Exam 2 - Practice Questions (CV, IV fluids)

Question 1

For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which of the following data is necessary to collect if the patient is experiencing chest pain?

a) Blood pressure in the left arm
b) Sound of the apical pulses
c) Pulse rate in upper extremities
d) Description of the pain

Answer 1

d)

Description of the pain

Explanation:

If the patient is experiencing chest pain, a history of its location, frequency, and duration is necessary, as is a description of the pain, if it radiates to a particular area, what precipitates its onset, and what brings relief. The nurse weighs the patient and measures vital signs. The nurse may measure BP in both arms and compare findings. The nurse assesses apical and radial pulses, noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.

Question 2

The nurse is caring for a patient who has undergone peripheral arteriography. How should the nurse assess the adequacy of peripheral circulation?

a) By checking for cardiac dysrhythmias
b) By hemodynamic monitoring
c) By checking peripheral pulses
d) By observing the patient for bleeding

Answer 2

c)By checking peripheral pulses Explanation: Peripheral arteriography is used to diagnose occlusive arterial disease in smaller arteries. The nurse observes the patient for bleeding and cardiac dysrhythmias and assesses the adequacy of peripheral circulation by frequently checking the peripheral pulses. Hemodynamic monitoring is used to assess the volume and pressure of blood in the heart and vascular system

Question 3

During the auscultation of a patient’s heart sounds, the nurse notes an S4. The nurse recognizes that an S4 is associated with which of the following?

a) Hypertensive heart disease
b) Diseased heart valves
c) Turbulent blood flow
d) Heart failure

Answer 3

a) Hypertensive heart disease Explanation:

Auscultation of the heart requires familiarization with normal and abnormal heart sounds. An extra sound just before S1 is an S4 heart sound, or atrial gallop. An S4 sound often is associated with hypertensive heart disease. A sound that follows S1 and S2 is called an S3 heart sound or a ventricular gallop. An S3 heart sound is often an indication of heart failure in an adult. In addition to heart sounds, auscultation may reveal other abnormal sounds, such as murmurs and clicks, caused by turbulent blood flow through diseased heart valves.

Question 4

Which of the following terms is used to describe the ability of the heart to initiate an electrical impulse?

a) Conductivity
b) Automaticity
c) Excitability
d) Contractility

Answer 4

b)Automaticity

Explanation:

Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse. Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse. Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another. Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.

Question 5

When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is measured, the measurement obtained is referred to as which of the following?

a) Pulmonary artery wedge pressure
b) Pulmonary artery pressure

c) Cardiac output
d) Central venous pressure

Answer 5

a)Pulmonary artery wedge pressure Explanation:

When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary artery until it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular end-diastolic pressure. Central venous pressure is measured in the right atrium. Pulmonary artery pressure is measured when the balloon tip is not inflated. Cardiac output is determined through thermodilution involving injection of fluid into the pulmonary artery catheter.

Question 6

Age-related changes associated with the cardiac system include which of the following? Select all that apply.

a) Increased size of the left atrium
b) Increase in the number of SA node cells
c) Myocardial thinning
d) Endocardial fibrosis

Answer 6

a)Increased size of the left atrium, d)Endocardial fibrosis

Explanation: Age-related changes associated with the cardiac system include endocardial fibrosis, increased size of the left atrium, decreased number of SA node cells, and myocardial thickening

Question 7

Decreased pulse pressure reflects which of the following?

a) Reduced stroke volume
b) Reduced distensibility of the arteries
c) Elevated stroke volume
d) Tachycardia

Answer 7

a)Reduced stroke volume

Explanation: Decreased pulse pressure reflects reduced stroke volume and ejection velocity or obstruction to blood flow during systole. Increased pulse pressure would indicate reduced distensibility of the arteries, along with bradycardia

Question 8

The nurse is observing a patient during an exercise stress test (bicycle). Which of the following findings indicates a positive test and the need for further diagnostic testing?

a) BP changes; 148/80 mm Hg to 166/90 mm Hg
b) Heart rate changes; 78 bpm to 112 bpm
c) Dizziness and leg cramping
d) ST-segment changes on the ECG

Answer 8

d)

ST-segment changes on the ECG

Explanation:

During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; BP; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue. The test is terminated when the target heart rate is achieved or if the patient experiences signs of myocardial ischemia. Further diagnostic testing, such as a cardiac catheterization, may be warranted if the patient develops chest pain, extreme fatigue, a decrease in BP or pulse rate, serious dysrhythmias or ST-segment changes on the ECG during the stress test. The other findings would not warrant the testing to be stopped.

Question 9

The nurse is caring for a patient in the ICU who is being monitored with a central venous pressure (CVP) catheter. The nurse records the patient’s CVP as 8 mm Hg. The nurse understands that this finding indicates the patient is experiencing which of the following?

a) Hypervolemia
b) Excessive blood loss
c) Left-sided heart failure (HF)
d) Overdiuresis

Answer 9

a)Hypervolemia Explanation:

The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right ventricular preload. Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP (<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.

Question 10

The nurse is caring for a patient with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which of the following questions?

a) “What was your morning blood sugar reading?”
b) “Are you allergic to shellfish?”
c) “Are you having chest pain?”
d) “When was the last time you ate or drank?”

Answer 10

b)“Are you allergic to shellfish?”

Explanation:

Radiopaque contrast agents are used to visualize the coronary arteries. Some contrast agents contain iodine, and the patient is assessed before the procedure for previous reactions to contrast agents or allergies to iodine-containing substances (e.g., seafood). If the patient has a suspected or known allergy to the substance, antihistamines or methylprednisolone (Solu-Medrol) may be administered before the procedure. Although the other questions are important to ask the patient, it is most important to ascertain if the patient has an allergy to shellfish.

Question 11

A nurse is preparing to assess a patient for postural BP changes. Which of the following indicates the need for further education?

a) Taking the patient’s BP with the patient sitting on the edge of the bed with feet dangling b)Obtaining the supine measurements prior to the sitting and standing measurements
c) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)
d) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR

Answer 11

c)Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)

Explanation:

The following steps are recommended when assessing patients for postural hypotension: Position the patient supine for 10 minutes before taking the initial BP and HR measurements; reposition the patient to a sitting position with legs in the dependent position, wait 2 minutes then reassess both BP and HR measurements; if the patient is symptom free or has no significant decreases in systolic or diastolic BP, assist the patient into a standing position, obtain measurements immediately and recheck in 2 minutes; continue measurements every 2 minutes for a total of 10 minutes to rule out postural hypotension. Return the patient to supine position if postural hypotension is detected or if the patient becomes symptomatic. Document HR and BP measured in each position (e.g., supine, sitting, and standing) and any signs or symptoms that accompany the postural changes.

Question 12

The nurse is caring for a patient in the ED who has a B-type natriuretic peptide (BNP) level of 115 pg/mL. The nurse understands that this finding is most suggestive of which of the following?

a) Heart failure
b) Pulmonary edema
c) Ventricular hypertrophy
d) Myocardial infarction

Answer 12

a)Heart failure

Explanation:

A BNP level greater than 100 pg/mL is suggestive of HF. Because this serum laboratory test can be quickly obtained, BNP levels are useful for prompt diagnosis of HF in settings such as the ED. Elevations in BNP can occur from a number of other conditions such as pulmonary embolus, myocardial infarction (MI), and ventricular hypertrophy. Therefore, the clinician correlates BNP levels with abnormal physical assessment findings and other diagnostic tests before making a definitive diagnosis of HF.

