign of acute
pulmonary edema. Because the client is at high risk for decompensation, the
nurse should call for help but not leave the room. The other three interventions
would immediately follow.
76. A. Afterload. Afterload refers to the resistance normally maintained by the aortic
and pulmonic valves, the condition and tone of the aorta, and the resistance
offered by the systemic and pulmonary arterioles. Cardiac output is the amount
of blood expelled by the heart per minute. Overload refers to an abundance of
circulating volume. Preload is the volume of blood in the ventricle at the end of
diastole.
77. C. Left ventricle. The left ventricle is responsible for the majority of force for the
cardiac output. If the left ventricle is damaged, the output decreases and fluid
accumulates in the interstitial and alveolar spaces, causing pulmonary edema.
Damage to the left atrium would contribute to heart failure but wouldn’t affect
cardiac output or, therefore, the onset of pulmonary edema. If the right atrium
and right ventricle were damaged, right-sided heart failure would result.
78. A. Erythema marginatum, subcutaneous nodules, and fever. Diagnosis of
rheumatic fever requires that the client have either two major Jones criteria or
one minor criterion plus evidence of a previous streptococcal infection. Major

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criteria include carditis, polyarthritis, Sydenham’s chorea, subcutaneous nodules,
and erythema maginatum (transient, nonprurtic macules on the trunk or inner
aspects of the upper arms or thighs). Minor criteria include fever, arthralgia,
elevated levels of acute phase reactants, and a prolonged PR-interval on ECG.
79. A. Activate the resuscitation team. Immediately after establishing
unresponsiveness, the nurse should activate the resuscitation team. The next
step is to open the airway using the head-tilt, chin-lift maneuver and check for
breathing (looking, listening, and feeling for no more than 10-seconds). If the
client isn’t breathing, give two slow breaths using a bag mask or pocket mask.
Next, check for signs of circulation by palpating the carotid pulse.
80. B. Ineffective tissue perfusion; cardiopulmonary. MI results from prolonged
myocardial ischemia caused by reduced blood flow through the coronary
arteries. Therefore, the priority nursing diagnosis for this client is Ineffective
tissue perfusion (cardiopulmonary). Anxiety, acute pain, and ineffective
therapeutic regimen management are appropriate but don’t take priority.
81. A. Pulmonary edema. SOB, tachypnea, low BP, tachycardia, crackles, and a cough
producing pink, frothy sputum are late signs of pulmonary edema.
82. D. A 76-year-old client who was admitted 1 hour ago with new-onset atrial
fibrillation and is receiving IV diltiazem (Cardizem). The client with A-fib has the
greatest potential to become unstable and is on IV medication that requires
close monitoring. After assessing this client, the nurse should assess the client
with thrombophlebitis who is receiving a heparin infusion, and then go to the 58-
year-old client admitted 2-days ago with heart failure (her s/s are resolving and
don’t require immediate attention). The lowest priority is the 89-year-old with end
stage right-sided heart failure, who requires time consuming supportive
measures.
83. A.“Report fever, anorexia, and night sweats to the physician.” The most essential
teaching point is to report signs of relapse, such as fever, anorexia, and night
sweats, to the physician. To prevent further endocarditis episodes, prophylactic
antibiotics are taken before and sometimes after dental work, childbirth, or GU,
GI, or gynecologic procedures. A potassium-rich diet and daily pulse monitoring
aren’t necessary for a client with endocarditis.
84. C. Peptic ulcer disease. Heart failure is precipitated or exacerbated by physical
or emotional stress, dysrhythmias, infections, anemia, thyroid disorders,
pregnancy, Paget’s disease, nutritional deficiencies (thiamine, alcoholism),
pulmonary disease, and hypervolemia.
85. B. Digoxin (Lanoxin). Digoxin exerts a positive inotropic effect on the heart while
slowing the overall rate through a variety of mechanisms. Digoxin is the
medication of choice to treat heart failure. Diltiazem (calcium channel blocker)
and propranolol and metoprolol (beta blockers) have a negative inotropic effect
and would worsen the failing heart.
86. D. Extremely anxious. Pulmonary edema causes the client to be extremely
agitated and anxious. The client may complain of a sense of drowning,
suffocation, or smothering.
87. C. Potassium level. The serum potassium level is measured in the client
receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin
toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes
the client to ventricular dysrhythmias.
88. D. Acute renal failure. The client who undergoes cardiac surgery is at risk for
renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor
medication therapy. Renal insult is signaled by decreased urine output, and
increased BUN and creatinine levels. The client may need medications such as
dopamine (Intropin) to increase renal perfusion and possibly could need
peritoneal dialysis or hemodialysis.
89. B. Premedicate the client with an analgesic. The nurse should encourage regular
use of pain medication for the first 48 to 72 hours after cardiac surgery because
analgesia will promote rest, decrease myocardial oxygen consumption resulting
from pain, and allow better participation in activities such as coughing, deep
breathing, and ambulation. Encouraging the client to cough and deep breathe and
providing the client with a walker will not help in tolerating ambulation. Removal
of telemetry equipment is contraindicated unless prescribed.
90. A. Normal sinus rhythm
91. D. It can develop into ventricular fibrillation at any time. Ventricular tachycardia
is a life-threatening dysrhythmia that results from an irritable ectopic focus that
takes over as the pacemaker for the heart. The low cardiac output that results
can lead quickly to cerebral and myocardial ischemia. Client’s frequently
experience a feeling of impending death. Ventricular tachycardia is treated with
antidysrhythmic medications or magnesium sulfate, cardioversion (client awake),
or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate
into ventricular defibrillation at any time.

