NCLEX-RN: Cardiovascular Practice Questions, Exams of Nursing

Download NCLEX-RN: Cardiovascular Practice Questions and more Exams Nursing in PDF only on Docsity! Exam 2: Cardiac Practice Questions NCLEX NCLEX-RN: Cardiovascular Practice Questions Latest Updated 2024/2025 A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure? a. A 36-year-old woman with aortic stenosis b. A 42-year-old man with pulmonary hypertension c. A 59-year-old woman who smokes cigarettes daily d. A 70-year-old man who had a cerebral vascular accident - Correct Answer a. A 36-year-old woman with aortic stenosis Although most people with heart failure will have failure that progresses from left to right, it is possible to have left-sided failure alone for a short period. It is also possible to have heart failure that progresses from right to left. Causes of left ventricular failure include mitral or aortic valve disease, coronary artery disease, and hypertension. Pulmonary hypertension and chronic cigarette smoking are risk factors for right ventricular failure. A cerebral vascular accident does not increase the risk of heart failure. A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? a. I have been drinking more water than usual. b. I am awakened by the need to urinate at night. c. I must stop halfway up the stairs to catch my breath. d. I have experienced blurred vision on several occasions. - Correct Answerc. I must stop halfway up the stairs to catch my breath. Clients with left-sided heart failure report weakness or fatigue while performing normal activities of daily living, as well as difficulty breathing, or catching their breath. This occurs as fluid moves into the alveoli. Nocturia is often seen with right-sided heart failure. Thirst and blurred vision are not related to heart failure. A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure? a. I sleep with four pillows at night. b. My shoes fit really tight lately. c. I wake up coughing every night. d. I have trouble catching my breath. - Correct Answerb. My shoes fit really tight lately. Signs of systemic congestion occur with right-sided heart failure. Fluid is retained, pressure builds in the venous system, and peripheral edema develops. Left-sided heart failure symptoms include respiratory symptoms. Orthopnea, coughing, and difficulty breathing all could be results of left-sided heart failure. While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. Which action should the nurse take next? a. Assess for symptoms of left-sided heart failure. b. Document this as a normal finding. c. Call the health care provider immediately. d. Transfer the client to the intensive care unit. - Correct Answera. Assess for symptoms of left-sided heart failure. The presence of an S3 gallop is an early diastolic filling sound indicative of increasing left ventricular pressure and left ventricular failure. The other actions are not warranted. A nurse cares for a client with right-sided heart failure. The client asks, Why do I need to weigh myself every day? How should the nurse respond? a. Weight is the best indication that you are gaining or losing fluid. b. Daily weights will help us make sure that you're eating properly. c. The hospital requires that all inpatients be weighed daily. d. You need to lose weight to decrease the incidence of heart failure. - Correct Answera. Weight is the best indication that you are gaining or losing fluid. Daily weights are needed to document fluid retention or fluid loss. One liter of fluid equals 2.2 pounds. The other responses do not address the importance of monitoring fluid retention or loss. A nurse is teaching a client with heart failure who has been prescribed enalapril (Vasotec). Which statement should the nurse include in this clients teaching? a. Avoid using salt substitutes. b. Take your medication with food. c. Avoid using aspirin-containing products. d. Check your pulse daily. - Correct Answera. Avoid using salt substitutes. Angiotensin-converting enzyme (ACE) inhibitors such as enalapril inhibit the excretion of potassium. Hyperkalemia can be a life-threatening side effect, and clients should be taught to limit potassium intake. Salt substitutes are composed of potassium chloride. ACE inhibitors do not need to be taken with food and have no impact on the clients pulse rate. Aspirin is often prescribed in conjunction with ACE inhibitors and is not contraindicated. A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, "Why will I need to take anticoagulants for the rest of my life?" How should the nurse respond? a. The prosthetic valve places you at greater risk for a heart attack. b. Blood clots form more easily in artificial replacement valves. c. The vein taken from your leg reduces circulation in the leg. d. The surgery left a lot of small clots in your heart and lungs. - Correct Answerb. Blood clots form more easily in artificial replacement valves. Synthetic valve prostheses and scar tissue provide surfaces on which platelets can aggregate easily and initiate the formation of blood clots. The other responses are inaccurate. After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the client's understanding. Which client statement indicates a need for additional teaching? a. I'll be able to carry heavy loads after 6 months of rest. b. I will have my teeth cleaned by my dentist in 2 weeks. c. I must avoid eating foods high in vitamin K, like spinach. d. I must use an electric razor instead of a straight razor to shave. - Correct Answerb. I will have my teeth cleaned by my dentist in 2 weeks. Clients who have defective or repaired valves are at high risk for endocarditis. The client who has had valve surgery should avoid dental procedures for 6 months because of the risk for endocarditis. When undergoing a mitral valve replacement surgery, the client needs to be placed on anticoagulant therapy to prevent vegetation forming on the new valve. Clients on anticoagulant therapy should be instructed on bleeding precautions, including using an electric razor. If the client is prescribed warfarin, the client should avoid foods high in vitamin K. Clients recovering from open heart valve replacements should not carry anything heavy for 6 months while the chest incision and muscle heal. A nurse cares for a client with infective endocarditis. Which infection control precautions should the nurse use? a. Standard Precautions b. Bleeding precautions c. Reverse isolation d. Contact isolation - Correct Answera. Standard Precautions The client with infective endocarditis does not pose any specific threat of transmitting the causative organism. Standard Precautions should be used. Bleeding precautions or reverse or contact isolation is not necessary. A nurse assesses a client with pericarditis. Which assessment finding should the nurse expect to find? a. Heart rate that speeds up and slows down b. Friction rub at the left lower sternal border c. Presence of a regular gallop rhythm d. Coarse crackles in bilateral lung bases - Correct Answerb. Friction rub at the left lower sternal border The client with pericarditis may present with a pericardial friction rub at the left lower sternal border. This sound is the result of friction from inflamed pericardial layers when they rub together. The other assessments are not related. After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, "Why is this important? How should the nurse respond?" a. Rapid position changes can create shear and friction forces, which can tear out your internal vascular sutures. b. Your new vascular connections are more sensitive to position changes, leading to increased intravascular pressure and dizziness. c. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes. d. While your heart is recovering, blood flow is diverted away from the brain, increasing the risk for stroke when you stand up. - Correct Answerc. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes. Because the new heart is denervated, the baroreceptor and other mechanisms that compensate for blood pressure drops caused by position changes do not function. This allows orthostatic hypotension to persist in the postoperative period. The other options are false statements and do not correctly address the clients question. A nurse teaches a client recovering from a heart transplant who is prescribed cyclosporine (Sandimmune). Which statement should the nurse include in this clients discharge teaching? a. Use a soft-bristled toothbrush and avoid flossing. b. Avoid large crowds and people who are sick. c. Change positions slowly to avoid hypotension. d. Check your heart rate before taking the medication. - Correct Answerb. Avoid large crowds and people who are sick. These agents cause immune suppression, leaving the client more vulnerable to infection. The medication does not place the client at risk for bleeding, orthostatic hypotension, or a change in heart rate. A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, I know a transplant is my last chance, but I dont want to become a vegetable. How should the nurse respond? a. Would you like to speak with a priest or chaplain? b. I will arrange for a psychiatrist to speak with you. c. Do you want to come off the transplant list? d. Would you like information about advance directives? - Correct Answerd. Would you like information about advance directives? The client is verbalizing a real concern or fear about negative outcomes of the surgery. This anxiety itself can have a negative effect on the outcome of the surgery because of sympathetic stimulation. The best action is to allow the client to verbalize the concern and work toward a positive outcome without making the client feel as though he or she is crazy. The client needs to feel that he or she has some control over the future. The nurse personally provides care to address the clients concerns instead of pushing the clients issues off on a chaplain or psychiatrist. The nurse should not jump to conclusions and suggest taking the client off the transplant list, which is the best treatment option. A nurse assesses a client who has a history of heart failure. Which question should the nurse ask to assess the extent of the clients heart failure? a. Do you have trouble breathing or chest pain? b. Are you able to walk upstairs without fatigue? c. Do you awake with breathlessness during the night? d. Do you have new-onset heaviness in your legs? - Correct Answerb. Are you able to walk upstairs without fatigue? Clients with a history of heart failure generally have negative findings, such as shortness of breath. The nurse needs to determine whether the clients activity is the same or worse, or whether the client identifies a decrease in activity level. Trouble breathing, chest pain, breathlessness at night, and peripheral edema are symptoms of heart failure, but do not provide data that can determine the extent of the clients heart failure. A nurse cares for an older adult client with heart failure. The client states, "I don't know what to do. I don't want to be a burden to my daughter, but I cant do it alone. Maybe I should die." How should the nurse respond? a. Would you like to talk more about this? b. You are lucky to have such a devoted daughter. c. It is normal to feel as though you are a burden. d. Would you like to meet with the chaplain? - Correct Answera. Would you like to talk more about this? b. A 42-year-old man recovering from coronary artery bypass graft surgery c. A 59-year-old woman recovering from a hysterectomy d. An 80-year-old man with a bacterial infection of the respiratory tract e. An 88-year-old woman with a stage III sacral ulcer - Correct Answera. A 36- year-old woman with systemic lupus erythematosus (SLE) b. A 42-year-old man recovering from coronary artery bypass graft surgery d. An 80-year-old man with a bacterial infection of the respiratory tract Acute pericarditis is most commonly associated acute exacerbations of systemic connective tissue disease, including SLE; with Dresslers syndrome, or inflammation of the cardiac sac after cardiac surgery or a myocardial infarction; and with infective organisms, including bacterial, viral, and fungal infections. Abdominal and reproductive surgeries and pressure ulcers do not increase clients risk for acute pericarditis. After teaching a client with congestive heart failure (CHF), the nurse assesses the clients understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.) a. I'll read the nutritional labels on food items for salt content. b. I will drink at least 3 liters of water each day. c. Using salt in moderation will reduce the workload of my heart. d. I will eat oatmeal for breakfast instead of ham and eggs. e. Substituting fresh vegetables for canned ones will lower my salt intake. - Correct Answera. I'll read the nutritional labels on food items for salt content. d. I will eat oatmeal for breakfast instead of ham and eggs. e. Substituting fresh vegetables for canned ones will lower my salt intake. Nutritional therapy for a client with CHF is focused on decreasing sodium and water retention to decrease the workload of the heart. The client should be taught to read nutritional labels on all food items, omit table salt and foods high in sodium (e.g., ham and canned foods), and limit water intake to a normal 2 L/day. A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client with congestive heart failure. Which instructions should the nurse provide to the UAP when delegating care for this client? (Select all that apply.) a. Reposition the client every 2 hours. b. Teach the client to perform deep-breathing exercises. c. Accurately record intake and output. d. Use the same scale to weigh the client each morning. e. Place the client on oxygen if the client becomes short of breath. - Correct Answera. Reposition the client every 2 hours. c. Accurately record intake and output. d. Use the same scale to weigh the client each morning. The UAP should reposition the client every 2 hours to improve oxygenation and prevent atelectasis. The UAP can also accurately record intake and output, and use the same scale to weigh the client each morning before breakfast. UAPs are not qualified to teach clients or assess the need for and provide oxygen therapy. A nurse prepares to discharge a client who has heart failure. Based on the Heart Failure Core Measure Set, which actions should the nurse complete prior to discharging this client? (Select all that apply.) a. Teach the client about dietary restrictions. b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor. c. Encourage the client to take a baby aspirin each day. d. Confirm that an echocardiogram has been completed. e. Consult a social worker for additional resources. - Correct Answera. Teach the client about dietary restrictions. b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor. d. Confirm that an echocardiogram has been completed. The Heart Failure Core Measure Set includes discharge instructions on diet, activity, medications, weight monitoring and plan for worsening symptoms, evaluation of left ventricular systolic function (usually with an echocardiogram), and prescribing an ACE inhibitor or angiotensin receptor blocker. Aspirin is not part of the Heart Failure Core Measure Set and is usually prescribed for clients who experience a myocardial infarction. Although the nurse may consult the social worker or case manager for additional resources, this is not part of the Core Measures. A nurse prepares to discharge a client who has heart failure. Which questions should the nurse ask to ensure this clients safety prior to discharging home? (Select all that apply.) a. Are your bedroom and bathroom on the first floor? b. What social support do you have at home? c. Will you be able to afford your oxygen therapy? d. What spiritual beliefs may impact your recovery? e. Are you able to accurately weigh yourself at home? - Correct Answera. Are your bedroom and bathroom on the first floor? b. What social support do you have at home? d. What spiritual beliefs may impact your recovery? To ensure safety upon discharge, the nurse should assess for structural barriers to functional ability, such as stairs. The nurse should also assess the clients available social support, which may include family, friends, and home health services. The clients ability to adhere to medication and treatments, including daily weights, should also be reviewed. The other questions do not address the clients safety upon discharge. A nurse assesses a client who is recovering from a heart transplant. Which assessment findings should alert the nurse to the possibility of heart transplant rejection? (Select all that apply.) a. Shortness of breath b. Abdominal bloating c. New onset bradycardia d. Increased ejection fraction e. Hypertension - Correct Answera. Shortness of breath b. Abdominal bloating c. New onset bradycardia Clinical manifestations of heart transplant rejection include shortness of breath, fatigue, fluid gain, abdominal bloating, new-onset bradycardia, hypotension, atrial fibrillation or flutter, decreased activity tolerance, and decreased ejection fraction. A nurse assesses a client who is diagnosed with infective endocarditis. Which assessment findings should the nurse expect? (Select all that apply.) a. Weight gain b. Night sweats c. Cardiac murmur d. Abdominal bloating e. Oslers nodes - Correct Answerb. Night sweats c. Cardiac murmur e. Oslers nodes Clinical manifestations of infective endocarditis include fever with chills, night sweats, malaise and fatigue, anorexia and weight loss, cardiac murmur, and Oslers nodes on palms of the hands and soles of the feet. Abdominal bloating is a manifestation of heart transplantation rejection. A nurse assesses a clients electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation? a. The client has hyperkalemia causing irregular QRS complexes. b. Ventricular tachycardia is overriding the normal atrial rhythm. c. The clients chest leads are not making sufficient contact with the skin. d. Ventricular and atrial depolarizations are initiated from different sites. - Correct Answerd. Ventricular and atrial depolarizations are initiated from different sites. Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization. This finding on an electrocardiograph tracing is not an indication of hyperkalemia, ventricular tachycardia, or disconnection of leads. In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and level of consciousness. The other interventions would not determine if the client is tolerating the loss of capture. A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client? a. Make sure the defibrillator is set to the synchronous mode. b. Administer 1 mg of intravenous epinephrine. c. Test the equipment by delivering a smaller shock at 100 joules. d. Ensure that everyone is clear of contact with the client and the bed. - Correct Answerd. Ensure that everyone is clear of contact with the client and the bed. To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock. A precordial thump can be delivered when no defibrillator is available. Defibrillation is done in asynchronous mode. Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis. Epinephrine should be administered after defibrillation. After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. I should wear a snug-fitting shirt over the ICD. b. I will avoid sources of strong electromagnetic fields. c. I should participate in a strenuous exercise program. d. Now I can discontinue my antidysrhythmic medication. - Correct Answerb. I will avoid sources of strong electromagnetic fields. The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Clients should avoid tight clothing, which could cause irritation over the ICD generator. The client should be encouraged to exercise but should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately. The client should continue all prescribed medications. A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions should the nurse implement to address this clients concerns? a. Administer oxygen therapy at 2 liters per nasal cannula. b. Provide the client with a sleeping pill to stimulate rest. c. Schedule periods of exercise and rest during the day. d. Ask unlicensed assistive personnel to help bathe the client. - Correct Answerc. Schedule periods of exercise and rest during the day. Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living. The nurse should schedule periods of exercise and rest during the day to decrease fatigue. The other interventions will not assist the client with self-care activities. A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion? a. Administer intravenous adenosine. b. Turn off oxygen therapy. c. Ensure a tongue blade is available. d. Position the client on the left side. - Correct Answerb. Turn off oxygen therapy. For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire. The other interventions are not appropriate for a cardioversion. The client should be placed in a supine position. A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge? a. Medication reconciliation b. Immunization history c. Religious beliefs d. Nutrition preferences - Correct Answera. Medication reconciliation The home health nurse needs to know current medications the client is taking to ensure assessment, evaluation, and further education related to these medications. The other information will not assist the nurse to develop a plan of care for the client. A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? a. Mid-sternal chest pain b. Increased urine output c. Mild orthostatic hypotension d. P wave touching the T wave - Correct Answera. Mid-sternal chest pain Chest pain, possibly angina, indicates that tachycardia may be increasing the clients myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain. Increased urinary output and mild orthostatic hypotension are not life-threatening conditions and therefore do not require immediate intervention. The P wave touching the T wave indicates significant tachycardia and should be assessed to determine the underlying rhythm and cause; this is an important assessment but is not as critical as chest pain, which indicates cardiac cell death. A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this clients teaching? a. Minimize or abstain from caffeine. b. Lie on your side until the attack subsides. c. Use your oxygen when you experience PACs. d. Take amiodarone (Cordarone) daily to prevent PACs. - Correct Answera. Minimize or abstain from caffeine. PACs usually have no hemodynamic consequences. For a client experiencing infrequent PACs, the nurse should explore possible lifestyle causes, such as excessive caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen is not necessary. Although medications may be needed to control symptomatic dysrhythmias, for infrequent PACs, the client first should try lifestyle changes to control them. The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, Why do you want to know if I use cocaine? How should the nurse respond? a. Substance abuse puts clients at risk for many health issues. b. The hospital requires that I ask you about cocaine use. c. Clients who use cocaine are at risk for fatal dysrhythmias. d. We can provide services for cessation of substance abuse. - Correct Answerc. Clients who use cocaine are at risk for fatal dysrhythmias. Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias. The other responses do not adequately address the clients question. A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure? a. Clean the skin and clip hairs if needed. b. Add gel to the electrodes prior to applying them. c. Place the electrodes on the posterior chest. d. Turn off oxygen prior to monitoring the client. - Correct AnswerTo ensure the best signal transmission, the skin should be clean and hairs clipped. Electrodes should a. Administer oxygen at 2 L/min. b. Allow continued bathroom privileges. c. Obtain a bedside commode. d. Suggest the client use a bedpan. - Correct AnswerThis clients physiologic parameters did not exceed normal during and after activity, so it is safe for the client to continue using the bathroom. There is no indication that the client needs oxygen, a commode, or a bedpan. A nursing student is caring for a client who had a myocardial infarction. The student is confused because the client states nothing is wrong and yet listens attentively while the student provides education on lifestyle changes and healthy menu choices. What response by the faculty member is best? a. Continue to educate the client on possible healthy changes. b. Emphasize complications that can occur with noncompliance. c. Tell the client that denial is normal and will soon go away. d. You need to make sure the client understands this illness. - Correct Answera. Continue to educate the client on possible healthy changes. Clients are often in denial after a coronary event. The client who seems to be in denial but is compliant with treatment may be using a healthy form of coping that allows time to process the event and start to use problem- focused coping. The student should not discourage this type of denial and coping, but rather continue providing education in a positive manner. Emphasizing complications may make the client defensive and more anxious. Telling the client that denial is normal is placing too much attention on the process. Forcing the client to verbalize understanding of the illness is also potentially threatening to the client. A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 0.5 mm Hg. What action by the nurse is most appropriate? a. Level the transducer at the phlebostatic axis. b. Lay the client in the supine position. c. Prepare to administer diuretics. d. Prepare to administer a fluid bolus. - Correct Answerd. Prepare to administer a fluid bolus. Normal right atrial pressures are from 1 to 8 mm Hg. Lower pressures usually indicate hypovolemia, so the nurse should prepare to administer a fluid bolus. The transducer should remain leveled at the phlebostatic axis. Positioning may or may not influence readings. Diuretics would be contraindicated. 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 Answer2. 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 Answer3. 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 Answer1. 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 Answer4. 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 Answer3. 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 Answer4. 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 4. Renal failure - Correct Answer3. Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel & doesn't cause an MI. Renal failure can be associated w/ MI but isn't a direct cause. Heart failure is usually a result from an MI. Which of the following complications is indicated by a third heart sound (S3)? 1. Ventricular dilation 2. Systemic hypertension 3. Aortic valve malfunction 4. Increased atrial contractions - Correct Answer1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricupsid valve malfunction - Correct Answer1. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial & alveolar spaces in the lungs & causes crackles. Pulmonic & tricuspid valve malfunction causes right sided heart failure. What is the first intervention for a pt experiencing MI? 1. Administer morphine 2. Administer oxygen 4. Decreased myocardial contractility - Correct Answer2. 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 Answer4. 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 Answer1. 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 Answer1. 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 Answer3. 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 Answer1. 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? 1. Pericarditis 2. Hypertension 3. MI 4. Heart failure - Correct Answer4. These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest & auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, & a flushed face. MI causes heart failure but isn't related to these symptoms. In which of the following types of cardiomyopathy does cardiac output remain normal? 1. Dilated 2. Hypertrophic 3. Obliterative 4. Restrictive - Correct Answer2. Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. All of the rest decrease cardiac output. Which of the following cardiac conditions does a fourth heart sound (S4) indicate? 1. Dilated aorta 2. Normally functioning heart 3. Decreased myocardial contractility 4. Failure of the ventricle to eject all of the blood during systole - Correct Answer4. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? 1. Antihypertensives 2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Nitrates - Correct Answer2. By decreasing the heart rate & contractility, beta- blockers improve myocardial filling & cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in pts who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as effective as beta-blockers & cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium. If medical treatments fail, which of the following invasive procedures is necessary for treating cariomyopathy? 1. Cardiac catherization 2. Coronary artery bypass graft (CABG) 3. Heart transplantation 4. Intra-aortic balloon pump (IABP) - Correct Answer3. The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible. Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina - Correct Answer2. The pain of stable angina is predictable in nature, builds gradually, & quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, & lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress. Which of the following types of angina is most closely related with an impending MI? 1. Angina decubitus 2. Chronic stable angina 3. Noctural angina 4. Unstable angina - Correct Answer4. Unstable angina progressively increases in frequency, intensity, & duration & is related to an increased risk of MI w/in 3 to 18 months. Which of the following conditions is the predominant cause of angina? 1. Increased preload 2. Decreased afterload 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium - Correct Answer4. 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? 4. Right ventricle - Correct Answer3. 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. Erythema marginatum, subcutaneous nodules, & fever 2. Tachycardia, finger clubbing, & a load S3 3. Dyspnea, cough, & palpitations 4. Dyspnea, fatigue, & synocope - Correct Answer1. Diagnosis of rheumatic fever requires that the pt have either two major Jones criteria or one minor criterion plus evidence of a previous streptococcal infection. Major criteria include carditis, polyarthritis, Sydenham's chorea, subcutaneous nodules, & erythema maginatum (transient, nonprurtic macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase reactants, & a prolonged PR-interval on ECG. A pt admitted with angina compains of severe chest pain & suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? 1. Activate the resuscitation team 2. Open the pt's airway 3. Check for breathing 4. Check for signs of circulation - Correct Answer1. Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver & check for breathing (looking, listening, & feeling for no more than 10-seconds). If the pt isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse. A 55-year-old pt is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this pt? 1. Anxiety 2. Ineffective tissue perfusion; cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management - Correct Answer2. MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this pt is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute pain, & ineffective therapeutic regimen management are appropriate but don't take priority. A pt comes into the E.R. with acute shortness of breath & a cough that produces pink, frothy sputum. Admission assessment reveals crackles & wheezes, a BP of 85/46, a HR of 122 BPM, & a respiratory rate of 38 breaths/minute. The pt's medical history included DM, HTN, & heart failure. Which of the following disorders should the nurse suspect? 1. Pulmonary edema 2. Pneumothorax 3. Cardiac tamponade 4. Pulmonary embolus - Correct Answer1. SOB, tachypnea, low BP, tachycardia, crackles, & a cough producing pink, frothy sputum are late signs of pulmonary edema. The nurse coming on duty receives the report from the nurse going off duty. Which of the following pts should the on-duty nurse assess first? 1. The 58-year-old pt who was admitted 2 days ago with heart failure, BP of 126/76, & a RR 21 bpm 2. The 88-year-old pt with end-stage right-sided heart failure, BP of 78/50, & a DNR order. 3. The 62-year-old pt who was admitted one day ago with thrombophlebitis & receiving IV heparin. 4. A 76-year-old pt who was admitted 1 hour ago with new-onset atrial fibrillation & is receiving IV diltiazem (Cardizem). - Correct Answer4. The pt w/ A-fib has the greatest potential to become unstable & is on IV med that requires close monitoring. After assessing this pt, the nurse should assess the pt w/ thrombophlebitis who is receiving a heparin infusion, & then go to the 58-year-old pt admitted 2-days ago w/ heart failure (her s/s are resolving & don't require immediate attention). The lowest priority is the 89-year-old w/ end stage right-sided heart failure, who requires time consuming supportive measures. When developing a teaching plan for a pt with endocarditis, which of the following points is most essential for the nurse to include? 1. "Report fever, anorexia, & night sweats to the physician." 2. "Take prophylactic antibiotics after dental work & invasive procedures." 3. "Include potassium rich foods in your diet." 4. "Monitor your pulse regularly." - Correct Answer1. The most essential teaching point is to report signs of relapse, such as fever, anorexia, & night sweats, to the physician. To prevent further endocarditis episodes, prophylactic antibiotics are taken before & sometimes after dental work, childbirth, or GU, GI, or gynecologic procedures. A potassium-rich diet & daily pulse monitoring aren't necessary for a pt w/ endocarditis. A nurse is conducting a health history with a pt with a primary diagnosis of heart failure. Which of the following disorders reported by the pt is unlikely to play a role in exacerbating the heart failure? 1. Recent URI 2. Nutritional anemia 3. Peptic ulcer disease 4. A-Fib - Correct Answer3. 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 Answer2. 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 Answer4. 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 Answer3. 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 in a chair as part of the cardiac rehabilitation program. Severe chest pain should not be present. Which of the following reflects the principle on which a pt's diet will most likely be based during the acute phase of MI? 1. Liquids as ordered 2. Small, easily digested meals 3. Three regular meals per day 4. NPO - Correct Answer2. Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are better tolerated. Fluids are given according to the pt's needs, & sodium restrictions may be prescribed, especially for pts w/ manifestations of heart failure. Cholesterol restrictions may be ordered as well. Pts are not prescribed a diet of liquids only or NPO unless their condition is very unstable. An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: 1. Left ventricular atrophy 2. Irregular heartbeats 3. peripheral vascular occlusion 4. Pacemaker placement - Correct Answer1. In older adults who are less active & do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased dem&s on the myocardial muscle. Which of the following nursing diagnoses would be appropriate for a pt with heart failure? Select all that apply. 1. Ineffective tissue perfusion R/T decreased peripheral blood flow secondary to decreased CI 2. Activity intolerance R/T increased cardiac output. 3. Decreased cardiac output R/T structural & functional changes. 4. Impaired gas exchange R/T decreased sympathetic nervous system activity. - Correct Answer1 & 3. HF is a result of structural & functional abnormalities of the heart tissue muscle. The heart muscle becomes weak & does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle & backs up into the left atrium, & eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition, this pooling leads to thrombus formation & ineffective tissue perfusion because of the decrease in blood flow to the other organs & tissues of the body. Typically, these pts have an ejection fraction of less than 50% & poorly tolerate activity. Activity intolerance is related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity. Which of the following would be a priority nursing diagnosis for the pt with heart failure & pulmonary edema? 1. Risk for infection related to stasis of alveolar secretions 2. Impaired skin integrity related to pressure 3. Activity intolerance related to pump failure 4. Constipation related to immobility - Correct Answer3. 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 Answer3. 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 Answer1. 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 Answer2. 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 Answer2. 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.