Question 13

The nurse is reviewing discharge instructions with a patient who underwent a left groin cardiac catheterization 8 hours ago. Which of the following instructions should the nurse include?

a) “If any discharge occurs at the puncture site, call 911 immediately.”
b) “Contact your primary care provider if you develop a temperature above 102°F.”
c) “Do not bend at the waist, strain, or lift heavy objects for the next 24 hours.”
d) “You can take a tub bath or a shower when you get home.”

Answer 13

c)“Do not bend at the waist, strain, or lift heavy objects for the next 24 hours.” Explanation:

The nurse should instruct the patient to complete the following: If the artery of the groin was used, for the next 24 hours, do not bend at the waist, strain, or lift heavy objects; the primary provider should be contacted if any of the following occur: swelling, new bruising or pain from your procedure puncture site, temperature of 101°F or more. If bleeding occurs, lie down (groin approach) and apply firm pressure to the puncture site for 10 minutes. Notify the primary provider as soon as possible and follow instructions. If there is a large amount of bleeding, call 911. The patient should not drive to the hospital.

Question 14

The nurse is caring for a patient in the ICU diagnosed with coronary artery disease (CAD). Which of the following assessment data indicates the patient is experiencing a decrease in cardiac output?

a) Reduced pulse pressure and heart murmur
b) Disorientation, 20 mL of urine over the last 2 hours
c) Elevated jugular venous distention (JVD) and postural changes in BP
d) BP 108/60 mm Hg, ascites, and crackles

Answer 14

Correct Response: b)

Disorientation, 20 mL of urine over the last 2 hours

Explanation:

Assessment findings associated with reduced cardiac output include reduced pulse pressure, hypotension, tachycardia, reduced urine output, lethargy, or disorientation.

Question 15

The nurse is caring for a patient with an intra-arterial BP monitoring device. The nurse recognizes the most preventable complication associated with hemodynamic monitoring includes which of the following?

a) Catheter-related bloodstream infections (CRBSI)
b) Pneumothorax
c) Air embolism
d) Hemorrhage

Answer 15

a)Catheter-related bloodstream infections (CRBSI)

Explanation:

CRBSIs are the most common preventable complication associated with hemodynamic monitoring systems. Comprehensive guidelines for the prevention of these infections have been published by Centers for Disease Control and Prevention (CDC). Complications from use of hemodynamic monitoring systems are uncommon and can include pneumothorax, infection, and air embolism. A pneumothorax may occur during the insertion of catheters using a central venous approach (CVP and pulmonary artery catheters). Air emboli can be introduced into the vascular system if the stopcocks attached to the pressure transducers are mishandled during blood drawing, administration of medications, or other procedures that require opening the system to air.

Question 16

hen teaching a patient with rheumatic carditis and a history of recurrent rheumatic fever, which of the following statements made by the patient indicates that teaching has been successful?

a) “I will avoid any kind of activity.”
b) “I will take nonsteroidal anti-inflammatory medication (NSAIDs) every day.”
c) “I may have to take prophylactic antibiotics for up to 10 years.”
d) “I will avoid milk, yogurt and other dairy products.”

Answer 16

c) “I may have to take prophylactic antibiotics for up to 10 years.”
Explanation:

Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require 10 or more years of antibiotic coverage (e.g., penicillin G intramuscularly (IM) every 4 weeks, penicillin V orally twice a day (BID), sulfadiazine orally daily, or erythromycin orally BID. Patients with a history of rheumatic fever are susceptible to infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Steroids are prescribed to suppress the inflammatory response and aspirin to control the formation of blood clots around heart valves. Activities that require minimal activity are recommended to reduce the work of the myocardium and counteract the boredom of weeks of bed rest.

Question 17

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis?

a) Administer supplemental oxygen.
b) Elevate the patient’s head.
c) Maintain the patient on bed rest.
d) Administer a prescribed antipyretic.

Answer 17

c) Maintain the patient on bed rest.
Explanation:

The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. Bed rest also helps decrease myocardial damage and the complications of myocarditis. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures such as minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient’s head to promote maximal breathing potential.

Question 18

A patient with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the patient for which of the following manifestations?

a) Anorexia and confusion
b) Tachypnea and dyspnea
c) Abdominal pain and diarrhea
d) Edema and orthopnea

Answer 18

a) Anorexia and confusion
Explanation:

Patients with RCM have increased sensitivity to digoxin, and the nurse must anticipate that low doses will be prescribed and assess for digoxin toxicity. The most common manifestations of digoxin toxicity are gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system (CNS) disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision).

Question 19

A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve?

a) “The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged.”
b) “The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged.”
c) “The valve is mechanical, and it will not deteriorate or need replacing.”
d) “The valve is from a tissue donor, and I will not need to take any blood thinning drugs with I am discharged.”

Answer 19

b) “The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged.”
Explanation:

Autografts (i.e., autologous valves) are obtained by excising the patient’s own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the patient’s own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.

Question 20

A nurse reviewing a patient’s echocardiogram report reads the following statements: “The heart muscle is asymmetrically thickened and has an increase in overall size and mass, especially along the septum. The ventricular walls are thickened reducing the size of the ventricular cavities. Several areas of the myocardium have evidence of scaring.” The nurse knows these manifestations are indicative of which type of cardiomyopathy?

a) Hypertrophic
b) Arrhythmogenic right ventricular cardiomyopathy
c) Restrictive
d) Dilated

Answer 20

a) Hypertrophic
Explanation:

In hypertrophic cardiomyopathy (HCM), the heart muscle asymmetrically increases in size and mass, especially along the septum. It often affects nonadjacent areas of the ventricle. The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax after systole. The coronary arteriole walls are also thickened, which decreases the internal diameter of the arterioles. The narrow arterioles restrict the blood supply to the myocardium, causing numerous small areas of ischemia and necrosis. The necrotic areas of the myocardium ultimately fibrose and scar, further impeding ventricular contraction. Because of the structural changes, HCM had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). RCM is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

Question 21

An asymptomatic patient questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which of the following is the most appropriate nursing response?

a) Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop.
b) Avoid any type of exercise.
c) Avoid strenuous cardiovascular exercise.
d) Continue the exercise routine but take ample rest after exercising.

Answer 21

a) Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop.
Explanation:

Exercise is not limited until mild symptoms develop. Once symptoms of heart failure develop, the patient needs to restrict his or her activity level to minimize symptoms. It is not important for an asymptomatic patient to avoid exercise and to take ample rest after exercise.

Question 22

A nurse is conducting a heath history on a patient with a primary diagnosis of mitral stenosis. Which of the following disorders reported by the patient is the most common cause of mitral stenosis?

a) Congestive heart failure
b) Atrial fibrillation
c) Myocardial infarction
d) Rheumatic endocarditis

Answer 22

d) Rheumatic endocarditis
Explanation:

Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.

Question 23

The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse?

a) Fatigue
b) Syncope
c) Dizziness
d) Extra heart sound

Answer 23

d) Extra heart sound

Explanation:

Often, the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapsed.

Question 24

A nurse is teaching a patient about an upcoming surgery to separate fused cardiac leaflets. Which of the following is the correct term used to describe this surgery?

a) Chordoplasty
b) Commissurotomy
c) Annuloplasty
d) Valvuloplasty

Answer 24

b) Commissurotomy
Explanation:

Commissurotomy is the splitting or separating of fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve’s outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.

