MSS: Cardiac Disorders Comprehensive Exam

Question 1

Which population is at a higher risk for dying from a myocardial infarction?

1. Caucasian males.
2. Hispanic females.
3. Asian males.
4. African American females.

Answer 1

1. Caucasian males have a high rate of coronary artery disease, but they do not delay seeking health care as long as some other ethnic groups. The average delay time is five (5) hours.
2. Hispanic females are at higher risk for diabetes than for dying from a myocardial infarction.
3. Asian males have fewer cardiovascular events, which is attributed to their diet, which is high in fiber and omega-3 fatty acids.
4. African American females are 35% more likely to die from coronary artery disease than any other population. This population has significantly higher rates of hypertension and it occurs at a younger age. The higher risk of death from an MI is also attributed to a delay in seeking emergency care—an average of 11 hours.

Question 2

Which preprocedure information should be taught to the female client having an exercise stress test in the morning?

1. Wear open-toed shoes to the stress test.
2. Inform the client not to wear a bra.
3. Do not eat anything for four (4) hours.
4. Take the beta blocker one (1) hour before the test.

Answer 2

1. The client should wear firm-fitting, solid athletic shoes.
2. The client should wear a bra to provide adequate support during the exercise.
3. NPO decreases the chance of aspiration in case of emergency. In addition, if the client has just had a meal, the blood supply will be shunted to the stomach for digestion and away from the heart, per- haps leading to an inaccurate test result.
4. A beta blocker is not taken prior to the stress test because it will decrease the pulse rate and blood pressure by direct parasympathetic stimulation to the heart

Question 3

Which intervention should the nurse implement with the client diagnosed with dilated cardiomyopathy?

1. Keep the client in the supine position with the legs elevated.
2. Discuss a heart transplant, which is the definitive treatment.
3. Prepare the client for coronary artery bypass graft.
4. Teach the client to take a calcium channel blocker in the morning.

Answer 3

1. Most clients with dilated cardiomyopathy prefer to sit up with their legs in the dependent position. This position causes pooling of blood in the periphery and reduces preload.
2. Without a heart transplant, this client will end up in end-stage heart failure. A transplant is the only treatment for a client with dilated cardiomyopathy.
3. A bypass is the treatment of choice for a client with occluded coronary arteries.
4. Calcium channel blockers are contraindicated in clients with dilated cardiomyopathy because they interfere with the contractility of the heart.

Question 4

Which medical client problem should the nurse include in the plan of care for a client diagnosed with cardiomyopathy?

1. Heart failure.
2. Activity intolerance.
3. Powerlessness.
4. Anticipatory grieving.

Answer 4

1. Medical client problems indicate the nurse and the physician must collaborate to care for the client; the client must have medications for heart failure.
2. The nurse can instruct the client to pace activities and can teach about rest versus activity without a health care provider order.
3. This is a psychosocial client problem that does not require a physician’s order to effectively care for the client.
4. Anticipatory grieving involves the nurse addressing issues that will occur based on the knowledge of the poor prognosis of this disease.

Question 5

The client has an implantable cardioverter defibrillator (ICD). Which discharge instructions should the nurse teach the client?

1. Do not lift or carry more than 23 kg.
2. Have someone drive the car for the rest of your life.
3. Carry the cell phone on the opposite side of the ICD.
4. Avoid using the microwave oven in the home.

Answer 5

1. Clients should not lift more than 5 to 10 pounds because it puts a strain on the heart; 23 kg is more than 50 pounds.
2. There may be driving restrictions, but the client should be able to drive independently.
3. Cell phones may interfere with the functioning of the ICD if they are placed too close to it.
4. Microwave ovens should not cause problems with the ICD.

Question 6

To what area should the nurse place the stethoscope to best auscultate the apical pulse?