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92. B. Anorexia, nausea, and visual disturbances. The first signs and symptoms of
digoxin toxicity in adults include abdominal pain, N/V, visual disturbances
(blurred, yellow, or green vision, halos around lights), bradycardia, and other
dysrhythmias.
93. C. Variant angina. Stable angina is induced by exercise and is relieved by rest or
nitroglycerin tablets. Unstable angina occurs at lower and lower levels of activity
and rest, is less predictable, and is often a precursor of myocardial infarction.
Variant angina, or Prinzmetal’s angina, is prolonged and severe and occurs at the
same time each day, most often in the morning.
94. A. Obtaining an infusion pump for the medication. IV nitro infusion requires an
infusion pump for precise control of the medication. BP monitoring would be
done with a continuous system, and more frequently than every 4 hours. Hourly
urine outputs are not always required. Obtaining serum potassium levels is not
associated with nitroglycerin infusion.
95. B. Antithrombotic action. Aspirin does have antipyretic, antiplatelet, and
analgesic actions, but the primary reason ASA is administered to the client
experiencing an MI is its antithrombotic action.
96. D. Can perform personal self-care activities without pain. By day 2 of
hospitalization after an MI, clients are expected to be able to perform personal
care without chest pain. Day 2 hospitalization may be too soon for clients to be
able to identify risk factors for MI or begin a walking program; however, the client
may be sitting up in a chair as part of the cardiac rehabilitation program. Severe
chest pain should not be present.
97. B. Small, easily digested meals. Recommended dietary principles in the acute
phase of MI include avoiding large meals because small, easily digested foods
are better digested foods are better tolerated. Fluids are given according to the
client’s needs, and sodium restrictions may be prescribed, especially for clients
with manifestations of heart failure. Cholesterol restrictions may be ordered as
well. Clients are not prescribed a diet of liquids only or NPO unless their
condition is very unstable.
98. A. Left ventricular atrophy. In older adults who are less active and do not
exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead
to abnormal changes in the myocardium of the older adult. As a result, under
sudden emotional or physical stress, the left ventricle is less able to respond to
the increased demands on the myocardial muscle.
99. A. Ineffective tissue perfusion related to decreased peripheral blood flow
secondary to decreased cardiac output. and C. Decreased cardiac output related
to structural and functional changes. HF is a result of structural and functional
abnormalities of the heart tissue muscle. The heart muscle becomes weak and
does not adequately pump the blood out of the chambers. As a result, blood
pools in the left ventricle and backs up into the left atrium, and eventually into the
lungs. Therefore, greater amounts of blood remain in the ventricle after
contraction thereby decreasing cardiac output. In addition, this pooling leads to
thrombus formation and ineffective tissue perfusion because of the decrease in
blood flow to the other organs and tissues of the body. Typically, these clients
have an ejection fraction of less than 50% and poorly tolerate activity. Activity
intolerance is related to a decrease, not increase, in cardiac output. Gas
exchange is impaired. However, the decrease in cardiac output triggers
compensatory mechanisms, such as an increase in sympathetic nervous system
activity.
100. C. Activity intolerance related to pump failure. Activity intolerance is a primary
problem for clients with heart failure and pulmonary edema. The decreased
cardiac output associated with heart failure leads to reduced oxygen and fatigue.
Clients frequently complain of dyspnea and fatigue. The client could be at risk for
infection related to stasis of secretions or impaired skin integrity related to
pressure. However, these are not the priority nursing diagnoses for the client with
HF and pulmonary edema, nor is constipation related to immobility.
101. C. Vasodilator. ACE inhibitors have become the vasodilators of choice in the
client with mild to severe HF. Vasodilator drugs are the only class of drugs clearly
shown to improve survival in overt heart failure.
102. A. 5 to 10 minutes. After IV injection of furosemide, diuresis normally begins in
about 5 minutes and reaches its peak within about 30 minutes. Medication
effects last 2 to 4 hours.
103. B. Tomato juice. Canned foods and juices, such as tomato juice, are typically high
in sodium and should be avoided in a sodium-restricted diet.
104. B. Left ventricular enlargement. A normal apical impulse is found under over the
apex of the heart and is typically located and auscultated in the left fifth
intercostal space in the midclavicular line. An apical impulse located or
auscultated below the fifth intercostal space or lateral to the midclavicular line
may indicate left ventricular enlargement.

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