Question 25

## Footnote A patient comes to the clinic with complaints of fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which of the following preventable diseases? a) Pericarditis b) Cardiomyopathy c) Rheumatic fever d) Mitral stenosis

Answer 25

c) Rheumatic fever Explanation: Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease

Question 26

## Footnote A patient comes into the emergency room complaining about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which of the following diagnoses? a) Mitral valve stenosis b) Pericarditis c) Cardiomyopathy d) Rheumatic fever

Answer 26

b) Pericarditis Explanation: The primary symptom of pericarditis is pain, which is assessed by evaluating the patient in various positions. The nurse tries to identify whether pain is influenced by respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexion, extension, or rotation of the spine, including the neck; by movements of shoulders and arms; by coughing; or by swallowing. Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of pericarditis from pain of myocardial infarction.

Question 27

## Footnote A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions? a) Decrease the amount of acidic beverages and fruits. b) A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions? c) Decrease the amount of sodium and saturated fat. d) Eliminate caffeine and alcohol

Answer 27

d) Eliminate caffeine and alcohol Explanation: To minimize symptoms of mitral valve prolapse, the nurse should instruct the patient to avoid caffeine and alcohol. The nurse encourages the patient to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine, and epinephrine, which may produce dysrhythmias and other symptoms. The nurse also explores possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms.

Question 28

## Footnote patient is admitted with aortic regurgitation. Which of the following medication classifications are contraindicated since they can cause bradycardia and decrease ventricular contractility? a) Calcium channel blockers b) Ace inhibitors c) Beta blockers d) Nitrates

Answer 28

a) Calcium channel blockers Explanation: The calcium channel blockers diltiazem (Cardizem) and verapamil (Calan, Isoptin) are contraindicated for patients with aortic regurgitation as they decrease ventricular contractility and may cause bradycardia

Question 29

## Footnote A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications? a) Bleeding and wound dehiscence b) Thrombosis and infection c) Evisceration d) Bleeding and infection

Answer 29

d) Bleeding and infection Explanation: Possible complications of an aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.

Question 30

## Footnote The nurse obtains a health history from a patient with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? a) Have you recently vacationed outside of the United States? b) Do you live with any domesticated animals in your home? c) Do you have a family history of endocarditis? d) Have you been to the dentist recently?

Answer 30

d) Have you been to the dentist recently? Explanation: Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a bacteremia, which rarely lasts more than 15 minutes. However, if a patient has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator [ICD]), bacteremia can cause bacterial endocarditis.

Question 31

## Footnote The nurse is assessing a patient admitted with infective endocarditis. Which of the following manifestations would the nurse expect to find? a) Involuntary muscle movements of the extremities b) Small painful lesions on the pads of the fingers and toes c) Bruising on the palms of the hands and soles of the feet d) Raised red rash on the trunk and face

Answer 31

b) Small painful lesions on the pads of the fingers and toes Explanation: Primary presenting symptoms of infective endocarditis are fever and a heart murmur. In addition small, painful nodules (Osler nodes) may be present in pads of fingers or toes.

Question 32

## Footnote Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community? a) Provide prophylactic antibiotics to individuals with a family history of rheumatic fever. b) Encourage susceptible groups in the community to receive immunizations with streptococcal vaccine. c) Educate individuals of the community about the importance of monitoring temperature when infections occur. d) Teach individuals of the community to seek medical treatment for streptococcal pharyngitis.

Answer 32

d) Teach individuals of the community to seek medical treatment for streptococcal pharyngitis. Explanation: Prevention of acute rheumatic fever is dependent upon effective antibiotic treatment of streptococcal pharyngitis. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Education about monitoring temperature will not decrease the incidence of rheumatic fever.

Question 33

## Footnote A patient is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the patient for which diagnostic test used to confirm the patient’s diagnosis? a) Chest x-ray b) Echocardiogram c) CT scan d) Cardiac cauterization

Answer 33

b) Echocardiogram Explanation: Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.

Question 34

## Footnote A patient who has had a recent myocardial infarction develops pericarditis and complains of level 6 (on a scale of 0–10) chest pain with deep breathing. Which of these ordered pro re nata (PRN) medications will be the most appropriate for the nurse to administer? a) Morphine sulfate 6 mg IVP every 2–4 hours b) Ibuprofen (Motrin) 800 mg po every 8 hours c) Fentanyl 2 mg intravenous pyelogram (IVP) every 2–4 hours d) Acetaminophen (Tylenol) 650 mg per os (po) every 4 hours

Answer 34

b) Ibuprofen (Motrin) 800 mg po every 8 hours Explanation: Pain associated with pericarditis is caused by inflammation, thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.

Question 35

## Footnote A patient with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which of the following assessment data obtained by the nurse should be immediately communicated to the health care provider? a) The patient has 4+ peripheral edema in both legs. b) The patient has crackles audible throughout the lungs. c) The patient has a palpable thrill felt over the left anterior chest. d) The patient has a loud systolic murmur all across the precordium.

Answer 35

b) The patient has crackles audible throughout the lungs. Explanation: Acute mitral regurgitation, resulting from a myocardial infarction, usually manifests as severe congestive heart failure. Dyspnea, fatigue and weakness are the most common symptoms. Palpitations, shortness of breath on exertion and cough from pulmonary congestion also occur. Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and need immediate interventions, such as diuretics.

Question 36

## Footnote A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking? a) Thromboangiitis obliterans b) Dyspnea c) Orthopnea d) Intermittent claudication

Answer 36

d) Intermittent claudication Explanation: ## Footnote Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger's disease.

Question 37

## Footnote A patient in the emergency department states, “I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though.” Based on this statement, which priority assessment should the nurse complete? a) Attempt to palpate the dorsalis pedis and posterior tibial pulses. b) Assess for unilateral swelling and tenderness of either leg. c) Ask about any skin color changes that occur in response to cold. d) Check for the presence of tortuous veins bilaterally on the legs.

Answer 37

a) Attempt to palpate the dorsalis pedis and posterior tibial pulses. Explanation: ## Footnote Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. A thorough assessment of the patient’s skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.

Question 38

## Footnote Which of the following observations regarding ulcer formation on the patient's lower extremity indicates to the nurse that the ulcer is a result of venous insufficiency? a) Is very painful to the patient, even though superficial b) Is deep, involving the joint space c) Is very painful to the patient, even though superficial d) Size is large and superficial

Answer 38

d) ## Footnote Size is large and superficial Explanation: Ulcerations are in the area of the medial or lateral malleolus (gaiter area) and are typically large, superficial, and highly exudative. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color.

Question 39

## Footnote The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes which of the following? a) Vasospasm b) Diuresis c) Slowed heart rate d) Depression of the cough reflex

Answer 39

a) Vasospasm Explanation: Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity. Patients with arterial insufficiency who smoke or chew tobacco must be fully informed of the effects of nicotine on circulation and be encouraged to stop.

Question 40

A patient in the ED has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, which symptoms will it be most important for the nurse to ask about? a) Abdominal swelling and tenderness b) Changes in bowel and bladder habits c) Back or lumbar pain d) Hoarse voice and difficulty swallowing

Answer 40

d) Hoarse voice and difficulty swallowing Explanation: Symptoms are dyspnea, the result of pressure of the aneurysm sac against the trachea, a main bronchus, or the lung itself; cough, frequently paroxysmal and with a brassy quality; hoarseness, stridor, or weakness or complete loss of the voice (aphonia), resulting from pressure against the laryngeal nerve; and dysphagia (difficulty in swallowing) due to impingement on the esophagus by the aneurysm.

Question 41

## Footnote A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm? a) Dissecting b) Anastomotic c) Saccular d) False

Answer 41

b) Anastomotic Explanation: ## Footnote An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma.