1. A
2. B
3. C
4. D

Answer 6

1. This is the best place to auscultate the aortic valve, the second intercostal space, right sternal notch.
2. This is the best place to auscultate the pulmonic valve, the second intercostal space, left sternal notch.
3. This is the best place to auscultate the tricuspid valve, the third intercostal space, left sternal border.
4. The best place to auscultate the apical pulse is over the mitral valve area, which is the fifth intercostal space, midclavicular line.

Question 7

The telemetry nurse notes a peaked T wave for the client diagnosed with congestive heart failure. Which laboratory data should the nurse assess?

1. CK-MB.
2. Troponin.
3. BNP.
4. Potassium.

Answer 7

1. CK-MB is assessed to determine if the client has had a myocardial infarction. The electrical activity of the heart will not be affected by elevation of this enzyme.
2. Troponin is assessed to determine if the client has had a myocardial infarction. The electrical activity of the heart will not be affected by elevation of this enzyme.
3. Beta-type natriuretic peptide (BNP) is elevated in clients with congestive heart failure, but it does not affect the electrical activity of the heart.
4. Hyperkalemia will cause a peaked T wave; therefore, the nurse should chec

Question 8

The client comes to the emergency department saying, “I am having a heart attack.” Which question is most pertinent when assessing the client?

1. “Can you describe your chest pain?”
2. “What were you doing when the pain started?”
3. “Did you have a high-fat meal today?”
4. “Does the pain get worse when you lie down?”

Answer 8

1. The chest pain for an MI usually is described as an elephant sitting on the chest or a belt squeezing the substernal midchest, often radiating to the jaw or left arm.
2. This helps to identify if it is angina (result- ing from activity) or MI (not necessarily brought on by activity).
3. Learning about a client’s intake of a high- fat meal would help the nurse to identify a gallbladder attack.
4. This is a question the nurse might ask the client with reflux esophagitis.

Question 9

The client with coronary artery disease is prescribed transdermal nitroglycerin, a coronary vasodilator. Which behavior indicates the client understands the discharge teaching concerning this medication?

1. The client places the medication under the tongue.
2. The client removes the old patch before placing the new.
3. The client applies the patch to a hairy area.
4. The client changes the patch every 36 hours.

Answer 9

1. The client does not understand how to apply this medication; it is placed on the skin, not under the tongue.
2. This behavior indicates the client understands the discharge teaching.
3. The patch needs to be in a nonhairy place so it makes good contact with the skin.
4. The patch should be changed every 12 or 24 hours but never every two (2) hours. It takes two (2) hours for the patch to warm up and begin delivering the optimum dose of medication.

Question 10

Which client would most likely be misdiagnosed for having a myocardial infarction?

1. A 55-year-old Caucasian male with crushing chest pain and diaphoresis.
2. A 60-year-old Native American male with an elevated troponin level.
3. A 40-year-old Hispanic female with a normal electrocardiogram.
4. An 80-year-old Peruvian female with a normal CK-MB at 12 hours.

Answer 10

1. Crushing pain and sweating are classic signs of an MI and should not be misdiagnosed.
2. An elevated troponin level is a benchmark in diagnosing an MI and should not be misdiagnosed.
3. The clients who are misdiagnosed concerning MIs usually present with atypical symptoms. They tend to be female, be younger than 55 years old, be members of a minority group, and have normal electrocardiograms.
4. CK-MB may not elevate until up to 24 hours after onset of chest pain.

Question 11

Which meal would indicate the client understands the discharge teaching concerning the recommended diet for coronary artery disease?

1. Baked fish, steamed broccoli, and garden salad.
2. Enchilada dinner with fried rice and refried beans.
3. Tuna salad sandwich on white bread and whole milk.
4. Fried chicken, mashed potatoes, and gravy.

Answer 11

1. The recommended diet for CAD is low fat, low cholesterol, and high fiber. The diet described is a diet that is low in fat and cholesterol.
2. This is a diet very high in fat and cholesterol.
3. The word “salad” implies something has been mixed with the tuna, usually mayonnaise, which is high in fat, but even if the test taker did not know this, white bread is low in fiber and whole milk is high in fat.
4. Meats should be baked, broiled, or grilled—not fried. Gravy is high in fat.

