NCLEX REVIEWER CARDIOVASCULAR DISORDERS-QUIZLET B.

Confusion, urine output 15 ml over last 2 hours, orthopnea

A client is admitted with chest pain and kept overnight C. SpO2 92% on 2L NC, respiration 20, 1+ edema of lower
for stress testing in the morning. Prior to the stress test, the extremities
nurse reviews the lab results. The nurse should report which D. weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with
ELEVATED lab value to HCP prior to the stress test? exercise
A. cholesterol The nurse notices that a client's HR decreases from 63 to
B. erythrocyte sedimentation rate 50 bpm on the monitor. The nurse should FIRST...
C. prothrombin time A. Administer atropine 0.5mg IV push
D. troponin B. Auscultate for abnormal heart sounds
A client with chest pain is prescribed nitroglycerin C. Prepare for transcutaneous pacing
intravenously. Which assessment is of greatest concern for D. Take the client's BP
the nurse initiating the nitroglycerin drip? A 60 year old comes into the ER with crushing substernal
A. Serum potassium is 3.5 chest pain that radiates to the shoulder and left arm. The
B. Blood pressure is 88/46 admitting dx is acute myocardial infarction. Admissions
C. ST elevation is present on ECG prescriptions include: 4L oxygen NC, CBC, chest radiograph,
D. Heart rate is 61 bpm ECG, and 2mg morphine given IV. The nurse should FIRST
A client has chest pain rated an 8 on the pain scale. The A. Administer the morphine
12-lead ECG reveals ST elevation in the inferior leads, and B. Obtain a 12 lead ECG
troponin levels are elevated. What should the nurse do C. Obtain the blood world
FIRST? D. prescribe the chest radiograph
A. Monitor daily weights and urine output When administering a thrombolytic drug to the client
B. Limit visitation by family and friends who is experiencing a MI and who has premature ventricular
C. Provide client education on meds and diet contractions, the expected outcome of the drug is to...
D. Reduce pain and myocardial oxygen demand A. Promote hydration
A client with acute chest pain is receiving IV morphine sulfate. B. Dissolve clots
Which is an expected effect of morphine? Select all that C. Prevent kidney failure
apply. D. Treat dysrhythmias
A. Reduces myocardial oxygen consumption The nurse is assessing a client who's had a stent inserted
B. Promotes reduction in respiratory rate in a coronary artery via the right femoral artery. The client is
C. Prevents ventricular remodeling receiving IV heparin 1,000 units/hour. During the second post
D. Reduces blood pressure and heart rate procedure check, the nurse notes that the puncture site at
E. Reduces anxiety and fear the groin has begun to steadily ooze blood. The nurse should
An older adult has chest pain and shortness of breath. first...
The HCP prescribes nitroglycerin tablets. What should the A. Don gloves and apply direct pressure over the site
nurse instruct the client to do? B. Observe and document the bleeding
A. Put the tablet under the tongue until it's absorbed C. notify the HCP
B. Swallow the tablet with 120 ml's of water D. prepare protamine sulfate for IV administration
C. Chew the tablet until it's dissolved The nurse is assessing a client who's had a MI. The nurse
D. Place the tablet between the cheek and gums until it notes the cardiac rhythm shown on the ECG strip. The nurse
disappears interprets this rhythm as...
The nurse has completed an assessment on a client with A. atrial fibrillation
the decreased cardiac output. Which findings should receive B. ventricular tachycardia
the HIGHEST priority? C. premature ventricular contractions
A. BP 112/62, atrial fibrillation with HR 82, bilateral basilar D. sinus tachycardia
crackles
 Which is an expected outcome for a client on the 2nd pain. Which instruction would most likely help the client
day of hospitalization after a MI? The client... prevent this problem?
A. continues to have severe chest pain A. Climb the steps early in the day
B. can identify risk factors for MI B. rest for at least 1 hour before climbing the stairs
C. participates in a cardiac rehabilitation walking program C. take a nitroglycerin tablet before climbing the stairs
D. can preform personal self-care activities without pain D. lie down after climbing the stairs
After a MI, the hospitalized client is taught to move the The client who experiences angina has been told to
legs while resting in bed. What is the expected outcome of follow a low cholesterol diet. Which meal is best?
this exercise? A. hamburger, salad, milkshake
A. prepare the client for ambulation B. baked liver, green beans, and coffee
B. promote urinary and intestinal elimination C. spaghetti with tomato sauce, salad, and coffee
C. prevent thrombophlebitis and blood clot formation D. fried chicken, green beans, and skim milk
D. decrease the likelihood of pressure ulcer formation Which symptom should the nurse teach the client with
The nurse is caring for a client who recently experienced unstable angina to report immediately to the HCP?
a MI and has been started in clopidogrel. The nurse should A. a change in the pattern of chest pain
develop a teaching plan that includes which points? Select all B. pain during sexual activity
that apply C. pain during an argument
A. The client should report unexpected bleeding or bleeding D. pain during or after physical activity
that lasts a long time A client with unstable angina is scheduled to have a
B. The client should take clopidogrel with food cardiac catheterization. The nurse explains to the client that
C. The client may bruise more easily and may experience this procedure is being used to...
bleeding gums A. open and dilate blocked coronary arteries
D. clopidogrel works by preventing platelets from sticking B. assess the extent of arterial blockage
together and forming a clot C. bypass obstructed vessels
E. The client should drink a glass of water after taking D. assess the functional adequacy of the valves and heart
clopidogrel muscle
Which client is at greatest risk for coronary artery A client has a throbbing headache when nitroglycerin is
disease? taken for angina. The nurse should instruct the client that:
A. a 32 year old female with mitral valve prolapse, who quit A. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken
smoking 10 years ago for this common side effect.
B. a 43 year old male with a family hx of CAD and cholesterol B. Nitroglycerin should be avoided if the client is experiencing
level of 158 this serious side effect.
C. a 56 year old male with an HDL of 60 who takes C. Taking the nitroglycerin with a few glasses of water will
atorvastatin reduce the problem.
D. a 65 year old female who's obese with an LDL of 188 D. The client should lie in a supine position to alleviate the
A 68 year old client on day 2 after hip surgery has no headache.
cardiac hx but reports having "chest heaviness." The nurse How should the nurse instruct the client with unstable
should FIRST... angina to use sublingual nitroglycerin tablets when chest pain
A. inquire about the onset, duration, severity, and occurs? "Sit down and then..."
precipitating factors of the heaviness A. take one tablet every 2-5 minutes until the pain stops
B. administer oxygen via NC B. take one tablet and rest for 15 minutes. Call the HCP if pain
C. offer pain medication for the chest heaviness persists after 15 minutes
D. inform the HCP of the chest heaviness C. take one tablet then if pain persists take 2 additional tabs
Following the diagnosis of angina pectoris, a client in 5 minutes. Call the HCP if pain persists after 15 minutes
reports being unable to walk up 2 flights of stairs without D. take 1 tablet. If pain persists after 5 minutes, call 9-1-1
 The nurse should asses the client with left sided heart The nurse should teach the client that signs of digoxin
failure for which findings? Select all that apply. toxicity include...
A. dyspnea B. jugular vein distension A. rash over the chest and back
C. crackles D. right upper quadrant pain B. increased appetite
E. oliguria F. decreased oxygen saturation levels C. visual disturbances such as seeing yellow spots
Which are indications that a client with a hx of left sided D. elevated blood pressure
heart failure is developing pulmonary edema? Select all that The nurse should assess the client for digoxin toxicity if
apply. serum levels indicate that the client has a...
A. distended jugular veins B. dependent edema A. low sodium level B. high glucose level
C. anorexia D. coarse crackles E. tachycardia C. high calcium level D. low potassium level
An older adult with a hx of heart failure is admitted to Which food should the nurse teach a client with heart
the ER with pulmonary edema. On admission, what should failure to limit when following a 2 gram sodium diet?
the nurse assess first? A. apples B. canned tomato juice
A. blood pressure B. skin breakdown C. whole wheat bread D. beef tenderloin
C. serum potassium level D. urine ouput A client receiving a loop diuretic should be encouraged
Which position is best for a client with heart failure who to eat which foods? Select all that apply.
has orthopnea? A. angel food cake B. banana
A. low Fowler's position with legs elevated on pillows C. dried fruit D. orange juice E peppers
B. lying on right side (sim's position) with pillow between legs The nurse is admitting an older adult to the hospital. The
C. high Fowler's position with legs resting on the matress echocardiogram report revealed left ventricular enlargement.
D. trendelenberg's position and legs elevated The nurse notes 2+ pitting edema in the ankles when getting
What is the major goal of nursing care for a client with the client into bed. Based on this finding, what should the
heart failure and pulmonary edema? nurse do first?
A. increase cardiac output B. improve respiratory status A. assess respiratory status B. draw blood for lab studies
C. decrease peripheral edema D. enhance comfort C. insert a foley catheter D. weigh the client
Furosemide is administered intravenously to a pt with The nurse's discharge teaching plan for the client with
HF. How soon after administration should the nurse heart failure should stress the importance of which of the
begin to see evidence of the drugs desired effect? following?
A. 5 to 10 min B. 30 to 60 min A. Maintaining a high-fiber diet.
C. 2 to 4 hours D. 6 to 8 hours B. Walking 2 miles every day.
A client with heart failure is receiving digoxin C. Obtaining daily weights at the same time each day.
intravenously. The nurse should determine effectiveness of D. Remaining sedentary for most of the day.
the drug by assessing... The nurse is teaching a client with heart failure how to
A. dilated coronary arteries avoid complications and future hospitalizations. The nurse is
B. increased myocardial contractility confident that the client has understood the teaching when
C. decreased cardiac arrhythmia's the client identifies which potential complications? Select all
D. decreased electrical conductivity in the heart that apply.
The nurse teaches a client with heart failure to take oral A. becoming increasingly short of breath at rest
furosemide in the morning. The primary reason for this is to B. weight gain of 2 lbs or more in 1 day
prevent... C. high intake of sodium for breakfast
A. electrolyte imbalance D. having to sleep sitting up in a reclining chair
B. nausea and vomiting E. weight loss of 2 lbs in 1 day
C. excretion of excessive fluids accumulated during the night A client is scheduled for a cardiac catheterization. The
D. sleep disturbances during the night nurse should do which preprocedure tasks? Select all that
apply.
A. administer all prescribed oral medications The nurse teaches a client who has recently been
B. check for iodine sensitivity diagnosed with hypertension about following a low-calorie,
C. verify that written consent has been obtained low-fat, low-sodium diet. Which of following menu selections
D. withhold food and oral fluids before the procedure would best meet the client's needs?
E. insert a urinary drainage catheter A. mixed green salad with blue cheese dressing, crackers, and
Which is the most important initial post-procedure cold cuts
nursing assessment for a client who has a had a cardiac B. ham sandwich on rye bread and an orange
catheterization? C. baked chicken, an apple, and a slice of white bread
A. monitor lab values D. hot dogs, baked beans, and celery and carrot sticks
B. observe neurologic function every 15 minutes Which would most likely assist the client with
C. observe the puncture site for swelling and bleeding hypertension in maintaining an exercise program?
D. monitor skin warmth and turgor A. give the client a written exercise program
The most effective measure the nurse can use to prevent B. explain the exercise program to the client's spouse
wound infection when changing a client's dressing after C. reassure the client that he/she can do the exercise program
coronary artery bypass surgery is... D. tailor a program to the client's needs and abilities
A. observe careful hand-washing procedures A 65-year-old male develops blockage in the pulmonary
B. clean the incisional area with an antiseptic artery. As a result of the blockage, blood would first back up
C. use prepackaged sterile dressings to cover the incision into the:
D. place soiled dressings in a waterproof bag before disposing a. Aorta b. Left ventricle
of them c. Pulmonary veins d. Right ventricle
The nurse should teach the client who is receiving A nurse is teaching about the heart. Which information
warfarin sodium that... should the nurse include? The chamber of the heart that
A. partial thromboplastin time values determine the dosage generates the highest pressure is the:
of warfarin sodium a. Right atrium b. Left atrium
B. protamine sulfate is used to reverse the effects of warfarin c. Left ventricle d. Right ventricle
sodium A nurse recalls the chamber that receives blood from the
C. INR is used to assess warfarin effectiveness systemic circulation is the:
D. warfarin sodium will facilitate clotting of the blood a. Right atrium b. Right ventricle
Before a client's discharge after mitral valve replacement c. Left atrium d. Left ventricle
surgery, the nurse should evaluate the client's understanding Which statement indicates the nurse understands blood
of post-surgery activity restrictions. The client should avoid flow? Oxygenated blood flows through the:
which activity until after the 1-month post-discharge a. Superior vena cava b. Pulmonary veins
appointment with the surgeon? c. Pulmonary artery d. Cardiac veins
A. showering The nurse is planning care for a patient with heart
B. lifting anything heavier than 10 lbs problems. Which information should the nurse remember?
C. a program of gradually progressive walking The _____ artery travels down the interventricular septum
D. light housework and delivers blood to portions of the left and right ventricle.
Three days after mitral valve replacement surgery, the a. Right coronary b. Circumflex
client tells the nurse there is a "clicking" noise coming from c. Left anterior descending d. Cardiac
the chest incision. The nurse's response should reflect the When a staff member asks where venous blood from the
understanding that the client may be experiencing... coronary circulation drains into, what is the best response by
A. anxiety related to body image the nurse? The:
B. depression related to altered health status a. Superior vena cava b. Inferior vena cava
C. altered tissue perfusion c. Right atrium d. Reft atrium
D. lack of knowledge regarding the postoperative course
 While viewing the electrocardiogram, the nurse recalls While planning care for a heart patient, which principle
the _____ conducts action potentials down the should the nurse recall? Right ventricular afterload is affected
atrioventricular septum. by:
a. Bachmann bundle b. Bundle of His a. Vascular resistance in the systemic vessels
c. Sinoatrial node d. Atrioventricular node b. Right end-diastolic pressure
A 13-year-old female took a weight loss drug that c. Pressures in the vena cava
activated the sympathetic nervous system. Which of the d. Pulmonary vascular resistance
following assessment findings would the nurse expect? Which principle should the nurse remember while
a. Decreased myocardial contraction planning care for a cardiac patient? Pressure in the left
b. Decreased heart rate ventricle must exceed pressure in the _____ before the left
c. Increased cardiac conduction ventricle can eject blood.
d. Increased intranodal conduction time a. Coronary arteries b. Aorta
A 50-year-old female received trauma to the chest that c. Inferior vena cava d. Pulmonary veins
caused severe impairment of the primary pacemaker cells of A 50-year-old female presents with a low heart rate and
the heart. Which of the following areas received the greatest low blood pressure. She is given an intravenous (IV) infusion
damage? of fluids. The increase in atrial distension results in:
a. Atrioventricular (AV) node b. Sinoatrial (SA) node a. Renal retention of fluids
c. Bundle of His d. Ventricles b. Depressed myocardial contractility
b. Sinoatrial (SA) node c. Release of acetylcholine
A nurse assesses the heart after acetylcholine because d. Increased heart rate
the effect of acetylcholine on the heart is to A nurse observes a cardiologist multiplying the heart rate
a. Decrease the refractory period by stroke volume. What is the cardiologist measuring?
b. Increase calcium influx a. Vascular resistance b. Preload
c. Increase the strength of myocardial contraction c. Cardiac output d. Ejection fraction
d. Decrease the heart rate A patient researches baroreceptors online. Which
A nurse is discussing the pressure generated at the end information indicates a good understanding? Baroreceptors
of diastole. Which term is the nurse describing? are located in the:
a. Preload b. Afterload a. Renal artery b. Superior vena cava
c. Systemic vascular resistance d. Total peripheral resistance c. Carotid sinus d. Circle of Willis
Which principle should the nurse remember when c. Carotid sinus
planning nursing care for a patient with heart problems? As A nurse is evaluating the direct end effect of the renin-
stated by the Frank-Starling law, there is a direct relationship angiotensin-aldosterone system. Which principle should the
between the _____ of the blood in the heart at the end of nurse remember?
diastole and the _____ of contraction during the next systole. a. Angiotensin II causes systemic vasoconstriction.
a. Pressure, duration b. Volume, force b. Renin promotes the excretion of sodium and water in the
c. Viscosity, force d. Viscosity, duration renal tubules.
b. Volume, force c. Aldosterone increases renal retention of water only.
Within a normal physiologic range, an increase in left d. Angiotensin I promotes sodium and water reabsorption by
ventricular end-diastolic volume would lead the nurse to the kidneys.
monitor for: When a patient wants to know about the renin-angiotensin-
a. An increased force of contraction aldosterone system, what is the nurse's best response?
b. A decrease in cardiac output Conversion of angiotensin I to angiotensin II happens in the:
c. An increase in heart rate a. Lungs b. Liver
d. Heart failure c. Kidneys d. Heart
A nurse is discussing the different types of regulation.
Which regulation is the nurse describing? Local myogenic a. hypernatremia. b. hypertension.
regulation of blood vessel diameter and thus blood flow c. hyperkalemia. d. hypokalemia.
through a vessel is an example of: A nurse is discussing heart failure with a group of nursing
a. Autonomic regulation b. Somatic regulation students. Which statement by a student reflects an
c. Autoregulation d. Metabolic regulation understanding of how compensatory mechanisms can
The pulmonologist is presenting a workshop over the compound existing problems in patients with heart failure?
lungs. Which information should be included? The lung a. "An increase in arteriolar tone to improve tissue perfusion
receives parasympathetic innervation by the _____ nerve. can decrease resistance."
a. Vagus b. Phrenic b. "An increase in contractility to increase cardiac output can
c. Brachial d. Pectoral cause pulmonary edema."