Question 42

## Footnote A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine if the students understand the pathophysiology of the disease, the instructor asks, “What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?” a) 30 b) 40 c) 20 d) 50

Answer 42

d) 50 Explanation: Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced

Question 43

Pentoxifylline (Trental) is a medication used for which of the following conditions? a) Thromboemboli b) Hypertension c) Elevated triglycerides d) Claudication

Answer 43

d) Claudication Explanation: Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications for using Trental

Question 44

In a patient with a bypass graft, the distal outflow vessel must be at least what percentage patent for the graft to remain patent? a) 40 b) 50 c) 20 d) 30

Answer 44

b) 50 Explanation: ## Footnote The distal outflow vessel must be at least 50% patent for the graft to remain patent

Question 45

## Footnote Which of the following are risk factors for venous disorders of the lower extremities? a) Pacing wires b) Trauma c) Obesity d) Surgery

Answer 45

c) Obesity Explanation: ## Footnote Careful assessment is invaluable in detecting early signs of venous disorders of the lower extremities. Patients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other patients at high risk include those who are obese or older adults and women taking oral contraceptives.

Question 46

## Footnote Which of the following medications classify lyses and dissolve thrombi? a) Anticoagulant b) Factor XA inhibitors c) Platelet inhibitors d) Fibrinolytic

Answer 46

d) Fibrinolytic Explanation: ## Footnote Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of patients. Anticoagulants, platelet inhibitors, and factor XA inhibitors do not lyse or dissolve thrombi

Question 47

## Footnote A patient admitted to the medical surgical unit with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are needed. Which response by the nurse is accurate? a) “Administration of two anticoagulants decreases the risk of recurrent venous thrombosis.” b) “The Lovenox will work immediately, but the Coumadin takes several days to reach its full effect.” c) “Lovenox will dissolve the clot, and Coumadin will prevent any more clots from occurring.” d) “Because of the potential for a pulmonary embolism, it is important for you to have at least two anticoagulants.”

Answer 47

b) “The Lovenox will work immediately, but the Coumadin takes several days to reach its full effect.” Explanation: Oral anticoagulants, such as warfarin, are monitored by the prothrombin time (PT) or the international normalized ratio (INR). Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0).

Question 48

## Footnote A patient is receiving enoxaparin (Lovenox) and warfarin (Coumadin) therapy for a venous thromboembolism (VTE). Which lab value indicates that anticoagulation is adequate and enoxaparin (Lovenox) can be discontinued? a) The patient’s K+ level is 3.5. b) The patient’s activated partial thromboplastin time (aPPT) is half of the control value. c) The patient’s international normalized ratio (INR) is 2.5. d) The patient’s prothrombin time (PT) is 0.5 times normal.

Answer 48

c) The patient’s international normalized ratio (INR) is 2.5. Explanation: ## Footnote Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

Question 49

## Footnote A patient is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in patient teaching prior to discharge? a) Prophylactic antibiotic therapy b) Methods of keeping the wound area dry c) Application of graduated compression stockings d) Adequate carbohydrate intake

Answer 49

c) Application of graduated compression stockings Explanation: Graduated compression stockings usually are prescribed for patients with venous insufficiency. The amount of pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose.

Question 50

A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements? a) “Since my family is from Italy, I have a higher risk of developing peripheral arterial disease.” b) “I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels.” c) “I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet.” d)“The older I get the higher my risk for peripheral arterial disease gets.”

Answer 50

c) “I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet.” Explanation: The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.

Question 51

## Footnote A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? a) Blood pressure every 2 hours b) Ankle-arm indices every 12 hours c) Peripheral pulses every 15 minutes following surgeryv d) Color of the leg every 4 hours

Answer 51

c) Peripheral pulses every 15 minutes following surgeryv Explanation: ## Footnote The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient’s status remains stable

Question 52

he nurse completes discharge teaching for a patient following a femoral-to-popliteal bypass graft. What response by the patient would indicate teaching was effective? a) “I will call if I develop any coldness, numbness, tingling, or pain in the surgical leg." b) "I can stop the exercises that were started in the hospital once I return home." c) "It will important for me to sit at the kitchen table to promote better breathing." d)"I can now stop taking my Lipitor because my leg is fixed."

Answer 52

a) “I will call if I develop any coldness, numbness, tingling, or pain in the surgical leg." Explanation: ## Footnote The nurse ensures that the patient has the knowledge and ability to assess for any postoperative complications such as infection, occlusion of the artery or graft, and decreased blood flow. Coldness, numbness, tingling, and pain are signs of peripheral arterial occlusion, and immediate intervention is required.

Question 53

## Footnote A patient with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which of the following is the most likely cause? a) The aneurysm may be preparing to rupture. b) The patient is experiencing normal sensations associated with this condition. c) The patient is experiencing inflammation of the aneurysm. d) The aneurysm has become obstructed.

Answer 53

a) The aneurysm may be preparing to rupture. Explanation: Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is rapidly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

Question 54

## Footnote To assess for peripheral edema, the nurse will examine which of the following areas of the body? a) Upper arms b) Feet, ankles c) Lips, earlobes d) Under the sacrum

Answer 54

b) Feet, ankles Explanation: ## Footnote When right-sided heart failure occurs, blood accumulates in the vessels and backs up in peripheral veins, and the extra fluid enters the tissues. Particular areas for examination are the dependent parts of the body, such as the feet and ankles. Other prominent areas prone to edema are the fingers, hands, and over the sacrum. Cyanosis can be detected by noting color changes in the lips and earlobes.

Question 55

Which of the following nursing interventions should a nurse perform when a patient with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta blockers? a) Withhold the drug and inform the primary health care provider. b) Continue the drug and document in the patient's chart. c) Check for signs of toxicity. d) Observe for symptoms of pulmonary edema.

Answer 55

a) Withhold the drug and inform the primary health care provider. Explanation: ## Footnote Before administering beta blockers, the nurse should monitor the patient's apical pulse. If the heart rate is less than 60 bpm, the nurse should withhold the drug and inform the primary health care provider

Question 56

A nurse is assessing a patient with congestive heart failure for jugular vein distension (JVD). Which of the following observations is important to report to the physician? a) No JVD is present. b) JVD is noted at the level of the sternal angle. c) JVD is noted 3 cm above the sternal angle. d) JVD is noted 1 cm above the sternal angle.

Answer 56

c) JVD is noted 3 cm above the sternal angle. Explanation: ## Footnote JVD is assessed with the patient sitting at a 45° angle. Jugular vein distention greater than 3 cm above the sternal angle is considered abnormal and is indicative of right ventricular failure

Question 57

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? a) Potassium levels b) Flexion contractures c) Enlargement of joints d) Vasculitis

Answer 57

a) Potassium levels Explanation: ## Footnote A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.

Question 58

A patient has been diagnosed with congestive heart failure. Which of the following is a cause of crackles heard in the bases of the lungs? a) Pulmonary hypertension b) Heart palpitations c) Mitral valve stenosis d) Pulmonary congestion

Answer 58

d) Pulmonary congestion Explanation: ## Footnote Crackles heard in the bases of the lungs are a sign of pulmonary congestion. Heart palpitations are caused by tachydysrhythmias. Crackles heard in the bases of the lungs are not signs of pulmonary hypertension and mitral valve stenosis.

Question 59

Which of the following medications is categorized as a loop diuretic? a) Furosemide (Lasix) b) Spironolactone (Aldactone) c) Chlorthalidone (Hygroton) d) Chlorothiazide (Diuril)

Answer 59

a) Furosemide (Lasix) Explanation: ## Footnote Lasix is commonly used in the treatment of cardiac failure. Loop diuretics inhibit sodium and chloride reabsorption mainly in the ascending loop of Henle. Chlorothiazide is categorized as a thiazide diuretic. Chlorthalidone is categorized as a thiazide diuretic. Spironolactone is categorized as a potassium-sparing diuretic.