Question 12

The unlicensed assistive personnel (UAP) tells the primary nurse that the client diagnosed with coronary artery disease is having chest pain. Which action should the nurse take first?

1. Tell the UAP to go take the client’s vital signs.
2. Ask the UAP to have the telemetry nurse read the strip. 3. Notify the client’s health-care provider.
3. Go to the room and assess the client’s chest pain.

Answer 12

1. The client with CAD who is having chest pain is unstable and requires further judgment to determine appropriate actions to take, and the UAP does not have that knowledge.
2. The UAP could go ask the telemetry nurse, but this is not the first action.
3. The client’s HCP may need to be notified, but this is not the first intervention.
4. Assessment is the first step in the nursing process and should be implemented first; chest pain is priority.

Question 13

Which interventions should the nurse discuss with the client diagnosed with coronary artery disease? Select all that apply.

1. Instruct the client to stop smoking.
2. Encourage the client to exercise three (3) days a week.
3. Teach about coronary vasodilators.
4. Prepare the client for a carotid endarterectomy. 5. Eat foods high in monosaturated fats.

Answer 13

1. Smoking is the one risk factor that must be stopped totally; there is no compromise
2. Exercising helps develop collateral circulation and decrease anxiety; it also helps clients to lose weight.
3. Clients with coronary artery disease are usually prescribed nitroglycerin, which is the treatment of choice for angina.
4. Carotid endarterectomy is a procedure to remove atherosclerotic plaque from the carotid arteries, not the coronary arteries.
5. The client should eat polyunsaturated fats, not monosaturated fats, to help decrease atherosclerosis.

Question 14

Which laboratory data confirm the diagnosis of congestive heart failure?

1. Chest x-ray (CXR).
2. Liver function tests.
3. Blood urea nitrogen (BUN).
4. Beta-type natriuretic peptide (BNP).

Answer 14

1. The CXR will show an enlarged heart, but it is not used to confirm the diagnosis of congestive heart failure.
2. Liver function tests may be ordered to evaluate the effects of heart failure on the liver, but they do not confirm the diagnosis.
3. The BUN is elevated in heart failure, dehydration, and renal failure, but it is not used to confirm congestive heart failure.
4. BNP is a hormone released by the heart muscle in response to changes in blood volume and is used to diagnose and grade heart failure.

Question 15

What is the priority problem in the client diagnosed with congestive heart failure?

1. Fluid volume overload.
2. Decreased cardiac output.
3. Activity intolerance.
4. Knowledge deficit.

Answer 15

1. Fluid volume overload is a problem in clients with congestive heart failure, but it is not priority because, if the cardiac output is improved, then the kidneys are perfused, which leads to elimination of excess fluid from the body.
2. Decreased cardiac output is responsible for all the signs/symptoms associated with CHF and eventually causes death, which is why it is the priority problem.
3. Activity intolerance alters quality of life, but it is not life threatening.
4. Knowledge deficit is important, but it is not priority over a physiological problem.

Question 16

Which data would cause the nurse to question administering digoxin to a client diagnosed with congestive heart failure?

1. The potassium level is 3.2 mEq/L.
2. The digoxin level is 1.2 mcg/mL.
3. The client’s apical pulse is 64.
4. The client denies yellow haze.

Answer 16

1. This potassium level is below normal levels; hypokalemia can potentiate digoxin toxicity and lead to cardiac dysrhythmias.
2. This digoxin level is within therapeutic range, 0.5 to 2.0 mcg/mL.
3. The nurse would question the medication if the apical pulse were less than 60.
4. Yellow haze is a sign of digoxin toxicity.

Question 17

The nurse is caring for clients on a cardiac floor. Which client should the nurse assess first?

