Cardiac Practice Questions for NCLEX Exam, Exams of Nursing

Download Cardiac Practice Questions for NCLEX Exam and more Exams Nursing in PDF only on Docsity! Exam 2: Cardiac Practice Questions NCLEX With complete solutions Which of the following actions is the first priority of care for a pt exhibiting signs & symptoms of coronary artery disease? 1. Decrease anxiety 2. Enhance myocardial oxygenation 3. Administer sublingual nitroglycerin 4. Educate the pt about his symptoms - correct answer ✔✔2. Enhancing myocardial oxygenation is always the first priority when a pt exhibits signs or symptoms of cardiac compromise. W/out adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the pt & decreasing anxiety are important in care delivery, neither are priorities when a pt is compromised. Medical treatment of coronary artery disease includes which of the following procedures? 1. Cardiac catherization 2. Coronary artery bypass surgery 3. Oral med therapy 4. Percutaneous transluminal coronary angioplasty - correct answer ✔✔3. Oral med administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery & percutaneous transluminal coronary angioplasty are invasive, surgical treatments. Which of the following is the most common symptom of myocardial infarction (MI)? 1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations - correct answer ✔✔1. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias. Which of the following symptoms is the most likely origin of pain the pt described as knifelike chest pain that increases in intensity with inspiration? 1. Cardiac 2. Gastrointestinal 3. Musculoskeletal 4. Pulmonary - correct answer ✔✔4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases w/ movement. Cardiac & GI pains don't change w/ respiration. Which of the following blood tests is most indicative of cardiac damage? 1. Lactate dehydrogenase 2. Complete blood count (CBC) 3. Troponin I 4. Creatine kinase (CK) - correct answer ✔✔3. Troponin I levels rise rapidly & are detectable w/in 1 hour of myocardial injury. Troponin I levels aren't detectable in people w/out cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues & not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, & a complete chemistry is obtained to review electrolytes. Because CK levels may rise w/ skeletal muscle injury, CK isoenzymes are required to detect cardiac injury What is the primary reason for administering morphine to a pt with an MI? 1. To sedate the pt 2. To decrease the pt's pain 3. To decrease the pt's anxiety 4. To decrease oxygen demand on the pt's heart - correct answer ✔✔4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain & anxiety while causing sedation, but it isn't primarily given for those reasons. Which of the following conditions is most commonly responsible for myocardial infarction? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec) - correct answer ✔✔1. One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other meds aren't associated w/ such an effect. Which of the following symptoms is most commonly associated with left-sided heart failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension - correct answer ✔✔1. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated w/ both right- & left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system. In which of the following disorders would the nurse expect to assess sacral edema in a bedridden pt? 1. Diabetes 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure - correct answer ✔✔4. The most accurate area on the body to assess dependent edema in a bed-ridden pt is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Which of the following symptoms might a pt with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia - correct answer ✔✔3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Which of the following classes of meds maximizes cardiac performance in pts with heart failure by increasing ventricular contractibility? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Diuretics 4. Inotropic agents - correct answer ✔✔4. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility & ultimately increasing cardiac output. Stimulation of the sympathetic nervous system produces which of the following responses? 1. Bradycardia 2. Tachycardia 3. Hypotension 4. Decreased myocardial contractility - correct answer ✔✔2. Stimulation of the sympathetic nervous system causes tachycardia & increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate. Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output? 1. Angina pectoris 2. Cardiomyopathy 3. Left-sided heart failure 4. Right-sided heart failure - correct answer ✔✔4. Weight gain, nausea, & a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left- sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output. Which of the following heart muscle diseases is unrelated to other cardiovascular disease? 1. Cardiomyopathy 2. Coronary artery disease 3. Myocardial infarction 4. Pericardial effusion - correct answer ✔✔1. Cardiomyopathy isn't usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. CAD & MI are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated w/ Pericarditis & advanced heart failure. Which of the following types of cardiomyopathy can be associated with childbirth? 1. Dilated 2. Hypertrophic 3. Myocarditis 4. Restrictive - correct answer ✔✔1. Although the cause isn't entirely known, cardiac dilation & heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't specifically associated w/ childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. Septal involvement occurs in which type of cardiomyopathy? 