~EXAM 1~ Flashcards
(135 cards)
1
Q
Which event leads to the development of acute coronary syndrome (ACS)?
A. Vasospasm of the coronary artery
B. Rupture of a stable atherosclerotic plaque
C. Vasodilation of coronary vessels
D. Chronic anemia
A
Answer: B
Rationale: ACS occurs when a stable atherosclerotic plaque becomes unstable and ruptures, leading to thrombus formation and partial or complete blockage of the coronary artery.
2
Q
Which condition represents complete blockage of a coronary artery?
A. Stable angina
B. NSTEMI
C. Unstable angina
D. STEMI
A
Answer: D
Rationale: STEMI is caused by a complete occlusion of a coronary artery, leading to ST-elevation and myocardial injury.
3
Q
How long are heart cells viable during total coronary occlusion without collateral circulation?
A. 30 seconds
B. 1 minute
C. 20 minutes
D. 2 hours
A
Answer: C
Rationale: Heart cells are viable for approximately 20 minutes under ischemic conditions before irreversible damage occurs.
4
Q
Which metabolic process occurs first during myocardial ischemia?
A. Ketogenesis
B. Anaerobic metabolism
C. Lipogenesis
D. Gluconeogenesis
A
Answer: B
Rationale: Anaerobic metabolism begins immediately after the heart is deprived of oxygen and glucose during ischemia.
5
Q
Which cardiac biomarker is the most specific for myocardial infarction (MI)?
A. CK
B. CK-MB
C. Troponin I
D. Myoglobin
A
Answer: C
Rationale: Cardiac-specific troponin I is the most sensitive and specific biomarker for myocardial infarction.
6
Q
Which symptom is most commonly reported with myocardial infarction (MI)?
A. Headache
B. Heavy, crushing chest pain
C. Intermittent back spasms
D. Left leg pain
A
Answer: B
Rationale: MI pain is often described as crushing, tight, or burning and can radiate to the jaw, neck, or arm.
7
Q
What symptom might an elderly patient with MI present with instead of chest pain?
A. Visual disturbances
B. Confusion
C. Fever
D. Polyuria
A
Answer: B
Rationale: Older adults may present with atypical symptoms such as confusion, shortness of breath, or dizziness.
8
Q
Which manifestation suggests sympathetic nervous system stimulation during an MI?
A. Bradycardia
B. Warm, dry skin
C. Cool, clammy skin
D. Decreased blood pressure
A
Answer: C
Rationale: Catecholamine release causes vasoconstriction, leading to cool and clammy skin.
9
Q
Which heart sound may indicate left ventricular dysfunction after an MI?
A. S1
B. S2
C. S3
D. Opening snap
A
Answer: C
Rationale: An S3 gallop may occur due to decreased left ventricular compliance.
10
Q
A patient with an inferior wall MI suddenly develops nausea and vomiting. What is the likely cause?
A. Food poisoning
B. Anxiety
C. Vagal stimulation from the infarct
D. Pericarditis
A
Answer: C
Rationale: Nausea and vomiting may occur due to vagal stimulation, especially in inferior wall MIs.
11
Q
What is the first intervention when a patient presents with chest pain in the emergency department?
A. Administer morphine
B. Give IV nitroglycerin
C. Obtain a 12-lead ECG
D. Check troponin levels
A
Answer: C
Rationale: The 12-lead ECG is the first diagnostic step to differentiate between STEMI, NSTEMI, or UA.
12
Q
What is the goal time frame for reperfusion using PCI in STEMI?
A. 60 minutes
B. 90 minutes
C. 120 minutes
D. 24 hours
A
Answer: B
Rationale: The goal is to perform PCI within 90 minutes of first medical contact for a STEMI.
13
Q
Which ECG change is most specific to STEMI?
A. T wave flattening
B. ST segment elevation in two contiguous leads
C. QRS prolongation
D. PR interval depression
A
Answer: B
Rationale: ST elevation ≥1 mm in 2 contiguous leads indicates STEMI.
14
Q
Which drug is administered first in suspected ACS?
A. Morphine
B. Atorvastatin
C. Aspirin
D. Heparin
A
Answer: C
Rationale: Chewable aspirin is given immediately to inhibit platelet aggregation.
15
Q
Which therapy is contraindicated in NSTEMI?
A. IV nitroglycerin
B. Thrombolytic therapy
C. Beta-blockers
D. Aspirin
A
Answer: B
Rationale: Thrombolytics are not used for NSTEMI due to the absence of total occlusion.
16
Q
What is the goal of IV nitroglycerin in ACS?
A. Decrease preload and improve O₂ delivery
B. Increase preload and afterload
C. Reduce blood glucose
D. Induce vasoconstriction
A
Answer: A
Rationale: IV NTG reduces myocardial oxygen demand by lowering preload and afterload.
17
Q
Why is morphine used in MI management?
A. To raise blood pressure
B. To improve glucose metabolism
C. To reduce pain and myocardial oxygen demand
D. To increase cardiac output
A
Answer: C
Rationale: Morphine reduces anxiety, pain, and workload on the heart.