Question 60

The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Increased appetite b) Weight loss c) Persistent cough d) Ability to sleep through the night

Answer 60

c) Persistent cough Explanation: Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite should be reported immediately. Weight gain should be reported immediately. Frequent urination, causing interruption of sleep, should be reported immediately.

Question 61

A patient with congestive heart failure is admitted to the hospital with complaints of shortness of breath. How should the nurse position the patient in order to decrease preload? a) Head of the bed elevated at 45 degrees and lower arms supported by pillows b) Head of the bed elevated at 30 degrees and legs elevated on pillows c) Supine with arms elevated on pillows above the level of the heart d) Prone with legs elevated on pillows

Answer 61

a) Head of the bed elevated at 45 degrees and lower arms supported by pillows Explanation: ## Footnote Preload is the amount of blood presented to the ventricle just before systole. The patient is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the patient may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the patient’s weight on the shoulder muscles.

Question 62

Which of the following is the hallmark of systolic heart failure? a) Low ejection fraction (EF) b) Pulmonary congestion c) Limitation of activities of daily living (ADLs) d) Basilar crackles

Answer 62

a) Low ejection fraction (EF) Explanation: A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the patient’s symptoms

Question 63

Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? a) IV b) III c) II d) I

Answer 63

a) IV Explanation: Symptoms of cardiac insufficiency at rest are classified as IV, according to the New York Heart Association Classification of Heart Failure. In Class I, ordinary activity does not cause undue fatigue, dyspnea, palpitations, or chest pain. In Class II there is a slight limitation of ADLs. In Class III there is marked limitation on ADLs.

Question 64

The nurse assessing a patient with an exacerbation of heart failure identifies which of the following symptoms as a cerebrovascular manifestation of heart failure (HF)? a) Nocturia b) Tachycardia c) Ascites d) Dizziness

Answer 64

d) Dizziness Explanation: ## Footnote Cerebrovascular manifestations of heart failure stemming from decreased brain perfusion causes dizziness, lightheadedness, confusion, restlessness, and anxiety due to decreased oxygenation and blood flow

Question 65

The nurse identifies which of the following symptoms as a characteristic of right-sided heart failure? a) Dyspnea b) Pulmonary crackles c) Cough d) Jugular vein distention (JVD)

Answer 65

d) Jugular vein distention (JVD) Explanation: ## Footnote JVD is a characteristic of right-sided heart failure. Dyspnea, pulmonary crackles, and cough are manifestations of left-sided heart failure

Question 66

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? a) Blood urea nitrogen (BUN) b) Echocardiogram c) Electrocardiogram (ECG) d) Serum electrolytes

Answer 66

b) Echocardiogram Explanation: ## Footnote An echocardiogram is usually performed to confirm the diagnosis of heart failure. ECG, serum electrolytes, and a BUN are usually completed in the initial workup

Question 67

The nurse recognizes which of the following lab tests is a key diagnostic indicator of heart failure? a) Brain natriuretic peptide (BNP) b) Complete blood count (CBC) c) Blood urea nitrogen (BUN) d) Creatinine

Answer 67

a) Brain natriuretic peptide (BNP) Explanation: The BNP is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of HF. A BUN, creatinine, and CBC are included in the initial workup

Question 68

Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)? a) Chlorothiazide (Diuril) b) Ethacrynic acid (Edecrin) c) Spironolactone (Aldactone) d) Bumetanide (Bumex)

Answer 68

c) Spironolactone (Aldactone) Explanation: ## Footnote Aldactone is a potassium-sparing diuretic. A thiazide diuretic is Diuril. Bumex and Edecrin are loop diuretics

Question 69

The nurse identifies which of the following symptoms as a manifestation of right-sided heart failure (HF)? a) Congestion in the peripheral tissues b) Reduction in forward flow c) Accumulation of blood in the lungs d) Reduction in cardiac output

Answer 69

a) Congestion in the peripheral tissues Explanation: ## Footnote Right-sided HF, failure of the right ventricle, results in congestion in the peripheral tissues and the viscera and causes systemic venous congestion and a reduction in forward flow. Left-sided HF refers to failure of the left ventricle; it results in pulmonary congestion and causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues.

Question 70

The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock? a) Restlessness and confusion b) Hyperactive bowel sounds c) Increased urinary output d) High blood pressure

Answer 70

a) Restlessness and confusion Explanation: ## Footnote Cardiogenic shock occurs when decreased cardiac output leads to inadequate tissue perfusion and initiation of the shock syndrome. Inadequate tissue perfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).

Question 71

## Footnote A nurse is teaching patients newly diagnosed with coronary heart disease (CHD) about their disease process and risk factors for heart failure. Which of the following problems can cause left-sided heart failure (HF)? a) Cystic fibrosis b) Pulmonary embolus c) Myocardial ischemia d) Ineffective right ventricular contraction

Answer 71

c) Myocardial ischemia Explanation: ## Footnote Myocardial dysfunction and HF can be caused by a number of conditions including coronary artery disease, hypertension, cardiomyopathy, valvular disorders, and renal dysfunction with volume overload. Atherosclerosis of the coronary arteries is a primary cause of HF, and coronary artery disease is found in the majority of patients with HF. Ischemia causes myocardial dysfunction because it deprives heart cells of oxygen and causes cellular damage. MI causes focal heart muscle necrosis, the death of myocardial cells, and a loss of contractility; the extent of the infarction correlates with the severity of HF. Left sided heart failure is caused by myocardial ischemia. Ineffective right ventricular contraction, pulmonary embolus, and cystic fibrosis cause right-sided heart failure.

Question 72

A patient arrives at the ED with an exacerbation of left-sided heart failure and complains of shortness of breath. Which of the following is the priority nursing intervention? a) Assess oxygen saturation level b) Administer angiotensin II receptor blockers c) Administer angiotensin-converting enzyme inhibitors d) Administer diuretics

Answer 72

a) Assess oxygen saturation level Explanation: ## Footnote Assessment is priority to determine severity of the exacerbation. It is important to assess the oxygen saturation level of a heart failure patient, as below normal oxygen saturation level can be life-threatening. Treatment options vary according to the severity of the patient’s condition and may include supplemental oxygen, oral and IV medications, major lifestyle changes, implantation of cardiac devices, and surgical approaches. The overall goal of treatment of heart failure is to relieve patient symptoms and reduce the workload on the heart by reducing afterload and preload.

Question 73

A patient who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly develops complaints of chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the patient for other signs and symptoms of which of the following problems? a) Pulmonary edema b) Pneumonia c) Pulmonary embolism d) Myocardial infarction

Answer 73

c) Pulmonary embolism Explanation: ## Footnote Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction where emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.

Question 74

Which action will the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? a) Encourage patient to ambulate in room b) Titrate milrinone rate slowly before discontinuing c) Monitor blood pressure frequently d) Teach patient about safe home use of the medication

Answer 74

c) Monitor blood pressure frequently Explanation: ## Footnote Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to patients with severe HF, including patients who are waiting for a heart transplant. Because the drug causes vasodilation, the patient’s blood pressure is monitored prior to administration since if the patient is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and following infusions of milrinone.