1. Congestive 2. Dilated 3. Hypertrophic 4. Restrictive - correct answer ✔✔3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy. Which of the following recurring conditions most commonly occurs in pts with cardiomyopathy? 1. Heart failure 2. Diabetes 3. MI 4. Pericardial effusion - correct answer ✔✔1. Because the structure & function of the heart muscle is affected, heart failure most commonly occurs in pts w/ cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in pts w/ pericarditis. Dyspnea, cough, expectoration, weakness, & edema are classic signs & symptoms of which of the following conditions? 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium - correct answer ✔✔4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina. Which of the following tests is used most often to diagnose angina? 1. Chest x-ray 2. Echocardiogram 3. Cardiac catherization 4. 12-lead electrocardiogram (ECG) - correct answer ✔✔4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, w/ variant angina, the ECG shows ST-segment elevation. A chest x- ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina. Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress & anxiety 4. Reduction of associated risk factors - correct answer ✔✔1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption & increasing oxygen supply. An infarction is permanent & can't be reversed. Which of the following interventions should be the first priority when treating a pt experiencing chest pain while walking? 1. Sit the pt down 2. Get the pt back to bed 3. Obtain an ECG 4. Administer sublingual nitroglycerin - correct answer ✔✔1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the pt down. An ECG can be obtained after the pt is sitting down. After the ECGm sublingual nitro would be administered. When the pt's condition is stabilized, he can be returned to bed. Myocardial oxygen consumption increases as which of the following parameters increase? 1. Preload, afterload, & cerebral blood flow 2. Preload, afterload, & renal blood flow 3. Preload, afterload, contractility, & heart rate. 4. Preload, afterload, cerebral blood flow, & heart rate. - correct answer ✔✔3. Myocardial oxygen consumption increases as preload, afterload, renal contractility, & heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption. Which of the following positions would best aid breathing for a pt with acute pulmonary edema? 1. Lying flat in bed 2. Left side-lying 3. In high Fowler's position 4. In semi-Fowler's position - correct answer ✔✔3. A high Fowler's position promotes ventilation & facilitates breathing by reducing venous return. Lying flat & side-lying positions worsen the breathing & increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as the Fowler's position will. Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia - correct answer ✔✔4. In an attempt to compensate for increased work of breathing due to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the condition persists, CO2 retention occurs & hypercapnia results. Which of the following is a compensatory response to decreased cardiac output? 1. Decreased BP 2. Alteration in LOC 3. Decreased BP & diuresis 4. Increased BP & fluid retention - correct answer ✔✔4. The body compensates for a decrease in cardiac output w/ a rise in BP, due to the stimulation of the sympathetic NS & an increase in blood volume as the kidneys retain sodium & water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists. Which of the following actions is the appropriate initial response to a pt coughing up pink, frothy sputum? 1. Call for help 2. Call the physician 3. Start an I.V. line 4. Suction the pt - correct answer ✔✔1. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the pt is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions would immediately follow. Which of the following terms describes the force against which the ventricle must expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload - correct answer ✔✔1. Afterload refers to the resistance normally maintained by the aortic & pulmonic valves, the condition & tone of the aorta, & the resistance offered by the systemic & pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole. Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle - correct answer ✔✔3. The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is damaged, the output decreases & fluid accumulates in the interstitial & alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium & right ventricle were damaged, right-sided heart failure would result. An 18-year-old pt who recently had an URI is admitted with suspected rheumatic fever. Which assessment findings confirm this diagnosis? 1. Recent URI 2. Nutritional anemia 3. Peptic ulcer disease 4. A-Fib - correct answer ✔✔3. Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, & hypervolemia. A nurse is preparing for the admission of a pt with heart failure who is being sent directly to the hospital from the physician's office. The nurse would plan on having which of the following meds readily available for use? 1. Diltiazem (Cardizem) 2. Digoxin (Lanoxin) 3. Propranolol (Inderal) 4. Metoprolol (Lopressor) - correct answer ✔✔2. Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the med of choice to treat heart failure. Diltiazem (calcium channel blocker) & propranolol & metoprolol (beta blockers) have a negative inotropic effect & would worsen the failing heart. A nurse caring for a pt in one room is told by another nurse that a second pt has developed severe pulmonary edema. On entering the 2nd pt's room, the nurse would expect the pt to be: 1. Slightly anxious 2. Mildly anxious 3. Moderately anxious 4. Extremely anxious - correct answer ✔✔4. Pulmonary edema causes the pt to be extremely agitated & anxious. The pt may complain of a sense of drowning, suffocation, or smothering. A pt with pulmonary edema has been on diuretic therapy. The pt has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the pt also will be started on Digoxin (Lanoxin), a nurse checks the pt's most recent: 1. Digoxin level 2. Sodium level 3. Potassium level 4. Creatinine level - correct answer ✔✔3. The serum potassium level is measured in the pt receiving digoxin & furosemide. Heightened digitalis effect leading to digoxin toxicity can occur in the pt w/ hypokalemia. Hypokalemia also predisposes the pt to ventricular dysrhythmias. A pt who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The pt received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL & the serum creatinine is 2.2 mg/dL. A nurse interprets the pt is at risk for: 1. Hypovolemia 2. UTI 3. Glomerulonephritis 4. Acute renal failure - correct answer ✔✔4. The pt who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor med therapy. Renal insult is signaled by decreased urine output, & increased BUN & creatinine levels. The pt may need meds such as dopamine (Intropin) to increase renal perfusion & possibly could need peritoneal dialysis or hemodialysis. A nurse is preparing to ambulate a pt on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the pt to best tolerate the ambulation? 1. Encourage the pt to cough & deep breathe 2. Premedicate the pt with an analgesic 3. Provide the pt with a walker 4. Remove telemetry equipment because it weighs down the hospital gown. - correct answer ✔✔2. The nurse should encourage regular use of pain med for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, & allow better participation in activities such as coughing, deep breathing, & ambulation. Options 1 & 3 will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed. A pt's electrocardiogram strip shows atrial & ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, & the QRS complex measures 0.08 second. The nurse interprets this rhythm is: 1. Normal sinus rhythm 2. Sinus bradycardia 3. Sinus tachycardia 4. Sinus dysrhythmia - correct answer ✔✔1 A pt has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: 1. It is uncomfortable for the pt, giving a sense of impending doom. 2. It produces a high cardiac output that quickly leads to cerebral & myocardial ischemia. 3. It is almost impossible to convert to a normal sinus rhythm. 4. It can develop into ventricular fibrillation at any time. - correct answer ✔✔4. Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral & myocardial ischemia. Pt's frequently experience a feeling of impending death. Ventricular tachycardia is treated w/ antidysrhythmic meds or magnesium sulfate, cardioversion (pt awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time. A home care nurse is making a routine visit to a pt receiving digoxin (Lanoxin) in the treatment of heart failure. The nurse would particularly assess the pt for: 1. Thrombocytopenia & weight gain 2. Anorexia, nausea, & visual disturbances 3. Diarrhea & hypotension 4. Fatigue & muscle twitching - correct answer ✔✔2. The first signs & symptoms of digoxin toxicity in adults include abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, & other dysrhythmias. A pt with angina complains that the angina pain is prolonged & severe & occurs at the same time each day, most often in the morning, On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as: 1. Stable angina 2. Unstable angina 3. Variant angina 4. Nonanginal pain - correct answer ✔✔3. Stable angina is induced by exercise & is relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower & lower levels of activity & rest, is less predictable, & is often a precursor of myocardial infarction. Variant angina, or Prinzmetal's angina, is prolonged & severe & occurs at the same time each day, most often in the morning. 2. Impaired skin integrity related to pressure 3. Activity intolerance related to pump failure 4. Constipation related to immobility - correct answer ✔✔3. Activity intolerance is a primary problem for pts w/ heart failure & pulmonary edema. The decreased cardiac output associated w/ heart failure leads to reduced oxygen & fatigue. Pts frequently complain of dyspnea & fatigue. The pt could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the pt w/ HF & pulmonary edema, nor is constipation related to immobility. Captopril may be administered to a pt with HF because it acts as a: 1. Vasopressor 2. Volume expander 3. Vasodilator 4. Potassium-sparing diuretic - correct answer ✔✔3. ACE inhibitors have become the vasodilators of choice in the pt w/ mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt heart failure. Furosemide is administered intravenously to a pt with HF. How soon after administration should the nurse begin to 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 - correct answer ✔✔1. After IV injection of furosemide, diuresis normally begins in about 5 minutes & reaches its peak w/in about 30 minutes. Med effects last 2 - 4 hours. 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 - correct answer ✔✔2. Canned foods & juices, such as tomato juice, are typically high in sodium & should be avoided in a sodium-restricted diet. BRING ON THE STEAK! 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 - correct answer ✔✔2. A normal apical impulse is found under over the apex of the heart & is typically located & auscultated in the left fifth intercostal space in the midclavicular line. An apical impulse located or auscultated below the fifth intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement.