1.

Which of the following arteries

primarily feeds the anterior wall of the
heart?

5. Atherosclerosis impedes coronary

blood flow by which of the following
mechanisms?
a. Plaques obstruct the vein

a. Circumflex artery

b. Plaques obstruct the artery

b. Internal mammary artery

c. Blood clots form outside the vessel wall

c. Left anterior descending artery

d. Hardened vessels dilate to allow the blood

to flow through

d. Right coronary artery

2. When do coronary arteries primarily

receive blood flow?

6. Which of the following risk factors for

coronary artery disease cannot be
corrected?

a. During inspiration

a. Cigarette smoking

b. During diastole

b. DM

c. During expiration

c. Heredity

d. During systole

d. HPN

3. Which of the following illnesses is the

leading cause of death in the US?

7. Exceeding which of the following

serum cholesterol levels significantly
increases the risk of coronary artery
disease?

a. Cancer
b. Coronary artery disease
c. Liver failure

a. 100 mg/dl

d. Renal failure

b. 150 mg/dl
c. 175 mg/dl

4. Which of the following conditions most

commonly results in CAD?

d. 200 mg/dl

a. Atherosclerosis
b. DM
c. MI

8. Which of the following actions is the

first priority care for a client exhibiting
signs and symptoms of coronary artery
disease?

d. Renal failure
a. Decrease anxiety
b. Enhance myocardial oxygenation

c. Administer sublignual nitroglycerin

d. Educate the client about his symptoms

1. C. The left anterior descending artery

is the primary source of blood for the
anterior wall of the heart. The
circumflex artery supplies the lateral
wall, the internal mammary artery
supplies the mammary, and the right
coronary artery supplies the inferior
wall of the heart.

6. C. Because heredity refers to our genetic

makeup, it cant be changed.
Cigarettesmoking cessation is a lifestyle
change that involves behavior modification.
Diabetes mellitus is a risk factor that can be
controlled with diet, exercise, and medication.
Altering ones diet, exercise, and medication
can correct hypertension.

7. D. Cholesterol levels above 200 mg/dl are

considered excessive. They require dietary
restriction and perhaps medication. Exercise
also helps reduce cholesterol levels. The other
levels listed are all below the nationally
accepted levels for cholesterol and carry a
lesser risk for CAD.

2. B. Although the coronary arteries may

receive a minute portion of blood during
systole, most of the blood flow to coronary
arteries is supplied during diastole. Breathing
patterns are irrelevant to blood flow

3. B. Coronary artery disease accounts for

over 50% of all deaths in the US. Cancer
accounts for approximately 20%. Liver failure
and renal failure account for less than 10% of
all deaths in the US.

4. A. Atherosclerosis, or plaque formation, is

the leading cause of CAD. DM is a risk factor
for CAD but isnt the most common cause.
Renal failure doesnt cause CAD, but the two
conditions are related. Myocardial infarction is
commonly a result of CAD.

8. B. Enhancing myocardial oxygenation is

always the first priority when a client exhibits
signs and symptoms of cardiac compromise.
Without adequate oxygen, the myocardium
suffers damage. Sublingual nitorglycerin is
administered to treat acute angina, but its
administration isnt the first priority. Although
educating the client and decreasing anxiety
are important in care delivery, nether are
priorities when a client is compromised.

9. Medical treatment of coronary artery

disease includes which of the following
procedures?
a. Cardiac catheterization
b. Coronary artery bypass surgery
c. Oral medication administration

5. B. Arteries, not veins, supply the coronary

arteries with oxygen and other nutrients.
Atherosclerosis is a direct result of plaque
formation in the artery. Hardened vessels
cant dilate properly and, therefore, constrict
blood flow.

d. Percutaneous transluminal coronary

angioplasty

10. Prolonged occlusion of the right

coronary artery produces an infarction in
which of he following areas of the heart?
a. Anterior
b. Apical

c. Inferior

d. Tricuspid

d. Lateral
15. Which of the following blood tests is
most indicative of cardiac damage?
11. Which of the following is the most
common symptom of myocardial
infarction?

a. Lactate dehydrogenase
b. Complete blood count

a. Chest pain
c. Troponin I
b. Dyspnea
d. Creatine kinase
c. Edema
d. Palpitations
16. What is the primary reason for
administering morphine to a client with
myocardial infarction?
12. Which of the following landmarks is
the corect one for obtaining an apical
pulse?

a. To sedate the client

b. To decrease the clients pain

a. Left intercostal space, midaxillary line

c. To decrease the clients anxiety
b. Left fifth intercostal space, midclavicular
line

d. To decrease oxygen demand on the clients

heart

c. Left second intercostal space, midclavicular

line
d. Left seventh intercostal space,
midclavicular line

13. Which of the following systems is the

most likely origin of pain the client
describes as knifelike chest pain that
increases in intensity with inspiration?

9. C. Oral medication administration is a

noninvasive, medical treatment for coronary
artery disease. Cardiac catheterization isnt a
treatment but a diagnostic tool. Coronary
artery bypass surgery and percutaneous
transluminal coronary angioplasty are
invasive, surgical treatments.

a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary

14. A murmur is heard at the second left

intercostal space along the left sternal
border. Which valve area is this?
a. Aortic
b. Mitral
c. Pulmonic

10. C. The right coronary artery supplies the

right ventricle, or the inferior portion of the
heart. Therefore, prolonged occlusion could
produce an infarction in that area. The right
coronary artery doesnt supply the anterior
portion (left ventricle), lateral portion (some
of the left ventricle and the left atrium), or the
apical portion (left ventricle) of the heart.
11. A. The most common symptom of an MI is
chest pain, resulting from deprivation of
oxygen to the heart. Dyspnea is the second
most common symptom, related to an
increase in the metabolic needs of the body
during an MI. Edema is a later sign of heart
failure, often seen after an MI. Palpitations

may result from reduced cardiac output,

producing arrhythmias.
12. B. The correct landmark for obtaining an
apical pulse is the left intercostal space in the
midclavicular line. This is the point of
maximum impulse and the location of the left
ventricular apex. The left second intercostal
space in the midclavicular line is where the
pulmonic sounds are auscultated. Normally,
heart sounds arent heard in the midaxillary
line or the seventh intercostal space in the
midclavicular line.
13. D. Pulmonary pain is generally described
by these symptoms. Musculoskeletal pain only
increase with movement. Cardiac and GI pains
dont change with respiration.

14. C. Abnormalities of the pulmonic valve are

auscultated at the second left intercostal
space along the left sternal border. Aortic
valve abnormalities are heard at the second
intercostal space, to the right of the sternum.
Mitral valve abnormalities are heard at the
fifth intercostal space in the midclavicular
line. Tricuspid valve abnormalities are heard
at the third and fourth intercostal spaces
along the sternal border.

d. Renal failure

18. What supplemental medication is

most frequently ordered in conjunction
with furosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium

19. After myocardial infarction, serum

glucose levels and free fatty acids are
both increase. What type of physiologic
changes are these?
a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic

15. C. Troponin I levels rise rapidly and are

detectable within 1 hour of myocardial injury.
Troponin I levels arent detectable in people
without cardiac injury. Lactate dehydrogenase
is present in almost all body tissues and not
specific to heart muscle. LDH isoenzymes are
useful in diagnosing cardiac injury. CBC is
obtained to review blood counts, and a
complete chemistry is obtained to review
electrolytes. Because CK levles may rise with
skeletal muscle injury, CK isoenzymes are
required to detect cardiac injury.
16. D. Morphine is administered because it
decreases myocardial oxygen demand.
Morphine will also decrease pain and anxiety
while causing sedation, but isnt primarily
given for those reasons.

17. Which of the following conditions is

most commonly responsible for
myocardial infarction?
a. Aneurysm
b. Heart failure
c. Coronary artery thrombosis

20. Which of the following complications

is indicated by a third heart sound (S3)?
a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions

21. After an anterior wall myocardial

infarction, which of the following
problems is indicated by auscultation of
crackles in the lungs?
a. Left-sided heart failure
b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricuspid valve malfunction

22. Which of the following diagnostic

tools is most commonly used to
determine the location of myocardial
damage?
a. Cardiac catheterization

18. C. Supplemental potassium is given with

furosemide because of the potassium loss
that occurs as a result of this diuretic.
Chloride and sodium arent loss during
diuresis. Digoxin acts to increase contractility
but isnt given routinely with furosemide.

b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram

23. What is the first intervention for a

client experiencing myocardial
infarction?

19. D. Both glucose and fatty acids are

metabolites whose levels increase after a
myocardial infarction. Mechanical changes are
those that affect the pumping action of the
heart, and electro physiologic changes affect
conduction. Hematologic changes would
affect the blood.

a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram

24. What is the most appropriate nursing

response to a myocardial infarction client
who is fearful of dying?
a. Tell me about your feeling right now.
b. When the doctor arrives, everything will
be fine.
c. This is a bad situation, but youll feel
better soon.
d. Please be assured were doing everything
we can to make you feel better.

17. C. Coronary artery thrombosis causes

occlusion of the artery, leading to myocardial
death. An aneurysm is an outpouching of a
vessel and doesnt cause an MI. Renal failure
can be associated with MI but isnt a direct
cause. Heart failure is usually the result of an
MI.

20. A. Rapid filling of the ventricles causes

vasodilation that is auscultated as S3.
Increased atrial contraction or systemic
hypertension can result is a fourth heart
sound. Aortic valve malfunction is heard as a
murmur.

21. A. The left ventricle is responsible for the

most of the cardiac output. An anterior wall MI
may result in a decrease in left ventricular
function. When the left ventricle doesnt
function properly, resulting in left-sided heart
failure, fluid accumulates in the interstitial
and alveolar spaces in the lungs and causes
crackles. Pulmonic and tricuspid valve
malfunction causes right-sided heart failure.

22. D. The ECG is the quickest, most accurate,

and most widely used tool to determine the
location of myocardial infarction. Cardiac
enzymes are used to diagnose MI but cant
determine the location. An echocardiogram is
used most widely to view myocardial wall
function after an MI has been diagnosed.
Cardiac catheterization is an invasive study
for determining coronary artery disease and
may also indicate the location of myocardial
damage, but the study may not be performed
immediately.

23. B. Administering supplemental oxygen to

the client is the first priority of care. The
myocardium is deprived of oxygen during an
infarction, so additional oxygen is
administered to assist in oxygenation and
prevent further damage. Morphine and
sublingual nitroglycerin are also used to treat
MI, but theyre more commonly administered

after the oxygen. An ECG is the most common

diagnostic tool used to evaluate MI.

24. A. Validation of the clients feelings is the

most appropriate response. It gives the client
a feeling of comfort and safety. The other
three responses give the client false hope. No
one can determine if a client experiencing MI
will feel or get better and therefore, these
responses are inappropriate.

27. With which of the following disorders

is jugular vein distention most
prominent?
a. Abdominal aortic aneurysm
b. Heart failure
c. Myocardial infarction
d. Pneumothorax

25. Which of the following classes of

medications protects the ischemic
myocardium by blocking catecholamines
and sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates

28. What position should the nurse place

the head of the bed in to obtain the most
accurate reading of jugular vein
distention?
a. High-fowlers
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position

29. Which of the following parameters

should be checked before administering
digoxin?
a. Apical pulse
26. What is the most common
complication of a myocardial infarction?

b. Blood pressure

a. Cardiogenic shock

c. Radial pulse

b. Heart failure

d. Respiratory rate

c. Arrhythmias
d. Pericarditis

30. Toxicity from which of the following

medications may cause a client to see a
green halo around lights?
a. Digoxin
b. Furosemide
c. Metoprolol
d. Enalapril

31. Which ofthe following symptoms is

most commonly associated with leftsided heart failure?

client is supine or when the head of the bed is

raised 10 degrees because the point that
marks the pressure level is above the jaw
(therefore, not visible). In high Fowlers
position, the veins would be barely discernible
above the clavicle.

a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension

25. A. Beta-adrenergic blockers work by

blocking beta receptors in the myocardium,
reducing the response to catecholamines and
sympathetic nerve stimulation. They protect
the myocardium, helping to reduce the risk of
another infarction by decreasing the workload
of the heart and decreasing myocardial
oxygen demand. Calcium channel blockers
reduce the workload of the heart by
decreasing the heart rate. Narcotics reduce
myocardial oxygen demand, promote
vasodilation, and decreased anxiety. Nitrates
reduce myocardial oxygen consumption by
decreasing left ventricular end-diastolic
pressure (preload) and systemic vascular
resistance (afterload).

26. C. Arrhythmias, caused by oxygen

deprivation to the myocardium, are the most
common complication of an MI. cardiogenic
shock, another complication of MI, is defined
as the end stage of left ventricular
dysfunction. The condition occurs in
approximately 15% of clients with MI. Because
the pumping function of the heart is
compromised by an MI, heart failure is the
second most common complication.
Pericarditis most commonly results from a
bacterial of viral infection but may occur after
MI.

27. B. Elevated venous pressure, exhibited as

jugular vein distention, indicates a failure of
the heart to pump. Jugular vein distention
isnt a symptom of abdominal aortic
aneurysm or pneumothorax. An MI, if severe
enough, can progress to heart failure;
however, in and of itself, an MI doesnt cause
jugular vein distention.

28. C. Jugular venous pressure is measured

with a centimeter ruler to obtain the vertical
distance between the sternal angle and the
point of highest pulsation with the head of the
bed inclined between 15 and 30 degrees.
Inclined pressure cant be seen when the

29. A. An apical pulse is essential or

accurately assessing the clients heart rate
before administering digoxin. The apical pulse
is the most accurate point in the body. Blood
pressure is usually only affected if the heart
rate is too low, in which case the nurse would
withhold digoxin. The radial pulse can be
affected by cardiac and vascular disease and
therefore, wont always accurately depict the
heart rate. Digoxin has no effect on
respiratory function.

30. A. One of the most common signs of

digoxin toxicity is the visual disturbance
known as the green halo sign. The other
medications arent associated with such an
effect.

31. A. Crackles in the lungs are a classic sign

of left-sided heart failure. These sounds are
caused by fluid backing up into the pulmonary
system. Arrhythmias can be associated with
both right and left-sided heart failure. Leftsided heart failure causes hypertension
secondary to an increased workload on the
system.

32. In which of the following disorders

would the nurse expect to assess sacral
edema in bedridden client?
a. DM
b. Pulmonary emboli
c. Renal failure
d. Right-sided heart failure

33. Which of the following symptoms

might a client with right-sided heart
failure exhibit?
a. Adequate urine output
b. Polyuria

c. Oliguria
d. Polydipsia

38. In which of the following areas is an

abdominal aortic aneurysm most
commonly located?

34. Which of the following classes of

medications maximizes cardiac
performance in clients with heat failure
by increasing ventricular contractility?

a. Distal to the iliac arteries

b. Distal to the renal arteries
c. Adjacent to the aortic branch

a. Beta-adrenergic blockers
d. Proximal to the renal arteries
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents

35. Stimulation of the sympathetic

nervous system produces which of the
following responses?

39. A pulsating abdominal mass usually

indicates which of the following
conditions?
a. Abdominal aortic aneurysm

a. Bradycardia
b. Enlarged spleen
b. Tachycardia
c. Gastic distention
c. Hypotension
d. Gastritis
d. Decreased myocardial contractility

36. Which of the following conditions is

most closely associated with weight
gain, nausea, and a decrease in urine
output?
a. Angina pectoris
b. Cardiomyopathy
c. Left-sided heart failure
d. Right-sided heart failure

32. D. The most accurate area on the body to

assed dependent edema in a bedridden client
is the sacral area. Sacral, or dependent,
edema is secondary to right-sided heart
failure. Diabetes mellitus, pulmonary emboli,
and renal disease arent directly linked to
sacral edema.

37. What is the most common cause of

abdominal aortic aneurysm?
a. Atherosclerosis
b. DM
c. HPN
d. Syphilis

33. C. Inadequate deactivation of aldosterone

by the liver after right-sided heart failure
leads to fluid retention, which causes oliguria.
Adequate urine output, polyuria, and
polydipsia arent associated with right-sided
heart failure.

34. D. Inotropic agents are administered to

increase the force of the hearts contractions,
thereby increasing ventricular contractility
and ultimately increasing cardiac output.
Beta-adrenergic blockers and calcium channel
blockers decrease the heart rate and
ultimately decrease the workload of the heart.
Diuretics are administered to decrease the
overall vascular volume, also decreasing the
workload of the heart.

40. What is the most common symptom

in a client with abdominal aortic
aneurysm?
a. Abdominal pain
b. Diaphoresis
c. Headache

35. B. Stimulation of the sympathetic nervous

system causes tachycardia and increased
contractility. The other symptoms listed are
related to the parasympathetic nervous
system, which is responsible for slowing the
heart rate.

d. Upper back pain

41. Which of the following symptoms

usually signifies rapid expansion and
impending rupture of an abdominal
aortic aneurysm?

36. D. Weight gain, nausea, and a decrease in

urine output are secondary effects of rightsided 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 doesnt cause
weight gain, nausea, or a decrease in urine
output.

a. Abdominal pain

37. A. Atherosclerosis accounts for 75% of all

abdominal aortic aneurysms. Plaques build up
on the wall of the vessel and weaken it,
causing an aneurysm. Although the other
conditions are related to the development of
an aneurysm, none is a direct cause.

42. What is the definitive test used to

diagnose an abdominal aortic aneurysm?

b. Absent pedal pulses

c. Angina
d. Lower back pain

a. Abdominal X-ray
b. Arteriogram

38. B. The portion of the aorta distal to the

renal arteries is more prone to an aneurysm
because the vessel isnt surrounded by stable
structures, unlike the proximal portion of the
aorta. Distal to the iliac arteries, the vessel is
again surrounded by stable vasculature,
making this an uncommon site for an
aneurysm. There is no area adjacent to the
aortic arch, which bends into the thoracic
(descending) aorta.

39. A. The presence of a pulsating mass in the

abdomen is an abnormal finding, usually
indicating an outpouching in a weakened
vessel, as in abdominal aortic aneurysm. The
finding, however, can be normal on a thin
person. Neither an enlarged spleen, gastritis,
nor gastic distention cause pulsation.

c. CT scan
d. Ultrasound

43. Which of the following complications

is of greatest concern when caring for a
preoperative abdominal aneurysm client?
a. HPN
b. Aneurysm rupture
c. Cardiac arrythmias
d. Diminished pedal pulses

d. Friction rubs

44. Which of the following blood vessel

layers may be damaged in a client with
an aneurysm?

40. A. Abdominal pain in a client with an

abdominal aortic aneurysm results from the
disruption of normal circulation in the
abdominal region. Lower back pain, not upper,
is a common symptom, usually signifying
expansion and impending rupture of the
aneurysm. Headache and diaphoresis arent
associated with abdominal aortic aneurysm.

a. Externa
b. Interna
c. Media
d. Interna and Media

45. When assessing a client for an

abdominal aortic aneurysm, which area
of the abdomen is most commonly
palpated?
a. Right upper quadrant
b. Directly over the umbilicus
c. Middle lower abdomen to the left of the
midline
d. Midline lower abdomen to the right of the
midline

46. Which of the following conditions is

linked to more than 50% of clients with
abdominal aortic aneurysms?

41. D. Lower back pain results from expansion

of the aneurysm. The expansion applies
pressure in the abdominal cavity, and the pain
is referred to the lower back. Abdominal pain
is most common symptom resulting from
impaired circulation. Absent pedal pulses are
a sign of no circulation and would occur after
a ruptured aneurysm or in peripheral vascular
disease. Angina is associated with
atherosclerosis of the coronary arteries.

42. B. An arteriogram accurately and directly

depicts the vasculature; therefore, it clearly
delineates the vessels and any abnormalities.
An abdominal aneurysm would only be visible
on an X-ray if it were calcified. CT scan and
ultrasound dont give a direct view of the
vessels and dont yield as accurate a
diagnosis as the arteriogram.

43. B. Rupture of the aneurysm is a lifethreatening emergency and is of the greatest

concern for the nurse caring for this type of
client. Hypertension should be avoided and
controlled because it can cause the weakened
vessel to rupture. Diminished pedal pulses, a
sign of poor circulation to the lower
extremities, are associated with an aneurysm
but isnt life threatening. Cardiac arrhythmias
arent directly linked to an aneurysm.

a. DM
b. HPN
c. PVD
d. Syphilis

44. C. The factor common to all types of

aneurysms is a damaged media. The media
has more smooth muscle and less elastic
fibers, so its more capable of vasoconstriction
and vasodilation. The interna and externa are
generally no damaged in an aneurysm.

47. Which of the following sounds is

distinctly heard on auscultation over the
abdominal region of an abdominal aortic
aneurysm client?
a. Bruit
b. Crackles
c. Dullness

45. C. The aorta lies directly left of the

umbilicus; therefore, any other region is
inappropriate for palpation.

50. Which hereditary disease is most

closely linked to aneurysm?
a. Cystic fibrosis
b. Lupus erythematosus
c. Marfans syndrome
46. B. Continuous pressure on the vessel walls
from hypertension causes the walls to weaken
and an aneurysm to occur. Atherosclerotic
changes can occur with peripheral vascular
diseases and are linked to aneurysms, but the
link isnt as strong as it is with hypertension.
Only 1% of clients with syphilis experience an
aneurysm. Diabetes mellitus doesnt have
direct link to aneurysm.

47. A. A bruit, a vascular sound resembling

heart murmur, suggests partial arterial
occlusion. Crackles are indicative of fluid in
the lungs. Dullness is heard over solid organs,
such as the liver. Friction rubs indicate
inflammation of the peritoneal surface.

d. Myocardial infarction

51. Which of the following treatments is

the definitive one for a ruptured
aneurysm?
a. Antihypertensive medication administration
b. Aortogram
c. Beta-adrenergic blocker administration
d. Surgical intervention

48. Which of the following groups of

symptoms indicated a ruptured
abdominal aneurysm?
a. Lower back pain, increased BP, decreased
RBC, increased WBC
b. Severe lower back pain, decreased BP,
decreased RBC, increased WBC
c. Severe lower back pain, decreased BP,
decreased RBC, decreased WBC

52. Which of the following heart muscle

diseases is unrelated to other
cardiovascular disease?
a. Cardiomyopathy
b. Coronary artery disease
c. Myocardial infarction
d. Pericardial Effusion

d. Intermittent lower back pain, decreased BP,

decreased RBC, increased WBC

49. Which of the following complications

of an abdominal aortic repair is indicated
by detection of a hematoma in the
perineal area?
a. Hernia
b. Stage 1 pressure ulcer
c. Retroperitoneal rupture at the repair site
d. Rapid expansion of the aneurysm

53. Which of the following types of

cardiomyopathy can be associated with
childbirth?
a. Dilated
b. Hypertrophic
c. Myocarditis
d. Restrictive

aneurysm. Although cystic fibrosis is

hereditary, it hasnt been linked to
aneurysms. Lupus erythematosus isnt
hereditary. Myocardial infarction is neither
hereditary nor a disease.

54. Septal involvement occurs in which

type of cardiomyopathy?

51. D. When the vessel ruptures, surgery is

the only intervention that can repair it.
Administration of antihypertensive
medications and beta-adrenergic blockers can
help control hypertension, reducing the risk of
rupture. An aortogram is a diagnostic tool
used to detect an aneurysm.

a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive

48. B. Severe lower back pain indicates an

aneurysm rupture, secondary to pressure
being applied within the abdominal cavity.
When rupture occurs, the pain is constant
because it cant be alleviated until the
aneurysm is repaired. Blood pressure
decreases due to the loss of blood. After the
aneurysm ruptures, the vasculature is
interrupted and blood volume is lost, so blood
pressure wouldnt increase. For the same
reason, the RBC count is decreased not
increase. The WBC count increases as cells
migrate to the site of injury.

52. A. Cardiomyopathy isnt usually related to

an underlying heart disease such as
atherosclerosis. The etiology in most cases is
unknown. Coronary artery disease and
myocardial infarction are directly related to
atherosclerosis. Pericardial effusion is the
escape of fluid into the pericardial sac, a
condition associated with pericarditis and
advanced heart failure.

53. A. Although the cause isnt entirely

known, cardiac dilation and heart failure may
develop during the last month of pregnancy of
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
isnt specifically associated with childbirth.
Restrictive cardiomyopathy indicates
constrictive pericarditis; the underlying cause
is usually myocardial.

54. C. In hypertrophic cardiomyopathy,

hypertrophy of the ventricular septum not
the ventricle chambers is apparent. This
abnormality isnt seen in other types of
cardiomyopathy.

49. C. Blood collects in the retroperitoneal

space and is exhibited as a hematoma in the
perineal area. This rupture is most commonly
caused by leakage at the repair site. A hernia
doesnt cause vascular disturbances, nor does
a pressure ulcer. Because no bleeding occurs
with rapid expansion of the aneurysm, a
hematoma wont form.

50. C. Marfans syndrome results in the

degeneration of the elastic fibers of the aortic
media. Therefore, clients with the syndrome
are more likely to develop an aortic

55. Which of the following recurring

conditions most commonly occurs in
clients with cardiomyopathy?
a. Heart failure

b. DM

b. Beta-adrenergic blockers

c. MI

c. Calcium channel blockers

d. Pericardial effusion

d. Nitrates

56. What is the term used to describe an

enlargement of the heart muscle?
a. Cardiomegaly
b. Cardiomyopathy
c. Myocarditis
d. Pericarditis

57. Dyspnea, cough, expectoration,

weakness, and edema are classic signs
and symptoms of which of the following
conditions?
a. Pericarditis
b. Hypertension
c. Obliterative
d. Restricitve

59. Which of the following cardiac

conditions does a fourth heart sound
(S4) indicate?
a. Dilated aorta

55. A. Because the structure and function of

the heart muscle is affected, heart failure
most commonly occurs in clients with
cardiomyopathy. Myocardial infarction results
from prolonged myocardial ischemia due to
reduced blood flow through one of the
coronary arteries. Pericardial effusion is most
predominant in clients with percarditis.
Diabetes mellitus is unrelated to
cardiomyopathy.
56. A. Cardiomegaly denotes an enlarged
heart muscle. Cardiomyopathy is a heart
muscle disease of unknown origin. Myocarditis
refers to inflammation of heart muscle.
Pericarditis is an inflammation of the
pericardium, the sac surrounding the heart.

b. Normally functioning heart

c. Decreased myocardial contractility
d. Failure of the ventricle to eject all the blood
during systole

60. Which of the following classes of

drugs is most widely used in the
treatment of cardiomyopathy?
a. Antihypertensive

57. D. These are the classic symptoms of

heart failure. Pericarditis is exhibited by a
feeling of fullness in the chest and
auscultation of a pericardial friction rub.
Hypertension is usually exhibited by
headaches, visual disturbances and a flushed
face. Myocardial infarction causes heart
failure but isnt related to these symptoms.

59. D. An S4 occurs as a result of increased

resistance to ventricular filling adterl atrial
contraction. This increased resistance is
related to decrease compliance of the
ventricle. A dilated aorta doesnt cause an
extra heart sound, though it does cause a
murmur. Decreased myocardial contractility is
heard as a third heart sound. An s4 isnt heard
in a normally functioning heart.
60. B. By decreasing the heart rate and
contractility, beta-adrenergic blockers
improve myocardial filling and cardiac output,
which are primary goals in the treatment of
cardiomyopathy. Antihypertensives arent
usually indicated because they would
decrease cardiac output in clients who are
often already hypotensive. Calcium channel
blockers are sometimes used for the same
reasons as beta-adrenergic blockers; however,
they arent as effective as beta-adrenergic
blockers and cause increase hypotension.
Nitrates arent used because of their dilating
effects, which would further compromise the
myocardium.

following should the nurse immediately perform?

a) shut off the mechanical ventilator
b) shut off the intravenous infusion going into the
client's arm
c) place the conductive gel pads for defibrillation
on the client's chest
d) step away from the bed and make sure that all
others have done the same
4. A client is scheduled for elective cardioversion to
treat chronic high-rate atrial fibrillation. The nurse
determines that the client is not yet ready for the
procedure after noting that the:
a) client has received a dose of midazolam
(Versed) intravenously
b) client's digoxin (Lanoxin) has been withheld for
the last 48 hours
c) defibrillator has the synchronizer turned and is
set at 50 joules
d) client is wearing a nasal cannula delivering
oxygen at 2 liters per minute
5. The nurse is assisting in the care of a client who
is to be cardioverted. The nurse plans to set the
monophasic defibrillator to which of the following
starting energy range levels, depending on the
specific physician order?
a) 50 to 100 joules
b) 150 to 200 joules
c) 250 to 300 joules
d) 350 to 400 joules

6. The nurse provides information to a client who

is scheduled for the implantation of an
implantablecardioverter defibrillator (ICD)
regarding care after implantation. The nurse tells
the client that there is a need to keep a diary and
that its primary purpose is to:
a) analyze which activities to avoid
b) document events that precipitate a
countershock
c) provide a count of the number of shocks
delivered
d) record a variety of data that are useful for the
physician during medical management

1. A client with an acute respiratory infection is

admitted to the hospital with a diagnosis of sinus
tachycardia. The nurse develops a plan of care for
the client and includes which intervention?
a) limiting oral and intravenous fluids
b) measuring the client's pulse once each shift
c) providing the client with short, frequent walks
d) eliminating sources of caffeine from meal trays
2. The nurse is assisting with cardiopulmonary
resuscitation and the physician is going to
defibrillate the client. Of the following items, which
is the only one that the nurse does not need to
remove from the client just before the client is
defibrillated?
a) oxygen
b)back board
c) nitroglycerin patch
d) pulse oximetry machine plugged into an
electrical socket
3. During a code, a physician is about to
defibrillate a client in ventricular fibrillation and
says in a loud voice "CLEAR!" Which of the

1) D
- Sinus tachycardia is often caused by fever,
physical and emotional stress, heart failure,
hypovolemia, certain medications,
nicotine, caffeine, and exercise. Measuring the
client's pulse during each shift will not
decrease the heart rate. Additionally, the
pulse should be taken more frequently than
once each shift. Exercise and fluid restriction
will not alleviate tachycardia.
2) B
- Flammable materials and metal devices or
liquids (that are capable of carrying
electricity) are removed from the client and
bed before discharging the paddles of the
defibrillator. The nitroglycerin patch may have
a metallic backing and should be removed.
3) D
- For the safety of all personnel, when the
defibrillator paddles are being discharged, all
personnel must stand back and be clear of all
contact with the client or the client's bed. It is

the primary responsibility of the person

defibrillating to communicate the "clear"
message loudly enough for all to hear and
ensure their compliance. All personnel must
immediately comply with this command. A
ventilator is not in use during a code; rather
an Ambu (resuscitation) bag is used. Shutting
off the intravenous infusion has no useful
purpose. The gel pads should have been
placed on the client's chest before the
defibrillator paddles were applied. Stepping
back from the bed prevents the nurse or
others from being defibrillated along with the
client.

c) I should cut my toenails straight across

d) I should raise my legs above the level of my
heart periodically

4) D
- The client typically receives a dose of
an intravenous sedative or antianxiety agent.
Digoxin may be withheld for up to 48 hours
before cardioversion because it increases
ventricular irritability and may cause
ventricular dysrhythmias post countershock.
The defibrillator is switched to synchronizer
mode to time the delivery of the electrical
impulse to coincide with the QRS and avoid
the T wave, which could causeventricular
fibrillation. Energy level is typically set at 50
to 100 joules. During the procedure, any
oxygen is removed temporarily, because
oxygen supports combustion, and a fire could
result from electrical arcing.

10. The nurse is reviewing the assessment data of

a clinic client. Which finding would be most
important for the client to modify to lessen the risk
for coronary artery disease (CAD)?

5) A
- When a client is cardioverted, the
defibrillator is charged to the energy level
ordered by the physician. Cardioversion is
usually started at 50 to 100 joules. Options B,
C, and D are incorrect and identify energy
levels that are too high for cardioversion.
6) D
- The client with an ICD maintains a log or
diary of a variety of data. This includes
recording the date and time of the shock, any
activity that took place before the shock, any
symptoms experienced, the number of shocks
delivered, and how the client felt after the
shock. The information is used by the
physician to adjust the medical regimen and
especially the medication therapy, which
must be maintained after ICD insertion.
7. The nurse is evaluating a hypertensive client's
understanding of a dietary modifications to control
the disease process. The nurse determines that the
client's understanding is satisfactory if the client
made which of the following meal selections?
a) corned beef, fresh carrots, boiled potato
b) hot dogs on a bun, sauerkraut, baked beans
c) turkey, baked potato, salad with oil and vinegar
d) scallops, french fries, salad with bleu cheese
dressing
8. The home-care nurse has given instructions to a
client who was recently discharged from the
hospital regarding the care of an arterial ischemic
leg ulcer. The nurse determines that further
instructions is needed if the client makes which of
the following statements?
a) I should wear shoes and socks
b) I should inspect my feet daily

9. The nurse has provided instructions to a client

being discharged from the hospital to home after
an abdominal aortic aneurysm (AAA) resection.
The nurse determines that the client understands
the instructions if the client stated that an
appropriate activity would be to:
a) move the lawn
b) lift objects up to 30 pounds
c) play a game of 18-hole golf
d) walk as tolerated, including up and down stairs
and outdoors

a) elevated triglyceride levels

b) elevated serum lipase levels
c) elevated low-density lipoprotein (LDL) levels
d) elevated high-density lipoprotein (HDL) levels
11. A client is diagnosed with thromboangitis
obliterans (Buerger disease). The nurse places
highest priority on teaching the client about
modifications of which risk factor related to this
disorder?
a) exposure to heat
b) cigarette smoking
c) diet low in vitamin C
d) excessive water intake
12. The nurse is providing homecare instructions to a client recovering from an
acute inferior myocardial infarction (MI)
with recurrent angina. The nurse teaches the client
to:
a) avoid sexual intercourse for at least 4 months
b) replace sublingual nitroglycerin tablets yearly
c) participate in an exercise program that includes
overhead lifting and reaching
d) recognize the adverse effects of acetylsalicylic
acid (aspirin), which include tinnitus and hearing
loss

7) C
- The client with hypertension should avoid
foods that are high in sodium. Foods from the
meat group that are higher in sodium include
bacon, hot dogs, luncheon meat, chipped or
corned beef, Kosher meat, smoked or salted
meat or fish, peanut butter, and a variety of
shellfish.

8) D
- Foot-care instructions for the client with
peripheral arterial ischemia are the same
instructions given to the client with diabetic
mellitus. The client with arterial disease,
however, should avoid raising the legs above
heart level unless instructed to do so as part
of an exercise program (such as Buerger's

postural exercises) or unless venous stasis is

also present. Options A, B, and C are accurate
client statements.

vein stripping and ligation and who is being

discharged from the ambulatory case unit. The
nurse tells the client to:

9) D
- The client can walk as tolerated after the
repair or resection of an AAA, including
climbing stairs and walking outdoors. The
client should not lift objects that weigh more
than 15 to 20 pounds for 6 to 12 weeks or
engage in any activities that involve pushing,
pulling, or straining. Driving is also prohibited
for several weeks.

a) remove elastic hose after 24 hours

b) maintain bed rest for the first 3 days
c) elevate the foot of the bed while in bed
d) ambulate for 5 to 10 minutes twice a day
beginning the day after surgery

10) C
- LDLs are more directly associated with CAD
than are other lipoproteins. LDL levels, along
with levels of cholesterol, have a higher
predictive association with CAD than levels of
triglycerides. Additionally, HDL is inversely
associated with the risk of CAD. Lipase is a
digestive enzyme that breaks down ingested
fats
in
the
gastrointestinal
tract.
11) B
- Buerger disease occurs predominantly
among men who are more than 40 years old
who smoke cigarettes. A familial tendency is
noted, but cigarette smoking is consistently a
risk factor. Symptoms of the disease improve
with smoking cessation. Options A, C, and D
are not risk factors.

12) D
- After an acute MI, many clients are
instructed to take an aspirin daily. Adverse
effects include tinnitus,hearing loss, epigastric
distress, gastrointestinal bleeding, and
nausea. Sexual intercourse usually can be
resumed in 4 to 8 weeks after an acute MI if
the physician agrees and if the client has
been able to achieve traditional parameters
such as climbing two flights of steps without
chest pain or dyspnea. Clients should be
advised to purchase a new supply of
nitroglycerin tablets every 6 months.
Expiration dates on the
medicationbottle should also be checked.
Activities that include lifting and reaching
over the head should be avoided, because
they reduce cardiac output.
13. The home-care nurse provides selfcare instructions to a client with chronic venous
insufficiency caused by deep vein thrombosis.
Which statement by the client indicates the need
for further instructions?
a) I need to avoid prolonged standing or sitting
b) I need to elevate the foot of the bed during
sleep
c) I can cross my legs at the knee but not at the
ankle
d) I should continue to wear elastic hose for at
least 6 to 8 weeks
14. The nurse is providing homecare instructions to a client who had varicose

15. The nurse is developing a teaching plan for the

client with Raynaud disease. Which of the
followinginstructions should the nurse include?
a) daily cool baths will provide an analgesic effect
b) a high-protein diet will minimize tissue
malnutrition
c) vitamin K administration will prevent tendencies
toward bleeding
d) keeping the hands and feet warm and dry will
prevent vasoconstriction
16. A client with peripheral arterial disease has
received instructions from the nurse about how to
limit the progression of the disease. The nurse
determines that the client needs
further instructions if which statement was made
by the client?
a) I need to eat balanced diet
b) a heating pad on my leg will help soothe the leg
pain
c) I need to take special care of my feet to prevent
injury
d) I should walk daily to increase the circulation to
my legs
17. The nurse is teaching a client with
hypertension about items that contain sodium and
reviews a written list of items sent from the cardiac
rehabilitation department. The nurse tells the client
that which of the following items is lowest in
sodium content?
a) antacids
b) laxatives
c) toothpaste
d) demineralized water
18. A client with congestive heart failure and
secondary hyperaldosteronism is started on
spironolactone (Aldactone) to manage this
disorder. The nurse informs the client that the need
for dosage adjustment may be necessary if which
of the following medications is also being taken?
a) potassium chloride
b) alprazolam (Xanax)
c) warfarin sodium (Coumadin)
d) verapamil hydrochloride (Calan)

13) C
- Clients with chronic venous insufficiency are
advised to avoid crossing their legs, sitting in
chairs where their feet do not touch the floor,
and wearing garters or sources of pressure
above the legs (such as girdles). The client
should sleep with the foot of the bed elevated
to promote venous return during sleep. The
client should wear elastic hose for 6 to 8
weeks or, in some situations, for life. Venous
problems are characterized by the insufficient
drainage of blood from the legs returning to
the heart. Because of this, interventions need
to be aimed at promoting the flow of blood
out of the legs and back to the heart.

14) C
- The foot of the bed should be elevated 15
degrees to promote venous drainage.
Standard postoperative care after vein
ligation and stripping consists of bedrest for
24 hours with ambulation for 5 to 10 minutes
every 2 hours thereafter. The continuous
elastic compression of the leg is maintained
usually for 1 week after the procedure, and
this is followed by the long-term use of elastic
hose.
15) D
- The use of measures to prevent
vasoconstriction are helpful for the
management of Raynaud disease. The hands
and feet should be kept dry. Gloves and warm
fabrics should be worn in cold weather, and
the client should avoid exposure to nicotine
and caffeine. The avoidance of situations that
trigger stress is also helpful. Options A, B, and
C are not components of the treatment for
this disorder.
16) B
- The long-term management of peripheral
arterial disease consists of measures that
increase peripheral circulation (exercise),
promote vasodilation (warmth), relieve pain,
and maintain tissue integrity (foot care and
nutrition). The application of heat directly to
the extremity is contraindicated. The limb
may have decreased sensitivity and be more
at risk for burns. Additionally, the direct
application of heat raises the oxygen and
nutritional requirements of the tissue even
further.
17) D
- Sodium intake can be increased with the use
of several types of products,
including toothpaste andmouthwashes; overthe-counter medications such as analgesics,
antacids, cough remedies, laxatives, and
sedatives; and softened water as well as
some mineral waters. Water that is bottled,
distilled, deionized, or demineralized may be
used for drinking and cooking. Clients are
advised to read labels for sodium content.
18) A
- Spironolactone (Aldactone) is a potassiumsparing diuretic. If the client is also
taking potassium chloride or
another potassium supplement, the risk for
hyperkalemia exists. Potassium doses would
need to be adjusted while the client is taking
this medication. A dosage adjustment would
not be necessary if the client was taking the
medications identified in options B, C, and D.
19. A client seeks treatment in an ambulatory care
center for symptoms of Raynaud's disease. The
nurse instructs the client to:
a) decrease cigarette smoking by one half
b) alternate exposures to both heat and cold
c) continue activity during vasospasm for quicker
relief of symptoms
d) wear protective items, such as gloves and warm
socks, as necessary
20. The nurse determines that the client with
atherosclerosis understands dietary modifications

to lower the risk of heart disease if which of the

following food selections is made?
a) roast beef
b) fresh cantaloupe
c) broiled cheeseburger
d) mashed potato with gravy
21. A client being discharged to home after
angioplasty via the right femoral groin as the
catheter insertionsite has received
discharge instructions from the nurse. Client
learning is evident if which of the following
statements is made?
a) coolness or discoloration of the right foot is
expected
b) I should expect a large area of bruising at the
right groin
c) temperature as high as 101F is nit unusual a
few days after the procedure
d) mild discomfort in the right groin may occur,
and Tylenol should relieve the pain
22. The nurse is teaching dietary modifications to
the client with hypertension. The nurse instructs
the client to eat which of the following snack
foods?
a) raw carrots
b) frozen pizza
c) cheese and crackers
d) canned tomato soup
23. The nurse teaches a client with hypertension
to recognize the signs and symptoms that may
occur during periods of elevated blood pressure.
The nurse determines that the client needs
additional teaching if the client states that which
sign or symptom is associated with this condition?
a) epistaxis
b) dizziness
c) blurred vision
d) a feeling of fullness in the head
24. A client who has been newly diagnosed
with angina pectoris asks the nurse how to prevent
future angina attacks. The nurse plans to
incorporate which instruction in a teaching session?
a) eat fewer, larger meals for more efficient
digestion
b) dress appropriately in very cold or very hot
weather
c) adjust medication doses freely until your
symptoms do not recur
d) plan all activities for early in the morning, when
you are the most rested

19) D
- Treatment for Raynaud's disease includes
the avoidance of precipitating factors such as
cold or damp weather, stress, and cigarettes.
The client should get sufficient rest and sleep,
protect the extremities by wearing protective
clothing, and stop activity during vasospasm.
20) B
- To lower the risk of heart disease, the diet
should be low in saturated fat with the
appropriate number of total calories. The diet

should include less red meat and more white

meat with the skin removed. Dairy products
used should be low in fat, and foods with high
amounts of empty calories should be avoided.

Club

21) D
- The client may feel some mild discomfort at
the catheter insertion site after angioplasty.
This is usually relieved by analgesics such as
acetaminophen (Tylenol). The client is taught
to report to the physician any neurovascular
changes to the affected leg, bleeding or
bruising at the insertion site, and signs of
local infection, such as drainage at the site or
increased temperature.

22) A
- Sodium should be avoided by the client with
hypertension. Fresh fruits and vegetables are
naturally low in sodium. Hypertensive clients
are also advised to keep fat intake to less
than 30% of their total calories as part of
prudent heart living. Each of the incorrect
options contain high amounts of sodium, and
options B and C are also likely to be higher in
fat.
23) D
- Cerebrovascular symptoms of
hypertension include early morning
headaches, occipital headaches, blurred
vision, lightheadedness, vertigo, dizziness,
and epistaxis. The client should be aware of
these symptoms and report them if they
occur. The client should also be taught to selfmonitor the blood pressure. A feeling of
fullness in the head is more likely associated
with a sinus condition.
24) B
- Anginal episodes are triggered by events
such as eating heavy meals, straining during
bowel movements, smoking, overexertion,
and experiencing emotional upset or
temperature extremes. Medication therapy is
monitored and regulated by the physician.

25. Both the client who had cardiac surgery and

the client's family express anxiety regarding how
to cope with the recuperative process when they
are home alone after discharge. The nurse plans to
tell the client and family about which available
resource?
a) the United Way
b) the Local Library
c) the American Cancer Society Research for
Recovery
d) the American Heart Association Mended Hearts

25) D
- Most clients and families benefit from
knowing that there are available resources to
help them cope with the stress of self-care
management at home. These can include
telephone contact with the surgeon, the
cardiologist, and the
nurse; cardiac rehabilitation programs; and
community support groups such as the
American Heart Association Mended Hearts
Club, which is a nationwide program with local

chapters. The United Way provides a wide

variety of services to people who may not
otherwise be able to afford them. The library
normally does not provide resources for
coping with the recuperative process. The
American Cancer Society Reach for Recovery
helps women recover after mastectomy.

2. The child had been diagnosed to have rheumatic

fever. Which of the following does the nurse expect
to assess in the child?
a) painless nodules in bony prominence
b) decreased antistreptoysin O (ASO) titer
c) desquamation of the skin on the tips of finger and
toes
d) high-grade fever that spikes in the morning

3. The nurse teaches the mother on lanoxin

(digoxin) administration to an infant. Which of the
following statements when made by the mother
indicates that the teaching is effective?
a) I can give the medication to my child as long as his
heart rate is above to 70 beats per minute
b) I will give the medication one hour before or 2
hours after feeding
c) I will mix the medication with the milk feeding
d) I will mix the medication with mashed fruits

4. Which of the following is most important to

monitor in the client after surgery for abdominal
aortic aneurysm?
a) intake and output measurement every shift
b) blood pressure every 4 hours
c) body temperature every 4 hours
d) abdominal girth

5. The client experiences intermittent

claudification. Which of the following should be
included in the nursing care plan of the client to
promote comfort and general condition?
a) elevate the legs when sitting or lying supine
b) apply warm compresses to the legs
c) encourage progressive exercises
d) apply elastic bandage on the legs

6. The client undergone cardiac catheterization.

His blanket is soaked with blood. What is the best
initial nursing action?
a) notify the physician
b) monitor vital signs
c) assess where the site of bleeding is, and apply
pressure on that site
d) transport the client back to
the cardiac catheterization laboratory

7. A client with heart disease is on low-fat diet. A

nurse evaluates that the client understands the
diet if the client states that a food item to avoid is:
a) plums
b) cherries
c) avocado
d) peaches

8. Which of the following best shows effective

coping of the client after myocardial infarction?
a) the patient plans to return to work in 2 to 3 days
b) the patient ask her husband to bathe and dress her
c) the patient states that she needs to commit to
lifelong lifestyle changes

1. Who among these clients with congenital heart

diseases should be cared for first by the nurse?
a) the child with coarctation of aorta with elevated
blood pressure in the upper extremity
b) the child with tetralogy of Fallot with clubbing of
fingers and elevated red blood cells
c) the child with ductus arteriosus who experiences
fatigue after feeding
d) the child with ventricular septal defect who
murmurs on auscultation of the chest

1) C
- the client is experiencing hypoxia. Need for
oxygenation take priority. Choices A, B and D
are expected findings.

d) administer sublingual nitroglycerine

2) A
- subcutaneous nodules are painless
swellings. Other signs and
symptoms of rheumatic fever are: migrating
polyarthritis, increased ASO titer, increased
ESR, arthralgia, fever. Choice C describes
kawasaki disease.

3) B
- digoxin should be given on empty stomach.
This ensures adequate absorption of the
medication. In an infant, digoxin is not given if
the apical pulse is below 90-110 bpm. For
older children, if the apical pulse is below 70
bpm, the drug is also withheld.

4) D
- internal bleeding will cause accumulation of
blood within the abdominal cavity. Increase in
abdominal girth is an accurate indicator of
this complication.

5) C
- progressive exercises, especially walking
promote arterial collateral circulation
(intermittent claudification is a sign of arterial
insufficiency).

6) C
- puncture site for catheter insertion may be
in the brachial or femoral vein/artery. In case
of bleeding, the initial nursing action is to
assess and apply pressure to the site.

7) C- avocado is high in fats

10. Which of the following assessment data are

the usual manifestations of a client with mitral
valve stenosis?
a) Dependent edema
b) dyspnea on exertion and fatigue
c) distended neck vein
d) enlarged liver

11. Which of the following are non-modifiable risk

factors for cardiovascular disorders?
a) age and gender
b) obesity and hypertension
c) stress and smoking
d) caffeine and alcohol

12. Which of the following laboratory findings is

expected in a patient with myocardial
infarction?
a) elevated troponin levels
b) elevated SGPT (ALT) levels
c) elevated LDH 2 levels
d) elevated CK-MM levels

13. Which of the following is a manifestation of

negligence when a client with heart disease is in
labor
a) the client is in lithotomy position with her feet in
stirrups
b) the client's vital signs are monitored closely
c) the client receives oxygen therapy through face
mask
d) the client has a patent IV access line

14. The client had undergone cardiac

catheterization using femoral artery. Which of the
following should be included in the nursing care
plan of the client?
a) keep the affected leg immobile and in
extended position for few hours
b) apply warm compress at the puncture site
c) allow the client to ambulate once vital signs are
stable
d) maintain NPO status until gag reflex returns

15. After cardiac catheterization, the client

experiences chest pain. Which of the following is
the best initial nursing action?
a) bring the patient back to the cardiac
catheterization laboratory
b) administer analgesic
c) take an ECG
d) assist the client to ambulate

16. Which of the following signs and

symptoms indicate pacemaker failure?

8) D
- the client accepts that a lifestyle change is
lifetime. This is to promote health and wellbeing of the person.

9. A client complains of chest pain. What should be

the nurses priority action?
a) check vital signs
b) notify physician
c) let the client lie down and check if the pain is
relieved by rest

a) excessive thirst
b) prolonged hiccups
c) flushing of the skin
d) increased urine output

9) A
- gather additional information about the
client's condition first. Next action is to notify
the physician. (Assessment is done before
implementation).

10) B
- mitral valve stenosis leads to left-sided heart
failure. This produces pulmonary
manifestations ("left lung"). Left heart
affectation results to lung manifestations like
dyspnea on exertion.

a) chest pain
b) circulatory overload
c) electrolytes imbalance
d) ventricular dysrhythmias

18. Which of the following physician's order should

the nurse question when preparing a client who
will undergo artery bypass graft within an hour?
a) potassium chloride per slow IV drip
b) calcium channel blocker
c) digoxin
d) prophylactic antibiotic

11) A
- age and gender are non-modifiable or
unavoidable risk factors for cardiovascular
disorders. The other options are
modifiable risk factors.

12) A
- elevated troponin levels are the best
indicator of M.I. Troponin I of 1.5
mg/ml, Troponin T greater than 0.1 to 0.2 are
supportive of MI.

13) A
- lithotomy position increases cardiac
workload. The client should be placed in semifowler's position to decrease cardiac workload
and promote oxygenation.

14) A
- after cardiac catheterization involving
femoral artery, the affected leg should be
kept immobile and in extendedposition for few
hours. This is to prevent bleeding and to
promote adequate circulation in the leg.

19. The client has been diagnosed to have rightsided congestive heart failure (RSCHF). Which of
the followingsigns and symptoms does the nurse
expect to observe in the client?
a) shortness of breath
b) ascites
c) rales in the lung apices
d) pink-tinged, frothy sputum

20. The client with cardiac disorder experiences

hypokalemia. Which of the following ECG changes
would the client have?
a) elevated ST segment
b) presence of U-wave
c) tall T-wave
d) prolonged QRS complex

21. The client with congestive heart

failure develops cardiac tamponade. Which of the
following signs and symptoms would the nurse
assess?
a) distant or muffled heart sounds
b) hypertension
c) bradycardia
d) increased urine output

22. The nurse is giving health teachings to several

clients. Which among these clients is at risk for
coronary artery diseases?
a) the client who works in the department store
b) the client who smokes cigarette
c) the client who had her menarche at age 12 years
old
d) the client whose serum cholesterol level is 180
mg/dL

15)
- assessment is the first nursing action. ECG
may reveal dysrhythmias which cause chest
pain after cardiac catheterization. Gather
adequate information before implementation.

23. Which of the following questions is most

important to ask in a client with congestive heart
failure who has jugular vein distention?

16) B
- prolonged hiccups indicate pacemaker
failure. Other signs and symptoms of
pacemaker failure are dysrhythmias,
dizziness, faintness, chest pain, shortness of
breath, increase or decrease in apical rate.

24. The drug of choice to control premature

ventricular contractions, ventricular tachycardia, or
ventricular fibrillation is

17. The client is diagnosed to have acute

myocardial infarction. He has a nursing diagnosis
of decreased cardiacoutput. This is secondary to

a) at what time do you go to sleep during the night?

b) how many pillows do you use when lying down?
c) what do you drink before going to sleep?
d) how many hours of night sleep do you have?

a) quinidine
b) procainamide
c) bretylium
d) lidocaine

17) D
- ventricular dysrhythmias are the primary
causes of decreased cardiac output with
myocardial infarction.

25. Which of the following situations in a client

with myocardial infarction (MI) should be given
highest priority?

18) C
- digoxin increases force
of cardiac contractility and therefore it
increases cardiac workload.

a) the client complains of palpitations

b) the client's BP is 170/95
c) the client has premature ventricular contractions of
4 multifocals/min
d) the client serum enzyme studies are elevated

26. The client has coronary artery disease (CAD).

Which of the following statements when made by
the client indicates that he understands the
health instructions?

19) B
- RSCHF is characterized by venous backup,
like ascites. Choices A, C, and D are
manifestations of a client with Left-sided CHF.

a) I need to avoid carbohydrates

b) I need to avoid working in cold weather
c) I need to avoid exercise
d) I need to avoid fruits

27. A client had a second myocardial infarction

episode. The nurse determines the precipitating
factor when the client says

20) B
- hypokalemia is characterized by presence of
U-wave, depressed ST segment, and short Twave.

21) A
- cardiac tamponade involves accumulation of
fluid in the pericardial sac. It restricts
ventricular filling and
decreases cardiac output. It is characterized
by distant, muffled sound, distended neck
veins, and diminished or absent pulse (Beck's
triad).

22) B
- cigarette smoking is one of the most
common risks of CAD (Coronary artery
disease).

a) I use my nicoderm patch, so I can quit smoking

b) I go for a walk in the park, each morning during
summer
c) I get tired when I climb a flight of stairs
d) I include fruits and vegetables in my diet

28. The client has been diagnosed to have chronic

congestive heart failure (CHF). What is the
earliest sign that indicates recurrence of CHF?
a) dyspnea
b) syncopal episode
c) tachycardia
d) elevated blood pressure

29. Which of the following is a prominent signs

and symptoms in a client with COA (coarctation
of aorta)?
a) elevated BP in both lower extremities
b) diminished femoral pulse
c) cyanosis
d) machinery murmurs

30. Which of the following signs and

symptoms indicate pacemaker failure?
a) increased pulse rate
b) decreased pulse rate of 60 beats per minute
c) flushing of the skin
d) elevated body temperature

23) B
- orthopnea, which is difficulty in breathing
when in lying position relieved by
upright position, is a sign of
progressive cardiac disorder.

24) D
- lidocaine is the first line of drug to control
PVC's, VT, VF. Lidocaine exerts anesthetic
effect on the heart thus decreasing
myocardial irritability.

31. Left-sided congestive heart failure is most

often associated with which of the following
manifestations?
a) dyspnea
b) distended neck vein
c) hepatomegaly
d) pedal edema

32. A client with chest pain is admitted to the

emergency department. He states that his chest
pain was not relieved after taking 3 nitroglycerine
tablets at home. Which of the following is the best
initial nursing action?
a) administer the prescribed analgesic
b) give nitroglycerine sublingually
c) monitor blood pressure
d) monitor ECG

25) B
- elevated BP increases afterload, and
therefore increases cardiac workload. This
leads to increased myocardial oxygen
demand.

26. B
- working in cold weather precipitates
coronary artery spasm. This reduces
myocardial tissue perfusion and oxygenation.
Therefore the client with CAD should
avoid working in cold weather.

27) A
- nicotine causes vasoconstriction. Nicoderm
patch is contraindicated for clients with
history of M.I.

28) A
- dyspnea is the earliest sign that indicates
recurrence of CHF

29) B
- coarctation of aorta is characterized by the
following signs and symptoms:

hypertension in the higher extremities

hypotension in the lower extremities
diminished pulse in the lower
extremities
30) B
- bradycardia is a sign of pacemaker failure.
Other signs and symptoms of pacemaker
failure are as follows: dizziness, faintness,
shortness of breath, prolonged hiccups.
31) A
- left-sided congestive heart failure is
characterized by signs and symptoms due to:
a. pulmonary edema ("left" - "lung"), b.
cellular hypoxia, c. RAAS activation -->
hypertension and hypokalemia.
Choices B, C, D are signs and symptoms of
right-sided CHF.
32) A
- relief of chest pain is a priority in myocardial
infarction. Pain increases cardiac workload
and may lead to shock.Morphine sulfate is the
drug of choice.

33. After cardiac catheterization, which of the

following findings should the nurse report to the
physician?

a) pain on the groin when changing positions

b) the client denies tingling sensation in the extremity
c) the client verbalizes that she experienced flushing
sensation during the procedure
d) the toenail blanches on compression and pinkish
color returns after 1 to 3 seconds

34. After cardiac catheterization that involves

femoral artery, which of the following actions by
the RN needs intervention by the charge nurse?
a) the RN monitors the client's vital signs
b) the RN applies small ice pack over the puncture
site
c) the RN elevates the head of the bed to
sitting position as requested by the client
d) the RN immobilizes the affected extremity in
extension

35. An elderly client who had suffered a severe

heart attack says to the nurse, "I have a living
will and my children do not agree with what I have
decided. I hope you nurses and doctors will abide
by my wishes." Which of these responses by the
nurse is best?
a) your wishes are the most important
b) do you expect your children to be here when you
have to make decisions?
c) you and your children should really decide together
d) it's always best to reconsider your decisions

36. The following are manifestations of leftsided congestive heart failure. Select all that apply
a) hypertension
b) dependent edema
c) hypokalemia
d) paroxysmal nocturnal dyspnea
e) non-productive cough
f) pink-tinged, frothy sputum
g) ascites

37. Which of the following health teachings should

be included when caring for a client with angina
pectoris?
a) limit cigarette smoking
b) do not go out during cold weather
c) take sublingual nitroglycerine every 5 minutes until
chest pain subsides
d) keep nitroglycerine in a clear plastic container

38. A client has dual chamber pacemaker, which of

the following is true about the pacemaker?
a) it provides atrial firing
b) it provides ventricular firing
c) it provides both atrial and ventricular firing
d) it provides alternate atrial and ventricular firing

39. Which of the following is a characteristic

manifestation of the patient with cardiac
tamponade?
a) increased pulse rate
b) rapid respiration
c) increased body temperature
d) distended neck vein

40. Which of the following findings in a client who

had undergone cardiac catheterization needs
immediate follow-up?

a) bleeding on dressing
b) capillary refill of more than 3 seconds
c) feeling of warmth and thirst
d) drowsiness

33) A
- pain in the groin after cardiac
catheterization may indicate hematoma at the
site. This indicates bleeding at the site and
compression of blood vessels by the
hematoma may occur. his in turn, may cause
circulatory impairment in the area.

34) C
- avoid acute hip flexion after cardiac
catheterization involving the femoral artery to
prevent circulatory impairment. HOB may be
elevated only up to 30 deg for the first 6 to 8
hours

35) A
- the client's wishes are primary
considerations in living will.

immediate follow-up. Normal capillary refill

time is 1 to 2 seconds.

41. The nurse is completing the admission

assessment on the client with chest pain. Which of
the following statements by the client indicates the
priority modifiable risk factor for coronary artery
disease?
a) I have been told that I have a high cholesterol level
b) my father died of a heart attack at age 48
c) I have been under a lot of stress at work lately
d) I know I am overweight and have to do something
about it

42. The client with chest pain was diagnosed

with myocardial infarction and is now ready to
be discharged. The nurse is reviewing
discharge instructions. Which statement if made by
the client indicates the highest priority teaching
need?
a) I am going to try and cut down on smoking
b) from now on I am going to eat mainly fruits and
vegetables
c) I plan to take up jogging when I go home
d) I plan to work half days for a while

43. A nurse is providing care to a client

immediately after the insertion of a cardiac
pacemaker. Which action is most important for the
nurse to do first?
a) observe the incision site for signs of local infection
b) arrange for the client to have a post-insertion x-ray
c) monitor vital signs every 15 minutes until stable
d) encourage client to get out of bed with assistance

36) A, C, D, E, F
- these are signs and symptoms of left-sided
CHF. Signs and symptoms of left-sided CHF
are due to pulmonary edema, cellular hypoxia
and activation of renin-angiotensinaldosterone system (RAAS).

37) B
- precipitating events to chest pain in angina
pectoris include exposure to cold, exertion,
eating a large meal, and strong emotions.

38) C
- a dual chamber pacemaker provides both
atrial and ventricular firing.

39) D
- cardiac tamponade, an accumulation of
blood in the pericardial sac is characterized by
Beck's triad signs and symptoms which are as
follows: distended neck vein, muffled heart
sounds and diminished or absent pulse.
40) B
- capillary refill of more than 3 seconds
indicates circulatory impairment, and needs

44. The home care nurse calls the wife of the

client with chronic heart disease who is coughing
frothy, white secretions and became confused
during the night. Which question is most important
for the nurse to ask?
a) did your husband eat breakfast this morning?
b) what did your husband do yesterday?
c) where did your husband sleep last night?
d) are your husband's ankles swollen?

45. The nurse is completing the admission

assessment form on the client with chronic heart
disease. Which of the following, if noted by the
nurse, indicates a priority symptom of left-sided
heart failure?
a) distended neck vein
b) edema of the lower extremities
c) weight gain of 10 pounds in the last month
d) crackles in the lungs

46. The nurse is caring for a client with congestive

heart failure. On assessment, the nurse notes that
the client is dyspneic and that crackles are audible
on auscultation. The nurse suspects excess fluid
volume. What additional signs would the nurse
expect to note in this client if excess fluid
volume is present?
a) weight loss
b) flat neck and hand veins
c) an increase in blood pressure
d) a decreased central venous pressure (CVP)

41) A
- high serum cholesterol level is one of the
most common modifiable risk factor
for coronary artery disease.

42) C
- walking is the best exercise for post-MI
clients undergoing cardiac rehabilitation.
Jogging may not be well-tolerated by the
client. Therefore, choice C indicates
knowledge deficit of the client and these
requires further teaching.

47. A nurse is caring for a client with acute

congestive heart failure who is receiving high
doses of a diuretic. On assessment, the nurse
notes that the client has flat neck veins,
generalized muscle weakness, and diminisheddeep
tendon reflexes. The nurse suspects hyponatremia.
What additional signs would the nurse expect to
note in this client if hyponatremia were present?
a) dry skin
b) decreased urinary output
c) hyperactive bowel sounds
d) increased specific gravity of the urine

48. A client arrives in the emergency room

complaining of chest pain that began 4 hours ago.
A troponin T blood specimen is obtained, and the
results indicate a level of 0.6 ng/mL. The nurse
interprets that this result indicates a:
a) normal level
b) low value that indicates possible gastritis
c) level that indicates a myocardial infarction
d) level that indicates the presence of possible angina

43) C
- close monitoring of the client
after insertion of cardiac pacemaker
especially the vital signs is very essential.
Changes in the vital signs indicate occurrence
of complications.

49. A client with atrial fibrillation who is receiving

maintainance therapy of warfarin sodium
(Coumadin) has a prothrombin time of 35 seconds.
Based on the prothrombin time, the nurse
anticipates which of the following orders?

44) C
- orthopnea, like sleeping in a couch indicates
progressive heart failure like CHF (congestive
heart failure) and pulmonary edema.

50. A client recently diagnosed with a myocardial

infarction and impaired renal function is
recuperating on the step-down cardiac unit. The
client's blood pressure has been borderline low and
intravenous (IV) fluids have been infusing at 100
ml/hr via a central line catheter in the right
internal jugular for approximately 24 hours to
increase renal output and maintain blood pressure.
on entering the client's room, the nurse notes that
the client is breathing rapidly and is coughing. The
nurse determines that hte client is most likely

45) D
- left-sided congestive heart failure may lead
to pulmonary edema. Signs and
symptoms pertaining to the lungs are
characteristic of left-sided congestive heart
failure.
Choices A, B, and C are due to venous backup which characterize right-sided congestive
heart failure.
46) C
- assessment findings associated with excess
fluid volume include cough, dyspnea,
crackles, tachypnea, tachycardia, an
elevated blood pressure and a bounding
pulse, an elevated CVP, weight gain, edema,
neck and hand vein distention, altered level of
consciousness, and a decreased hematocrit.
Options A, B and D identify signs noted in
deficient fluid volume.

a) adding a dose of heparin sodium

b) holding the next dose of warfarin
c) increasing the next dose of warfarin
d) administering the next dose of warfarin

a) hematoma
b) systemic infection
c) electrolyte overload
d) circulatory overload

51. A clinic nurse has provided home

care instructions o the client with a history
of cardiac disease who has just been told that she
is pregnant. Which statement, if made by the
client, indicates a need for further instructions?
a) it is best that I rest lying on my side to promote
blood return to the heart
b) I need to avoid excessive weight gain to prevent
increased demands on my heart
c) I need to try to avoid stressful situations because
stress increases the workload of the heart
d) During the pregnancy, I need to avoid contact with
other individuals as much as possible to prevent
infection

52. A nurse is providing instructions to a maternity

client with a history of cardiac disease regarding
appropriate dietary measures. Which statement, if
made by the client, indicates an understanding of
the information provided by the nurse?

a) I should drink adequate fluids and increase my

intake of high-fiber foods
b) I should maintain a low-calorie diet to prevent any
weight gain
c) I should lower my blood volume by limiting fluids
d) I should increase my sodium intake during
pregnancy

47) C
- hyperactive bowel sounds indicate
hyponatremia. Options A, B and D are signs of
hypernatremia. In hyponatremia, increased
urinary output and decreased specific gravity
of the urinEdit Postse would be noted. Dry
skin occurs in deficient fluid volume.

48) C
- troponin is a regulatory protein found
in striated muscle. The troponins function
together in the contractile apparatus
for striated muscle in skeletal muscle and in
the myocardium. Increased amounts of
troponins T are released to the bloodstream
when an infarction causes damage to the
myocardium. A troponin T value that is higher
than 0.1 to 0.2 ng/mL is consistent with a
myocardial infarction.
49) B
- the normal prothrombin time (PT) is 9.6 to
11.8 seconds (male adult) or 9.5 to 11.3
seconds (female adult). A therapeutic PT level
is 1.5 to 2.0 times higher than the normal
level. Because the value of 35 seconds is high
(and perhaps near the critical range), the
nurse should anticipate that the client would
not receive further doses at this time.
50) D
- circulatory (fluid overload) is a complication
of intravenous therapy. Signs include rapid
breathing, dyspnea, a moist cough, and
crackles. When circulatory overload is
present, the client's blood pressure would also
increase. Hematoma is characterized by
ecchymosis, swelling and leakage at the
IV insertion site, and hard and painful lumps
at the site. Systemic infection is characterized
by chills, fever, malaise, headache, nausea,
vomiting, backaches, and tachycardia. Signs
of electrolyte imbalance depend on the
specific electrolyte.
51) D
- to avoid infections, visitors with active
infections should not be allowed to visit the
client; otherwise, restrictions are not required.
Stress causes increased heart workload, and
the client should be instructed to avoid stress.
Too much weight gain can place further
demands on the heart. Resting should be
done by lying on the side to promote blood
return.
52) A
- constipation can cause the client to use
Valsalva's maneuver. This maneuver can
cause blood to rush to the heart and overload
the cardiac system. Therefore, high-fiber

foods are important. A low-calorie diet is not

recommended during pregnancy and could be
harmful to the fetus. Diets low in fluid can
cause a decrease in blood volume, which
could deprive the fetus of nutrients, so
adequate fluid intake and high-fiber foods are
important. Sodium should be restricted
somewhat, as prescribed by the physician,
because excess sodium will cause an overload
to the circulating blood volume and contribute
to cardiac complications.
53. A clinic nurse reviews the record of a child just
seen by a physician and diagnosed with suspected
aortic stenosis. The nurse expects to note
documentation of which clinical manifestation
specifically found in this disorder?
a) pallor
b) hyperactivity
c) exercise intolerance
d) gastrointestinal disturbances

54. A nurse has provided home care instructions to

the mother of a child who is being discharged
following cardiac surgery. Which statement made
by the mother indicates a need for
further instructions?
a) a balance of rest and exercise is important
b) I can apply lotion or powder to the incision if it is
itchy
c) activities in which my child could fall need to be
avoided for 2 to 4 weeks
d) large crowds of people need to avoided for at least
2 weeks following surgery

55. A nurse provides home care instructions to the

parents of a child with congestive heart failure
(CHF) regarding the procedure for the
administration of digoxin (Lanoxin). Which
statement, if made by the parent, indicates the
need for further instructions?
a) I will not mix the medication with food
b) If more than one dose is missed, I will call the
physician
c) I will take the child's pulse before administering the
medication
d) if the child vomits after medication administration,
I will repeat the dose

56. A nurse is caring for an infant with congenital

heart disease is monitoring the infant closely for
signs ofcongestive heart failure (CHF). The nurse
assesses the infant for which early sign of CHF?
a) cough
b) pallor
c) tachycardia
d) slow and shallow breathing

57. A physician has prescribed oxygen as needed

for an infant with congestive heart failure (CHF). In
which situation should the nurse administer the
oxygen to the infant?
a) during sleep
b) when changing the infant's diapers
c) when the mother is holding the infant
d) when drawing blood for electrolyte testing

58. A nurse is monitoring an infant with congestive

heart failure (CHF). Which of the following alerts
the nurse to suspect fluid accumulation and the
need to call the physician?
a) bradypnea
b) diaphoresis
c) decreased blood pressure

d) a weight gain of 1 lb in 1 day

59. The nurse is preparing the client with chronic

heart failure for discharge to home. Which
statement if made by the client indicates the
highest priority teaching need?
a) I will get out of bed slowly in the morning
b) I plan to rest as much as possible when I get home
c) I will let my health care provider know if I gain 4
pounds or more in two days
d) I will have to cut down on potato chips

53) C
- The child with aortic stenosis shows signs of
exercise intolerance, chest pain, and dizziness
when standing for long periods of time. Pallor
may be noted but is not specific to this type of
disorder alone. Options B and D are not
related to this disorder.
54) B
- The mother should be instructed that lotions
and powders should not be applied to the
incision site. Lotions and powders can irritate
the surrounding skin, which could lead to skin
breakdown and subsequent infection of the
incision site. Options A, C and D are
accurate instructions regarding home care
after cardiac surgery.

55) D
- The parents need to be instructed that if the
child vomits after the digoxin is administered,
they are not to repeat the dose. Options A, B
and C are accurate instructions regarding the
administration of this medication. In addition,
the parents should be instructed that if a dose
is missed and is not identified until 4 hours
later, the dose should not be administered.

56) C
- The early signs of congestive heart
failure (CHF) include tachycardia, tachypnea,
profuse scalp sweating, fatigue and
irritability, sudden weight gain, and
respiratory distress. A cough may occur in
CHF as a result of mucosal swelling and
irritation but is not an early sign. Pallor may
be noted in the infant with CHF but is also not
an early sign.
57) D
Crying exhausts the limited energy supply,
increases the workload of the heart, and
increases the oxygen demands. Oxygen
administration may be prescribed for stressful
periods, especially during bouts of crying or
invasive procedures. Options A,B, C are
not likely to produce crying in the infant.
58) D
A weight gain of 0.5 kg (1 lb) in 1 day is
caused by the accumulation of fluid. The
nurse should assess urine output, assess for
evidence of facial or peripheral edema,

auscultate lung sounds, and report the weight

gain to the physician. Tachypnea and an
increased blood pressure would occur with
fluid accumulation. Diaphoresis is a sign of
CHF but is not specific to fluid accumulation,
and usually occurs with exertional activities.
59) B
- the client with chronic heart failure should
have a balance between rest and activity.
Therefore, choice B indicates knowledge
deficit of the client and this indicates need for
further teaching.
60. A 22-year old adult has cholesterol blood test
done at screening clinic sponsored by a local health
club. The nurse volunteering at the screening
teaches the client that diet and exercise should be
used as health measures to keep the total
cholesterol below:
a) 80 mg/dL
b) 200 mg/dL
c) 250 mg/dL
d) 300 mg/dL

61. The nurse notes an isolated premature

ventricular contraction (PVC) on the cardiac
monitor. The appropriate nursing action is to:
a) prepare for defibrillation
b) continue to monitor the rhythm
c) notify the physician immediately
d) prepare to administer lidocaine hydrochloride
(xylocaine)

62. The nurse is caring for a client who has been

transferred to the surgical unit after having a
pelvic exenteration. During the postoperative
period, the client complains of pain in the calf area.
What action should the nurse take?
a) ask the client to walk and observe the gait
b) lightly massage the calf area to relieve the pain
c) check the calf area for temperature, color, and size
d) administer prn morphine as prescribed for
postoperative pain

63. A client has developed atrial fibrillation and

has a ventricular rate of 150 bpm. The nurse
assesses the client for:
a) flat neck veins
b) nausea and vomiting
c) hypotension and dizziness
d) hypertension and headache

64. A 45 year old client is admitted to the hospital

for evaluation of recurrent runs of ventricular
tachycardia noted on Holter monitoring. The client
is scheduled for electrophysiology studies (EPS)
the following morning. Which statement should the
nurse include in a teaching plan for this client?
a) you will continue to take your medications until the
morning of the test
b) you will be sedated during the procedure and will
not remember what has happened
c) this test is a noninvasive method of determining
the effectiveness of your medication
d) during the procedure, a special wire is used
to increase the heart rate and produce the irregular
beats that caused your signs and symptoms

65. A nurse is providing diet teaching to a client

with congestive heart failure (CHF). The nurse tells
the client to avoid which of the following?

a) sherbet
b) steak sauce
c) apple juice
d) leafy green vegetables

66. The nurse is preparing to initiate an

intravenous nitroglycerin drip on a client with acute
myocardial infarction. In the absence of an
invasive (arterial) monitoring line, the nurse
prepares to have which piece of equipment for use
at the bedside?
a) defibrillator
b) pulse oximeter
c) central venous pressure (CVP) tray
d) noninvasive blood pressure monitor

60) B
- The nurse should counsel the client to keep
the total cholesterol level under 200 mg/dL.
This will aid in the prevention of
atherosclerosis, which can lead to a number
of cardiovascular disorders later in life.
Options C and D are elevated values and
place the client at risk for cardiovascular
disease. Although option A is a low
cholesterollevel, option B identifies the
realistic value to assist in preventing
cardiovascular disease.
61) B
- As an isolated occurrence, the PVC is not life
threatening. In this situation, the nurse should
continue to monitor the client. Frequent PVCs,
however, may be precursors of more lifethreatening rhythms, such as ventricular
tachycardia and ventricular fibrillation. If this
occurs, the physician needs to be notified.
62) C
- The nurse monitors for postoperative
complications such as deep vein thrombosis,
pulmonary emboli, and wound infection. Pain
in the calf area could indicate a deep vein
thrombosis. Change in color, temperature, or
size of the client's calf could also indicate this
complication. Options A and B could result in
an embolus if in fact the client had a deep
vein thrombosis. Administering pain
medication for this client complaint is not the
appropriate nursing action. Further
assessment needs to take place.
63) C
- The client with uncontrolled atrial fibrillation
with a ventricular rate over 100 beats per
minute is at risk for low cardiac output caused
by loss of atrial kick. The nurse assesses the
client for palpitations, chest pain or
discomfort, hypotension, pulse deficit, fatigue,
weakness, dizziness, syncope, shortness of
breath, and distended neck veins.
64) D
- The purpose of EPS is to study the heart's
electrical system. During this invasive
procedure, a special wire is introduced into
the heart to produce dysrhythmias. To prepare
for this procedure, the client should be NPO
for 6 to 8 hours before the test, and all
antidysrhythmics are held for at least 24
hours before the test in order to study the
dysrhythmias without the influence of
medications. Because the client's verbal
responses to the rhythm changes are
extremely important, sedation is avoided if

possible.
65) B
- Steak sauce is high in sodium. Leafy green
vegetables, any juice (except tomato or V8
brand vegetable), and sherbet are all low in
sodium. Clients with CHF should monitor
sodium intake.
66) D
- Nitroglycerin dilates both arteries and veins,
causing peripheral blood pooling, thus
reducing preload, afterload, and myocardial
workload. This action accounts for the primary
side effect of nitroglycerin, which is
hypotension. In the absence of an arterial
monitoring line, the nurse should have a
noninvasive blood pressure monitor for use at
the bedside.
67. A client is in ventricular tachycardia and the
physician orders intravenous (IV) lidocaine
(xylocaine). The nurse plans to dilute the
concentrated solution of lidocaine with:
a) lactated ringer's
b) normal saline 0.9%
c) 5% dextrose in water
d) normal saline 0.45%

68. A client who recently experienced a myocardial

infarction is scheduled to have a percutaneous
transluminal coronary angioplasty (PTCA). The
nurse plans to teach the client that, during this
procedure, a balloon-tipped catheter will:
a) inflate a meshlike device that will spring open
b) be used to compress the plaque against the
coronary blood vessel wall
c) cut away the plaque from the coronary vessel wall
using a cutting blade
d) be positioned in coronary artery to take pressure
measurements in the vessel

69. A nurse is planning care for the client with

heart failure. The nurse asks the dietary
department to remove which item from all meal
trays before delivering them to the client?
a) 1% milk
b) margarine
c) salt packets
d) decaffeinated tea

70. A client has just been admitted to the

emergency department with chest pain. Serum
enzyme levels are drawn, and the results indicate
an elevated serum creatinine kinase (CK)-MB
isoenzyme, troponin T, and troponin I. The nurse
concludes that these results are compatible with:
a) stable angina
b) unstable angina
c) prinzmetal's angina
d) new-onset myocardial infarction (MI)

71. The nurse has applied the prescribed dressing

to the leg of a client with an ischemic arterial leg
ulcer. The nurse should use which of the following
methods to cover the dressing?
a) apply a kerlix roll and tape it to the skin
b) apply a large, soft pad, and tape it to the skin
c) apply small Montgomery straps and tie the edges
together
d) apply a Kling roll and tape the edge of the roll onto
the bandage

72. A client develops bilateral wheezes, crackles

from bases to apices, orthopnea, and tachypnea,
and the nurse notes the presence of +2 pitting
edema. The nurse suspects pulmonary edema and

notifies the physician. While awaiting the

physician's arrival, the nurse avoids which action?
a) elevating the client's legs
b) preparing to administer IV morphine sulfate
c) preparing to administer IV furosemide (Lasix)
d) placing the client in the high Fowler's position

73. The nurse is caring for a client scheduled to

undergo a cardiac catheterization for the first time.
The nurse tells the client that the:
a) procedure is performed in the operating room
b) initial catheter insertion is quite painful; after that,
there is little or no pain
c) client may feel fatigue and have various aches,
because it is necessary to lie quietly on a hard x-ray
table for about 4 hours
d) client may feel certain sensations at various points
during the procedure, such as a fluttery feeling,
flushed warm feeling, desire to cough, or palpitations

67) C
- Lidocaine for IV administration is dispensed
in concentrated and dilute formulations. The
concentrated formulation must be diluted with
5% dextrose in water.

68) B
- In PTCA, a balloon-tipped catheter is used to
compress the plaque against the coronary
blood vessel wall. Option C describes coronary
atherectomy, option A describes placement of
a coronary stent, and option D describes part
of the process used in cardiac catheterization.

69) C
- Sodium restriction reduces water retention
and improves cardiac efficiency. A standard
dietary modification for the client with heart
failure is sodium restriction.
70) D
- Creatine kinase (CK)-MB isoenzyme is a
sensitive indicator of myocardial damage.
Levels begin to rise 3 to 6 hours after the
onset of chest pain, peak at approximately 24
hours, and return to normal in about 3 days.
Troponin is a regulatory protein found
in striated muscle (skeletal and myocardial).
Increased amounts of troponins are released
into the bloodstream when an infarction
causes damage to the myocardium.
Therefore, the client's results are compatible
with new-onset MI. Options A, B, and C all
refer to angina. These levels would not be
elevated in angina.
71) D
- With an arterial leg ulcer, the nurse applies
tape only to the bandage. Tape is never used
directly on the skin because it could
cause further tissue damage. For the same
reason, Montgomery straps could not be
applied to the skin (although these are
generally intended for use on abdominal
wounds, anyway). Standard dressing
technique includes the use of Kling rolls on
circumferential dressings.
72) A

- Elevating the client's legs would

rapidly increase venous return to the right
side of the heart and worsen the client's
condition. The feet should be in the
horizontal position, or the client could dangle
at the bedside if the client's condition permits.
Anxiety causes an increase in the oxygen
demands on the heart. Morphine sulfate
reduces anxiety and causes peripheral
vasodilation and is likely to be prescribed.
Furosemide will be prescribed because of its
diuretic action. A high
Fowler's position increases the thoracic
capacity, allowing for improved ventilation.
73) D
- Preprocedure teaching points include that
the procedure is done in a darkened cardiac
catheterization room and that ECG leads are
attached to the client. A local anesthetic is
used so there is little to no pain with
catheterinsertion. The X-ray table is hard and
may be tilted periodically. The procedure may
take up to 2 hours, and the client may feel
various sensations with catheter passage and
dye injection.
74. A nurse admits a client with myocardial
infarction (MI) to the coronary care unit (CCU).
The nurse plans to do which of the following in
delivering care to this client?
a) begin thrombolytic therapy
b) place the client on continuous cardiac
monitoring
c) infuse intravenous (IV) fluid at a rate of 150 ml
per hour
d) administer oxygen at a rate of 6 liters per
minute by nasal cannula
75. The nurse is analyzing an ECG rhythm strip on
an assigned client. The nurse notes that there are
three small boxes from the beginning of the "P"
wave to the "R" wave. The nurse records that the
client's PR interval is:
a) 0.12 second
b) 0.20 second
c) 0.24 second
d) 0.40 second

74) B
- Standard interventions upon admittance to
the CCU as they relate to this question include
continuous cardiac monitoring, administering
oxygen at a rate of 2 to 4 liters per minute
unless otherwise ordered, and ensuring an
adequate IV line insertion of an intermittent
lock. If an IV infusion is administered, it is
maintained at a keep vein open rate to
prevent fluid overload and heart failure.
Thrombolytic therapy may or may not be
prescribed by the physician. Thrombolytic
agents are most effective if administered
within the first 6 hours of the coronary event.
75) A
- Standard ECG graph paper measurements
are 0.04 second for each small box on the
horizontal axis (measuring time) and 1 mm
(measuring voltage) for each small box on the
vertical axis.

W/ God,
Nothing is
impossible
Wilma Bongotan
Padawil