Question 75

A nurse taking care of a patient recently admitted to the ICU observes the patient coughing up large amounts of pink, frothy sputum. Auscultation of the lungs reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this patient is developing which of the following problems? a) Acute exacerbation of chronic obstructive pulmonary disease b) Decompensated heart failure with pulmonary edema c) Tuberculosis d) Bilateral pneumonia

Answer 75

b) Decompensated heart failure with pulmonary edema Explanation: ## Footnote Large quantities of frothy sputum, which is sometimes pink or tan (blood tinged), may be produced, indicating acute decompensated HF with pulmonary edema

Question 76

The nurse understands that a patient with which cardiac arrhythmia is most at risk for developing heart failure? a) Atrial fibrillation b) Supraventricular tachycardia c) First-degree heart block d) Sinus tachycardia

Answer 76

a) Atrial fibrillation Explanation: ## Footnote Cardiac dysrhythmias such as atrial fibrillation may either cause or result from HF; in both instances, the altered electrical stimulation impairs myocardial contraction and decreases the overall efficiency of myocardial function

Question 77

## Footnote The nurse is caring for a patient newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the patient to address modifiable risk factors for CAD, the nurse will include which of the following? Select all that apply. a) Elevated blood pressure b) Drug use c) Decreased LDL level d) Alcohol use e) Obesity

Answer 77

a) Elevated blood pressure, e)Obesity Explanation: Hypertension, obesity, hyperlipidemia, tobacco use, diabetes mellitus, metabolic syndrome, and physical inactivity are modifiable risk factor for CAD. Alcohol and drug use are not included in the list of modifiable risk factors for CAD.

Question 78

The nurse is reviewing the laboratory results for a patient diagnosed with coronary artery disease (CAD). The patient’s low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as which of the following? a) Low b) Within normal limits c) High d) Critically high

Answer 78

c)High Explanation: The normal LDL range is 100 mg/dL to 130 mg/dL. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk patients).

Question 79

## Footnote When a patient who has been diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Variant b) Unstable c) Intractable d) Refractory

Answer 79

b) Unstable Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

Question 80

A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient’s ECG reveals peaked T waves. The nurse reviews the patient's serum electrolytes anticipating which of the following abnormalities? a) Hypercalcemia b) Hypomagnesemia c) Hyponatremia d) Hyperkalemia

Answer 80

d) Hyperkalemia Explanation: Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T-wave formation.

Question 81

In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? a) 60 minutes b) 6 to 12 months c) 30 minutes d) 9 days

Answer 81

a) 60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.

Question 82

A patient diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes an overall goal of rehabilitation for a patient who has had an MI includes which of the following? a) Prevention of another cardiac event b) Limiting the effects and progression of atherosclerosis c) Returning the patient to work and a preillness lifestyle d) Improvement of the quality of life

Answer 82

d) Improvement of the quality of life Explanation: Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. An immediate objective of rehabilitation of the MI patient is to limit the effects and progression of atherosclerosis. An immediate objective of rehabilitation of the MI patient is to return the patient to work and a preillness lifestyle. An immediate objective of rehabilitation of the MI patient is to prevent another cardiac event.

Question 83

Following a percutaneous coronary intervention (PCI), a patient is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which of the following methods to induce hemostasis after sheath is contraindicated? a) Direct manual pressure b) Application of a vascular closure device c) Application of a sandbag to the area d) Application of a mechanical compression device

Answer 83

c) Application of a sandbag to the area Explanation: Applying a sandbag to the sheath insertion site is ineffective in reducing the incidence of bleeding and is not an acceptable standard of care. Application of a vascular closure device (Angioseal, VasoSeal), direct manual pressure to the sheath introduction site, and application of a mechanical compression device (C-shaped clamp) are all appropriate methods used to induce hemostasis following peripheral sheath removal.

Question 84

The nurse is caring for a patient following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which of the following medications to neutralize the unfractionated heparin the patient received? a) Aspirin b) Protamine sulfate c) Alteplase (t-PA) d) Clopidogrel (Plavix)

Answer 84

b) Protamine sulfate Explanation: Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin). Alteplase is a thrombolytic agent. Clopidogrel (Plavix) is an antiplatelet medication that is given to reduce the risk of thrombus formation post coronary stent placement. The antiplatelet effect of aspirin does not reverse the effects of heparin.

Question 85

The nurse is reevaluating a patient 2 hours following a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which of the following assessment findings may indicate the patient is experiencing a complication of the procedure? a) Heart rate of 100 bpm b) Dried blood at the puncture site c) Potassium level of 4.0 mE/qL d) Urine output of 40 mL

Answer 85

d) Urine output of 40 mL Explanation: Complications that may occur following a PTCA include myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure. The urine output of 40 mL over a 2-hour period may indicate acute renal failure. The patient is expected to have a minimum urine output of 30 mL per hour. Dried blood at the insertion site is a finding warranting no acute intervention. A serum potassium level of 4.0 mEq/L is within normal range. The heart rate of 100 bmp is within the normal range and indicates no acute distress.

Question 86

The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse? a) Sinus tachycardia b) Frequent premature atrial contractions (PACs) c) ST elevations d) Isolated premature ventricular contractions (PVCs)

Answer 86

c) ST elevations Explanation: The first signs of an acute MI are usually seen in the T wave and ST segment. The T wave becomes inverted; the ST segment elevates (usually flat). An elevation in ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e. ST elevation myocardial infarction, STEMI). This patient requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.

Question 87

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? a) CVP reading: 1 mmHg b) Pain score: 5/10. c) Heart rate: 66 bpm d) Blood pressure: 110/68 mmHg

Answer 87

a) CVP reading: 1 mmHg Explanation: The central venous pressure (CVP) reading of 1 is low (2–6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse’s priority.

Question 88

The nurse is caring for patient experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase (Activase). Prior to administering this medication, which of the following questions is most important for the nurse to ask the patient? a) “What time did your chest pain start today?” b) “How many sublingual nitroglycerin tabs did you take?” c) “Do your parents have a history of heart disease?” d) “What is your pain level on a scale of 1 to 10?”

Answer 88

a) “What time did your chest pain start today?” Explanation: The patient may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the patient’s chest pain lasts longer than 20 minutes, unrelieved by nitroglycerin, ST-segment elevation in the at least two leads that face the same area of the heart, less than 6 hours from onset of pain. The most appropriate question for the nurse to ask is in relationship to when the chest pain began. The other questions would not aid in determining if the patient is a candidate for thrombolytic therapy.

Question 89

A patient presents to the emergency room complaining of chest pain. The patient’s orders include the following elements. Which order should the nurse complete first? a) Aspirin 325 mg orally b) Oxygen 2 liters nasal cannula c) 12-lead ECG d) Troponin level

Answer 89

c) 12-lead ECG Explanation: The nurse should complete the 12-lead ECG first. The priority is to determine if the patient is suffering an acute MI and implement appropriate interventions as quickly as possible. The other orders should be completed after the ECG.

Question 90

## Footnote The nurse has completed a teaching session on the self-administration of sublingual nitroglycerin. Which of the following patient statements indicates that the patient teaching has been effective? a) “Side effects of nitroglycerin include, flushing, throbbing headache, and hypertension”. b) “I can put the nitroglycerin tablets in my daily pill dispenser with my other medications”. c) “After taking two tablets with no relief, I should call emergency medical services.” d) “I can take nitroglycerin prior to having sexual intercourse so I won’t develop chest pain”.