1. The client with three (3) unifocal PVCs in one (1) minute.
2. The client diagnosed with coronary artery disease who wants to ambulate.
3. The client diagnosed with mitral valve prolapse with an audible S3.
4. The client diagnosed with pericarditis who is in normal sinus rhythm.

Answer 17

1. Three (3) unifocal PVCs in one (1) minute is not life threatening.
2. The client wanting to ambulate is not a priority over a client with a physiological problem.
3. An audible S3 indicates the client is developing left-sided heart failure and needs to be assessed immediately.
4. A client in normal sinus rhythm will not be priority over someone with a potentially life-threatening situation.

Question 18

The nurse is told in report the client has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur?

1. Second intercostal space, right sternal notch.
2. Erb’s point.
3. Second intercostal space, left sternal notch.
4. Fourth intercostal space, left sternal border.

Answer 18

1. The second intercostal space, right sternal notch, is the area on the chest where the aorta can best be heard opening and closing.
2. Erb’s point allows the nurse to hear the opening and closing of the tricuspid valve.
3. The second intercostal space, left sternal notch, is the area on the chest where the pulmonic valve can best be heard opening and closing.
4. The fourth intercostal space, left sternal border, is another area on the chest that can assess the tricuspid valve.

Question 19

The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first?

1. Call a code immediately.
2. Assess the client for a pulse.
3. Begin chest compressions.
4. Continue to monitor the client.

Answer 19

1. The nurse should call a code if the client does not have vital signs.
2. The nurse must first determine if the client has a pulse. Pulseless ventricular tachycardia is treated as ventricular fibrillation. Stable ventricular tachycardia is treated with medications.
3. Chest compression is only done if the client is not breathing and has no pulse.
4. Ventricular tachycardia is a potentially life-threatening dysrhythmia and needs to be treated immediately.

Question 20

The nurse is assisting with a synchronized cardioversion on a client in atrial fibrillation. When the machine is activated, there is a pause. What action should the nurse take?

1. Wait until the machine discharges.
2. Shout “all clear” and don’t touch the bed.
3. Make sure the client is all right.
4. Increase the joules and redischarge.

Answer 20

1. Cardioversion involves the delivery of a timed electrical current. The electrical impulse discharges during ventricular depolarization and therefore there might be a short delay. The nurse should wait until it discharges.
2. Calling “all clear” and not touching the bed should be done prior to activating the machine to discharge the electrical current.
3. A pause is an expected event, and asking if the client is all right may worry the client unnecessarily.
4. Increasing joules and redischarging is implemented during defibrillation, not during synchronized cardioversion.

Question 21

The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement?

1. Notify the health-care provider.
2. Document that the pericarditis has resolved.
3. Ask the client to lean forward and listen again.
4. Prepare to insert a unilateral chest tube.

Answer 21

1. These assessment data are not life threatening and do not warrant notifying the HCP.
2. The nurse should attempt to hear the friction rub in multiple ways before documenting that it is not heard. The nurse does not determine if pericarditis has resolved.
3. Having the client lean forward and to the left uses gravity to force the heart nearer to the chest wall, which allows the friction rub to be heard.
4. Chest tubes are not the treatment of choice for not hearing a friction rub.

Question 22

The nurse assessing the client with pericardial effusion at 1600 notes the apical pulse is 72 and the BP is 138/94. At 1800, the client has neck vein distention, the apical pulse is 70, and the BP is 106/94. Which action would the nurse implement first?

1. Stay with the client and use a calm voice.
2. Notify the health-care provider immediately.
3. Place the client left lateral recumbent.
4. Administer morphine intravenous push slowly.

Answer 22

1. This is a medical emergency; the nurse should stay with the client, keep him calm, and call the nurses’ station to notify the health-care provider. Cardiac output declines with each contraction as the pericardial sac constricts the myocardium.
2. The client’s signs/symptoms would make the nurse suspect cardiac tamponade, a medical emergency. The pulse pressure is narrowing, and the client is experiencing severe rising central venous pressure as evidenced by neck vein distention. Notifying the health-care provider is important, but the nurse should stay with the client first.
3. A left lateral recumbent position is used when administering enemas.
4. Morphine would be given to a client with pain from myocardial infarction; it is not a treatment option for cardiac tamponade.

Question 23

The client is admitted to the emergency department, and the nurse suspects a cardiac problem. Which assessment interventions should the nurse implement? Select all that apply.

1. Obtain a midstream urine specimen.
2. Attach telemetry monitor to the client.
3. Start a saline lock in the right arm.
4. Draw a basal metabolic panel (BMP).
5. Request an order for a STAT 12-lead ECG.

Answer 23

1. A midstream urine specimen is ordered for a client with a possible urinary tract infection, not for a client with cardiac problems.
2. Anytime a nurse suspects cardiac problems, the electrical conductivity of the heart should be assessed.
3. Emergency medications for heart problems are primarily administered intravenously, so starting a saline lock in the right arm is appropriate.
4. This serum blood test is not specific to assess cardiac problems. A BMP evaluates potassium, sodium, glucose, and more.
5. A 12-lead ECG evaluates the electrical conductivity of the heart from all planes.

Question 24

The client is three (3) hours post–myocardial infarction. Which data would warrant immediate intervention by the nurse?

1. Bilateral peripheral pulses 2+.
2. The pulse oximeter reading is 96%.
3. The urine output is 240 mL in the last four (4) hours.
4. Cool, clammy, diaphoretic skin.

Answer 24

1. This pulse indicates the heart is pumping adequately. Normal pulses should be 2+ to 3+.
2. A pulse oximeter reading of greater than 93% indicates the heart is perfusing the periphery.
3. An output of 30 mL/hr indicates the heart is perfusing the kidneys adequately.
4. Cold, clammy skin is an indicator of cardiogenic shock, which is a complication of MI and warrants immediate intervention.

Question 25

The nurse is transcribing the doctor’s orders for a client with congestive heart failure. The order reads 2.5 mg of Lanoxin daily. Which action should the nurse implement? 1. Discuss the order with the health-care provider.

2. Take the client’s apical pulse rate before administering.
3. Check the client’s potassium level before giving the medication.
4. Determine if a digoxin level has been drawn.

Answer 25

1. This dosage is 10 times the normal dose for a client with CHF. This dose is potentially lethal.
2. No other action can be taken because of the incorrect dose.
3. No other action can be taken because of the incorrect dose.
4. No other action can be taken because of the incorrect dose.

Question 26

The nurse is teaching basic cardiopulmonary resuscitation (CPR) to individuals in the community. Which is the order of basic CPR? List in order of performance.

1. Perform head-tilt chin-lift maneuver.
2. Give two (2) rescue breaths.
3. Look, listen, and feel for breathing.
4. Begin cardiac compressions.
5. Shake and shout.

Answer 26

In order of performance: 5, 1, 3, 2, 4.

5. The first step in CPR is to determine if the client is unresponsive.
6. The rescuer performs the head-tilt chin-lift maneuver to open the client’s airway.
7. The next action must be to determine if the client is breathing.
8. If the rescuer determines the client is not breathing, then two (2) rescue breaths should be given.
9. After determining that the client has no pulse, the rescuer begins compressions.

Question 27

The nurse has received report when the telemetry technician notifies the nurse of the telemetry readings. Which client should the nurse assess first?

Answer 27

1. Atrial fibrillation is not life threatening.
2. Unifocal PVCs are common in most clients and are not life threatening. Up to six (6) per minute may occur before the nurse must intervene.
3. This is complete heart block with bradycardia, a potentially life-threatening situation. The nurse should assess this client first and make interventions accordingly.
4. Sinus tachycardia may occur for different reasons, such as ambulating to the bathroom, fever, or anemia. This is not life threatening.