18
Q
What is the role of ACE inhibitors after MI?
A. Increase contractility
B. Prevent ventricular remodeling
C. Improve AV node conduction
D. Decrease cardiac enzymes
A
Answer: B
Rationale: ACE inhibitors help prevent ventricular remodeling post-MI.
19
Q
Which medication should be continued indefinitely post-PCI?
A. Ticagrelor
B. Atorvastatin
C. Aspirin
D. Heparin
A
Answer: C
Rationale: Low-dose aspirin is continued indefinitely for secondary prevention.
20
Q
What is the purpose of dual antiplatelet therapy (DAPT)?
A. Lower blood pressure
B. Stabilize blood glucose
C. Reduce platelet aggregation and prevent clot formation
D. Dilate coronary arteries
A
Answer: C
Rationale: DAPT helps prevent thrombotic events following stent placement or ACS.
21
Q
What is the priority nursing action during the first hour post-MI?
A. Encourage ambulation
B. Start physical therapy
C. Monitor ECG and vital signs frequently
D. Begin discharge teaching
A
Answer: C
Rationale: Continuous monitoring is essential to detect life-threatening arrhythmias.
22
Q
When can a patient with an uncomplicated MI start sitting up in a chair?
A. Immediately after PCI
B. Within a few hours
C. After 5 days
D. After cardiac rehab begins
A
Answer: B
Rationale: For uncomplicated MIs, patients may sit up within hours if stable.
23
Q
Which lab value is most important to monitor after thrombolytic therapy?
A. BUN
B. Hemoglobin and hematocrit
C. Blood glucose
D. Potassium
A
Answer: B
Rationale: Bleeding is a major risk; monitor for signs of hemorrhage post-thrombolytics.
24
Q
What should a nurse do if a post-PCI patient reports chest pain again?
A. Reassure the patient and continue monitoring
B. Administer antacids
C. Notify the provider and obtain an ECG
D. Increase oxygen flow
A
Answer: C
Rationale: Recurrent chest pain post-PCI may indicate reocclusion; act quickly.
25
Which assessment finding in a post-MI patient requires immediate action?
A. Mild fatigue
B. Occasional PVCs
C. New onset S3 sound
D. Elevated temperature of 100.2°F
Answer: C
Rationale: An S3 gallop may indicate heart failure and requires prompt intervention.
26
A patient has a heart rate of 45 bpm and reports dizziness. What is the priority nursing action?
A. Prepare for synchronized cardioversion
B. Administer IV atropine
C. Initiate CPR immediately
D. Administer a beta-blocker
Answer: B
Rationale: Symptomatic bradycardia is treated with IV atropine to increase heart rate.
27
Which ECG finding is characteristic of atrial fibrillation?
A. Sawtooth P waves
B. Regular R-R intervals
C. No visible P waves and irregular rhythm
D. PR interval longer than 0.20 seconds
Answer: C
Rationale: Atrial fibrillation shows absent P waves and irregularly irregular ventricular rhythm.
28
The patient reports palpitations and a heart rate of 160 bpm. Vagal maneuvers are ineffective. What is the next step?
A. Administer IV adenosine
B. Perform defibrillation
C. Administer IV digoxin
D. Administer epinephrine
Answer: A
Rationale: Adenosine is used to terminate paroxysmal supraventricular tachycardia (PSVT).
29
Which rhythm requires immediate defibrillation?
A. Asystole
B. Atrial flutter
C. Ventricular fibrillation
D. Sinus bradycardia
Answer: C
Rationale: Ventricular fibrillation is a lethal rhythm that requires rapid defibrillation.
30
The ECG monitor shows tall, peaked T waves. What is the most likely cause?
A. Hyperkalemia
B. Hypokalemia
C. Hypomagnesemia
D. Hypernatremia
Answer: A
Rationale: Tall, peaked T waves are a hallmark of hyperkalemia.
31
What is the priority intervention for a patient in asystole?
A. Defibrillate immediately
B. Administer amiodarone
C. Start CPR and give epinephrine
D. Administer atropine and lidocaine
Answer: C
Rationale: Asystole is treated with high-quality CPR and epinephrine.
32
What distinguishes PVCs on an ECG?
A. Narrow QRS complexes
B. Irregular R-R intervals
C. Wide and bizarre QRS complexes
D. No visible T wave
Answer: C
Rationale: PVCs have wide, distorted QRS complexes due to ectopic ventricular origin.
33
Atrial flutter often leads to decreased cardiac output due to:
A. Prolonged QT interval
B. Loss of atrial kick
C. Hypercontractile ventricles
D. Bradycardia
Answer: B
Rationale: Atrial flutter causes rapid atrial rates, reducing atrial contraction and CO.
34
Which action is essential before synchronized cardioversion?
A. Start chest compressions
B. Ensure synchronizer switch is OFF
C. Administer IV heparin
D. Turn ON the synchronizer switch
Answer: D
Rationale: The synchronizer must be ON to avoid delivering shock during vulnerable phases.
35
Which drug is most appropriate to control ventricular rate in atrial fibrillation?
A. Atropine
B. Amiodarone
C. Diltiazem
D. Lidocaine
Answer: C
Rationale: Diltiazem (a calcium channel blocker) slows AV conduction to control ventricular rate.
36
What is a common cause of sinus tachycardia?
A. Increased vagal tone
B. Digitalis toxicity
C. Pain or anxiety
D. Hypercalcemia
Answer: C
Rationale: Stressors like pain, fever, and anxiety can increase sympathetic stimulation.
37
Which ECG feature is expected in sinus bradycardia?
A. Wide QRS complex
B. No visible P waves
C. Rate less than 60 bpm with normal P waves
D. Irregular rhythm
Answer: C
Rationale: Sinus bradycardia has a regular rhythm with normal P waves and HR < 60 bpm.
38
What should the nurse do when artifact appears on the ECG?
A. Administer atropine
B. Recheck lead placement and equipment connections
C. Increase paper speed
D. Activate the emergency response system
Answer: B
Rationale: Artifact often results from poor lead contact or movement. Check leads and connections.
39
The initial energy for biphasic defibrillation is:
A. 50 joules
B. 120 to 200 joules
C. 360 joules
D. 10 to 20 joules
Answer: B
Rationale: Biphasic defibrillators use 120–200 joules for initial shock.
40
What does a widened QRS complex (>0.12 sec) typically indicate?
A. Atrial ectopic beat
B. Normal sinus rhythm
C. Bradycardia
D. Ventricular origin of impulse
Answer: D
Rationale: Widened QRS suggests ventricular origin or conduction delay.
41
Which complication may occur after permanent pacemaker insertion?
A. Frequent urination
B. Sinus arrhythmia
C. Pneumothorax
D. Hypercalcemia
Answer: C
Rationale: Pneumothorax is a known complication after lead insertion.
42
Which is true regarding implantable cardioverter-defibrillators (ICDs)?
A. They cannot sense rhythm
B. They prevent all arrhythmias
C. They deliver shock in VT/VF
D. They require weekly charging
Answer: C
Rationale: ICDs detect VT/VF and deliver shocks to restore normal rhythm.
42
A thoracic aortic aneurysm is most likely to cause which symptom?
A. Hoarseness
B. Lower back pain
C. Pulsating abdominal mass
D. Cyanotic toes
Answer: A. Hoarseness
Rationale: Pressure on the laryngeal nerve from a thoracic aneurysm can cause hoarseness.
43
For a patient on amiodarone, what monitoring is essential?
A. Liver and thyroid function
B. Serum calcium levels
C. Vitamin D levels
D. BUN and creatinine only
Answer: A
Rationale: Amiodarone can affect liver and thyroid function.
44
What is a priority nursing intervention during transcutaneous pacing?
A. Teach deep breathing exercises
B. Provide sedation or analgesia
C. Administer vasodilators
D. Encourage ambulation
Answer: B
Rationale: Transcutaneous pacing is uncomfortable, so pain and sedation management are essential.
45
What condition is characterized by ECG electrical activity without a pulse?
A. Ventricular tachycardia
B. Pulseless electrical activity (PEA)
C. Asystole
D. Junctional rhythm
Answer: B
Rationale: PEA shows organized ECG activity without mechanical heart action or a pulse.
46
A patient is diagnosed with an abdominal aortic aneurysm (AAA). Which risk factor is the most important modifiable contributor to aneurysm formation?
A. Male gender
B. Age over 60
C. Tobacco use
D. Family history
Answer: C. Tobacco use
Rationale: Tobacco use is the most significant modifiable risk factor for aortic aneurysms.
47
Which diagnostic test is most appropriate for screening a small abdominal aortic aneurysm?
A. Chest x-ray
B. ECG
C. Ultrasound
D. Angiography
Answer: C. Ultrasound
Rationale: Ultrasound is a noninvasive and accurate method for screening and monitoring AAAs.
48
Which symptom is most suggestive of a ruptured abdominal aortic aneurysm?
A. Hypertension
B. Abdominal bruit
C. Severe back pain
D. Jugular vein distension
Answer: C. Severe back pain
Rationale: Rupture may cause sudden and severe back or abdominal pain.
49
Which is a key goal of surgical intervention in aortic aneurysm management?
A. Lower BP to under 80/60 mm Hg
B. Prevent aneurysm rupture
C. Increase blood volume
D. Restore heart rhythm
Answer: B. Prevent aneurysm rupture
Rationale: Surgical intervention is aimed at preventing rupture and associated mortality.
49
A patient with a small, asymptomatic AAA is being managed conservatively. What should the nurse include in the teaching plan?
A. Avoid low-impact exercise
B. Maintain strict bed rest
C. Stop smoking immediately
D. Limit fluid intake
Answer: C. Stop smoking immediately
Rationale: Smoking cessation is critical in reducing aneurysm growth and rupture risk.
50
What finding would the nurse expect to auscultate over an AAA?
A. S1 and S2 murmurs
B. Pericardial rub
C. Bruit
D. Rales
Answer: C. Bruit
Rationale: A turbulent blood flow through an aneurysm can create a bruit.
51
A patient reports blue toes but has palpable pedal pulses. What is this a sign of?
A. Diabetic neuropathy
B. Arterial embolism
C. Blue toe syndrome
D. Venous thrombosis
Answer: C. Blue toe syndrome
Rationale: Indicates microemboli from an aneurysm despite presence of pedal pulses.
51
Which is a postoperative complication of open aortic aneurysm repair (OAR)?
A. Bradycardia
B. Hypercalcemia
C. Acute kidney injury
D. Hypernatremia
Answer: C. Acute kidney injury
Rationale: Especially in resections above the renal arteries, renal perfusion can be compromised.
52
In assessing peripheral perfusion post-aortic repair, what should the nurse evaluate?
A. Serum calcium levels
B. Capillary refill and pulse quality
C. Hematocrit
D. Visual acuity
Answer: B. Capillary refill and pulse quality
Rationale: Assessing for adequate perfusion includes checking pulses, temperature, and refill time.
53
After EVAR, which complication is most common?
A. Graft occlusion
B. Infection
C. Endoleak
D. Stroke
Answer: C. Endoleak
Rationale: The most frequent EVAR complication is blood leaking into the aneurysm sac.
54
Which action helps assess for postoperative ileus?
A. Checking pupil reaction
B. Monitoring ECG
C. Listening for bowel sounds
D. Assessing urine output
Answer: C. Listening for bowel sounds
Rationale: Absence or return of bowel sounds indicates ileus resolution or continuation.
55
Which patient teaching point is most critical following discharge for aneurysm repair?
A. Daily blood glucose monitoring
B. Monitoring incision only
C. Lifelong imaging follow-up
D. Daily anticoagulation labs
Answer: C. Lifelong imaging follow-up
Rationale: Surveillance is essential to detect endoleak or aneurysm expansion.
55
The patient asks when they can resume sex after aortic surgery. What is the appropriate response?
A. “You can resume in 2 weeks.”
B. “It depends on your BP control and healing.”
C. “Only after 3 months.”
D. “Never.”
Answer: B. “It depends on your BP control and healing.”
Rationale: Resumption of sexual activity depends on physical recovery and perfusion status.
56
Which medication is likely prescribed after aneurysm repair?
A. Antidepressant
B. ACE inhibitor
C. Corticosteroid
D. NSAID
Answer: B. ACE inhibitor
Rationale: ACE inhibitors help reduce BP and support vascular healing.
57
What is a major nursing goal in early post-op care after OAR?
A. Wean oxygen within 12 hours
B. Encourage solid food
C. Maintain BP within target range
D. Remove NG tube immediately
Answer: C. Maintain BP within target range
Rationale: Graft patency depends on carefully controlled BP.
58
The nurse marks pedal pulses pre-op. Why?
A. To document temperature
B. For ease of post-op assessment
C. To assess motor function
D. To check fluid status
Answer: B. For ease of post-op assessment
Rationale: Marking pulses helps in quick postoperative perfusion evaluation.
59
Which lab value is most important to monitor after AAA repair?
A. Platelets
B. Bilirubin
C. Creatinine
D. Hemoglobin A1c
Answer: C. Creatinine
Rationale: Monitoring renal function is critical due to risk of kidney injury.
60
Which early symptom suggests a graft infection?
A. Hypertension
B. Fever and leukocytosis
C. Hypoglycemia
D. Bradycardia
Answer: B. Fever and leukocytosis
Rationale: These signs indicate infection which must be managed promptly.
61
Which lifestyle change is most important post-aortic aneurysm surgery?
A. Start a high-protein diet
B. Begin marathon training
C. Avoid tobacco and manage BP
D. Increase salt intake
Answer: C. Avoid tobacco and manage BP
Rationale: Controlling BP and stopping smoking reduce future vascular events.
62
A patient with acute Type A aortic dissection reports sudden chest pain described as "ripping." What is the nurse’s priority action?
A. Administer morphine
B. Notify the provider immediately
C. Reassure the patient and apply oxygen
D. Assess for pedal pulses
Correct Answer: B. Notify the provider immediately
Rationale: Type A aortic dissections require emergency surgical intervention due to high risk of rupture and death. Immediate notification of the provider is priority.
63
What is the most important modifiable risk factor for aortic dissection?
A. Family history
B. Tobacco use
C. Gender
D. Connective tissue disorders
Correct Answer: B. Tobacco use
Rationale: Tobacco use is a major modifiable risk factor that contributes to vessel damage and dissection.
64
Which clinical finding is associated with cardiac tamponade in a patient with aortic dissection?
A. Bounding peripheral pulses
B. Widened pulse pressure
C. Muffled heart sounds
D. High urine output
Correct Answer: C. Muffled heart sounds
Rationale: Muffled heart sounds, hypotension, and JVD are classic signs of tamponade, a life-threatening complication.
65
A patient has a history of Marfan syndrome. What are they at high risk for?
A. Pulmonary embolism
B. Aortic dissection
C. Myocardial infarction
D. Coronary artery spasm
Correct Answer: B. Aortic dissection
Rationale: Marfan syndrome affects connective tissue and predisposes patients to dissection due to weakened aortic walls.
66
In a patient with suspected aortic dissection, which diagnostic test is preferred for unstable patients?
A. Chest X-ray
B. MRI
C. CT scan with contrast
D. Transesophageal echocardiogram (TEE)
Correct Answer: D. Transesophageal echocardiogram (TEE)
Rationale: TEE is preferred in unstable patients as it can be done bedside and gives accurate results.
67
A patient with an acute aortic dissection has a systolic BP of 180. Which medication would you anticipate administering first?
A. Lisinopril
B. Metoprolol
C. Esmolol
D. Digoxin
Correct Answer: C. Esmolol
Rationale: IV beta-blockers like esmolol are first-line to rapidly reduce heart rate and BP to decrease stress on the aorta.
68
Which statement by a patient with aortic dissection requires further teaching?
A. “I need to take my BP meds every day.”
B. “If I feel the pain again, I’ll wait and see if it gets better.”
C. “I will have regular imaging tests.”
D. “I might need surgery again in the future.”
Correct Answer: B. “If I feel the pain again, I’ll wait and see if it gets better.”
Rationale: Sudden or new pain may indicate recurrence and requires immediate medical attention.
69
A nurse is assessing a patient with descending aortic dissection. What would be an expected symptom?
A. Facial swelling
B. Left-sided chest pain
C. Sharp abdominal pain
D. Difficulty swallowing
Correct Answer: C. Sharp abdominal pain
Rationale: Type B (descending) dissections often present with back or abdominal pain due to impaired perfusion.
70
What is a possible neurologic complication of aortic dissection?
A. Hemiparesis
B. Tinnitus
C. Facial droop
D. Spinal cord ischemia
Correct Answer: D. Spinal cord ischemia
Rationale: Aortic dissection may disrupt blood flow to the spinal cord, leading to ischemia and paralysis.
71
Aortic dissection can lead to which renal complication?
A. Kidney stones
B. Hydronephrosis
C. Renal ischemia and failure
D. Urinary retention
Correct Answer: C. Renal ischemia and failure
Rationale: Dissection can block renal artery flow, resulting in decreased perfusion and renal failure.
72
Which blood pressure goal is appropriate for a patient in the acute phase of aortic dissection?
A. 140–160 mm Hg
B. 90–100 mm Hg
C. 100–110 mm Hg
D. 160–180 mm Hg
Correct Answer: C. 100–110 mm Hg
Rationale: Controlled systolic pressure helps reduce stress on the aortic wall and prevent extension.
73
Which pulse assessment supports the diagnosis of aortic dissection?
A. Equal bilateral pulses
B. Bounding radial pulses
C. Absent pedal pulses
D. Difference in BP or pulse between arms
Correct Answer: D. Difference in BP or pulse between arms
Rationale: Pulse discrepancies are common when the dissection involves subclavian arteries.
74
What is the primary goal of preoperative nursing management in aortic dissection?
A. Encourage early ambulation
B. Decrease oxygen demands
C. Control BP and pain
D. Increase oral fluid intake
Correct Answer: C. Control BP and pain
Rationale: Reducing HR and BP helps prevent further tearing of the vessel wall.
75
A patient with aortic dissection is extremely anxious. What is the best nursing intervention?
A. Provide distraction techniques
B. Administer sedatives as prescribed
C. Limit visitor access
D. Reposition the patient
Correct Answer: B. Administer sedatives as prescribed
Rationale: Reducing anxiety is critical to control HR and BP and prevent dissection extension.
76
Which complication must be closely monitored after surgical repair of aortic dissection?
A. Hypoglycemia
B. Stroke
C. Hearing loss
D. Peritonitis
Correct Answer: B. Stroke
Rationale: Stroke can occur due to carotid involvement, emboli, or surgical complications.
77
Which medication is essential after discharge to reduce the chance of redissection?
A. Diuretic
B. Beta-blocker
C. Anticoagulant
D. Statin
Correct Answer: B. Beta-blocker
Rationale: Beta-blockers reduce BP and myocardial contractility, lowering risk of recurrence.
78
What is a classic description of pain with aortic dissection?
A. Dull and constant
B. Crushing and radiating
C. Tearing and sharp
D. Aching and mild
Correct Answer: C. Tearing and sharp
Rationale: Patients typically describe dissection pain as sudden, tearing, or ripping.
79
What should a nurse include in discharge education for a patient after aortic dissection repair?
A. Avoid BP medications if dizzy
B. Resume heavy lifting after 2 weeks
C. Report any new pain immediately
D. Take diuretics at bedtime
Correct Answer: C. Report any new pain immediately
Rationale: New pain may indicate redissection or rupture and requires urgent evaluation.
80
Which patient history factor increases the risk of aortic dissection?
A. Type 2 diabetes
B. Seasonal allergies
C. Cocaine use
D. Asthma
Correct Answer: C. Cocaine use
Rationale: Cocaine causes acute hypertension and vasospasm, leading to vessel wall damage.
81
. What is the purpose of follow-up imaging after treatment for aortic dissection?
A. Assess for anemia
B. Monitor for recurrence
C. Evaluate muscle strength
D. Detect fluid overload
Correct Answer: B. Monitor for recurrence
Rationale: Regular CT or MRI scans are essential to detect redissection, aneurysm formation, or complications.
82
A patient presents with BP 224/132 mm Hg, confusion, headache, and vomiting. What is the nurse’s priority action?
A. Start IV labetalol
B. Prepare patient for discharge
C. Place patient in high Fowler’s position
D. Ask the patient to lie quietly for 30 minutes
Answer: A
Rationale: This patient is in hypertensive emergency with evidence of encephalopathy. IV antihypertensive therapy is necessary to reduce BP safely and quickly.
83
Which clinical finding is most consistent with hypertensive encephalopathy?
A. Cool extremities
B. Dry mucous membranes
C. Sudden confusion and seizures
D. Hyperactive bowel sounds
Answer: C
Rationale: Hypertensive encephalopathy causes cerebral edema, leading to neurologic symptoms like seizures, confusion, and vomiting.
84
A patient is diagnosed with hypertensive urgency. Which treatment is most appropriate?
A. Immediate IV vasodilators
B. Emergency surgery
C. Oral antihypertensives and outpatient follow-up
D. High-dose IV corticosteroids
Answer: C
Rationale: Hypertensive urgencies are treated with oral agents and do not typically require hospitalization unless BP remains elevated or worsens.
85
What distinguishes hypertensive emergency from urgency?
A. Systolic BP above 200 mm Hg
B. Presence of target organ damage
C. Use of IV beta blockers
D. History of chronic hypertension
Answer: B
Rationale: The presence of acute or progressive target organ damage (e.g., brain, kidneys, heart) is the defining feature of hypertensive emergency.
86
Which is the most important nursing assessment during IV antihypertensive therapy?
A. Capillary refill every 4 hours
B. BP and HR every 2–3 minutes
C. Daily weight and abdominal girth
D. Pupil reaction every 12 hours
Answer: B
Rationale: BP and HR must be monitored closely during IV therapy to avoid hypotension and decreased perfusion to vital organs.
87
A patient receiving IV sodium nitroprusside requires what priority nursing intervention?
A. Monitor for hearing loss
B. Check for cyanide toxicity with prolonged use
C. Elevate legs to reduce preload
D. Administer only through peripheral IV
Answer: B
Rationale: Nitroprusside can lead to cyanide toxicity if used for prolonged periods or in high doses. Monitoring for this is essential.
88
Which drug is most effective for treating hypertensive emergencies?
A. Lisinopril
B. Losartan
C. Sodium nitroprusside
D. Hydrochlorothiazide
Answer: C
Rationale: Sodium nitroprusside is a potent IV vasodilator used in hypertensive emergencies due to its rapid onset and titratability.
89
A patient with hypertensive crisis develops chest pain and ECG changes. What is the suspected complication?
A. Pulmonary embolism
B. Myocardial infarction
C. Hypoglycemia
D. Pericarditis
Answer: B
Rationale: A sudden rise in BP can cause myocardial ischemia or infarction. Chest pain and ECG changes are classic signs.
90
What is the initial goal when lowering BP in hypertensive emergency?
A. Reduce systolic BP to <100 mm Hg
B. Normalize BP within 1 hour
C. Reduce MAP by 20–25%
D. Bring DBP under 80 mm Hg
Answer: C
Rationale: A gradual reduction in MAP (mean arterial pressure) avoids sudden drops that can impair perfusion to the brain, heart, or kidneys.
91
The nurse explains to a patient discharged after hypertensive urgency that they must:
A. Check BP monthly
B. Stop all medications once symptoms resolve
C. Take antihypertensive medications as prescribed
D. Avoid antihypertensive medications with food
Answer: C
Rationale: Medication adherence is critical to avoid recurrence and complications. Stopping abruptly may worsen hypertension.
92
Which clinical sign is a red flag for aortic dissection in hypertensive crisis?
A. Headache and neck stiffness
B. Sudden severe back pain with weak pulses
C. Tachypnea and wheezing
D. Hyperactive reflexes
Answer: B
Rationale: Sudden tearing back pain and decreased pulses indicate aortic dissection—a life-threatening hypertensive emergency.
93
Which medication is appropriate for outpatient management of hypertensive urgency?
A. IV labetalol
B. Oral captopril
C. IV hydralazine
D. IV furosemide
Answer: B
Rationale: Oral captopril is effective in reducing BP in hypertensive urgency. IV drugs are not needed in urgent cases without target organ damage.
94
A patient on clonidine reports dizziness and fatigue. What should the nurse prioritize?
A. Encourage bed rest and fluids
B. Administer another dose immediately
C. Instruct the patient to stop taking the drug
D. Teach slow position changes
Answer: D
Rationale: Clonidine can cause orthostatic hypotension and drowsiness. Teaching safety with position changes is appropriate.
95
Which is a complication of treating hypertensive crisis too rapidly?
A. Increased urine output
B. Improved vision
C. Stroke or MI
D. Increased appetite
Answer: C
Rationale: A rapid BP drop can reduce perfusion to vital organs and result in stroke, MI, or renal failure.
96
In a hypertensive emergency, what is the purpose of calculating MAP?
A. Estimate sodium levels
B. Determine cardiac output
C. Guide titration of antihypertensives
D. Diagnose stroke
Answer: C
Rationale: MAP helps guide safe and controlled BP reduction to prevent under- or overcorrection of BP.
97
The nurse prepares to give IV labetalol. What teaching is most important?
A. “You may experience temporary diarrhea.”
B. “This drug may cause sleep disturbances.”
C. “Do not stop taking this drug suddenly.”
D. “Eat salty foods to maintain BP.”
Answer: C
Rationale: Abrupt cessation of beta-blockers like labetalol can lead to rebound hypertension, angina, or MI.
98
Which patient should the nurse assess first?
A. BP 190/110, reports fatigue
B. BP 172/98, no symptoms
C. BP 218/120, confused and vomiting
D. BP 160/90, with dizziness on standing
Answer: C
Rationale: Confusion and vomiting are signs of hypertensive encephalopathy. This is a medical emergency requiring immediate intervention.
99
A nurse caring for a hypertensive crisis patient will monitor hourly for which complication?
A. Peripheral neuropathy
B. Increased blood glucose
C. Renal failure
D. Deep vein thrombosis
Answer: C
Rationale: Decreased renal perfusion from high BP or its treatment can lead to acute kidney injury. Monitor urine output and labs.
100
A patient with history of crack cocaine use presents with BP 240/130 and chest pain. What is the nurse’s first priority?
A. Administer sublingual nitroglycerin
B. Call security
C. Begin IV antihypertensive therapy
D. Encourage rest and fluids
Answer: C
Rationale: Cocaine-induced hypertensive emergencies require prompt BP control with IV therapy to reduce risk of MI, stroke, or aortic dissection.
101
Which intervention is appropriate for a patient during the resolution phase of hypertensive crisis?
A. Restrict fluids to prevent overload
B. Continue IV antihypertensives at full rate
C. Educate about long-term lifestyle changes
D. Withhold beta-blockers to prevent bradycardia
Answer: C
Rationale: Long-term management includes education on medication adherence, lifestyle changes, and follow-up to prevent future crises.
102
A nurse is teaching a patient with chronic bronchitis how to perform huff coughing. Which instruction should the nurse include?
A. "Cough deeply after each breath."
B. "Take a deep breath, hold for 2–3 seconds, then exhale forcefully saying 'huff'."
C. "Use a regular cough to clear secretions."
D. "Breathe rapidly before exhaling."
B
Rationale: Huff coughing involves inhaling deeply, holding the breath, and then forcefully exhaling in a “huff” to mobilize mucus.
103
Which patient would benefit most from diaphragmatic breathing?
A. A patient with COPD in acute distress
B. A patient recovering from abdominal surgery
C. A patient with hyperventilation
D. A patient with asthma
B
Rationale: Diaphragmatic breathing is ideal for post-op thoracic or abdominal surgery patients to promote lung expansion and reduce WOB.
104
Which finding is a contraindication to postural drainage?
A. Cystic fibrosis
B. Mild pneumonia
C. Chest trauma
D. Atelectasis
C
Rationale: Postural drainage is contraindicated in patients with chest trauma due to the risk of exacerbating injury.
105
The nurse is assessing a patient with bronchiectasis who is receiving chest percussion. Which action ensures the percussion is done correctly?
A. Keeping the patient in a flat supine position
B. Placing a pillow under the chest
C. Using cupped hands to produce a hollow sound
D. Striking the chest directly with a flat palm
C
Rationale: Percussion is performed with cupped hands to produce a hollow sound and loosen secretions.
106
A nurse teaches a COPD patient how to use pursed-lip breathing. What is the expected outcome?
A. Increased oxygen demand
B. Rapid respiratory rate
C. Airway collapse
D. Prolonged exhalation and reduced air trapping
D
Rationale: Pursed-lip breathing helps prolong exhalation, preventing bronchiolar collapse and air trapping.
107
The nurse prepares to assist a patient with CPT. What is the best time to schedule this intervention?
A. Immediately after a heavy meal
B. Before a meal or 3 hours after eating
C. While the patient is sleeping
D. After pain medication is given
B
Rationale: CPT should be scheduled at least 1 hour before or 3 hours after meals to prevent aspiration.
108
Which complication should the nurse monitor for during chest physiotherapy?
A. Hypoxemia
B. Hyperglycemia
C. Bradycardia
D. Hypertension
A
Rationale: Improper CPT can lead to hypoxemia due to impaired gas exchange during the procedure.
109
What action should the nurse take when teaching about the Acapella device?
A. Instruct the patient to breathe only through the nose
B. Have the patient sit upright and exhale through the device
C. Tell the patient to blow forcefully into the device
D. Advise against combining with aerosolized medication
B
Rationale: The Acapella can be used in any position and involves exhaling through the device to mobilize secretions.
110
A patient using the Flutter device reports thick mucus. Which action should follow Flutter use?
A. Repeat the process continuously for 20 minutes
B. Cough and perform huff coughing to expel mucus
C. Drink cold fluids
D. Stop the session
B
Rationale: Huff coughing should follow Flutter use to aid mucus clearance.
111
The nurse is reviewing CPT for a patient with excessive secretions. Which component is not part of standard CPT?
A. Postural drainage
B. Chest percussion
C. Chest vibration
D. Deep tissue massage
D
Rationale: CPT includes percussion, vibration, and postural drainage, not massage.
112
Which of the following is a sign of effective chest physiotherapy?
A. Clear lung sounds after treatment
B. Fatigue and confusion
C. Retained secretions
D. Decreased respiratory rate with accessory muscle use
A
Rationale: Clear lung sounds indicate mucus mobilization and effective therapy.
113
Which patient is most appropriate for high-frequency chest wall oscillation (vest therapy)?
A. A patient with multiple rib fractures
B. A patient with cystic fibrosis
C. A patient with lung cancer
D. A patient with pulmonary embolism
B
Rationale: The vest system is particularly useful in patients with CF to mobilize thick mucus.
114
The nurse explains huff coughing to a patient. What should the nurse include?
A. “Inhale through your nose and cough normally.”
B. “Hold your breath, then forcefully exhale with an open mouth, making a ‘huff’ sound.”
C. “Take shallow breaths and cough quickly.”
D. “Exhale slowly without coughing.”
B
Rationale: Huff coughing involves a breath hold followed by a forceful exhalation in a ‘huff’ to move secretions.
115
Which condition is a contraindication for chest percussion?
A. COPD
B. Lung abscess
C. Rib fractures
D. Bronchiectasis
C
Rationale: Rib fractures are a contraindication due to the risk of further injury with percussion.
116
What is the purpose of vibration in CPT?
A. Enhance oxygen absorption
B. Promote blood flow to the lungs
C. Loosen secretions for easier expectoration
D. Improve tidal volume
C
Rationale: Vibration helps move secretions to larger airways, facilitating their removal.
117
What position is best for draining the right lower lobe posterior segment?
A. High Fowler's
B. Supine with legs flat
C. Left side-lying with head down
D. Prone with pillow under chest
C
Rationale: Left side-lying with head down helps drain the right lower lobe.
118
A nurse prepares to teach about the TheraPEP device. What should the nurse include?
A. “Avoid using the pressure indicator.”
B. “Exhale through the resistor after a deep breath.”
C. “Use only when lying flat.”
D. “Always use with suction.”
B
Rationale: The patient should exhale through the resistor after inhaling to create positive pressure.
119
Which instruction is most important for home care CPT?
A. “Skip treatments when you feel well.”
B. “Clean devices weekly with alcohol.”
C. “Perform airway clearance before meals.”
D. “Avoid coughing after the session.”
C
Rationale: Treatments are most effective when done before meals and followed by coughing.
120
A nurse is evaluating a patient after CPT. Which indicates an adverse effect?
A. Mild coughing
B. Dizziness and pallor
C. Clear mucus production
D. Slight fatigue
B
Rationale: Dizziness and pallor may suggest hypoxemia or intolerance to the therapy.
121
What teaching should the nurse provide regarding Flutter device cleaning?
A. “Rinse with hot water only.”
B. “Soak in alcohol overnight.”
C. “Wash daily in warm, soapy water.”
D. “Clean it once a week.”
C
Rationale: The Flutter should be cleaned daily with warm, soapy water to prevent infection and ensure function.
122
Which of the following is a key difference between unstable angina and a myocardial infarction (MI)?
Unstable angina shows no significant elevation in biomarkers, while MI does.
123
What is the primary reason for administering aspirin to a patient with suspected ACS?
To prevent platelet aggregation
124
A patient presents with chest pain radiating to the jaw and left arm. Which is the most appropriate nursing action?
12 Lead ECG
125
In a patient with a STEMI, what is the most critical intervention to be performed within 90 minutes of
PCI
126
Which of the following ECG changes is most commonly associated with an acute STEMI?
ST-segment elevation
127
Which cardiac biomarker is considered the most specific for diagnosing a myocardial infarction?
Troponin I
128
During the initial management of a patient with ACS, what is the purpose of sublingual nitroglycerin?
Decreases myocardial oxygen demand by dilating veins
129
A patient with ACS is prescribed metoprolol. What is the rationale for this medication?
To decrease heart rate and myocardial oxygen consumption.
130
Which of the following is a common complication associated with ACS if not promptly treated?
Ventricular fibrillation (V-Fib)
131
A patient with ACS is being discharged with clopidogrel (Plavix). What should the nurse teach?
"Avoid taking NSAIDs unless approved by your healthcare provider."