Answer 90

d) “I can take nitroglycerin prior to having sexual intercourse so I won’t develop chest pain”. Explanation: Nitroglycerin can be taken in anticipation of any activity that may produce pain. Because nitroglycerin increases tolerance for exercise and stress when taken prophylactically (i.e. before angina-producing activity, such as exercise, stair-climbing, or sexual intercourse), it is best taken before pain develops. The client is instructed to take three tablets 5 minutes apart and if the chest pain is not relieved emergency medical services should be contacted. Nitroglycerin is very unstable; it should be carried securely in its original container (e.g., capped dark glass bottle); tablets should never be removed and stored in metal or plastic pillboxes. Side effects of nitroglycerin includes: flushing, throbbing headache, hypotension, and tachycardia.

Question 91

The nurse is caring for a patient who was admitted to the telemetry unit with a diagnosis of rule/out acute MI. The patient’s chest pain began 3 hours ago. Which of the following laboratory tests would be most helpful in confirming the diagnosis of a current MI? a) Troponin C level b) Myoglobin level c) CK-MM d) Creatinine kinase-myoglobin (CK-MB) level

Answer 91

d) Creatinine kinase-myoglobin (CK-MB) level Explanation: ## Footnote Elevated CK-MB assessment by mass assay is an indicator of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (due to thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. There are three isomers of troponin: C, I, and T. Troponin I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. An increase in myoglobin is not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI.

Question 92

A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following? a) Decreases resting heart rate b) Decreases platelet aggregation c) Decreases cholesterol level d) Increases cardiac output

Answer 92

a) Decreases resting heart rate Explanation: The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce the myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. Generally the dosage of medication is titrated to achieve a resting heart rate of 50–60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.

Question 93

## Footnote he nurse is caring for a patient diagnosed with unstable angina receiving IV heparin. The patient is placed on bleeding precautions. Bleeding precautions include which of the following measures? a) Avoiding continuous BP monitoring b) Avoiding the use of nail clippers c) Avoiding subcutaneous (SQ) injections d) Using an electric toothbrush

Answer 93

a) Avoiding continuous BP monitoring Explanation: The patient receiving heparin is placed on bleeding precautions, which can include: applying pressure to the site of any needle punctures for a longer time than usual, avoiding intramuscular injections, avoiding tissue injury and bruising from trauma or constrictive devices (e.g. continuous use of an automatic BP cuff). SQ injections are permitted; a soft toothbrush should be used, and the patient may use nail clippers, but with caution.

Question 94

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse? a) Minimal oozing of blood from the IV site b) Presence of reperfusion dysrhythmias c) Altered level of consciousness d) Chest pain: 2 of 10 (1-to-10 pain scale)

Answer 94

c) Altered level of consciousness Explanation: ## Footnote A patient receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low, and indicates the patient’s chest pain is subsiding, an expected outcome of this therapy.

Question 95

A patient admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which of the following medications will the nurse administer to relieve the patient’s anxiety and decrease cardiac workload? a) Norvasc (amlodipine) b) IV nitroglycerin c) Tenormin (atenolol) d) IV morphine

Answer 95

d) IV morphine Explanation: IV morphine is the analgesic of choice for treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of Tenormin and Norvasc are not indicated in this situation.

Question 96

## Footnote The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following? a) Thrombolytics b) IV nitroglycerin c) IV heparin d) Percutaneous coronary intervention (PCI)

Answer 96

d) Percutaneous coronary intervention (PCI) Explanation: ## Footnote The patient with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.

Question 97

The nurse is caring for a male patient who is being evaluated for lipid-lowering medication. The patient’s laboratory results reveal the following: Total cholesterol: 230 mg/dL, LDL: 120 mg/dL, and a triglyceride level of 310 mg/dL. Which of the following classes of medications would be most appropriate for the patient based on his laboratory findings? a) Nicotinic acids b) HMG-CoA reductase inhibitors c) Bile acid sequestrants d) Fibric acids

Answer 97

a) Nicotinic acids Explanation: The most appropriate class of medications based on the patient’s laboratory findings would be nicotinic acids. This class of medications is prescribed for patients with: minimally elevated cholesterol and LDL levels or as an adjunct to a statin when the lipid goal has not been has not been achieved and triglyceride (TG) levels are elevated.

Question 98

A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a) Intermittent nausea and emesis for 3 days b) Anxiousness, restlessness, and lightheadedness c) Chest discomfort not relieved by rest or nitroglycerin d) Cool, clammy, diaphoretic, and pale appearance

Answer 98

c) Chest discomfort not relieved by rest or nitroglycerin Explanation: Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with ACS (acute coronary syndrome) or MI, may also occur with angina and, alone, are not indicative of an MI.

Question 99

The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which of the following measures should the nurse complete to prevent deep venous thrombosis (DVT) and possible pulmonary embolism (PE) development? Select all that apply. a) Place pillows in the popliteal space. b) Avoid elevating the knees on the bed. c) Initiate passive exercises. d) Apply antiembolism stockings. e) Encourage the crossing of the legs.

Answer 99

b) Avoid elevating the knees on the bed., c) Initiate passive exercises., d) Apply antiembolism stockings. Explanation: Preventative measures utilized to prevent venous stasis include: Application of sequential pneumatic compression wraps or antiembolic stockings; discouraging leg crossing; avoiding elevating the knees on the bed; omitting pillows in the popliteal space; beginning passive exercises followed by active exercises to promote circulation and prevent venous stasis.

Question 100

A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well." The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a) Ativan 1 mg orally b) Serum electrolytes c) Nitroglycerin SL d) Chest x-ray

Answer 100

c) Nitroglycerin SL Explanation: Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client’s tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient’s chest pain.

Question 101

A patient has had a 12-lead -ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes this finding indicates which of the following? a) A past MI b) Variant angina c) A cardiac dysrhythmia d) An evolving MI

Answer 101

a) A past MI Explanation: An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI

Question 102

A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding? a) Flattened P waves b) Prolonged QT interval c) Peaked T waves d) Occasional U waves

Answer 102

c) Peaked T waves Explanation: The patient’s serum potassium level is high. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or “peaked” if a patient’s serum potassium level is high. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient's serum potassium level is low. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria and is not affected by a patient's serum potassium level. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization, and is not affected by a patient’s serum potassium level.

Question 103

## Footnote A nurse is completing a shift assessment on a patient admitted to the telemetry unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The patient is also experiencing dizziness and shortness of breath. Which of the following medications will the nurse anticipate administering to the patient based on these clinical findings? a) Pronestyl b) Cardizem c) Lidocaine d) Atropine

Answer 103

d) Atropine Explanation: The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias

Question 104

## Footnote A patient’s ECG tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as which of the following? a) Atrial fibrillation b) Ventricular tachycardia c) Atrial flutter d) Ventricular fibrillation

Answer 104

c) Atrial flutter Explanation: The nurse correctly identifies the ECG tracing as atrial flutter. Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per

Question 105

A nurse is evaluating a client with a temporary pacemaker. The patient’s ECG tracing shows each P wave followed by the pacing spike. The nurse’s best response is which of the following? a) Reposition the extremity and turn the patient to left side. b) Check the security of all connections and increase the milliamperage. c) Obtain a 12-lead ECG and a portable chest x-ray. d) Document the findings and continue to monitor the patient.

Answer 105

d) Document the findings and continue to monitor the patient. Explanation: Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the patient. Repositioning the patient, placing the patient on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape.

Question 106

A nurse is providing morning care for a patient in the ICU. Suddenly, the bedside monitor shows ventricular fibrillation and the patient becomes unresponsive. After calling for assistance, what action should the nurse take next? a) Provide electrical cardioversion. b) Begin cardiopulmonary resuscitation. c) Administer intravenous epinephrine. d) Prepare for endotracheal intubation.