If an individual with respiratory difficulty were retaining c. "When the heart rate increases to increase cardiac output,
too much carbon dioxide, which of the following it can prevent adequate filling of the ventricles."
compensatory responses would the nurse expect to be d. "When venous tone increases to increase ventricular filling,
initiated? an increase in arterial pressure occurs."
a. Increase in respiratory rate A patient with chronic hypertension is admitted to the
b. Decrease in ventilation rate hospital. During the admission assessment, the nurse notes a
c. Increase in tidal volume heart rate of 96 beats per minute, a blood pressure of 150/90
d. Vasodilation of the pulmonary arterioles mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and
A nurse remembers the majority of total airway distension of the jugular veins. The nurse will contact the
resistance occurs in the: provider to request an order for which medication?
a. Bronchi b. Nose a. ACE inhibitor b. Digoxin (Lanoxin)
c. Oral pharynx d. Diaphragm c. Furosemide (Lasix) d. Spironolactone (Aldactone)
An aide asks a nurse how surfactant works. How should A diabetic patient is recovering from a myocardial
the nurse respond? Surfactant facilitates alveolar distention infarction but does not have symptoms of heart failure. The
and ventilation by: nurse will expect to teach this patient about:
a. Decreasing thoracic compliance a. ACE inhibitors and beta blockers.
b. Attracting water to the alveolar surface b. biventricular pacemakers.
c. Decreasing surface tension in alveoli c. dietary supplements and exercise.
d. Increasing diffusion in alveoli d. diuretics and digoxin.
c. Decreasing surface tension in alveoli A patient with heart failure who has been taking an ACE
A patient asks how oxygen is transported in the body. inhibitor, a thiazide diuretic, and a beta blocker for several
What is the nurse's best response? Most of the oxygen (O2) is months comes to the clinic for evaluation. As part of the
transported ongoing assessment of this patient, the nurse will expect the
a. Dissolved in the plasma provider to evaluate:
b. Bound to hemoglobin a. complete blood count. b. ejection fraction.
c. In the form of carbon dioxide (CO2) c. maximal exercise capacity. d. serum electrolyte levels.
d. As a free-floating molecule The potassium-sparing diuretic spironolactone
A consequence of alveolar hypoxia is: (Aldactone) prolongs survival and improves heart failure
a. Reactive vasodilation symptoms by which mechanism?
b. Local bronchoconstriction a. Blocking aldosterone receptors b. Increasing diuresis
c. Decreased respiratory rate c. Reducing venous pressure d. Reducing afterload
d. Pulmonary artery vasoconstriction A nurse prepares to administer a scheduled dose of
A patient is taking enalapril (Vasotec) an ACE inhibitor. digoxin. The nurse finds a new laboratory report showing a
The nurse understands that patients taking this type of drug plasma digoxin level of 0.7 ng/mL. What action should the
for heart failure need to be monitored carefully for: nurse take?
a. Withhold the drug for an hour and reassess the level. following factors affect stroke volume? (Select all that apply.)
b. Withhold the drug and notify the prescriber immediately. a. Preload b. Peripheral vascular resistance
c. Administer Digibind to counteract the toxicity. c. Afterload d. Ejection fractione. Contractility
d. Check the patient's apical pulse, and if it is within a safe The nurse is monitoring a client who is taking digoxin
range, administer the digoxin. (Lanoxin) for adverse effects. Which findings are
A man asks a nurse why he cannot use digoxin (Lanoxin) characteristics of digoxin toxicity? Select all that apply.
for his heart failure, because both of his parents used it for a. Irritability b. Nausea and Vomiting
HF. The nurse will explain that digoxin is not first-line therapy c. Blurred Vision d. Diarrhea e. Tremors
for which reason? The nurse in a medical unit is caring for a client with
a. It causes tachycardia and increases the cardiac workload. heart failure. The client suddenly develops extreme dyspnea,
b. It does not correct the underlying pathology of heart tachycardia, and lung crackles and the nurse suspects
failure. pulmonary edema. The nurse immediately asks another nurse
c. It has a wide therapeutic range that makes dosing difficult. to contact the HCP and prepares to implement which
d. It may actually shorten the patient's life expectancy. PRIORITY interventions? Select all that apply.
A nurse is preparing to administer digoxin (Lanoxin) to a a. Inserting a Foley catheter
patient. The patient's heart rate is 62 beats per minute, and b. Transporting the client to the coronary care unit
the blood pressure is 120/60 mm Hg. The last serum c. Placing the client in a low Fowler's side-lying position
electrolyte value showed a potassium level of 5.2 mEq/L. d. Administering oxygen
What will the nurse do? e. Administering furosemide (Lasix)
a. Contact the provider to request an increased dose of f. Administering morphine sulfate intravenously
digoxin. Which client teaching should the nurse implement for
b. Give the dose of digoxin and notify the provider of the the client diagnosed with CAD? Select all that apply.
potassium level. a. Refer to counselor for stress reduction techniques
c. Request an order for a diuretic. b. Decrease the salt intake to 2g a day
d. Withhold the dose and notify the provider of the heart c. Instruct client to walk 30 minutes a day
rate. d. Encourage a low-fat, low-cholesterol diet
A patient with heart failure who has been given digoxin e. Increase fiber in the diet
(Lanoxin) daily for a week complains of nausea. Before giving The client with coronary artery disease asks the nurse,
the next dose, the nurse will: "Why do I get chest pain?" Which statement would be the
a. Assess the heart rate (HR) and give the dose if the HR is most appropriate response by the nurse?"
greater than 60 beats per minute. a. "Chest pain is caused by decreased oxygen to the heart
b. Contact the provider to report digoxin toxicity. muscle."
c. Request an order for a decreased dose of digoxin. b. "Chest pain occurs when the lungs cannot adequately
d. Review the serum electrolyte values and withhold the dose oxygenate the blood"
if the potassium level is greater than 3.5 mEq/L c. "The heart muscle is unable to pump effectively to perfuse
Increases in which of the following would cause the the body"
nurse to assess for decreased blood flow? (Select all that d. "There is ischemia to the myocardium as a result of
apply.) hypoxemia."
a. Blood viscosity b. Blood vessel diameter The client diagnosed with essential hypertension asks
c. Blood pressure d. Blood vessel length the nurse, "Why do I have high blood pressure?" Which
Important mechanisms for maintaining venous return to response by the nurse would be the most appropriate?
the right atrium include (select all that apply): a. "More than likely you have had a diet high in salt, fat, and
a. Cardiac output b. Atrioventricular (AV) valves c. Skeletal cholesterol."
muscle contraction d. Blood volume e. Vascular tone b. "You probably have some type of kidney disease that
A nurse is evaluating stroke volume. Which of the causes the high BP."
c. "There is no specific cause for hypertension, but there are the client diagnosed with CAD. Which assessment data would
many known risk factors." cause the nurse to question administering the medication?
d. "You are concerned that you have high blood pressure. a. The client's potassium level is 4.5 mEq/L
Let's sit down and talk." b. The client is complaining of a headache
The client diagnosed with hypertension asks the nurse, "I c. The client has a BP of 110/70
don't know why the doctor is worried about my blood d. The client had an apical pulse of 56
pressure. I feel just great." Which statement by the nurse Which intervention should the nurse implement when
would be the most appropriate response? administering a loop diuretic to a client diagnosed with CAD?
a. "When is the last time you saw your doctor? Does he know a. Assess the client's radial pulse
you are feeling great?" b. Assess the client's serum potassium level
b. "Damage can be occurring to your heart and kidneys even c. Assess the client's pulse oximeter reading
if you feel great." d. Assess the client's glucometer reading
c. "Unless you have a headache your blood pressure is The HCP prescribes an ACE inhibitor for the client
probably within normal limits" diagnosed with essential hypertension. Which statement is
d. "Your blood pressure reflects how well your heart is the most appropriate rationale for administering this
working." medication?
The client is admitted to the telemetry unit diagnosed a. ACE inhibitors decrease blood pressure by relaxing vascular
with acute exacerbation of congestive heart failure. Which smooth muscle
signs/symptoms would the nurse expect to find when b. ACE inhibitors prevent the beta-receptor stimulation in the
assessing this client? heart
a. Apical pulse rate of 110 and 4+ pitting edema of feet c. ACE inhibitors prevent vasoconstriction and sodium and
b. Radial pulse of 90 and capillary refill time <3 seconds water retention
c. Thick white sputum and crackles that clear with cough d. This medication blocks the alpha receptors in the vascular
d. The client sleeping with no pillows and eupnea. smooth muscle
The nurse is assessing the client diagnosed with The client diagnosed with essential hypertension is
congestive heart failure. Which signs/symptoms would taking a loop diuretic daily. Which assessment data would
indicate that the medical treatment has been effective? require immediate intervention by the nurse?
a. The client is able to perform activities of daily living a. The client's serum potassium level is 4.5 mEq/L
without dyspnea b. The client's BP is 148/92
b. The client's peripheral pitting edema has gone from 3+ to c. The telemetry reads normal sinus rhythm
4+ d. The client has a weight gain of 2 kg within 1-2 days
c. The client has minimal jugular vein distention The nurse is monitoring a client who is taking
d. The client is able to take the radial pulse accurately propranolol (Inderal LA). Which assessment data indicates a
The nurse provides home care instructions to the parents potential serious complication associated with this
of a child with heart failure regarding the procedure for medication?
administration of digoxin (Lanoxin). Which statement by the a. A baseline resting heart rate of 88 beats/minute followed
parent indicates the need for further instruction? by a resting heart rate of 72 beats/minute after two doses of
a. "If more than one dose is missed, I will call the HCP." the medication
b. "If my child vomits after medication administration, I will b. The development of audible expiratory wheezes
repeat the dose." c. The development of complaints of insomnia
c. "I will not mix the medication with food." d. A baseline blood pressure of 150/80 mm Hg followed by a
d. "I will take my child's pulse before administering the blood pressure of 138/72 mm Hg after two doses of the
medication." medication

The nurse is preparing to administer a beta blocker to The nurse is planning to administer hydrochlorothiazide to a
client. The nurse understands that which is a concern related diagnosed with essential hypertension. Which intervention
to the administration of this medication? should the nurse implement?
a. Hypokalemia, hyperglycemia, sulfa allergy a. Notify the HCP if the potassium level is 3.8 mEq/L
b. Hyperkalemia, hypoglycemia, penicillin allergy b. Do not administer the medication if the client's radial pulse
c. Increased risk of osteoporosis is >100
d. Hypouricemia, hyperkalemia c. Monitor the client's blood pressure while he or she is lying,
Prior to administering a client's daily dose of digoxin, the standing, and sitting
nurse reviews the client's laboratory data and notes the d. Question administering the medication if the BP is <90/60
following results: serum calcium, 9.8 mg/dL; serum mmHg
magnesium , 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum The male client diagnosed with essential hypertension
creatinine, 0.9 mg/dL. Which result should alert the nurse has been prescribed an alpha-adrenergic blocker. Which
that the client is at risk for digoxin toxicity? intervention should the nurse discuss with the client?
a. Serum magnesium level b. Serum creatinine level a. Explain that impotence is an expected side effect of the
c. Serum potassium level d. Serum calcium level medication
The nurse is monitoring an infant with congenital heart b. Eat at least one banana a day to help increase the
disease closely for signs of heart failure. The nurse should potassium level
assess the infant for which EARLY signs of heart failure? c. Take the medication on an empty stomach to increase
a. Slow and shallow breathing b. Cough absorption
c. Pallor d. Tachycardia d. Change position slowly when going from lying to sitting
The elderly client has coronary artery disease. Which position
question should the nurse ask the client during the client The nurse just received the AM shift report. Which client
teaching? should the nurse assess first?
a. "Do you get a yearly x-ray?" a. Client diagnosed with DVT who is complaining of chest
b. "Do you have a daily bowel movement?" pain.
c. "Are you sexually active?" b. Client diagnosed with CAD who has a BP of 170/100
d. "Have you had any weight change?" c. Client diagnosed with pneumonia who has a pulse oximeter
The 66-year-old male client has his BP checked at a reading of 98%
health fair. His BP is 168/98. Which action should the nurse d. Client diagnosed with Ulcerative colitis who has non-
implement first? bloody diarrhea.
a. Recommend that the client have his blood pressure The nurse is teaching the Dietary Approaches to Stop
checked in 1 month. Hypertension (DASH) diet to a client diagnosed with
b. Explain that this BP is within the normal range for an hypertension. Which statement indicates that the client
elderly person understands the client teaching concerning the DASH diet?
c. Discuss the importance of eating a low salt, low fat, low a. "I should eat at least 4-5 servings of vegetables a day."
cholesterol diet b. "I should drink no more than two glasses of whole milk a
d. Instruct the client to see his HCP as soon as possible day"
The nurse is teaching the client recently diagnosed with c. "I should decrease my grain intake to no more than twice a
essential hypertension. Which instruction should the nurse week."
provide when discussing exercise? d. "I should eat meat that has a lot of white streaks in it."
a. Perform light weight lifting 3 times a week. The nurse is teaching a class on arterial essential
b. Encourage the client to swim laps once a week. hypertension. Which modifiable risk factors would the nurse
c. Recommend high-level aerobics daily. include when preparing this presentation?
d. Walk at least 30 minutes a day on flat surfaces. a. Include discussions on family history and gender
b. Provide information on low fiber and high salt diet
The nurse is administering a beta-blocker to the client c. Include information on retinopathy and nephropathy
d. Discuss sedentary lifestyle and smoking cessation position.
The HCP has provided an ACE inhibitor for the client To determine the effects of therapy for a patient who is
diagnosed with CHF. Which discharge instructions should the being treated for heart failure, which laboratory result will
nurse include? the nurse plan to review?
a. Explain the importance of taking medication with food a. Homocysteine (Hcy) b. B-type natriuretic peptide (BNP)
b. Teach the client how to prevent orthostatic hypotension c. Myoglobin d. Low-density lipoprotein (LDL)
c. Encourage the client to eat bananas to increase potassium While doing the admission assessment for a thin 72-year-
level old patient, the nurse observes pulsation of the abdominal
d. Instruct the client to take a cough suppressant if a cough aorta in the epigastric area. Which action should the nurse
develops take?
After noting a pulse deficit when assessing a patient who a. Instruct the patient to remain on bed rest.
has just arrived in the emergency department, the nurse will b. Notify the hospital rapid response team.
anticipate that the patient may require c. Teach the patient about aortic aneurysms.
a. electrocardiographic (ECG) monitoring. d. Document the finding in the patient chart.
b. 2-D echocardiogram. A patient is scheduled for a cardiac catheterization with
c. cardiac catheterization. coronary angiography. Before the test, the nurse informs the
d. hourly blood pressure (BP) checks patient that
When reviewing the 12-lead electrocardiograph (ECG) a. a warm feeling may be noted when the contrast dye is
for a healthy 86-year-old patient who is having an annual injected.
physical examination, which of the following will be of most b. it will be important to lie completely still during the
concern to the nurse? procedure.
a. The PR interval is 0.21 seconds. c. electrocardiographic (ECG) monitoring will be required for
b. The QRS duration is 0.13 seconds. 24 hours after the test.
c. There is a right bundle-branch block. d. monitored anesthesia care will be provided during the
d. The heart rate (HR) is 43 beats/minute. procedure.
During a physical examination of a patient, the nurse While assessing a patient who was admitted with heart
palpates the point of maximal impulse (PMI) in the sixth failure, the nurse notes that the patient has jugular venous
intercostal space lateral to the left midclavicular line. The distention (JVD) when lying flat in bed. Which action should
most appropriate action for the nurse to take next will be to the nurse take next?
a. auscultate both the carotid arteries for the presence of a a. Observe for JVD with the head at 30 degrees.
bruit. b. Use a ruler to measure the level of the JVD.
b. document that the PMI is in the normal anatomic location. c. Have the patient perform the Valsalva maneuver.
c. assess the patient for symptoms of left ventricular d. Document this finding in the patient's record.
hypertrophy. The nurse teaches the patient being evaluated for
d. ask the patient about risk factors for coronary artery rhythm disturbances with a Holter monitor to
disease. a. connect the recorder to a telephone transmitter once daily.
To auscultate for S3 or S4 gallops in the mitral area, the b. keep a diary of daily activities while the monitor is worn.
nurse listens with the c. remove the electrodes when taking a shower or tub bath.
a. bell of the stethoscope with the patient sitting and leaning d. exercise more than usual while the monitor is in place.
forward. When auscultating over the patient's abdominal aorta,
b. diaphragm of the stethoscope with the patient in a the nurse hears a humming sound. The nurse documents this
reclining position. finding as a
c. diaphragm of the stethoscope with the patient lying flat on a. heave. b. bruit.
the left side. c. thrill. d. murmur.
d. bell of the stethoscope with the patient in the left lateral The nurse has received the laboratory results for a
patient who developed chest pain 4 hours ago and may be nurse?
having a myocardial infarction. The most important a. BP increase from 134/68 to 150/80 mm Hg.
laboratory result to review will be b. Pulse change from 80 to 96 beats/minute.
a. troponins T and I. b. LDL cholesterol. c. Electrocardiographic (ECG) changes indicating coronary
c. C-reactive protein. d. creatine kinase-MB (CK-MB). ischemia.
When assessing a newly admitted patient, the nurse d. Patient complaint of feeling tired.
notes a thrill along the left sternal border. To obtain more The standard policy on the cardiac unit states, "Notify
information about the cause of the thrill, which action will the health care provider for mean arterial pressure (MAP) less
the nurse take next? than 70 mm Hg." The nurse will need to call the health care
a. Find the point of maximal impulse. provider about
b. Compare the apical and radial pulse rates. a. the patient with left ventricular failure who has a BP of
c. Palpate the quality of the peripheral pulses. 110/70.
d. Auscultate for any cardiac murmurs. b. the newly admitted patient with a BP of 122/60.
The nurse hears a murmur between the S1 and S2 heart c. the patient with a myocardial infarction who has a BP of
sounds at the patient's left 5th intercostal space and 114/50.
midclavicular line. How will the nurse record this d. the postoperative patient with a BP of 116/42.
information? When admitting a patient for a coronary arteriogram and
a. "Diastolic murmur heard at tricuspid area." angiogram, which information about the patient is most
b. "Systolic murmur heard at Erb's point." important for the nurse to communicate to the health care
c. "Diastolic murmur heard at aortic area." provider?
d. "Systolic murmur heard at mitral area." a. The patient is allergic to shellfish.
The RN is observing a student nurse who is doing a b. The patient had an arteriogram a year ago.
physical assessment on a patient. The RN will need to c. The patient's pedal pulses are +1.
intervene immediately if the student nurse d. The patient has not eaten anything today.
a. places the patient in the left lateral position to check for A client returns from a left heart catheterization. The
the point of maximal impulse (PMI). right groin was used for catheter access. In which location
b. presses on the skin over the tibia for 10 seconds to check should the nurse palpate the distal pulse on this client?
for edema. 1. anterior to the right tibia 2. dorsal surface of the right foot
c. palpates both carotid arteries simultaneously to compare 3. posterior to the right knee 4. right midinguinal area
pulse quality. A client is admitted with chest pain and kept overnight
d. documents a murmur heard along the left sternal border as for stress testing the next morning. Prior to sending the client
an aortic murmur. to the stress test, the nurse reviews the results of the
Which information obtained by the nurse who is laboratory reports. The nurse should report which elevated
admitting the patient for magnetic resonance imaging (MRI) laboratory value to the healthcare provider (HCP) prior to the
will be most important to report to the health care provider stress test?
before the MRI? 1. cholesterol level 2. erythrocyte sedimentation rate
a. The patient has a permanent ventricular pacemaker in 3. prothrombin time 4. troponin
place. A client has chest pain rated at 8 on a 10-point visual
b. The patient has an allergy to shellfish and iodine. analog scale. The 12-lead electrocardiogram reveals ST
c. The patient has a history of coronary artery disease. elevation in the inferior leads, and troponin levels are
d. The patient took all the prescribed cardiac medications elevated. What should the nurse do first?
today 1. Monitor daily weights and urine output.
When the nurse is monitoring a patient who is 2. Limit visitation by family and friends.
undergoing exercise (stress) testing on a treadmill, which 3. Provide client education on medications and diet.
assessment finding requires the most rapid action by the 4. Reduce pain and myocardial oxygen demand.
 A client with chest pain is prescribed intravenous 4. weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with
nitroglycerin. Which assessment is of greatest concern for the exercise
nurse initiating the nitroglycerin drip? The nurse notices that a client's heart rate decreases
1. Serum potassium is 3.5 mEq/L (3.5 mmol/L). from 63 to 50 bpm on the monitor. The nurse should first:
2. Blood pressure is 88/46 mm Hg. 1. administer atropine 0.5 mg IV push.
3. ST elevation is present on the electrocardiogram. 2. auscultate for abnormal heart sounds.
4. Heart rate is 61 bpm. 3. prepare for transcutaneous pacing.
The nurse is caring for a client diagnosed with an 4. take the client's blood pressure.
anterior myocardial infarction 2 days ago. Upon assessment, When preparing a client for a cardiac angiogram, what
the nurse identifies a systolic murmur at the apex. The nurse actions should the nurse take? Select all that apply.
should first: 1. Determine if the client has an allergy to liquid contrast
1. assess for changes in vital signs. material.
2. draw an arterial blood gas. 2. Inform the client that an intravenous infusion will be
3. evaluate heart sounds with the client leaning forward. started before the procedure.
4. obtain a 12-lead electrocardiogram. 3. Remind the client to have nothing to eat or drink 8 hours
A client with acute chest pain is receiving IV morphine before the procedure.
sulfate. Which is an expected effect of morphine? Select all 4. Instruct the client to remain still during the procedure.
that apply. 5. Explain that the client will receive a fast-acting acting
1. reduces myocardial oxygen consumption anesthetic.
2. promotes reduction in respiratory rate A client is admitted with a myocardial infarction and
3. prevents ventricular remodeling atrial fibrillation. While auscultating the heart, the nurse
4. reduces blood pressure and heart rate notes an irregular heart rate and hears an extra heart sound
5. reduces anxiety and fear at the apex after the S2 that remains constant throughout the
A client is receiving an IV infusion of heparin sodium at respiratory cycle. The nurse should document these findings
1,200 units/h. The dilution is 25,000 units/500 mL. How many as:
milliliters per hour will this client receive? Round your answer 1. heart rate irregular with S3.
to a whole number. 2. heart rate irregular with S4.
24 mL/h 3. heart rate irregular with aortic regurgitation.
An older adult has chest pain and shortness of breath. 4. heart rate irregular with mitral stenosis.
The healthcare provider (HCP) prescribes nitroglycerin A 60-year-old comes into the emergency department
tablets. What should the nurse instruct the client to do? with crushing substernal chest pain that radiates to the
1. Put the tablet under the tongue until it is absorbed. shoulder and left arm. The admitting diagnosis is acute
2. Swallow the tablet with 120 mL of water. myocardial infarction (MI). Admission prescriptions include
3. Chew the tablet until it is dissolved. oxygen by nasal cannula at 4 L/min, complete blood count
4. Place the tablet between the cheek and gums until it (CBC), a chest radiograph, a 12-lead electrocardiogram (ECG),
disappears. and 2 mg of morphine sulfate given IV. The nurse should first:
The nurse has completed an assessment on a client with 1. administer the morphine. 2. obtain a 12-lead ECG.
a decreased cardiac output. Which findings should receive 3. obtain the blood work. 4. prescribe the chest radiograph.
the highest priority? An older adult had a myocardial infarction (MI) 4 days
1. BP 110/62 mm Hg, atrial fibrillation with HR 82, bilateral ago. At 0930, the client's blood pressure is 102/64 mm Hg.
basilar crackles After reviewing the client's progress notes (see chart), the
2. confusion, urine output 15 mL over the last 2 hours, nurse should first:
orthopnea Nurses Progress Notes:
3. SpO2 92 on 2 L nasal cannula, respirations 20, 1+ edema of Urinary output for the last 4 hours: 90 mL
lower extremities Capillary refill: > 3 seconds
Blood pressure: 128/82 99 (37.2)
Extremities: Cool HR: 70
1. give a fluid challenge/bolus. 75
2. notify the healthcare provider (HCP). R: 20
3. assist the client to walk. 26
4. administer furosemide as prescribed. Urine output: 90 mL/h
When administering a thrombolytic drug to the client 20 mL/h
who is experiencing a myocardial infarction (MI) and who has 1. urine output
premature ventricular contractions, the expected outcome of 2. heart rate
the drug is to: 3. blood pressure
1. promote hydration. 2. dissolve clots. 4. respiratory rate
3. prevent kidney failure. 4. treat dysrhythmias. The healthcare provider (HCP) prescribes continuous IV
The nurse is assessing a client who has had a myocardial nitroglycerin infusion for the client with myocardial infarction.
infarction (MI). The nurse notes the cardiac rhythm on the The nurse should:
monitor (see the electrocardiogram strip). The nurse should: 1. obtain an infusion pump for the medication.
1. notify the healthcare provider (HCP). 2. take the blood pressure every 4 hours.
2. call the rapid response team. 3. monitor urine output hourly.
3. assess the client for changes in the rhythm. 4. obtain serum potassium levels daily.
4. administer lidocaine as prescribed. The client is admitted to the telemetry unit due to chest
The nurse is assessing a client who has had a stent pain. The client has polysubstance abuse, and the nurse
inserted in a coronary artery via the right femoral artery. The assesses that the client is anxious and irritable and has moist
client is receiving intravenous heparin sodium at 1,000 units skin. What should the nurse do in order of priority from first
per hour. During the second postprocedure check, the nurse to last? All options must be used.
notes that the puncture site at the groin has begun to steadily 1. Obtain a history of which drugs the client has used
ooze blood. The nurse should first: recently. (4)
1. don gloves and apply direct pressure over the site. 2. Administer the prescribed dose of morphine. (3)
2. observe and document the bleeding. 3. Position electrodes on the chest. (1)
3. notify the healthcare provider (HCP). 4. Take vital signs. (2)
4. prepare protamine sulfate for intravenous administration. A client is scheduled for insertion of a coronary stent
A client admitted for a myocardial infarction (MI) with right groin access. Which teaching points should the
develops cardiogenic shock. An arterial line is inserted. Which nurse include in this client's preoperative teaching plan?
prescription from the healthcare provider should the nurse Select all that apply.
verify before implementing? 1. "If you have a hearing aid, you will need to remove it prior
1. Call for urine output < 30 mL/h for 2 consecutive hours. to leaving for the procedure."
2. Administer metoprolol 5 mg IV push. 2. "If you have chest pain during this procedure, please tell
3. Prepare for a pulmonary artery catheter insertion. the staff when or if this should occur."
4. Titrate dobutamine to keep systolic BP > 100 mm Hg. 3. "The stitches at your right groin will be able to be removed
The nurse is monitoring a client admitted with a in 7 to 10 days following the procedure."
myocardial infarction (MI) who is at risk for cardiogenic shock. 4. "You will be given general anesthesia and will be asleep for
The nurse should report which changes noted from the throughout this procedure."
client's chart to the healthcare provider (HCP)? 5. "You will need to remain flat during the procedure and for
Nurses Progress Notes 3 to 6 hours after the procedure."
BP: 110/70 6. "You will need to keep your right leg in a flexed position for
100/65 1 to 2 hours following the procedure."
T: 98.7 (37.1) The nurse is assessing a client who has had a myocardial
infarction. The nurse notes the cardiac rhythm shown on the 1. liquids as desired 2. small, easily digested meals
electrocardiogram strip. The nurse interprets this rhythm as: 3. three regular meals per day 4. nothing by mouth
1. atrial fibrillation. 2. ventricular tachycardia. The nurse is caring for a client who recently experienced
3. premature ventricular contractions. 4. sinus tachycardia. a myocardial infarction and has been started on clopidogrel.
While caring for a client who has sustained a myocardial The nurse should develop a teaching plan that includes which
infarction (MI), the nurse notes eight premature ventricular points? Select all that apply.
contractions (PVCs) in 1 minute on the cardiac monitor. The 1. The client should report unexpected bleeding or bleeding
client is receiving an IV infusion of 5% dextrose in water that lasts a long time.
(D5W) at 125 mL/h and oxygen at 2 L/min. The nurse should 2. The client should take clopidogrel with food.
first: 3. The client may bruise more easily and may experience
1. increase the IV infusion rate to 150 mL/h. bleeding gums.
2. notify the healthcare provider (HCP). 4. Clopidogrel works by preventing platelets from sticking
3. increase the oxygen concentration to 4 L/min. together and forming a clot.
4. administer a prescribed analgesic. 5. The client should drink a glass of water after taking
Which is an expected outcome for a client on the 2nd clopidogrel.
day of hospitalization after a myocardial infarction (MI)? The Which client is at greatest risk for coronary artery
client: disease?
1. continues to have severe chest pain. 1. a 32-year-old female with mitral valve prolapse who quit
2. can identify risk factors for MI. smoking 10 years ago
3. participates in a cardiac rehabilitation walking program. 2. a 43-year-old male with a family history of CAD and
4. can perform personal self-care activities without pain. cholesterol level of 158 (8.8 mmol/L)
Which is an expected outcome when a client is receiving 3. a 56-year-old male with an HDL of 60 (3.3 mmol/L) who
an IV administration of furosemide? takes atorvastatin
1. increased blood pressure 2. increased urine output 4. a 65-year-old female who is obese with an LDL of 188 (10.4
3. decreased pain mmol/L)
4. decreased premature ventricular contractions The client has been managing angina episodes with
The nurse is preparing to measure central venous nitroglycerin. Which finding indicates that the therapeutic
pressure (CVP). Where on the torso should the location for effect of the drug has been achieved?
leveling the transducer be? 1. decreased chest pain 2. increased blood pressure
Correct location: The zero point on the CVP transducer needs 3. decreased blood pressure 4. decreased heart rate
to be at the level of the right atrium. A client has risk factors for coronary artery disease,
A client has had a pulmonary artery catheter inserted. In including smoking cigarettes, eating a diet high in saturated
performing hemodynamic monitoring with the catheter, the fat, and leading a sedentary lifestyle. The nurse can coach this
nurse should wedge the catheter to gain information about: client to improve health by:
1. cardiac output. 2. right atrial blood flow. 1. explaining how the risk factors lead to poor health.
3. left end-diastolic pressure. 4. cardiac index. 2. withholding praise until the client changes the risky
After a myocardial infarction, the hospitalized client is behavior.
taught to move the legs while resting in bed. What is the 3. helping the client establish a wellness vision to reduce the
expected outcome of this exercise? health risks.
1. Prepare the client for ambulation. 4. instilling mild fear into the client about the potential
2. Promote urinary and intestinal elimination. outcomes of the risky health behaviors.
3. Prevent thrombophlebitis and blood clot formation. Alteplase recombinant, or tissue plasminogen activator
4. Decrease the likelihood of pressure ulcer formation. (t-PA), a thrombolytic enzyme, is administered during the first
Which is the most appropriate diet for a client during the 6 hours after onset of myocardial infarction (MI) to:
acute phase of myocardial infarction? 1. control chest pain.
2. reduce coronary artery vasospasm. 3. spaghetti with tomato sauce, salad, and coffee
3. control the arrhythmias associated with MI. 4. fried chicken, green beans, and skim milk
4. revascularize the blocked coronary artery. Which symptom should the nurse teach the client with
When monitoring a client who is receiving tissue unstable angina to report immediately to the healthcare
plasminogen activator (t-PA), the nurse should have provider (HCP)?
resuscitation equipment available because reperfusion of the 1. a change in the pattern of the chest pain
cardiac tissue can result in: 2. pain during sexual activity
1. cardiac arrhythmias. 2. hypertension. 3. pain during an argument
3. seizure. 4. hypothermia. 4. pain during or after a physical activity
Prior to administering tissue plasminogen activator (t- A client with unstable angina is scheduled to have a
PA), the nurse should assess the client for which contradiction cardiac catheterization. The nurse explains to the client that
to administering the drug? this procedure is being used to:
1. age > 60 years 2. history of cerebral hemorrhage 1. open and dilate blocked coronary arteries.
3. history of heart failure 4. cigarette smoking 2. assess the extent of arterial blockage.
A middle-aged client being admitted to the hospital has a 3. bypass obstructed vessels.
history of hypertension and informs the nurse that his father 4. assess the functional adequacy of the valves and heart
died from a heart attack at age 60. The client reports having muscle.
"indigestion." The nurse connects the client to a cardiac The nurse is caring for a client who has just returned
monitor, which reveals eight premature ventricular from having a percutaneous transluminal balloon angioplasty
contractions (PVCs) per minute. The nurse should next: with femoral artery access. In which order, from first to last,
1. call the healthcare provider (HCP). should the nurse obtain information about the client? All
2. start an IV line. options must be used.
3. obtain a portable chest radiograph. 1. vital signs and oxygen saturation (1)
4. draw blood for laboratory studies. 2. pedal pulses (2)
A 68-year-old client on day 2 after hip surgery has no 3. color and sensation of extremity (4)
cardiac history but reports having chest heaviness. The nurse 4. catheterization site (3)
should first: Which is not a risk factor for the development of
1. inquire about the onset, duration, severity, and atherosclerosis?
precipitating factors of the heaviness. 1. family history of early heart attack
2. administer oxygen via nasal cannula. 2. late onset of puberty
3. offer pain medication for the chest heaviness. 3. total blood cholesterol level > 220 mg/dL (12.2 mmol/L)
4. inform the healthcare provider (HCP) of the chest 4. elevated fasting blood glucose concentration
heaviness. As an initial step in treating a client with angina, the
Following diagnosis of angina pectoris, a client reports healthcare provider (HCP) prescribes nitroglycerin tablets, 0.3
being unable to walk up two flights of stairs without pain. mg, given sublingually. This drug's principal effects are
Which instruction would most likely help the client prevent produced by:
this problem? 1. antispasmodic effects on the pericardium.
1. Climb the steps early in the day. 2. causing an increased myocardial oxygen demand.
2. Rest for at least an hour before climbing the stairs. 3. vasodilation of peripheral vasculature.
3. Take a nitroglycerin tablet before climbing the stairs. 4. improved conductivity in the myocardium.
4. Lie down after climbing the stairs. A client has a throbbing headache when nitroglycerin is
The client who experiences angina has been told to taken for angina. The nurse should instruct the client that:
follow a low-cholesterol diet. Which meal would be best? 1. acetaminophen or ibuprofen can be taken for this common
1. hamburger, salad, and milk shake side effect.
2. baked liver, green beans, and coffee 2. nitroglycerin should be avoided if the client is experiencing
this serious side effect. Hematocrit: 37% (0.37)
3. taking the nitroglycerin with a few glasses of water will 1. Administer the medications.
reduce the problem. 2. Call the healthcare provider (HCP).
4. the client should lie in a supine position to alleviate the 3. Withhold the captopril.
headache. 4. Question the metoprolol dose.
How should the nurse instruct the client with unstable A client with chronic heart failure has atrial fibrillation
angina to use sublingual nitroglycerin tablets when chest pain and a left ventricular ejection fraction of 15%. The client is
occurs? "Sit down and then: taking warfarin. The expected outcome of this drug is to:
1. take one tablet every 2 to 5 minutes until the pain stops." 1. decrease circulatory overload.
2. take one tablet and rest for 15 minutes. Call the healthcare 2. improve the myocardial workload.
provider if pain persists after 15 minutes." 3. prevent thrombus formation.
3. take one tablet; then if the pain persists, take additional 4. regulate cardiac rhythm.
two tablets in 5 minutes. Call the healthcare provider if pain A client has a history of heart failure and has been
persists after 15 minutes." prescribed furosemide, digoxin, and potassium chloride. The
4. take one tablet. If pain persists after 5 minutes, call 911." client has nausea, blurred vision, headache, and weakness.
A client with angina is taking nifedipine. What instruction The nurse notes that the client is confused. The telemetry
should the nurse give the client? strip shows first-degree atrioventricular block. The nurse
1. Monitor blood pressure monthly. should assess the client for signs of:
2. Perform daily weights. 1. hyperkalemia. 2. digoxin toxicity.
3. Inspect gums daily. 3. fluid deficit. 4. pulmonary edema.
4. Limit intake of green leafy vegetables. The nurse should assess the client with left-sided heart
The nurse is developing a teaching plan for a client who failure for which findings? Select all that apply.
will be starting a prescription for simvastatin 40 mg/day. 1. dyspnea 2. jugular vein distention (JVD)
What instructions should the nurse give the client? Select all 3. crackles 4. right upper quadrant pain
that apply. 5. oliguria 6. decreased oxygen saturation levels
1. "Take once a day in the morning." Which are indications that a client with a history of left-
2. "If you miss a dose, take it when you remember it." sided heart failure is developing pulmonary edema? Select all
3. "Limit greens such as lettuce in the diet to prevent that apply.
bleeding." 1. distended jugular veins 2. dependent edema
4. "Be sure to take the pill with food." 3. anorexia 4. coarse crackles 5. tachycardia
5. "Report muscle pain or tenderness to your healthcare An older adult with a history of heart failure is admitted
provider." to the emergency department with pulmonary edema. On
6. "Continue to follow a diet that is low in saturated fats." admission, what should the nurse assess first?
Captopril, furosemide, and metoprolol are prescribed for 1. blood pressure 2. skin breakdown
a client with systolic heart failure. The client's blood pressure 3. serum potassium level 4. urine output
is 136/82 mm Hg, and the heart rate is 65 bpm. Prior to The nurse is caring for an older adult with mild dementia
medication administration at 0900, the nurse reviews the admitted with heart failure. What nursing care will be helpful
following lab tests (see chart). What should the nurse do for this client in reducing potential confusion related to
first? hospitalization and change in routine? Select all that apply.
Laboratory Results 1. Reorient frequently to time, place, and situation.
Sodium: 140 mEq/L (140 mmol/L) 2. Put the client in a quiet room furthest from the nursing
Potassium: 6.8 mEq/L (6.8 mmol/L) station.
BUN: 18 mg/dL (6.4 mmol/L) 3. Perform necessary procedures quickly.
Creatinine: 1.0 mg/dL (76.3 μmol/L) 4. Arrange for familiar pictures or special items at bedside.
Hemoglobin: 12 g/dL (120 g/L) 5. Limit the client's visitors.
6. Spend time with the client, establishing a trusting prevent:
relationship. 1. electrolyte imbalances.
The nurse is assessing a client with chronic heart failure 2. nausea or vomiting.
who is demonstrating neurohormonal compensatory 3. excretion of excessive fluids accumulated during the night.
mechanisms. Which are expected findings on assessment? 4. sleep disturbances during the night.
Select all that apply. The nurse should teach the client that signs of digoxin
1. decreased cardiac output toxicity include:
2. increased heart rate 1. rash over the chest and back.
3. vasoconstriction in skin, GI tract, and kidneys 2. increased appetite.
4. decreased pulmonary perfusion 3. visual disturbances such as seeing yellow spots.
5. fluid overload 4. elevated blood pressure.
Furosemide 40 mg intravenous push (IVP) is prescribed. The nurse should assess the client for digoxin toxicity if
Furosemide 10 mg/mL is available. How much should the serum levels indicate that the client has a:
nurse administer? Round your answer to a whole number. 1. low sodium level. 2. high glucose level.
4 mL. Desired amount (D) divided by what is available (H) 3. high calcium level. 4. low potassium level.
times quantity (Q) = amount to administer. D = 40 mg divided Which food should the nurse teach a client with heart
by H = 10 mg/mL equals 40 divided by 10 = 4 mL. failure to limit when following a 2-g sodium diet?
Which position is best for a client with heart failure who 1. apples 2. canned tomato juice
has orthopnea? 3. whole wheat bread 4. beef tenderloin
1. semisitting (low Fowler's position) with legs elevated on A client receiving a loop diuretic should be encouraged
pillows to eat which foods? Select all that apply.
2. lying on the right side (Sims' position) with a pillow 1. angel food cake 2. Banana 3. dried fruit
between the legs 4. orange juice 5. peppers
3. sitting upright (high Fowler's position) with legs resting on When assessing an older adult, the nurse finds the apical
the mattress impulse below the fifth intercostal space. The nurse should
4. lying on the back with the head lowered (Trendelenburg's further assess the client for:
position) and legs elevated 1. left atrial enlargement. 2. left ventricular enlargement.
What is the major goal of nursing care for a client with 3. right atrial enlargement. 4. right ventricular enlargement.
heart failure and pulmonary edema? The nurse is admitting an older adult to the hospital. The
1. Increase cardiac output. 2. Improve respiratory status. echocardiogram report revealed left ventricular enlargement.
3. Decrease peripheral edema. 4. Enhance comfort. The nurse notes 2+ pitting edema in the ankles when getting
A client with heart failure is receiving digoxin the client into bed. Based on this finding, what should the
intravenously. The nurse should determine the effectiveness nurse do first?
of the drug by assessing: 1. Assess respiratory status.
1. dilated coronary arteries. 2. Draw blood for laboratory studies.
2. increased myocardial contractility. 3. Insert a Foley catheter.
3. decreased cardiac arrhythmias. 4. Weigh the client.
4. decreased electrical conductivity in the heart. The nurse's discharge teaching plan for the client with
Furosemide is administered intravenously to a client with heart failure should emphasize the importance of:
heart failure. How soon after administration should the nurse 1. maintaining a high-fiber diet.
begin to see evidence of the drug's desired effect? 2. walking 2 miles (3.2 km) every day.
1. 5 to 10 minutes 2. 30 to 60 minutes 3. obtaining daily weights at the same time each day.
3. 2 to 4 hours 4. 6 to 8 hours 4. remaining sedentary for most of the day.
The nurse teaches a client with heart failure to take oral The nurse is teaching a client with heart failure how to
furosemide in the morning. The primary reason for this is to avoid complications and future hospitalizations. The nurse is
confident that the client has understood the teaching when catheterization?
the client identifies which potential complications? Select all 1. Monitor the laboratory values.
that apply. 2. Observe neurologic function every 15 minutes.
1. becoming increasingly short of breath at rest 3. Observe the puncture site for swelling and bleeding.
2. weight gain of 2 lb (0.9 kg) or more in 1 day 4. Monitor skin warmth and turgor.
3. high intake of sodium for breakfast A client experiences initial indications of dizziness after
4. having to sleep sitting up in a reclining chair having an IV infusion of lidocaine hydrochloride started. The
5. weight loss of 2 lb (0.9 kg) in 1 day nurse should further assess the client when the client reports
A client has returned from the cardiac catheterization having:
laboratory after a balloon valvuloplasty for mitral stenosis. 1. palpitations. 2. tinnitus.
Which finding requires immediate nursing action? 3. urinary frequency. 4. lethargy.
1. There is a low, grade 1 intensity mitral regurgitation A pulmonary artery catheter is inserted in a client with
murmur. severe mitral stenosis and regurgitation. The nurse
2. SpO2 is 94% on 2 L of oxygen via nasal cannula. administers furosemide to treat pulmonary congestion and
3. Client has become more somnolent. begins a nitroprusside drip as prescribed. The nurse notices a
4. Urine output decreased from 60 mL/h to 40 mL over the sudden drop in the pulmonary artery diastolic pressure and
last hour. pulmonary artery wedge pressure. The nurse should first
An older client with diabetes who has been maintained assess:
on metformin has been scheduled for a cardiac 1. 12-lead EKG. 2. blood pressure.
catheterization. The nurse should verify that the healthcare 3. lung sounds. 4. urine output.
provider (HCP) has written a prescription to: A client has mitral stenosis and will have a valve
1. limit the amount of protein in the diet prior to the cardiac replacement. The nurse is instructing the client about health
catheterization. maintenance prior to surgery. Inability to follow which
2. withhold the metformin prior to the cardiac prescription would pose the greatest health hazard to this
catheterization. client at this time?
3. administer the metformin with only a sip of water prior to 1. medication therapy 2. diet modification
the cardiac catheterization. 3. activity restrictions 4. dental care
4. give the metformin before breakfast. In preparing the client and the family for a postoperative
A client with aortic stenosis has increasing dyspnea and stay in the intensive care unit (ICU) after open-heart surgery,
dizziness. Identify the area where the nurse would place the the nurse should explain that:
stethoscope to assess a murmur from aortic stenosis. 1. the client will remain in the ICU for 5 days.
To assess a murmur from aortic stenosis, the stethoscope is 2. the client will sleep most of the time while in the ICU.
placed at the second intercostal space right of sternum; (1) 3. noise and activity within the ICU are minimal.
location, (2) the pulmonic valve area, (3) Erb's point, (4) 4. the client will receive medication to relieve pain.
tricuspid valve area, and (5) mitral valve area. A client who has undergone a mitral valve replacement
A client is scheduled for a cardiac catheterization. The has had a mediastinal chest tube inserted. The client has
nurse should do which preprocedure tasks? Select all that persistent bleeding from the sternal incision during the early
apply. postoperative period. What actions should the nurse take?
1. Administer all prescribed oral medications. Select all that apply.
2. Check for iodine sensitivity. 1. Administer warfarin.
3. Verify that written consent has been obtained. 2. Check the postoperative CBC, INR, PTT, and platelet levels.
4. Withhold food and oral fluids before the procedure. 3. Confirm availability of blood products.
5. Insert a urinary drainage catheter. 4. Monitor the mediastinal chest tube drainage.
Which is the most important initial postprocedure 5. Start a dopamine drip for a systolic BP < 100 mm Hg.
nursing assessment for a client who has had a cardiac
 The most effective measure the nurse can use to prevent the chest incision. The nurse's response should reflect the
wound infection when changing a client's dressing after understanding that the client may be experiencing:
coronary artery bypass surgery is to: 1. anxiety related to altered body image.
1. observe careful handwashing procedures. 2. depression related to altered health status.
2. clean the incisional area with an antiseptic. 3. altered tissue perfusion.
3. use prepackaged sterile dressings to cover the incision. 4. lack of knowledge regarding the postoperative course.
4. place soiled dressings in a waterproof bag before disposing Metoprolol is added to the pharmacologic therapy of a
of them. diabetic female diagnosed with stage 2 hypertension who has
Which measure should the nurse institute to help been initially treated with furosemide and ramipril. An
prevent complications associated with excessive calcium expected therapeutic effect is:
excretion following cardiac surgery to replace an aortic valve? 1. decrease in heart rate.
1. Ensure a liberal fluid intake. 2. lessening of fatigue.
2. Provide an alkaline-ash diet. 3. improvement in blood sugar levels.
3. Prevent constipation. 4. increase in urine output.
4. Enrich the client's diet with dairy products. Which set of postural vital signs (BP in mm Hg and heart
The nurse should teach the client who is receiving rate in beats per minute) indicate inadequate blood volume?
warfarin sodium that: 1. Supine 124/76, 88 Sitting 124/74, 92 Standing 122/74, 92
1. partial thromboplastin time values determine the dosage 2. Supine 120/70, 70 Sitting 102/64, 86 Standing 100/60, 92
of warfarin sodium. 3. Supine 138/86, 74 Sitting 136/84, 80 Standing 134/82, 82
2. protamine sulfate is used to reverse the effects of warfarin 4. Supine 100/70, 72 Sitting 100/68, 74 Standing 98/68, 80
sodium. A client is taking clonidine for treatment of hypertension.
3. international normalized ratio (INR) is used to assess The nurse should teach the client about which common
effectiveness. adverse effects of this drug? Select all that apply.
4. warfarin sodium will facilitate clotting of the blood. 1. dry mouth 2. hyperkalemia
Good dental care is an important measure in reducing 3. impotence 4. Pancreatitis5. sleep disturbance
the risk of endocarditis. What should a teaching plan to A client with hypertensive emergency is being treated
promote good dental care in a client with mitral stenosis with sodium nitroprusside. In a dilution of 50 mg/250 mL,
instruct the client to do? Select all that apply. how many micrograms of sodium nitroprusside are in each
1. Brush the teeth at least twice a day. milliliter? Round your answer to a whole number.
2. Avoid use of an electric toothbrush. 200 mcg
3. Take an antibiotic prior to oral surgery. The nurse is discussing medications with a client with
4. Floss the teeth at least once a day. hypertension who has a prescription for furosemide daily. The
5. Have regular dental checkups. client needs further education when the client states:
6. Rinse the mouth with an antibiotic mouthwash once a day. 1. "I know I should not drive after taking my furosemide."
Before a client's discharge after mitral valve replacement 2. "I should be careful not to stand up too quickly when
surgery, the nurse should evaluate the client's understanding taking furosemide."
of postsurgery activity restrictions. The client should avoid 3. "I should take the furosemide in the morning instead of
which activity until after the 1-month postdischarge before bed."
appointment with the surgeon? 4. "I need to be sure to also take the potassium supplement
1. showering that the doctor prescribed along with my furosemide."
2. lifting anything heavier than 10 lb (4.5 kg) In teaching the client with hypertension to avoid
3. a program of gradually progressive walking orthostatic hypotension, the nurse should teach the client to
4. light housework follow which instructions? Select all that apply.
Three days after mitral valve replacement surgery, the 1. Plan regular times for taking medications.
client tells the nurse there is a "clicking" noise coming from 2. Arise slowly from bed.
3. Avoid standing still for long periods. 4. Tailor a program to the client's needs and abilities.
4. Avoid excessive alcohol intake. Which would be most helpful when coaching a client to
5. Avoid hot baths. stop smoking?
The nurse is teaching a client with hypertension about 1. Review the negative effects of smoking on the body.
taking atenolol. The nurse should instruct the client to: 2. Discuss the effects of passive smoking on environmental
1. avoid sudden discontinuation of the drug. pollution.
2. monitor the blood pressure annually. 3. Establish the client's daily smoking pattern.
3. follow a 2-g sodium diet. 4. Explain how smoking worsens high blood pressure.
4. discontinue the medication if severe headaches develop. When teaching a client about propranolol hydrochloride,
The nurse teaches a client who has recently been the nurse should base the information on the knowledge that
diagnosed with hypertension about following a low-calorie, propranolol:
low-fat, low-sodium diet. Which of the following menu 1. blocks beta-adrenergic stimulation and thus causes
selections would best meet the client's needs? decreased heart rate, myocardial contractility, and
1. mixed green salad with blue cheese dressing, crackers, and conduction.
cold cuts 2. increases norepinephrine secretion and thus decreases
2. ham sandwich on rye bread and an orange blood pressure and heart rate.
3. baked chicken, an apple, and a slice of white bread 3. is a potent arterial and venous vasodilator that reduces
4. hot dogs, baked beans, and celery and carrot sticks peripheral vascular resistance and lowers blood pressure.
A client who has diabetes is taking metoprolol for 4. is an angiotensin-converting enzyme inhibitor that reduces
hypertension. What should the nurse instruct the client to blood pressure by blocking the conversion of angiotensin I to
do? Select all that apply. angiotensin II.
1. Take the tablets with food at same time each day. What is the most important long-term goal for an obese
2. Do not crush or chew the tablets. client with hypertension who smokes?
3. Notify the healthcare provider (HCP) if pulse is 82 1. Take medications as prescribed.
beats/min. 2. Stop smoking.
4. Have a blood glucose level drawn every 6 to 12 months 3. Make a commitment to long-term lifestyle changes.
during therapy. 4. Lose weight.
5. Use an appropriate decongestant if needed. Cardiac telemetry shows that a client who is up to the
6. Report any fainting spells to the HCP. bathroom has converted from normal sinus rhythm with a
A client diagnosed with primary (essential) hypertension rate of 72 beats/min to atrial fibrillation with a ventricular
is taking chlorothiazide. The nurse determines teaching about response rate of 100 beats/min. In what order from first to
this medication is effective when the client makes which last should the nurse perform these interventions? All options
statement? "I will: (Select all that apply.) must be used.
1. take my weight daily at the same time each day." 1. Assess vital signs. (2)
2. not drink alcoholic beverages while on this medication." 2. Assist the client to the bed. (1)
3. reduce salt intake in my diet." 3. Initiate intravenous access. (3)
4. reduce my dosage if I have severe dizziness." 4. Obtain a stat 12-lead electrocardiogram. (4)
5. use sunscreen if I have prolonged exposure to sunlight." A client admitted with normal sinus rhythm converts to
6. take the drug late in the evening." the following rhythm on the cardiac monitor. For which
Which would most likely assist the client with symptoms should the nurse assess the client? Select all that
hypertension in maintaining an exercise program? apply.
1. Give the client a written exercise program. 1. carotid bruit 2. light-headedness
2. Explain the exercise program to the client's spouse. 3. nausea 4. palpitations
3. Reassure the client that he or she can do the exercise 5. shortness of breath 6. systolic murmur
program.
 A client is admitted to the hospital for evaluation of 3. Place client on a cardiac monitor (ECG). (2)
recurrent episodes of ventricular tachycardia as observed on 4. Obtain vital signs including BP, P, R, T, and O2 saturation. (3)
Holter monitoring. The client is scheduled for A client is scheduled for the insertion of an implantable
electrophysiology studies (EPS) the following morning. Which cardioverter-defibrillator (ICD). The spouse expresses anxiety
statement should the nurse include in a teaching plan for this about what would happen if the device discharges during
client? physical contact. What should the nurse tell the spouse?
1. "You will continue to take your medications until the 1. Physical contact should be avoided whenever possible.
morning of the test." 2. They will not feel the countershock.
2. "You might be sedated during the procedure and will not 3. The shock would feel like a "tingle," but it would not cause
remember what has happened." any harm.
3. "This test is a noninvasive method of determining the 4. A warning device sounds before countershock, so there is
effectiveness of your medication regimen." time to move away.
4. "During the procedure, the healthcare provider will insert a An older adult is admitted to the telemetry unit for
special wire to increase the heart rate and produce the placement of a permanent pacemaker because of sinus
irregular beats that caused your signs and symptoms." bradycardia. What is a priority goal for the client within 24
During physical assessment, the nurse should further hours after insertion of a permanent pacemaker?
assess the client for signs of atrial fibrillation when palpation 1. Maintain skin integrity.
of the radial pulse reveals: 2. Maintain cardiac conduction stability.
1. two regular beats followed by one irregular beat. 3. Decrease cardiac output.
2. an irregular rhythm with pulse rate > 100. 4. Increase activity level.
3. pulse rate below 60 bpm. The client who had a permanent pacemaker implanted 2
4. a weak, thready pulse. days earlier is being discharged from the hospital. The nurse
When teaching a client about self-care following knows that the client understands the discharge plan when
placement of a new permanent pacemaker to the left upper the client:
chest, the nurse should include which information? Select all 1. selects a low-cholesterol diet to control coronary artery
that apply. disease.
1. Take and record daily pulse rate. 2. states a need for bed rest for 1 week after discharge.
2. Avoid air travel because of airport security alarms. 3. verbalizes safety precautions needed to prevent pacemaker
3. Immobilize the affected arm for 4 to 6 weeks. malfunction.
4. Avoid using a microwave oven. 4. explains signs and symptoms of myocardial infarction (MI).
5. Avoid lifting anything heavier than 3 lb (1.36 kg). An 85-year-old client is admitted to the emergency
A client has been admitted to the coronary care unit. The department (ED) at 2000 hours with syncope, shortness of
nurse observes third-degree heart block at a rate of 35 bpm breath, and reported palpitations (see nurse's notes below).
on the client's cardiac monitor. The client has a blood At 2015, the nurse places the client on the ECG monitor and
pressure of 90/60 mm Hg. The nurse should first: identifies the following rhythm (see below). What should the
1. prepare for transcutaneous pacing. nurse do? Select all that apply.
2. prepare to defibrillate the client at 200 J. Nurse's Progress Notes
3. administer an IV lidocaine infusion. Pulse: 150
4. schedule the operating room for insertion of a permanent BP: 90/62
pacemaker. Oxygen saturation: 92% on room air
A client has atrial fibrillation and a heart rate of 165 bpm. RR: 22
In which order from first to last should the nurse implement Progress notes: Client has shortness of breath and states, "My
these prescriptions? All options must be used. heart is jumping out of my chest and hurts some. I am having
1. Administer oxygen via nasal cannula. (1) trouble catching my breath. I don't want to faint again."
2. Gather supplies for an IV insertion. (4)
1. Apply oxygen. using SBAR format.
2. Prepare to defibrillate the client. The nurse is assessing a client with heart failure whose
3. Monitor vital signs. blood pressure and weight are being monitored remotely.
4. Have the client sign consent for cardioversion as The nurse reviews data obtained within the last 3 days.
prescribed. Weight
5. Teach the client about warfarin treatment and the need for 160 (72 kg)
frequent blood testing. 162 (73 kg)
6. Draw blood for a CBC count and thyroid function study. 165 (74 kg)
A nurse working the day shift on a cardiac unit receives Blood Pressure
the following shift report: 120/80
At the conclusion of shift report, it is 0730. Put the clients in 130/88
the order from first to last in which the nurse should plan to 140/90
assess them. All options must be used. The nurse calls the client to follow up. The nurse should first
1. Client 1: Admitted yesterday morning with hypokalemia. ask the client:
Awaiting repeat electrolyte lab results drawn at 06:00. (4) 1. "How are you feeling today?"
2. Client 2: Experienced chest pain at 06:30. Pain resolved 2. "Are you having shortness of breath?"
after 2 sublingual nitroglycerin tablets. (1) 3. "Did you calibrate the scales before using them?"
3. Client 3: Scheduled for oral antihypertensive medications 4. "How much fluid did you drink during the last 24 hours?"
at 0900. Incontinent of urine during the night. (3) The nurse is tracking data on a group of clients with
4. Client 4: Scheduled for coronary artery bypass surgery at heart failure who have been discharged from the hospital and
0800. The client's family is in the client's room. (2) are being followed at a clinic. Which data are the best
Which activity would be appropriate to delegate to indicators that nursing interventions of monitoring and
unlicensed assistive personnel (UAP) for a client diagnosed teaching have been effective?
with a myocardial infarction who is stable? 1. Ninety percent of clients have not gained weight.
1. Evaluate the lung sounds. 2. Seventy-five percent of the clients viewed the educational
2. Help the client identify risk factors for CAD. DVD.
3. Provide teaching on a 2-g sodium diet. 3. Eighty percent of the clients reported that they are taking
4. Record the intake and output. their medications.
The unlicensed assistive personnel (UAP) reports to the 4. Five percent of the clients required hospitalization in the
nurse that a client is "feeling short of breath." The client's last 90 days.
blood pressure was 124/78 mm Hg 2 hours ago with a heart The nurse in the intensive care unit is giving a report to
rate of 82 bpm; the unlicensed assistive personnel reports the nurse in a cardiac step-down unit about a client who had
that blood pressure is now 84/44 mm Hg with a heart rate of coronary artery bypass surgery. Which is the most effective
54 bpm, and the client stated, "I just do not feel good." What way to assure essential information about the client is
actions should the nurse take? Select all that apply. reported?
1. Confirm the client's vital signs, and complete a quick 1. Give the report face-to-face with both nurses in a quiet
assessment. room.
2. Inform the charge nurse of the change in condition, and 2. Audiotape the report for future reference and
initiate the hospital's rapid/emergency response team. documentation.
3. Make a quick check on other assigned clients before 3. Use a printed checklist with information individualized for
spending the amount of time required to take care of this the client.
client. 4. Document essential transfer information in the client's
4. Position the client in semi-Fowler's position. medical record.
5. Stay with the client, and reassure the client. The nurse is planning care for a group of elderly clients
6. Call the healthcare provider (HCP), and report the situation who are affected by orthostatic hypotension. What should
the nurse do? Select all that apply. many blood cells.
1. Assist the clients to stand to help prevent falls. [ ] 2. Sustained hypertension leads to the formation of
2. Teach clients how to gradually change their position. venous blood clots.
3. Request a prescription for antihypertensive medications for [ ] 3. Sustained hypertension compromises blood fl ow to
clients at high risk. many vital organs.
4. Conduct "fall risk" assessments. [ ] 4. Sustained hypertension predisposes to narrowing
5. Consider the use of sequential compression devices (SCDs) of the cardiac valves.
for high-risk clients. 5. When obtaining a health history from this client,
6. Place clients on bed rest. which finding strongly suggests that the client is
The nurse is caring for a group of clients on a medical- hypertensive?
surgical nursing unit. Which task(s) could the nurse delegate Select all that apply.
to unlicensed assistive personnel (UAP)? Select all that apply. 1. Unexplained nosebleeds 2. Difficulty sleeping at night
1. Assess pedal pulses on a client who just returned from a 3. Waking to urinate at night4. Occasional heart palpitations
cardiac angiogram. 5. Dizziness 6. Pale skin color
2. Administer oxygen via nasal cannula to a client with a 6. When the nurse at the physician's office reviews the
saturation of 89%. client's medical record, which finding is the best indication
3. Administer acetaminophen to a client with a pain level of that the client's heart has been affected by sustained high
"5" out of "10." blood pressure?
4. Perform vital signs and oxygen saturation on a client [ ] 1. The client has a strong S1
returning from the catheterization lab. heart sound.
5. Obtain intake and outputs on a client experiencing heart [ ] 2. The client's heart rate is 100 beats/minute when active.
failure. [ ] 3. The client's heart is moderately enlarged.
1. Which modification used by the nurse is most [ ] 4. The client has an irregular heart rhythm.
appropriate when taking the blood pressure of a client who 7. The best evidence that the client understands the
weighs 250 pounds? nurse's instructions regarding dietary restrictions is if the
1. The nurse takes the blood pressure on the client's client states to avoid which food?
thigh. [ ] 1. Soy sauce [ ] 2. Lemon juice
2. The nurse has the client lie down during the [ ] 3. Maple syrup [ ] 4. Onion powder
assessment. 8. If the client with hypertension is willing to implement
3. The nurse pumps the manometer up to 250 mm Hg. lifestyle changes to reduce blood pressure, which changes,
4. The nurse uses an extra-large blood pressure cuff encouraged by the nurse, would be most benefi cial? Select
2. The nurse obtains adult blood pressure readings on all that apply.
four separate clients. Which client should have a follow-up [ ] 1. Eating a diet higher in fi ber
blood pressure check within 2 months? [ ] 2. Balancing rest with exercise
[ ] 1. The client whose blood pressure is 138/88 mm Hg [ ] 3. Taking time for more leisure activities
[ ] 2. The client whose blood pressure is 132/98 mm Hg [ ] 4. Giving up smoking cigarettes
[ ] 3. The client whose blood pressure is 120/80 mm Hg [ ] 5. Pursuing measures for losing weight
[ ] 4. The client whose blood pressure is 118/78 mm Hg [ ] 6. Assessing blood pressure in the morning and
3. According to the nurse, when is the correct time to evening
note the diastolic blood pressure reading? 9. Which observation by the nurse is the best indication
[ ] 1. When the loud knocking sounds become muffl ed that the furosemide (Lasix) has had a desired effect?
[ ] 2. When the last loud knocking sound is heard [ ] 1. The client's pulse becomes slower.
[ ] 3. When the swishing sound becomes loud [ ] 2. The client's blood pressure stabilizes.
[ ] 4. When the swishing sound becomes faint [ ] 3. The client's urine output increases.
4. Which response by the nurse is most accurate? [ ] 4. The client's anxiety is diminished.
[ ] 1. Sustained hypertension decreases the life span of 10. When preparing discharge instructions for this client,
the nurse's instructions should include taking oral furosemide [ ] 2. History of mitral valve repair
(Lasix) at what time of day? [ ] 3. Rheumatic fever during childhood
[ ] 1. Before bedtime [ ] 2. When arising in the morning [ ] 4. Weighing 25 pounds (11.3 kg) above norm
[ ] 3. With the main meal [ ] 4. In the late afternoon 17. When the client asks the nurse how cholesterol acts
11. When teaching the client about the side effects of as a cardiac risk factor, what is the best explanation?
furosemide (Lasix), the nurse's instructions should include [ ] 1. Excess fat in the blood expands the circulating
the need to eat foods high in which mineral? blood volume.
[ ] 1. Potassium [ ] 2. Sodium [ ] 2. Excess fat in the blood thickens the lining of the
[ ] 3. Calcium [ ] 4. Iron arteries.
12. The nurse instructs the client to monitor urine output [ ] 3. Excess fat in the blood causes slower blood clotting.
while taking furosemide (Lasix) at home because use of the [ ] 4. Excess fat in the blood stimulates the heart to beat
medication may lead to which condition? faster.
[ ] 1. Dehydration [ ] 2. Fluid overload 18. When providing dietary instructions for this client,
[ ] 3. Hypernatremia [ ] 4. Hyperkalemia which healthful alternative should the nurse recommend?
13. Which of the following client statements will the 1. Wheat toast for white bread 2. Margarine for butter
nurse recognize as a potential side effect of the medication? 3. Cereal for eggs 4. Ham for sausage
[ ] 1. "I have noticed that I am urinating more than 19. After providing medication instructions, the best
normal." evidence that the client knows this drug's potential side
[ ] 2. "I have a dry, hacky cough throughout the day." effects is when the client states it may cause which adverse
[ ] 3. "I feel weak and lethargic in the afternoon." effect?
[ ] 4. "I feel that I am having heart palpitations." [ ] 1. Muscle pain [ ] 2. Palpitations
14. When caring for the client who is prescribed the [ ] 3. Visual changes [ ] 4. Weight loss
combination of a loop diuretic and beta blocker to control 20. When the client asks why the physician ordered the
hypertension, which nursing considerations are essential? ECG, how does the nurse correctly explain its purpose?
Select all that apply. 1. It will show how the heart performs during exercise.
[ ] 1. Assist the client to a standing position. 2. It will determine the client's potential target heart rate.
[ ] 2. Maintain an intake and output record. 3. It will verify how much the client needs to improve fitness.
[ ] 3. Maintain bed rest until blood pressure is normal. 4. It will help predict whether the client will have a heart
[ ] 4. Encourage keeping up with work as a diversional attack soon.
activity. 21. If the client is typical of others who have angina
[ ] 5. Monitor blood sugar readings. pectoris, the nurse would expect the client to report that
[ ] 6. Discuss sexual implications. chest pain is best relieved by which nonpharmacological
15. If the client reports taking the following drugs, which measure?
are more than likely to have contributed to this client's signs [ ] 1. Taking a deep breath [ ] 2. Resting in a chair
and symptoms? Select all that apply. [ ] 3. Applying heat to the chest [ ] 4. Rubbing the chest
[ ] 1. Lisinopril (Zestril) 22. The nurse informs the client that the correct way to
[ ] 2. Valsartan (Diovan) administer nitroglycerin is to place one tablet where?
[ ] 3. Metoprolol ( Lopressor) 1. Between the gum and cheek 2. At the back of the throat
[ ] 4. Warfarin (Coumadin) 3. Under the tongue 4. Between the teeth
[ ] 5. Hydrochlorothiazide (HydroDIURIL) 23. Which side effects are most closely associated with
[ ] 6. Aspirin (Bufferin) the use of nitroglycerin tablets? Select all that apply.
1. Headache 2. Backache 3. Diarrhea
4. Jaundice 5. Dizziness 6. Pallor
16. Which of the following client risk factors is most 24. The nurse knows that the client understands how to
significant for developing CAD? determine when the nitroglycerin tablets need replacing
[ ] 1. Drinking a nightly cocktail when the client makes which statement?
[ ] 1. "The tablets will smell like vinegar." chest."
[ ] 2. "The tablets will be discolored." [ ] 2. "I will feel a heavy sensation all over my body."
[ ] 3. "They won't tingle in my mouth." [ ] 3. "I will be anesthetized and will not feel any discomfort."
[ ] 4. "They will disintegrate when I touch them." [ ] 4. "I will feel a warm sensation as the dye is instilled."
25. If the chest pain is not relieved after taking one 32. Before the cardiac catheterization and coronary
nitroglycerin tablet, the nurse should teach the client to take arteriogram, it is essential for the nurse to ask the client
what action? about any allergy to iodine or which other substance?
[ ] 1. Take another tablet in 5 minutes. 1. Penicillin 2. Morphine
[ ] 2. Drive to the emergency department. 3. Shellfish 4. Eggs
[ ] 3. Call the physician immediately. 33. After the coronary arteriogram, the nurse must keep
[ ] 4. Swallow two additional tablets. the client flat in bed with the affected leg in which position?
26. Which nursing action is most appropriate when 1. Extended 2. Flexed
applying a new transdermal patch? 3. Abducted 4. Adducted
1. Rotate the application site. 34. After the femoral artery has been cannulated and the
2. Clean the skin with alcohol. client is returned to the room, what should the nurse plan
3. Tape the patch to the client's chest. to do first?
4. Take the blood pressure afterward. [ ] 1. Palpate the client's distal peripheral pulses.
27. Which assessment finding should signal the nurse [ ] 2. Auscultate the client's heart and breath sounds.
to withhold applying the client's nitroglycerin patch and [ ] 3. Percuss all four quadrants of the client's abdomen.
notify the physician? [ ] 4. Inspect the skin integrity in the client's groin.
[ ] 1. Temperature of 99.8°F (37.6°C) 35. The nurse provides discharge instructions for a client
[ ] 2. Respiratory rate of 24 breaths/minute at rest who has recovered after a cardiac catheterization. Which
[ ] 3. Apical heart rate of 90 beats/minute instructions should be included? Select all that apply.
[ ] 4. Blood pressure of 94/62 mm Hg 1. Take a shower rather than a tub bath until the puncture
28. The best evidence that the client is complying with site heals.
the diet therapy is the report of using which type of fat for 2. Perform leg exercises every 2 hours while awake.
cooking? 3. Drink a generous amount of fluids for the next 24 hours.
1. Melted margarine 2. Clarified butter 4. Report worsening of pain in the leg that was catheterized.
3. Cooking spray 4. Liquid corn oil 5. Flush the toilet twice after eliminating urine and stool in
29. If the literature supplied by the fast-food chain the next 24 hours.
indicates that one hot apple pie contains 2 g of protein, 14 g 6. Change the dressing over the puncture site daily until it
of fat, and 31 g of carbohydrates, how many calories are heals
contained in one hot apple pie? 258 calories 36. The nurse knows that the client understands the
30. Which nursing action can best help reduce the physician's explanation of the PTCA procedure when the
client's anxiety in this situation? client makes which statement?
1. Teach the client how coronary artery disease (CAD) is 1. "A balloon-tipped catheter will be inserted into my
usually treated. coronary artery."
[ ] 2. Listen to the client's feelings about this condition. 2. "A Tefl on graft will be used to replace an area of weakened
[ ] 3. Explain that the procedure has been very helpful heart muscle."
for other clients. [ ] 3. "A section of my leg vein will be grafted around a
[ ] 4. Avoid discussing the heart catheterization until the narrowed coronary artery."
client has relaxed. [ ] 4. "A battery-operated pacemaker will be implanted
31. Which statement by the client indicates an to maintain my heart rate."
understanding of what will happen during the testing 37. When the client asks the nurse how propranolol
procedure? helps to prevent angina, what is the best explanation?
[ ] 1. "I will be able to hear my heart beating in my 1. Propranolol promotes excretion of body fluid.
2. Propranolol reduces the rate of heart contraction. the PCA pump, which instruction is most important to
3. Propranolol alters pain receptors in the heart. include?
4. Propranolol dilates the major coronary arteries. 1. "Press the control button whenever you feel you
38. While the client takes propranolol (Inderal), what need pain medication."
changes would the nurse expect to see in the client's pulse 2. "Call the nurse each time you need to use the PCA
rate? pump."
1. Faster than usual 2. Stronger than before 3. "Use the PCA pump only when the pain is severe."
3. Temporarily irregular 4. Slower than in the past 4. "Do not use the PCA pump too frequently, because it can
39. What is the best explanation for the drug therapy in cause addiction."
this situation? 45. What information about the client's use of a patient
[ ] 1. Aspirin tends to relieve chest pain. controlled analgesia (PCA) pump is most important to
[ ] 2. Aspirin tends to prevent blood clots. communicate to the staff on the next shift?
[ ] 3. Aspirin tends to lower the blood pressure. 1. Name of the client's physician
[ ] 4. Aspirin tends to dilate the coronary arteries. 2. Purpose for using the pump
40. When the client returns to the room after the 3. Number of doses administered
percutaneous transluminal coronary angioplasty (PTCA) 4. The client's need for further teaching
procedure, which assessment finding should be reported 46. After the coronary artery bypass graft (CABG)
immediately to the physician? surgery, which assessment finding provides the best evidence
1. Urine output of 100 mL/hour that collateral circulation at the donor graft site is adequate?
2. Blood pressure of 108/68 mm Hg [ ] 1. The client is free from chest pain.
3. Dry mouth 4. Chest pain [ ] 2. The client's toes are warm and nonedematous.
41. The nurse checking the client's leg incision is aware [ ] 3. The client moves the operative leg easily.
that which is the most common blood vessel used in CABG [ ] 4. The client's heart rate remains regular.
surgery? 47. Which assessment finding is most closely correlated
1. The saphenous vein 2. The femoral artery with an evolving MI?
3. The popliteal vein 4. The iliac artery 1. Profuse sweating 2. Facial flushing
42. Which action by a newly hired nursing assistant 3. Severe headache 4. Coughing up pink-tinged mucus
indicates that the nurse needs to provide more instruction 48. Which of the following electrocardiogram (ECG)
to the nursing assistant on how to accurately assess the changes supports the diagnosis that the client is experiencing
client's pulse rate? a myocardial infarction (MI)?
1. The nursing assistant places a thumb over the radial artery. 1. Inverted P wave 2. Prolonged PR interval
2. The nursing assistant counts the pulse rate for 1 full 3. Widened QRS complex 4. Elevated ST segment
minute. 49. When the nurse is obtaining this client's health
3. The nursing assistant rests the client's arm on the history, which question about pain is least helpful?
abdomen. [ ] 1. "How long have you been in pain?"
4. The nursing assistant presses the radial artery against the [ ] 2. "Where is your pain located?"
bone. [ ] 3. "What were you doing when your pain started?"
[ ] 4. "What medications do you take for pain?"
43. Based on the client's complaint, the nurse would 50. If the client's severe chest pain is typical of other
expect the pain to have which possible effect on the vital people who experience myocardial infarction (MI), the client
signs? is most likely to tell the nurse that the discomfort radiates
1. Temperature may be elevated. to which area?
2. Pulse rate may become rapid. 1. Flank 2. Groin
3. Respiratory rate may slow. 3. Abdomen 4. Shoulder
4. Blood pressure may fall.
44. When the nurse informs the client about the use of A 70-year-old female is scheduled to undergo mitral
valve replacement for severe mitral stenosis and mitral a) Prepare for transcutaneous pacing.
regurgitation. Although the diagnosis was made during b) Prepare to defibrillate the client at 200 joules.
childhood, she did not have symptoms until 4 years ago. c) Administer an I.V. lidocaine infusion.
Recently, she noticed increased symptoms, despite daily d) Schedule the operating room for insertion of a permanent
doses of digoxin and furosemide. During the initial interview pacemaker.
with the client, the nurse would most likely learn that the A 74-year-old female is admitted to the telemetry unit
client's childhood health history included: for placement of a permanent pacemaker because of sinus
a) Chickenpox. b) Poliomyelitis. bradycardia. A priority goal for the client within 24 hours after
c) Rheumatic fever. d) Meningitis. insertion of a permanent pacemaker is to:
A client has mitral stenosis and is a prospective valve a) Maintain skin integrity.
recipient. The nurse is instructing the client about health b) Maintain cardiac conduction stability.
maintenance prior to surgery. Inability to follow which of the c) Decrease cardiac output.
following regimens would pose the greatest health hazard to d) Increase activity level
this client at this time? A client with peripheral vascular disease has undergone
a) Medication therapy. b) Diet modification. a right femoral-popliteal bypass graft. The blood pressure has
c) Activity restrictions. d) Dental care. decreased from 124/80 to 94/62. What should the nurse
A client who has undergone a mitral valve replacement assess first?
has persistent bleeding from the sternal incision during the a) IV fluid solution. b) Pedal pulses.
early postoperative period. The nurse should do which of the c) Nasal cannula flow rate. d) Capillary refill.
following? Select all that apply. The nurse is unable to palpate the client's left pedal
a) Begin Warfarin (Coumadin). pulses. Which of the following actions should the nurse take
b) Check the postoperative CBC, INR, PTT, & platelet levels. next?
c) Confirm availability of blood products. a) Auscultate the pulses with a stethoscope.
d) Monitor the mediastinal chest tube drainage. b) Call the physician.
e) Start a Dopamine (Intropin) drip for a systolic BP < 100. c) Use a Doppler ultrasound device.
For a client who excretes excessive amounts of calcium d) Inspect the lower left extremity.
during the postoperative period after open heart surgery, A client with peripheral vascular disease returns to the
which of the following measures should the nurse institute to surgical care unit after having femoral-popliteal bypass
help prevent complications associated with excessive calcium grafting. Indicate in which order the nurse should conduct
excretion? assessment of this client.
a) Ensure a liberal fluid intake. Answer:
b) Provide an alkaline-ash diet. 1. Peripheral pulses. 2. Incision site.
c) Prevent constipation. 3. Urine output. 4. Level of Pain
d) Enrich the client's diet with dairy products. The nurse is assessing an older Caucasian male who has
Good dental care is an important measure in reducing a history of peripheral vascular disease. The nurse observes
the risk of endocarditis. A teaching plan to promote good that the man's left great toe is black. The discoloration is
dental care in a client with mitral stenosis should include probably a result of:
demonstration of the proper use of: a) Atrophy. b) Contraction.
a) A manual toothbrush. b) An electric toothbrush. c) Gangrene. d) Rubor.
c) An irrigation device. d) Dental floss. Rationale: The term gangrene refers to blackened,
A client has been admitted to the coronary care unit. The decomposing tissue that is devoid of circulation. Atrophy is
nurse observes third-degree heart block at a rate of 35 bpm the shrinking of tissue, and contraction is joint stiffening
on the client's cardiac monitor. The client has a blood secondary to disuse. The term rubor denotes a reddish color
pressure of 90/60. The nurse should take which of the of the skin
following actions first? A client is scheduled for an arteriogram. The nurse
should explain to the client that the arteriogram will confirm d) "You're fortunate to have a wife who can take care of you."
the diagnosis of occlusive arterial disease by: The client asks the nurse, "Why can't the doctor tell me
a) Showing the location of the obstruction and the collateral exactly how much of my leg they're going to take off? Don't
circulation. you think I should know that?" The nurse responds, knowing
b) Scanning the affected extremity and identifying the areas that the final decision on the level of the amputation will
of volume changes. depend primarily on:
c) Using ultrasound to estimate the velocity changes in the a) The need to remove as much of the leg as possible.
blood vessels. b) The adequacy of the blood supply to the tissues.
d) Determining how long the client can walk c) The ease with which a prosthesis can be fitted.
A client is scheduled to have an arteriogram. During the d) The client's ability to walk with a prosthesis
arteriogram, the client reports having nausea, tingling, and A client has undergone an amputation of several toes
dyspnea. The nurse's immediate action should be to: and a femoral-popliteal bypass. The nurse should teach the
a) Administer epinephrine. b) Inform the physician. client that after surgery which of the following leg positions is
c) Administer oxygen. contraindicated for her while sitting in a chair?
d) Inform the client that the procedure is almost over. a) Crossing the legs. b) Elevating the legs.
A client with peripheral vascular disease has bypass c) Flexing the ankles. d) Extending the knees.
surgery. The primary goal of the plan of care after surgery is The nurse is monitoring a client after an above-the-knee
to: amputation and notes that blood has saturated through the
a) Maintain circulation. b) Prevent infection. distal part of the dressing. The nurse should immediately:
c) Relieve pain. d) Provide education. a) Apply a tourniquet. b) Assess vital signs.
A client is scheduled to undergo right axillary-to-axillary c) Call the physician.
artery bypass surgery. Which of the following interventions is d) Elevate the surgical extremity with a large pillow.
most important for the nurse to implement in the The client has had a below-the-knee amputation
preoperative period? secondary to arterial occlusive disease. The nurse is
a) Assess the temperature in the affected arm. instructing the client in stump care. Which of the following
b) Monitor the radial pulse in the affected arm. statements by the client indicates that she understands how
c) Protect the extremity from cold. to implement her plan of care?
d) Avoid using the arm for a venipuncture. a) "I should inspect the incision carefully when I change the
A client is admitted to the hospital with peripheral dressing every other day."
vascular disease (PVD) of the lower extremities. He is b) "I should wash the incision, dry it, and apply moisturizing
scheduled for an amputation of the left leg. The client says, lotion daily."
"I've really tried to manage my condition well." Which of the c) "I should rewrap the stump as often as needed."
following routines should the nurse evaluate as having been d) "I should elevate the stump on pillows to decrease
appropriate for him? swelling."
a) Resting with his legs elevated above the level of his heart. The client with peripheral vascular disease has been
b) Walking slowly but steadily for 30 minutes twice a day. prescribed diltiazem (Cardizem). The nurse should determine
c) Minimizing activity. the effectiveness of this medication by assessing the client
d) Wearing antiembolism stockings at all times when out of for:
bed. a) Relief of anxiety. b) Sedation.
While the nurse is providing preoperative teaching, the c) Vasoconstriction. d) Vasodilation.
client says, "I hate the idea of being an invalid after they cut A client is receiving Pentoxifylline (Trental) for
off my leg." The nurse's most therapeutic response should be: intermittent claudication. The nurse should determine the
a) "You'll still have one good leg to use." effectiveness of the drug by asking the client:
b) "Tell me more about how you're feeling." a) If he has improved circulation in the legs.
c) "Let's finish the preoperative teaching." b) If he can wiggle his toes.
c) If he is urinating more frequently. c) Position onto the left side. d) Insert a nasogastric tube.
d) If he is less dizzy. A client had a repair of a thoracoabdominal aneurysm 2
A client with peripheral vascular disease is recovering days ago. Which of the following findings should the nurse
from an aorto-femoral-popliteal bypass graft. When consider unexpected and report to the physician
developing a postoperative education plan, which question by immediately? The client has:
the nurse will provide the most helpful information? a) Abdominal pain at 5 on a scale of 0 to 10 for the last 2
a) "How did you manage your health before admission?" days.
b) "How far could you walk without pain before surgery?" b) Heart rate of 100 beats per minute after ambulating 200
c) "What is your home environment like?" feet.
d) "Do you have problems with urine retention?" c) Urine output of 2,000 mL in 24 hours.
The nurse is developing a discharge teaching plan for a d) Weakness and numbness in the lower extremities.
client who underwent a repair of abdominal aortic aneurysm A client is admitted to the emergency department
4 days ago. The nurse reviews the client's chart for complaining of severe abdominal pain. A radiograph reveals a
information about the client's history. Key findings are noted large abdominal aortic aneurysm. The primary goal at this
in the chart below: time is to:
History And Physical a) Maintain circulation.
1) Smokes four cigars a month. b) Manage pain.
2) Vital signs: blood pressure, ranges from 150/76 mm Hg to c) Prepare the client for emergency surgery.
170/98 mm Hg; heart rate, 90 to 100 beats per minute; d) Teach postoperative breathing exercises.
respirations, 12-18 per minute; temperature, 99.9° F (37.8° Before surgery for a known aortic aneurysm, the client's
C). pulse pressure begins to widen, suggesting increased aortic
3) +1 bilateral ankle edema. valvular insufficiency. If the branches of the aortic arch are
Based on the data and expected outcomes, which should the involved, the nurse should assess the client for:
nurse emphasize in the teaching plan? a) Loss of consciousness. b) Anxiety.
a) Food intake b) Fluid volume c) Headache. d) Disorientation.
c) Skin integrity d) Tissue perfusion A client has sudden, severe pain in his back and chest,
A client is admitted with a 6.5-cm thoracic aneurysm. accompanied by shortness of breath. The client describes the
The nurse records findings from the initial assessment in the pain as a "tearing" sensation. The physician suspects the
client's chart, as shown below. client is experiencing a dissecting aortic aneurysm. The code
Vital Signs Date: 05/07/07 cart is brought into the room because one complication of a
Time: 10:00 am Blood pressure 160/90 mm Hg dissecting aneurysm is:
Heart rate 74 bpm Respirations 20 per minute a) Cardiac tamponade. b) Stroke.
At 10:30 a.m., the client complains of sharp mid-chest pain c) Pulmonary edema. d) Myocardial infarction.
after having a bowel movement. What should the nurse do Which of the following increases the risk of having a
first? large abdominal aortic aneurysm rupture?
a) Assess the client's vital signs. a) Anemia. b) Dehydration.
b) Administer a bolus of lactated Ringer's solution. c) High blood pressure. d) Hyperglycemia.
c) Assess the client's neurologic status. The nurse is planning care for a client who has returned
d) Contact the physician. to the medical-surgical unit following repair of an aortic
Nursing assessment of a 54-year-old client in the aneurysm. The nurse first should assess the client for:
emergency department reveals severe back pain, Grey a) Alteration in renal perfusion. b) Electrolyte imbalance.
Turner's sign, nausea, blood pressure of 90/40, heart rate 128 c) Ineffective coping. d) Wound infection.
beats per minute and respirations 28 per minute. The nurse A client underwent surgery to repair an abdominal aortic
should first: aneurysm. The surgeon made an incision that extends from
a) Assess the urine output. b) Place a large bore I.V. the xiphoid process to the pubis. At 12 noon 2 days after
surgery, the client complains of abdominal distention. The about drug dose, frequency of administration, the client's
nurse checks the progress notes in the medical record, as vital signs, and the client's score on the pain scale. The nurse
shown: requests an order for a different, or stronger, pain
Date:07/07/07 Time: 10:00 pm medication. The physician tells the nurse that the current
Progress Notes: The client is receiving D5W, 1,000 mL q 8 h. order for pain medication is sufficient for this client and that
The NG tube is attached to low suction and draining well. The the client will feel better in several days. The nurse should
client has been NPO except ice chips. The client has had 10 next:
mg morphine for pain at 6 a.m. E. Levine, RN a) Explain to the physician that the current pain medication
What is most likely contributing to the client's abdominal and other strategies are not helping the client and it is
distention? making it difficult for the client to ambulate as ordered.
a) Nasogastric (NG) tube. b) Ice chips. b) Ask the hospitalist to write an order for a stronger pain
c) I.V. fl uid intake. d) Morphine. medication.
A client is discharged after an aortic aneurysm repair c) Wait until the next shift and ask the nurse on that shift to
with a synthetic graft to replace part of the aorta. The nurse contact the physician.
should instruct the client to notify the physician before d) Report the incident to the team leader.
having: The nurse is preparing to teach the pt newly diagnosed
a) Blood drawn. b) An I.V. line inserted. with angina pectoris how to self-administer nitroglycerine
c) Major dental work. d) An X-ray examination (NTG) tablets. What pt teaching should the nurse emphasize?
A client is admitted for a revascularization procedure for select all that apply
arteriosclerosis in his left iliac artery. To promote circulation in A. stop all activities immediately and sit down if chest pain
the extremities, the nurse should: occurs
a) Position the client on a firm mattress. B. if the pain is unrelieved after three NTG tablets, continue
b) Keep the involved extremity warm with blankets. to rest and call the prescriber right away
c) Position the left leg at or below the body's horizontal plane. C. After discharge, keep NTG tablets on your bedside table
d) Encourage the client to raise and lower his leg four times day and night
every hour. D. immediately after chest pain begins, notify your personal
A client with a history of hypertension and peripheral prescriber
vascular disease underwent an aorto-bifemoral bypass graft. E. the NTG tablet should tingle when placed under the tongue
Preoperative medications included pentoxifylline (Trental); The pt states, "I always put my nitroglycerine patch in
metoprolol (Toprol XL); and furosemide (Lasix). On the same place so I do not forget to take it off." Which of the
postoperative day 1, the 12 noon vital signs are: Temperature following is the best response by the nurse?
37.2 ° C; heart rate 132 beats per minute; respiratory rate 20; A. change the patch every 24 hours
blood pressure 126/78. Urine output is 50 to 70 mL/ hour. B. massage into the skin if ointment comes in contact with
The hemoglobin and hematocrit are stable. Using the SBAR your hands
(Situation-Background-Assessment-Recommendation) C. rotate the NTG patch to a different hairless area each day
technique for communication, the nurse recommends that D. after removing the patch, scrub the are vigorously with
the primary care provider: soap and water
a) Continues the pentoxifylline. b) Increases the I.V. fluids. A healthcare provider orders NTG to be administered by
c) Restarts the metoprolol. d) Resumes the furosemide. IV drip. The nurse carrying out the order would monitor for
The nurse is planning care for a client who had surgery which of the following as a priority specific to medication?
for abdominal aortic aneurysm repair 2 days ago. The pain A. shortness of breath when raising head of bed
medication and the use of relaxation and imagery techniques B. urine output
are not relieving the client's pain and the client refuses to get C. blood pressure and heart rate
out of bed to ambulate as ordered. The nurse contacts the D. facial flushing and headache
physician, explains the situation, and provides information Before a pt receives metoprolol (Lopressor) for
hypertension, the nurse should ask the pt about a history of B. apt time of 60 seconds
which of the following? C. apt time of 28 seconds
A. bronchospasms B. seizures D. apt time longer than 120 sec
C. peripheral vascular disease D. myasthenia gravis A nurse provides discharge instructions to a post op pt
The nurse provides discharge instructions to a pt about who is taking warfarin sodium (Coumadin). Which statement,
the use of amiodarone. Which of the following statements if made by the pt, reflects the need for further teaching?
indicates that the pt has the knowledge necessary to safely A. I will take my pills every day at the same time
administer the drug? B. I will be certain to limit my alcohol consumption
A. as soon as the physician says I can stop taking this C. I have already called my family to pick up my Medic-Alert
medication, I will be able to enjoy the sun again bracelet
B. the side effects of this med may not begin to show up for D. I will take enteric-coated Aspirin for my headaches
several weeks or even months after I start taking it A nurse is caring for a pt receiving heparin IV. The nurse
C. If my pulse drops below 100 beats/minute, I should call the anticipates that which lab study will be prescribed to monitor
physician right away the therapeutic effect of heparin?
D. If I miss a dose of me, I should take it as soon as I A. hematocrit B. hemoglobin
remember it C. prothrombin time D. activated partial thromboplastin time
The nurse is scheduled to administer a dose of digoxin to A pt is diagnosed with an acute myocardial infarction and
and adult pt with atrial fibrillation. The pt has a potassium is receiving tissue plasminogen activator, alteplase (Activase).
level of 4.3 mEq/L. The nurse should perform which of the Which of the following is a priority nursing intervention?
following activities next? A. monitor for renal failure
A. withhold dose only for that day B. monitor for psychosocial status
B. obtain order for dose of potassium before giving digoxin C. monitor for signs of bleeding
C. withhold dose and notify prescriber D. have heparin sodium available
D. administer dose as ordered A home health nurse instructs a pt about the use of a
A pt is taking digoxin and furosemide (Lasix) to manage nitrate patch. The nurse tells the pt that which of the
congestive heart failure. The nurse determines that the pt following will prevent pt tolerance to nitrates?
understands diet therapy when the pt makes which meal A. do not remove the patches
choice? B. have a 12-hr no-nitrate time
A. veggie beef soup, mac and cheese, and a roll C. have a 24-hr no-nitrate time
B. beef ravioli w/ bread D. keep nitrates on 48 hrs, then off 24 hrs
C. baked white fish, mashed potatoes, and carrot salad A pt is receiving thrombolytic therapy with a continuous
D. roasted chicken, brown rice, and stewed tomatoes infusion of streptokinase. The pt suddenly becomes
After a healthcare provider prescribed propranolol for a extremely anxious with complaints of itching. A nurse hears
pt with frequent premature ventricular contractions, the stridor and on examination of the pt notes generalized
nurse should include with of the following in the care plan? urticarial and hypotension. Which of the following should be
A. inform pt that excessive respiratory response to activity the priority action?
should gradually decrease A. administer oxygen and protamine sulfate
B. measure heart rate daily before taking dose B. stop the infusion and call the physician
C. Pt will have increased resistance to infection C. cut the infusion rate in half and sit the pt up in bed
D. current skin eruptions will improve within 30 days D. administer benadryl and continue the infusion slowly
A pt with atrial fibrillation is receiving continuous Which of the following pts is at greatest risk for digital
heparin infusion at 1000 units/hr. The nurse would determine toxicity?
that the pt is receiving the therapeutic effect based on which A. a 25 y/o pt with congestive heart disease
of the following results? B. a 50 y/o pt with CHF
A. prothrombin time of 12.5 seconds C. a 60 y/o pt who had an MI
D. an 80 y/o pt with CHF pt. Before ambulating the pt for the first time after
Which of the following is a contraindication for digoxin administration, the nurse should monitor for:
administration? A. hypokalemia B. irregular heartbeat
A. BP of 140/90 B. HR>80 C. edema D. hypotension
C. HR<60 D. RR>18 Mira is managing her hypertension with an ACE inhibitor.
The action of medication is inotropic when it: Which of the following statements stated by her indicates a
A. decreases afterload B. increases heart rate need for further teaching?
C. increases the force of contraction D. is uses to treat CHF A. I should not take my pills with food
Which is the most important action for the nurse to take B. I need to increase my intake of orange juice, bananas, and
before administering digoxin? green veggies
A. monitor the potassium level C. I will avoid coffee, tea, and cola
B. assess the BP D. I will avoid salt substitutes
C. evaluate urinary output The action of an ACE inhibitor interrupts the renin-
D. avoid giving with a thiazide diuretic angiotensin-aldosterone mechanism, thereby producing
The therapeutic drug level for digoxin is: which of the following?
A. 0.1-2.0 B. 1.0-2.0 A. reduced renal blood flow
C. 0.1-0.5 D. 0.5-2.0 B. reduced sodium and water retention
Blurred vision or halos are signs of: C. increased peripheral vascular resistance
A. beta blocker toxicity B. digoxin toxicity D. increased sodium excretion and potassium reabsorption
C. diuretic toxicity D. ACE inhibitor toxicity Raymund is reviewing on cardio drugs for his upcoming
Beta blockers should be avoided in which of the exam. For a well-prepared student, he should know that
following conditions: vasodilators are agents that:
A. bronchoconstriction B. hypertension A. relax smooth muscle
C. Angina D. myocardial infarction B. are used to treat hypotension
You know that the action of nitrates is: C. stimulate the adrenergic receptors
A. smooth muscle contraction B. vasoconstriction D. cause respiratory depression
C. smooth muscle relaxation D. increase preload As a competent nurse, you are aware that vasodilators
A 50 y/o pt is prescribed to take nitrate each day for his are used mainly to treat:
condition. You know the result of nitrate administration is: A. diabetes B. hypertension
A. decreased myocardial oxygen demand C. atrial fibrillation D. hypotension
B. increased myocardial oxygen demand Which of the following is a potential side effect of IV
C. increased left ventricular end-diastolic volume furosemide (Lasix)?
D. increased atrial pressure A. drowsiness B. diarrhea
A student nurse is asked to give an example of a long- C. cystitis D. hearing loss
acting nitrate. She is correct by saying:
A. Nitroglycerin sublingual B. nitroglycerin IV All potassium-sparing diuretics:
C. isosorbide PO D. Nitroglycerin transmucosal A. are required during blood transfusions
When nitrates are administered early to the acute MI pt, B. enhance aldosterone action
the result is: C. cause hypokalemia
A. Hypotension B. Bradycardia D. are weak diuretics
C. reduced mortality D. reduced morbidity Which of the following pts is most likely to experience
When teaching about nitrate administration, the nurse adverse effects from tx with diuretics?
should instruct the pt to: A. a 21 y/o college student B. a 40 y/o unmarried man
A. change positions slowly B. take pulse weekly C. a 60 y/o widower D. a 75 y/o man
C. reduce salt intake D. chew the sustained-release tablets SC heparin should be administered in the:
Nurse Margie just administered an ACE inhibitor to her A. flank B. abdominal fat
C. thigh D. buttock every 2 hours
The half-life of heparin is: C. IV nitroglycerin must be protected form exposure to light
A. 10 minutes B. 1-1.5 hrs through use of special tubing
C. 8-12 hrs D. 1-2 days D. IV nitroglycerin can be given via gravity drip infusions
When teaching the pt about the signs and symptoms of A nurse with adequate knowledge about the
cardiac glycoside toxicity, the nurse should alert the pt to administration of IV nitroglycerin will recognize that which of
watch for: the following statements is correct?
A. visual changes B. flickering lights or halos A. the intravenous form is given by bolus injection
C. dizziness when standing up D. increased urine output B. because the IV forms are short-lived, the dosing must be
During assessment of a pt who is receiving digoxin, every 2 hours
which finding would indicate an increased possibility of C. IV nitroglycerin must be protected form exposure to light
toxicity? through use of special tubing
A. apical pulse rate of 60 bpm B. digoxin level of 1.5 D. IV nitroglycerin can be given via gravity drip infusions
C. serum potassium level of 2.0 D. serum potassium level of 4.8 Which statement by the pt reflects the need for
When a pt is experiencing digitalis toxicity, in which of additional pt education about the CCB diltiazem (Cardizem)?
the following situations would it be appropriate to treat with A. I can take this drug to stop acute anginal attacks
digoxin immune Fab (Digibind)? B. I understand that food and antacids alter the absorption of
A. hypokalemia this oral drug
B. hyperkalemia C. when the long-acting forms are taken, the drug cannot be
C. apical heart rate of 60 bpm crushed
D. supraventricular dysrhythmias D. this drug may cause my blood pressure to drop, so I should
A pt with a rapid, irregular heart rhythm is being treated be careful when getting up
in the ER with adenosine. During administration of this drug, While assessing a pt with angina who is to start Beta
the nurse should be prepared to monitor the pt for which Blocker therapy, the nurse is aware that the presence of
effect? which condition may be a problem if these drugs are used:
A. nausea and vomiting B. transitory asystole A. hypertension B. essential tremors
C. muscle tetany D. hypertension C. exertional angina D. asthma
When assessing a pt who has been taking amiodarone A 68 y/o man has been taking the nitrate isosorbide for 2
for 6 months, which adverse reaction might the nurse years for angina. He recently has been experiencing erectile
identify? dysfunction and wants a prescription for sildenafil (Viagra).
A. glycosuria B. dysphagia Which response would the nurse most likely hear from the
C. photophobia D. urticaria prescriber?
A pt has a new prescription from transdermal A. He will have to be switched to isosorbide mononitrate if he
nitroglycerin patches. The nurse teaches the pt that these wants to take sildenafil
patches are most appropriately used for which of the B. taking sildenafil with the nitrate may result in severe
following? hypotension
A. to relieve exertional angina C. I'll write a prescription, but if he uses it, he needs to stop
B. to prevent palpitations talking the isosorbide for one dose
C. to prevent the occurrence of angina D. these drugs are compatible with each other, and so I'll
D. to reduce the severity of anginal episodes write a prescription
A nurse with adequate knowledge about the Which of the following adverse effects is of most concern
administration of IV nitroglycerin will recognize that which of for the older adult pt taking anti-hypertensive drugs
the following statements is correct? A. dry mouth B. hypotension
A. the intravenous form is given by bolus injection C. restlessness D. constipation
B. because the IV forms are short-lived, the dosing must be When giving antihypertensives drugs, the nurse must
consider giving the first dose at bedtime for which of the C. increases contractility
following classes of drugs? What is the digitalizing dose of Digoxin (Lanoxin)?
A. alpha blockers B. diuretics A. 0.125-0.5 B. 0.5-2 C. 0.5-3
C. ACE inhibitors D. vasodilators Hypokalemia is a potential side effect of Digoxin. You
A 56 y/o man started antihypertensive drug therapy 3 need to educate your pt on consuming potassium-rich foods.
months earlier and is in the office for a follow-up visit. While Which of the following will you include in your list of
the nurse is taking his BP, he informs the nurse that he has potassium-rich foods?
had some problems with sexual intercourse. Which of the A. Eggs B. strawberries C. whole grain bread
following would be the most appropriate response by the A pt has been admitted with chest pain. He states that it
nurse: began while he was watching tv on his couch. Which kind of
A. not to worry. Tolerance will develop angina does he likely have?
B. the physician can work with you on changing the dose or A. stable B. unstable C. variant
drug Which of the following is NOT a nursing intervention
C. sexual dysfunction happens with this therapy, and you relevant to administration of nitroglycerin?
must lean to accept it A. inform the pt there may be a burning sensation under their
D. this is an unusual occurrence, but it is important to stay on tongue upon ingestion
your meds B. inform the pt that this med must be kept in its original
When a pt is being taught about the potential adverse bottle
effects of an ACE inhibitor, which of the following should be C. inform the pt that a headache is the most common side
mentioned as possibly occurring when this drug is taken to effect associated with this drug
treat hypertension Which group of drugs can be either selective or non-
A. hypokalemia B. nausea selective?
C. dry, nonproductive cough D. sedation a. sodium channel blockers B. beta blockers
When applying a nitro patch it should be placed on C. calcium channel blockers
A. non hairy part of the chest B. thigh Which of the following is a class of antidysrhythmic
C. upper back D. buttocks drug?
A pt with congestive heart failure is receiving digoxin. A. osmotic B. carbonic-anhydrase inhibitor
What is the desired effect: C. beta adrenergic blocker
A. neck vein distention B. decreased appetite When administering hydrochlorothiazide, which labs
C. increased urinary output D. increased pedal edema must be monitored?
A pt has a new prescription for an adrenergic drug. A. BUN, creatinine B. INR, electrolytes C. APPT, PTT
During a review of the pt's list of current meds, which would Which of the following is the serum abnormality with
cause concern about a possible interaction with this new thiazides?
prescription: A. hyperkalemia B. hyperglycemia C. hyperchloremia
A. a benzodiazepine taken as needed for allergies Which of the following serum abnormalities is unique to
B. a multivitamin with iron loop diuretics?
C. an oral anticoagulant A. hypokalemia B. hypomagnesia C. hyponatremia
D. NSAIDS Potassium sparing diuretics work where?
A pt has a potassium level of 6.0 and a digoxin level of A. collecting distal tubules
3.0. What medication would the nurse be giving: B. ascending loop of henle
A. digibind B. sodium citrate C. descending loop of henle
C. epinephrine D. lidocaine What is the antidote for heparin?
Positive inotropic action does which of the following? A. vitamin K B. immunefab C. protamine sulfate
A. decreases heart rate Which of the following anticoagulants is used
B. decreases cellular conduction prophylactically?
A. heparin B. lovenox C. coumadin A. potassium B. digibind
Which of the following drugs are known as "clot C. protamine sulfate D. heparin
busters"? Your pt starts showing signs of gynecomastia, which
A. anticoagulants B. antiplatelets C. thrombolytics diuretic would you suspect they are on?
Which of the following must be given within 3 hours of A. potassium-sparing B. thiazide
the beginning of an MI or stroke? C. loop D. calcium channel blockers
A. thrombolytics B. antiplatelets C. cardiac glycosides The nurse is monitoring a pt taking digoxin (Lanoxin) for
Which drug category has intermittent claudication as a treatment of heart failure. Which assessment finding
characteristic side effect? indicates a therapeutic effect of the drug?
A. peripheral vasodilators B. diuretics A. HR 110 beats/minute B. HR 58 beats/minute
C. antilipidemics C. urinary output 40 mL/hr D. BP 90/50 mm Hg
What is the most common side effect of ACE inhibitors? The nurse knows that the mechanism of action of
A. headache B. persistent dry cough Clopidogrel (Plavix) is to:
C. visual disturbances A. inhibit the actions of vitamin K
Your pt is on coumadin. You must instruct them to limit B. turn plasminogen to plasmin
their intake of what? C. inhibit the aggregation of platelets
A. milk B. juice C. tea D. inhibit angiotensin I from converting to angiotensin II
A pt is on Spironolactone (Aldactone) and has a Nursing interventions for a pt receiving enoxaparin
potassium level of 5.9. What should the nurse do? (Lovenox) may include:
A. hold the med and contact the physician A. monitoring multiple lab tests and values
B. give the med as prescribed B. monitoring for development of deep vein thrombosis
C. give the pt half the prescribed dose C. teaching the pt or family to give subcutaneous injections at
D. give the pt a banana home
Which of the following is a potential side effect of IV D. teaching to observe for excessive bleeding
furosemide (lasix)? A client who has been taking warfarin (Coumadin) is
A. drowsiness B. diarrhea admitted with coffee-ground emesis. What is the nurse's
C. cystitis D. hearing loss primary action?
The nurse reviews lab studies of a pt receiving digoxin A. Administer vitamin E
(Lanoxin). Intervention by the nurse is required if the results B. Administer vitamin K
include which of the following laboratory values? C. Administer protamine sulfate
A. serum digoxin level of 1.2 ng/dL D. Administer calcium gluconate
B. Serum potassium level of 3 mEq/L All potassium-sparing diuretics:
C. hemoglobin of 14.4 g/ dL A. are required during blood transfusions
D. serum sodium level of 140 mEq/L B. enhance aldosterone action
A nurse teaching a pt on correct self administration of C. cause hypokalemia
sublingual nitroglycerin (Nitrostat) tablets realizes the pt D. are weak diuretics
requires further teaching when they state: A pt is experiencing digitalis toxicity, in which of the
A. I will call an ambulance while administering the 3rd tablet following situations would it be appropriate to treat with
B. I will not drive while taking nitroglycerin tablets digoxin immune Fab (digibind)
C. I will keep my tablets in a clear bottle A. hypokalemia
D. I will not take nitroglycerin with erectile dysfunction B. hyperkalemia
medication C. apical heart rate of 60 bpm
Your pt is currently taking Digoxin. What should you, as a D. supraventricular arrhythmias
nurse be prepared to administer in the event of digitalis A client receives a dose of furosemide (Lasix) 120 mg
toxicity? intravenously for treatment of congestive heart failure. Which
symptom indicates that an adverse reaction is most likely
occurring? A. eat extra helpings of bananas
A. bradycardia B. weight gain B. increase intake of water
C. hypotension D. crackles C. avoid salt substitutes
Sublingual nitroglycerin is given to a client who D. increase intake of green leafy veggies
experiences chest pain. Which symptom can occur with A 68 y/o male is experiencing severe hypotension after
nitroglycerin? receiving IV nitroglycerin. What is the most probable cause
A. tachycardia B. tinnitus for this reaction?
C. diarrhea D. Diplopia A. pt is having a MI
An elderly client receives instructions regarding the use B. the pt has a high potassium level
of warfarin sodium (Coumadin). Which statement indicates C. the pt routinely exercises, but has not be active in over a
the client understands the possible food interactions which week
may occur with this medication? D. the pt failed to report that he is on Viagra
A. I'm going to miss having my evening glass of wine now A pt receives a nitroglycerin drip. Which is the true
B. I told my daughter to buy bananas for me. I'll have to eat statement regarding the use of this med in IV therapy?
more of those now A. vented tubing is needed to administer this med
C. I will have to watch my intake of salads, something that I B. a glass bottle and vented tubing are needed to administer
really love this med
D. I am going to begin eating more fish and pork and leave C. admixture must be done under a laminar flow hood with
beef alone now proper handling techniques
An elderly pt is prescribed spironolactone (Aldactone) D. this med cannot be given through small diameter catheters
with the addition of potassium chloride (Kaochlor). Which in elderly pts
statement is a true statement regarding the use of these two Nitroglycerin is ordered for an elderly pt who is having an
meds together? episode of chest pain. Which is a correct statement regarding
A. spironolactone should not have potassium chloride added the use of nitroglycerin spray instead of nitroglycerin tablets
to the regimen b/c it is a potassium-sparing diuretic in this age group?
B. potassium is necessary when clients are placed on A. there is increased absorption in the older client with the
spironolactone b/c it is a loop diuretic spray
C. spironolactone and potassium chloride have no additive or B. older clients attempt to chew the tablet
antagonistic effects with each other C. tablets dissolve slower in this population
D. potassium chloride added to spironolactone causes renal D. the spray lasts longer in the system
failure Alpha-adrenergic blocking agents include medications
such as doxazosin and prazosin hydrochloride. The
mechanism of action for these meds is to:
A 62 y/o male pt has nitroglycerin (Nitrostat) added to A. inhibit the parasympathetic system
his med regimen. Which statement made by this pt indicates B. stimulate the sympathetic system
that further education is needed? C. inhibit the sympathetic system
A. I will take this med if I have an episode of chest pain D. stimulate the parasympathetic system
B. I will wait at least 1 hour after I take my sildanefil (Viagra) Warfarin works by obstructing certain clotting factors in
before using Nitrostat the clotting cascade. Which info is correct regarding this
C. I can take up to 3 tablets every 5 minutes if my angina mechanism of action?
occurs A. interference with calcium occurs within the clotting
D. I know that I must put this tablet under my tongue for it to cascade
work B. increased solubility of vitamin D occurs in the mucosal
Which dietary change must a pt make when starting lining of the stomach
treatment with the med spironolactone? C. decreased functioning of vitamin K occurs within the
production sites 1. To sedate the pt
D. binding with magnesium occurs in the hepatic cells 2. To decrease the pt's pain
A nurse gives a subq injection of heparin sodium 3. To decrease the pt's anxiety
(heparin). Which is a true statement regarding this injection? 4. To decrease oxygen demand on the pt's heart
A. massage the area after heparin is administered subq Which of the following conditions is most commonly
B. aspiration before injection can cause hematoma formation responsible for myocardial infarction?
C. give the injection each time in the same general area 1. Aneurysm 2. Heart failure
D. hold the skin taut when giving the injection 3. Coronary artery thrombosis 4. Renal failure
A pt who is being discharged home will be giving his own Which of the following complications is indicated by a
enoxaparin sodium (Lovenox) subq. Which statement by the third heart sound (S3)?
client indicates the need for further education? 1. Ventricular dilation 2. Systemic hypertension
A. i remember that i need to hold the needle at a 45 degree 3. Aortic valve malfunction 4. Increased atrial contractions
angle After an anterior wall myocardial infarction, which of the
B. i know to pinch the skin up for the injection following problems is indicated by auscultation of crackles in
C. i will not pull back on the plunger before injecting the med the lungs?
D. i am going to use the right side of my lower abdomen all 1. Left-sided heart failure 2. Pulmonic valve malfunction
the time 3. Right-sided heart failure 4. Tricuspid valve malfunction
Which of the following actions is the first priority of care What is the first intervention for a pt experiencing MI?
for a pt exhibiting signs & symptoms of coronary artery 1. Administer morphine 2. Administer oxygen
disease? 3. Administer sublingual nitroglycerin 4. Obtain an ECG
1. Decrease anxiety Which of the following classes of meds protects the
2. Enhance myocardial oxygenation ischemic myocardium by blocking catecholamines &
3. Administer sublingual nitroglycerin sympathetic nerve stimulation?
4. Educate the pt about his symptoms 1. Beta-adrenergic blockers 2. Calcium channel blockers
Medical treatment of coronary artery disease includes 3. Narcotics 4. Nitrates
which of the following procedures? What is the most common complication of an MI?
1. Cardiac catheterization 1. Cardiogenic shock 2. Heart failure
2. Coronary artery bypass surgery 3. arrhythmias 4. Pericarditis
3. Oral med therapy With which of the following disorders is jugular vein
4. Percutaneous transluminal coronary angioplasty distention most prominent?
Which of the following is the most common symptom of 1. Abdominal aortic aneurysm 2. Heart failure
myocardial infarction (MI)? 3. MI 4. Pneumothorax
1. Chest pain 2. Dyspnea
3. Edema 4. Palpitations Toxicity from which of the following meds may cause a pt
Which of the following symptoms is the most likely origin to see a green-yellow halo around lights?
of pain the pt described as knifelike chest pain that increases 1. Digoxin 2. Furosemide (Lasix)
in intensity with inspiration? 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec)
1. Cardiac 2. Gastrointestinal Which of the following symptoms is most commonly
3. Musculoskeletal 4. Pulmonary associated with left-sided heart failure?
Which of the following blood tests is most indicative of 1. Crackles 2. Arrhythmias
cardiac damage? 3. Hepatic engorgement 4. Hypotension
1. Lactate dehydrogenase 2. Complete blood count (CBC) In which of the following disorders would the nurse
3. Troponin I 4. Creatine kinase (CK) expect to assess sacral edema in a bedridden pt?
What is the primary reason for administering morphine 1. Diabetes 2. Pulmonary emboli
to a pt with an MI? 3. Renal failure 4. Right-sided heart failure
Which of the following symptoms might a pt with right-
sided heart failure exhibit? 2. Normally functioning heart
1. Adequate urine output 2. Polyuria 3. Decreased myocardial contractility
3. Oliguria 4. Polydipsia 4. Failure of the ventricle to eject all of the blood during
Which of the following classes of meds maximizes systole
cardiac performance in pts with heart failure by increasing Which of the following classes of drugs is most widely
ventricular contractibility? used in the treatment of cardiomyopathy?
1. Beta-adrenergic blockers 2. Calcium channel blockers 1. Antihypertensives 2. Beta-adrenergic blockers
3. Diuretics 4. Inotropic agents 3. Calcium channel blockers 4. Nitrates
Stimulation of the sympathetic nervous system produces If medical treatments fail, which of the following invasive
which of the following responses? procedures is necessary for treating cariomyopathy?
1. Bradycardia 2. Tachycardia 1. Cardiac catheterization
3. Hypotension 4. Decreased myocardial contractility 2. Coronary artery bypass graft (CABG)
Which of the following conditions is most closely 3. Heart transplantation
associated with weight gain, nausea, & a decrease in urine 4. Intra-aortic balloon pump (IABP)
output? Which of the following conditions is associated with a
1. Angina pectoris 2. Cardiomyopathy predictable level of pain that occurs as a result of physical or
3. Left-sided heart failure 4. Right-sided heart failure emotional stress?
Which of the following heart muscle diseases is 1. Anxiety 2. Stable angina
unrelated to other cardiovascular disease? 3. Unstable angina 4. Variant angina
1. Cardiomyopathy 2. Coronary artery disease Which of the following types of angina is most closely
3. Myocardial infarction 4. Pericardial effusion related with an impending MI?
Which of the following types of cardiomyopathy can be 1. Angina decubitus 2. Chronic stable angina
associated with childbirth? 3. Nocturnal angina 4. Unstable angina
1. Dilated 2. Hypertrophic 4.
3. Myocarditis 4. Restrictive Which of the following conditions is the predominant cause
Septal involvement occurs in which type of of angina?
cardiomyopathy? 1. Increased preload
1. Congestive 2. Dilated 2. Decreased afterload
3. Hypertrophic 4. Restrictive 3. Coronary artery spasm
Which of the following recurring conditions most 4. Inadequate oxygen supply to the myocardium
commonly occurs in pts with cardiomyopathy? Which of the following tests is used most often to diagnose
1. Heart failure 2. Diabetes angina?
3. MI 4. Pericardial effusion 1. Chest x-ray 2. Echocardiogram
Dyspnea, cough, expectoration, weakness, & edema are 3. Cardiac catheterization
classic signs & symptoms of which of the following 4. 12-lead electrocardiogram (ECG)
conditions? Which of the following results is the primary treatment
1. Pericarditis 2. Hypertension goal for angina?
3. MI 4. Heart failure 1. Reversal of ischemia
In which of the following types of cardiomyopathy does 2. Reversal of infarction
cardiac output remain normal? 3. Reduction of stress & anxiety
1. Dilated 2. Hypertrophic 4. Reduction of associated risk factors
3. Obliterative 4. Restrictive Which of the following interventions should be the first
Which of the following cardiac conditions does a fourth priority when treating a pt experiencing chest pain while
heart sound (S4) indicate? walking?
1. Dilated aorta 1. Sit the pt down 2. Get the pt back to bed
3. Obtain an ECG 4. Administer sublingual nitroglycerin
 Myocardial oxygen consumption increases as which of failure, BP of 126/76, & a RR 21 bpm
the following parameters increase? 2. The 88-year-old pt with end-stage right-sided heart failure,
1. Preload, afterload, & cerebral blood flow BP of 78/50, & a DNR order.
2. Preload, afterload, & renal blood flow 3. The 62-year-old pt who was admitted one day ago with
3. Preload, afterload, contractility, & heart rate. thrombophlebitis & receiving IV heparin.
4. Preload, afterload, cerebral blood flow, & heart rate. 4. A 76-year-old pt who was admitted 1 hour ago with new-
Acute pulmonary edema caused by heart failure is onset atrial fibrillation & is receiving IV diltiazem (Cardizem).
usually a result of damage to which of the following areas of When developing a teaching plan for a pt with
the heart? endocarditis, which of the following points is most essential
1. Left atrium 2. Right atrium for the nurse to include?
3. Left ventricle 4. Right ventricle 1. "Report fever, anorexia, & night sweats to the physician."
An 18-year-old pt who recently had an URI is admitted 2. "Take prophylactic antibiotics after dental work & invasive
with suspected rheumatic fever. Which assessment findings procedures."
confirm this diagnosis? 3. "Include potassium rich foods in your diet."
1. Erythema marginatum, subcutaneous nodules, & fever 4. "Monitor your pulse regularly."
2. Tachycardia, finger clubbing, & a load S3 A nurse is conducting a health history with a pt with a
3. Dyspnea, cough, & palpitations primary diagnosis of heart failure. Which of the following
4. Dyspnea, fatigue, & syncope disorders reported by the pt is unlikely to play a role in
A pt admitted with angina complains of severe chest pain exacerbating the heart failure?
& suddenly becomes unresponsive. After establishing 1. Recent URI 2. Nutritional anemia
unresponsiveness, which of the following actions should the 3. Peptic ulcer disease 4. A-Fib
nurse take first? A nurse is preparing for the admission of a pt with heart
1. Activate the resuscitation team 2. Open the pt's airway failure who is being sent directly to the hospital from the
3. Check for breathing 4. Check for signs of circulation physician's office. The nurse would plan on having which of
A 55-year-old pt is admitted with an acute inferior-wall the following meds readily available for use?
myocardial infarction. During the admission interview, he says 1. Diltiazem (Cardizem) 2. Digoxin (Lanoxin)
he stopped taking his metoprolol (Lopressor) 5 days ago 3. Propranolol (Inderal) 4. Metoprolol (Lopressor)
because he was feeling better. Which of the following nursing A nurse caring for a pt in one room is told by another
diagnoses takes priority for this pt? nurse that a second pt has developed severe pulmonary
1. Anxiety edema. On entering the 2nd pt's room, the nurse would
2. Ineffective tissue perfusion; cardiopulmonary expect the pt to be:
3. Acute pain 1. Slightly anxious 2. Mildly anxious
4. Ineffective therapeutic regimen management 3. Moderately anxious 4. Extremely anxious
A pt comes into the E.R. with acute shortness of breath A pt with pulmonary edema has been on diuretic
& a cough that produces pink, frothy sputum. Admission therapy. The pt has an order for additional furosemide (Lasix)
assessment reveals crackles & wheezes, a BP of 85/46, a HR in the amount of 40 mg IV push. Knowing that the pt also will
of 122 BPM, & a respiratory rate of 38 breaths/minute. The be started on Digoxin (Lanoxin), a nurse checks the pt's most
pt's medical history included DM, HTN, & heart failure. Which recent:
of the following disorders should the nurse suspect? 1. Digoxin level 2. Sodium level
1. Pulmonary edema 2. Pneumothorax 3. Potassium level 4. Creatinine level
3. Cardiac tamponade 4. Pulmonary embolus A pt who had cardiac surgery 24 hours ago has a urine
The nurse coming on duty receives the report from the output averaging 19 ml/hr for 2 hours. The pt received a
nurse going off duty. Which of the following pts should the single bolus of 500 ml of IV fluid. Urine output for the
on-duty nurse assess first? subsequent hour was 25 ml. Daily laboratory results indicate
1. The 58-year-old pt who was admitted 2 days ago with heart the blood urea nitrogen is 45 mg/dL & the serum creatinine is
2.2 mg/dL. A nurse interprets the pt is at risk for: 3. Monitoring urine output hourly
1. Hypovolemia 2. UTI 4. Obtaining serum potassium levels daily
3. Glomerulonephritis 4. Acute renal failure Aspirin is administered to the pt experiencing an MI
A nurse is preparing to ambulate a pt on the 3rd day because of its:
after cardiac surgery. The nurse would plan to do which of the 1. Antipyretic action 2. Antithrombotic action
following to enable the pt to best tolerate the ambulation? 3. Antiplatelet action 4. Analgesic action
1. Encourage the pt to cough & deep breathe Which of the following is an expected outcome for a pt
2. Premedicate the pt with an analgesic on the second day of hospitalization after an MI?
3. Provide the pt with a walker 1. Has severe chest pain
4. Remove telemetry equipment because it weighs down the 2. Can identify risks factors for MI
hospital gown. 3. Agrees to participate in a cardiac rehabilitation walking
A pt's electrocardiogram strip shows atrial & ventricular program
rates of 80 complexes per minute. The PR interval is 0.14 4. Can perform personal self-care activities without pain
second, & the QRS complex measures 0.08 second. The nurse Which of the following reflects the principle on which a
interprets this rhythm is: pt's diet will most likely be based during the acute phase of
1. Normal sinus rhythm 2. Sinus bradycardia MI?
3. Sinus tachycardia 4. Sinus dysrhythmia 1. Liquids as ordered 2. Small, easily digested meals
A pt has frequent bursts of ventricular tachycardia on the 3. Three regular meals per day 4. NPO
cardiac monitor. A nurse is most concerned with this An older, sedentary adult may not respond to emotional
dysrhythmia because: or physical stress as well as a younger individual because of:
1. It is uncomfortable for the pt, giving a sense of impending 1. Left ventricular atrophy 2. Irregular heartbeats
doom. 3. peripheral vascular occlusion 4. Pacemaker placement
2. It produces a high cardiac output that quickly leads to Which of the following nursing diagnoses would be
cerebral & myocardial ischemia. appropriate for a pt with heart failure? Select all that apply.
3. It is almost impossible to convert to a normal sinus rhythm. 1. Ineffective tissue perfusion R/T decreased peripheral blood
4. It can develop into ventricular fibrillation at any time. flow secondary to decreased CI
A home care nurse is making a routine visit to a pt 2. Activity intolerance R/T increased cardiac output.
receiving digoxin (Lanoxin) in the treatment of heart failure. 3. Decreased cardiac output R/T structural & functional
The nurse would particularly assess the pt for: changes.
1. Thrombocytopenia & weight gain 4. Impaired gas exchange R/T decreased sympathetic nervous
2. Anorexia, nausea, & visual disturbances system activity.
3. Diarrhea & hypotension Which of the following would be a priority nursing
4. Fatigue & muscle twitching diagnosis for the pt with heart failure & pulmonary edema?
A pt with angina complains that the angina pain is 1. Risk for infection related to stasis of alveolar secretions
prolonged & severe & occurs at the same time each day, most 2. Impaired skin integrity related to pressure
often in the morning, On further assessment a nurse notes 3. Activity intolerance related to pump failure
that the pain occurs in the absence of precipitating factors. 4. Constipation related to immobility.
This type of anginal pain is best described as: Captopril may be administered to a pt with HF because it
1. Stable angina 2. Unstable angina acts as a:
3. Variant angina 4. Nonanginal pain 1. Vasopressor 2. Volume expander
The physician orders continuous intravenous 3. Vasodilator 4. Potassium-sparing diuretic
nitroglycerin infusion for the pt with MI. Essential nursing 3.
actions include which of the following? Furosemide is administered intravenously to a pt with
1. Obtaining an infusion pump for the med HF. How soon after administration should the nurse begin to
2. Monitoring BP q4h see evidence of the drugs desired effect?
1. 5 to 10 min 2. 30 to 60 min
3. 2 to 4 hours 4. 6 to 8 hours
1.
Which of the following foods should the nurse teach a pt
with heart failure to avoid or limit when following a 2-gram
sodium diet?
1. Apples 2. Tomato juice
3. Whole wheat bread 4. Beef tenderloin
The nurse finds the apical pulse below the 5th intercostal
space. The nurse suspects:
1. Left atrial enlargement 2. Left ventricular enlargement
3. Right atrial enlargement 4. Right ventricular enlargement