Answer 106

b) Begin cardiopulmonary resuscitation. Explanation: In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the patient as soon as possible. If defibrillation is not readily available, CPR is begun until the patient can be defibrillated, followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. Electrical cardioversion is not indicated for a patient in ventricular fibrillation.

Question 107

A 26-year-old male patient, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is being treated in the emergency department. The patient is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the patient becomes lightheaded but does not lose consciousness. Which of the following maneuvers may be used to interrupt the patient's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. a) Instructing the patient to vigorously exercise b) Placing the patient’s face in cold water c) Instructing the patient to breathe deeply d) Stimulating the patient’s gag reflex e) Performing carotid massage.

Answer 107

b) Placing the patient’s face in cold water, d) Stimulating the patient’s gag reflex, e) Performing carotid massage. Explanation: The following vagal maneuvers can be used to interrupt AVNRT: stimulating the patient's gag reflex, having the patient hold his breath, cough, bear down, placing his face in cold water, or performing carotid massage. These measures elicit a vagal response which will slow AV conduction time and help restore a regular rhythm. Because of the risk of a cerebral embolic event, carotid massage is contraindicated in patients with carotid bruits. If the vagal maneuvers are ineffective, the patient may receive a bolus of adenosine to correct the rhythm; this is nearly 100% effective in terminating AVNRT. Overexertion and deep inspirations are measures that could precipitate SVT.

Question 108

A 1-minute ECG tracing of a patient with a regular heart rate reveals 25 small square boxes within an RR interval. The nurse correctly identifies the patient heart rate as which of the following? a) 60 bpm. b) 70 bpm c) 80 bpm d) 100 bpm

Answer 108

a) 60 bpm. Explanation: A patient's HR can be obtained from the ECG tracing by several methods. A 1-minute strip contains 300 large boxes and 1500 small boxes. Therefore, an easy and accurate method of determining heart rate with a regular rhythm is to count the number of small boxes within an RR interval and divide by 1,500. In this instance, 1,500/25 = 60.

Question 109

A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient’s 6-second rhythm tracing. The nurse correctly identifies the patient’s heart rate as which of the following? a) 100 bpm b) 80 bpm c) 90 bpm d) 70 bpm

Answer 109

c) 90 bpm Explanation: An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90.

Question 110

A patient tells the nurse “my heart is skipping beats again; I’m having palpitations.” After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? a) Apply supplemental oxygen. b) Lie down and elevate the feet. c) Request sublingual nitroglycerin. d) Avoid caffeinated beverages

Question 111

A patient tells the nurse “my heart is skipping beats again; I’m having palpitations.” After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? a) Apply supplemental oxygen. b) Avoid caffeinated beverages. c) Lie down and elevate the feet. d) Request sublingual nitroglycerin.

Answer 111

b) Avoid caffeinated beverages. Explanation: If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages.

Question 112

The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient’s ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse’s most appropriate action? a) Instruct the patient to bear down as if having a bowel movement. b) Notify the patient’s primary care provider of the findings. c) Document the findings and continue to monitor the patient. d) Apply oxygen via nasal cannula and obtain a 12-lead ECG.

Answer 112

c) Document the findings and continue to monitor the patient. Explanation: The patient’s ECG tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the patient.

Question 113

A patient is being treated in the intensive care unit following an acute MI. During the nursing assessment, the patient states shortness of breath and chest pain. In addition, the patient’s blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which of the following actions should the nurse complete first? a) Prepare for defibrillation. b) Obtain a 12-lead ECG. c) Administer 1 mg of IV atropine. d) Initiate transcutaneous pacing.

Answer 113

d) Initiate transcutaneous pacing. Explanation: The patient is experiencing a third-degree heart block. Transcutaneous pacing should be implemented first. A permanent pacemaker may be indicated if the block continues. Defibrillation is not indicated; third-degree heart block does not respond to atropine; a 12-lead ECG may be obtained, but is not completed first.

Question 114

A patient with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The patient's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of which of the following? a) Embolic stroke b) Heart failure c) Renal failure d) Myocardial infarction

Answer 114

a) Embolic stroke Explanation: Intervention is implemented to prevent the development of an embolic event/stroke. Patients with a history of previous stroke, transient ischemic attack (TIA), embolic event, mitral stenosis, or prosthetic heart valve and who develop atrial fibrillation are at significant risk of developing an embolic stroke. Antithrombotic therapy is indicated for all patients with atrial fibrillation, especially those at risk of an embolic event, such as a stroke, and is the only therapy that decreases cardiovascular mortality. These patients are often placed on warfarin, in contrast to patients who have no risk factors, who are often prescribed 81 to 325 mg of aspirin daily.

Question 115

## Footnote The nurse is assigned to care for the following patients admitted to a telemetry unit. Which patient should the nurse assess first? a) A patient diagnosed with new onset of atrial fibrillation requiring scheduled IV Cardizem b) A patient returned from an electrophysiology (EP) procedure 2 hours ago complaining of constipation c) A patient whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift requiring amiodarone IV d) A patient who received elective cardioversion 1 hour ago with a heart rate (HR) is 115 bpm

Answer 115

c) A patient whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift requiring amiodarone IV Explanation: ## Footnote The patient’s ICD that has fired on the previous shift should be seen first. This patient is in need of antidysrhythmic medication and this is the priority intervention. The remaining patients should be seen after this patient and are in no acute distress.

Question 116

The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? a) QRS complex that is 0.10 seconds long b) PR interval that is 0.18 seconds long c) ST segment that is isoelectric in appearance d) QT interval that is 0. 46 seconds long

Answer 116

d) QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.

Question 117

## Footnote The nurse is caring for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which of the following actions should the nurse complete? a) Prepare for emergent electrical cardioversion. b) Request a digoxin level be ordered. c) Prepare to administer IV lidocaine. d) Withhold the patient’s oral potassium supplement.

Answer 117

b) Request a digoxin level be ordered. Explanation: The nurse should request a digoxin level be obtained. Junctional tachycardia generally does not have any detrimental hemodynamic effect; it may indicate a serious underlying condition, such as digitalis toxicity, myocardial ischemia, hypokalemia, or chronic obstructive pulmonary disease (COPD). Potassium supplements do not cause junctional tachycardia. Lidocaine is indicated for the treatment of premature ventricular contractions (PVCs). Because junctional tachycardia is caused by increased automaticity, cardioversion is not an effective treatment; in fact, it causes an increase in ventricular rate.

Question 118

The nurse understands that asystole can be caused by several of the following. Select all that apply. a) Hypovolemia b) Hypothermia c) Acidosis d) Hypoxia e) Alkalosis

Answer 118

a) Hypovolemia, b) Hypothermia, c) Acidosis, d) Hypoxia Explanation: ## Footnote Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the “Hs and Ts”: hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).

Question 119

The nurse is analyzing a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as which of the following? a) Junctional tachycardia b) Sinus tachycardia c) Normal sinus rhythm d) First-degree atrioventricular (AV) block

Answer 119

c) Normal sinus rhythm Explanation: The ECG tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.

Question 120

A nurse is providing evening care for a patient wearing a continuous telemetry monitor. While the nurse is giving the patient a back rub, the patient’s monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse’s first response? a) Call for assistance and begin CPR. b) Administer a pericardial thump. c) Call a code and obtain the crash cart. d) Assess the patient and monitor leads.

Answer 120

d) Assess the patient and monitor leads. Explanation: The nurse should assess the patient and monitor leads first. It is important that the nurse “treat the patient, not the monitor.” Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary.