Cardiovascular and peripheral vascular disorders

Question 1

For the patient receiving care for a myocardial infarction, typical vital signs will display which of the following?
A) Hypotension, bradycardia, weakened pulse, and temperature elevation
B) Hypotension, tachycardia, weakened pulse and temperature elevation.
C) Hypertension, tachycardia, weakened pulse and temperature elevation.
D) Hypertension, bradycardia, weakened pulse and temperature elevation.

Answer 1

B) Hypotension, tachycardia, weakened pulse and temperature elevation.

Question 2

During a discharge teaching session, the patient voices concern about why her risk of heart disease is elevated simply because she has a history of diabetes mellitus. Based on the nurse’s knowledge, a good explanation is that:
A) Elevated insulin levels associated with diabetes cause vasoconstriction
B) Elevated blood glucose levels promote arterial damage and contribute to arterial damage
C) Diabetics are often obese and thus at higher risk
D) There must be some misunderstanding, since risk for heart disease is not higher for the patient who has diabetes.

Answer 2

B) Elevated blood glucose levels promote arterial damage and contribute to arterial damage

Question 3

Trace the impulse pattern of the cardiac conduction system.
A) Pacemaker→Bundle of His→SA node→Bundle branches
B) Purkinje fibers→SA node→Right and left bundle branches→AV node
C) SA node→AV node→Bundle of His→Right and left bundle branches→Purkinje fibers
D) Pacemaker→SA node→Bundle of His→AV node→Purkinje fibers

Answer 3

C) SA node→AV node→Bundle of His→Right and left bundle branches→Purkinje fibers

Question 4

Fill in the blanks for the following description of the blood circulation pattern in the body by placing the option numbers in the correct order here: _______. Do not use commas or spaces.
Superior vena cava/inferior vena cava→Right atrium→ __________ valve→Right ventricle→ __________ valve→Pulmonary artery→Capillaries in the lung→Pulmonary veins→Left atrium→ __________ valve→Left ventricle→ __________ valve→ aorta.
1. Aortic semilunar
2. Bicuspid
3. Pulmonary semilunar
4. Tricuspid

Answer 4

4321

Question 5

Which of the following is appropriate patient teaching for self-administration of nitrate medications? (select all that apply)
A) Place nitroglycerin tablets under the tongue at the onset of anginal pain; if pain is unreleived, take a 2nd after 5 minutes and a 3rd after another 5 minutes.
B) Refridgerate medications until use.
C) A burning sensation on the tongue indicates an allergic reaction and requires immediate attention.
D) Place nitroglycerin patches on skin in the morning and remove at bedtime. This prevents development of tolerance and maintains effectiveness.

Answer 5

A) Place nitroglycerin tablets under the tongue at the onset of anginal pain; if pain is unreleived, take a 2nd after 5 minutes and a 3rd after another 5 minutes.
D) Place nitroglycerin patches on skin in the morning and remove at bedtime. This prevents development of tolerance and maintains effectiveness.

Question 6

Which of the following cardiac markers is specific to the heart, not influenced by skeletal muscle trauma or renal failure, and rises 3 hours following a myocardial infarction?
A) CK-MB
B) Troponin I
C) Homocysteine
D) Myoglobin

Answer 6

B) Troponin I

Question 7

You are caring for an older woman with cardiac disease. Based on your knowledge, you realize that the older cardiac patient is different from the younger cardiac patient because:
A) The cardiac output tends to be increased in the older adult.
B) The younger adult tends to have a more extensive network of collateral circulation than the older adult.
C) Dyspnea is a typical symptom of a myocardial infarction in the younger adult, whereas angina is the more common symptom in the older adult.
D) Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity.

Answer 7

D) Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity.

Question 8

In evaluating your patient’s risk factors for cardiovascular disease, you identify that the following is a modifiable risk factor that he possesses:
A) Family history of cardiovascular disease
B) Age
C) Active lifestyle
D) Hyperlipidemia

Answer 8

D) Hyperlipidemia

Question 9

Of the following, which is the most serious type of dysrhythmia?
A) Atrial fibrillation
B) Ventricular fibrillation
C) Supraventricular tachycardia
D) Sinus bradycardia

Answer 9

B) Ventricular fibrillation

Question 10

Which of the following is/are true statements regarding angina pectoris? Select all that apply.
A) Angina indicates a lack of oxygen and blood supply to the heart.
B) Angina only occurs at rest.
C) Angina may resemble heartburn or indigestion.
D) Angina is usually relieved by nitroglycerin.
E) Angina may appear as jaw pain.

Answer 10

A) Angina indicates a lack of oxygen and blood supply to the heart
C) Angina may resemble heartburn or indigestion.
D) Angina is usually relieved by nitroglycerin.
E) Angina may appear as jaw pain.

Question 11

Your patient was admitted yesterday for a myocardial infarction. Select the following statement that is true regarding treatment for a patient with myocardial infarction.
A) Thrombolytic agents, such as aspirin, are used to minimize infarct size and maximize heart function.
B) Thrombolytic agents must be initiated within 24 hours of the onset of symptoms in order to be effective.
C) Morphine sulfate is contraindicated in a patient with a myocardial infarction due to its effects on the central nervous system.
D) The patient with an acute myocardial infarction will be on bedrest with commode privileges for 24 to 48 hours.

Answer 11

D) The patient with an acute myocardial infarction will be on bedrest with commode privileges for 24 to 48 hours.

Question 12

The nurse is interviewing a male client with hypertension.  Which additional medical diagnosis in the client's history presents the greatest risk for development of a cerebral vascular accident (CVA)?
A.  Diabetes mellitus
B.  Hypothyroidism
C.  Parkinson disease
D.  Recurring pneumonia

Answer 12

A. Diabetes mellitus

Poorly controlled glucose levels stimulate fat mobilization, which predisposes to atherosclerosis.

Question 13

A 55 year old male client is admitted to the coronary care unit with chest pain.  Within the first 24 hours, which diagnostic laboratory value should the nurse suspect to be indicative of an acute myocardial infarction?
A.  Elevated serum amylase level
B.  Elevated CM-MB level
C.  Prolonged prothrombin time (PT)
D.  Elevated serum BUN and creatinine

Answer 13

B. Elevated CM-MB level
Tissue damage in the myocardium causes the release of cardiac enzymes into the blood system. An elevated CM-MB is a recognized indicator of MI.
**Other tests to diagnose MI: BNP and troponins I and T

Question 14

The blood that is pumped out of the left ventricle contains:

1: a full supply of oxygen
2: impurities that must be removed by the liver
3: a high percentage of carbon dioxide
4: all the wastes to be delivered to the organs of excretion

Answer 14

1: a full supply of oxygen

Question 15

The heart contracts in the following patterns:

1: right atrium, left atrium then the ventricles
2: both atria, then both ventricles
3: right atrium, right ventricle, then left atrium, left ventricle
4: ventricles, then atria

Answer 15

2: both atria, then both ventricles

Question 16

The interior lining of the heart, the valves, and the large vessels of the heart together are called the:

1: endocardium
2: myocardium
3: pericardium
4: epicardium

Answer 16

1: endocardium

Question 17

Valve flaps prevent the backflow of blood from the pulmonary artery into the:

1: lung
2: right atrium
3: right ventricle
4: left atrium

Answer 17

3: right ventricle

Question 18

The normal period in the heart cycle during which the muscle fibers lengthen, the heart dilates, and the cavities fill with blood, roughly the period of relaxation, is called:

1: systole
2: pulse pressure
3: diastose
4: diastole

Answer 18

4: diastole

Question 19

The right atrium receives blood from the:

1: superior and inferior venae cavae
2: pulmonary veins, pulmonary arteries
3: superior and inferior venae cavae and coronary sinus
4: membranous septum, coronary sinus

Answer 19

3: superior and inferior venae cavae and coronary sinus

Question 20

When a patient is receiving heparin therapy, the nurse should:

1: observe him for cyanosis
2: remember that a sedimentation rate is ordered for monitoring blood coagulation
3: give the injection intramuscularly
4: observe emesis, urine and stools for blood

Answer 20

4: observe emesis, urine and stools for blood

Question 21

A 72-year-old patient is admitted to the medical floor with a diagnosis of HF. In HF an increase in abdominal girth, increase in total body weight, and pitting edema are indications of:

1: fluid retention
2: electrolyte imbalance
3: disorganized ventricle pulsation
4: AV node dysfunction

Answer 21

1: fluid retention

Question 22

A 10-year-old patient is diagnosed with rheumatic fever. Of all the manifestations seen in rheumatic fever, the one that can lead to permanent complications is:

1: Sydenham’s chorea
2: erythema marginatum
3: subcutaneous nodules
4: carditis

Answer 22

4: carditis

Question 23

Patients with which type of dysrhythmia make up the largest group of those hospitalized with dysrhythmias?
A.  Sinus tachycardia
B.  Sinus bradycardia
C.  Ventricular fibrillation
D.  Atrial Fibrillation

Answer 23

D. Atrial Fibrillation
Atrial fibrillation is the most common dysrhythmia. Can lead to heart failure and stroke.
A-fib: cells in the atria other than the SA node depolarize the atria in a disorganized manner. EKG shows no P waves

Question 24

A patient with suspected paroxysmal supraventricular tachycardia (PSVT) has received 6 mg of adenosine (Adenocard) by rapid IV push, followed by 20 mL of normal saline. Suddenly the cardiac monitor indicates asystole. The nurse should:
A. Check the patient’s level of consiciousness and lead placement.
B. Initiate emergency procedures because the patient is in cardiac arrest
C. Initiate emergency procedures because the patient has received an overdose of adenosine.
D. Monitor the patient because a brief period of asystole is common after this drug is given.

Answer 24

D. Monitor the patient because a brief period of asystole is common after this drug is given.

Question 25

During a resuscitation attempt, the nurse stops chest compressions to observe the cardiac rhythm.  The rhythm has changed from ventricular tachycardia to asystole.  The next thing the nurse should do is:
A.  Resume chest compressions
B.  Check the rhythm in another ECG lead
C.  Prepare for immediate defibrillation
D.  Prepare to administer epinephrine

Answer 25

B. Check the rhythm in another ECG lead

Question 26

The following are signs and symptoms of Left-sided heart failure:  (Select all that apply)
A.  Dyspnea
B.  Tachycardia
C.  Fatigue
D.  Peripheral edema
E.  Orthopnea

Answer 26

A.  Dyspnea
B.  Tachycardia
C.  Fatigue
E.  Orthopnea
**Peripheral edema is a S/S of Right-Sided HF

Question 27

A 67-year-old patient has a diagnosis of hypertension. She is being dismissed from the hospital. Her teaching should include:

1: instruction in consuming a bland diet
2: instruction of sodium intake up to 4g/day
3: encouragement to begin a vigorous exercise program
4: education on continuing to take antihypertensive medications as prescribed

Answer 27

4: education on continuing to take antihypertensive medications as prescribed

Question 28

An 86-year-old patient is receiving D51/2 NS per IV at 83 mL/hr on the electronic infusion pump. It is vitally important that the IV lines of older adult patients be monitored carefully because:

1: these patients do not get dehydrated very easily
2: they may get a fluid overload of the circulatory system
3: of the increased risk of infection in the veins
4: of the danger of thrombophlebitis developing in the peripheral system

Answer 28

2: they may get a fluid overload of the circulatory system

Question 29

A 34-year-old patient with a history of IV drug use is diagnosed with acute infective endocarditis. Nursing interventions for this patient include:

1: early ambulation and activity progression
2: restricted activity for several weeks
3: low-calorie diet
4: dilution of blood by increased fluid intake

Answer 29

2: restricted activity for several weeks

Question 30

A 62-year-old patient has a history of angina pectoris. To decrease the pain from angina pectoris, the patient should:

1: take a cardiac glycoside at first symptom of cardiac pain
2: avoid taking more than three or four nitroglycerin pills daily
3: take nitroglycerin sublingually QID
4: take nitroglycerin sublingually prophylactically before strenuous exercise

Answer 30

4: take nitroglycerin sublingually prophylactically before strenuous exercise

Question 31

A patient has peripheral arterial disorder (PAD) of the lower extremities. Patient teaching for PAD includes:

1: encouraging the patient to ambulate frequently
2: the importance of of avoiding exposure to cold and chilling
3: teaching self-massage of the legs with lotion
4: maintaining a reduced-calorie diet

Answer 31

2: the importance of of avoiding exposure to cold and chilling

Question 32

A 75-year-old patient is diagnosed with heart failure. The nursing diagnosis of activity intolerance, related to dyspnea and fatigue, would be appropriate. Choose the appropriate nursing intervention in keeping with this diagnosis:

1: plan frequent rest periods
2: allow patient to shower
3: encourage patient to perform all ADL’s
4: encourage fluid intake of 3000 L/day

Answer 32

1: plan frequent rest periods

Question 33

A patient recovering from an MI is being prepared for discharge and should be instructed to:

1: remain inactive until healing is complete
2: remain at home and avoid exposure to cold temperatures
3: begin a cardiac rehabilitation program
4: perform isometric exercises in a relaxed environment

Answer 33

3: begin a cardiac rehabilitation program

Question 34

Dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distension, and abdominal distension are signs and symptoms of:

1: right-sided heart failure
2: left-sided heart failure
3: cardiac dysrhythmias
4: valvular heart disease

Answer 34

1: right-sided heart failure

Question 35

The primary function of patient teaching after a myocardial infarction is:

1: explaining the disease process
2: assisting the patient in developing a healthy lifestyle
3: describing the precipitating causes and onset of pain
4: educating the patient on causative factors that initiate cardiac vasoconstriction

Answer 35

2: assisting the patient in developing a healthy lifestyle

Question 36

An important nursing intervention when caring for a patient with remote telemetry is to:

1: encourage independence by permitting patient to shower
2: never remove telemetry and allow patient to shower unless physician has written an order to allow it
3: encourage the use of stairclimbing, aerobic exercise, and other forms of exertion to promote collateral circulation
4: be aware that special microphones, attached to the patient’s chest, pick up cardiac sounds produced by changes in the heart

Answer 36

2: never remove telemetry and allow patient to shower unless physician has written an order to allow it

Question 37

Signs and symptoms of cardiogenic shock include:

1: warm, dry skin
2: decreasing blood pressure and weak, rapid pulse
3: flushed face, restlessness
4: polyuria and dysuria

Answer 37

2: decreasing blood pressure and weak, rapid pulse

Question 38

Modifiable risk factors for coronary artery disease (CAD) includes?

1: Diabetes, family history
2: Family history, smoking
3: Smoking, heredity
4: High cholesterol, obesity

Answer 38

4: High cholesterol, obesity

Question 39

The name of the neurohormone released from the left ventricle in response to volume expansion and pressure overload that has emerged as the blood marker for the identification of individuals with HF is:

1: A-type natriuretic peptide (ANP)
2: troponin I
3: B-type natriuretic peptide (BNP)
4: CPK peptide

Answer 39

3: B-type natriuretic peptide (BNP)

Question 40

The normal range for BNP is:

1: 0 to 100 pg/mL
2: 500 to 900 pg/mL
3: 0.003 to 1 pg/mL
4: 400 to 500 pg/mL

Answer 40

1: 0 to 100 pg/mL

Question 41

______________ is a myocardial muscle protein released into circulation after myocardial injury and is useful in diagnosing a myocardial infarction.

Answer 41

Troponin I

Question 42

In the United States, the two beta blocker medications specifically approved for heart failure are carvedilol (Coreg) and:

1: benazepril (Lotensin)
2: captopril (Capoten)
3: long-acting metoprolol (Toprol X-L)
4: verapamil (Calan)

Answer 42

3: long-acting metoprolol (Toprol X-L)

Question 43

The most useful non-invasive diagnostic tool for evaluating the patient with heart failure is:

1: coronary angiography
2: echocardiogram
3: electrocardiogram
4: thallium scanning

Answer 43

2: echocardiogram

Question 44

Electrocardiogram findings during an MI:

1: are less likely to show ST-segment elevation in women than in men
2: always show ST-segment elevation in women, but not in men
3: always show ST-segment elevation in women and men
4: are easier to interpret in women than in men

Answer 44

1: are less likely to show ST-segment elevation in women than in men

Question 45

The nursing diagnosis of decreased cardiac output, related to loss of myocardial contractility, would be appropriate for the patient who has had an acute myocardial infarction. The correct nursing interventions for this nursing diagnosis would include: (Select All That Apply)

1: assess for and report decreased blood pressure and dysrhythmias
2: assess for oliguria
3: administer oxygen therapy as ordered
4: give opioids sparingly

Answer 45

1: assess for and report decreased blood pressure and dysrhythmias
2: assess for oliguria
3: administer oxygen therapy as ordered

Question 46

Heart failure is usually treated with: (Select All That Apply)

1: cardiotonic drugs (digitalis)
2. diuretic agents
3. generous fluid intake
4. ACE inhibitors, beta-adrenergic blockers (carvediol), nitrates

Answer 46

1: cardiotonic drugs (digitalis)
2. diuretic agents
4. ACE inhibitors, beta-adrenergic blockers (carvediol), nitrates

Question 47

An invasive procedure in which a catheter from a femoral or brachial artery is placed in the coronary artery and a balloon is inflated against the narrowing wall, thus reducing the arterial constriction, is called:

1: coronary artery bypass graft (CABG) surgery
2: pacemaker
3: vectorcardiogram
4: percutaneous transluminal coronary angioplasty (PTCA)

Answer 47

4: percutaneous transluminal coronary angioplasty (PTCA)

Question 48

Thrombolytic agents such as streptokinase and tissue plasminogen activators such as alteplase and activase are agents used to dissolve blood clots. These agents are most effective in a patient with acute MI signs and symptoms:

1: in the first 24 hours
2: in the first 30 minutes to 1 hour
3: in the first 72 hours
4: in the second 6 hours after an MI

Answer 48

2: in the first 30 minutes to 1 hour

Question 49

A 74-year-old patient with heart failure is admitted to the hospital because of a weight gain of 12 pounds in the past 2 weeks. After effective results from IV furosemide (Lasix), the patient has lost 8 pounds. This would reflect a loss of how much fluid?

1: 1.6 L
2: 6 L
3: 3.6 or 4 L
4: 2.2 L

Answer 49

3: 3.6 or 4 L

Question 50

A patient is admitted with a diagnosis of possible aortic abdominal aneurysm. In assessment for possible complications it is most important to monitor:

1: body temperature
2: skin turgor
3: respiratory rate
4: blood pressure

Answer 50

4: blood pressure

Question 51

A 63-year-old patient has Buerger’s disease. The most important aspect of patient compliance to decrease signs and symptoms of Buerger’s disease is:

1: low-fat diet
2: weight loss
3: cessation of tobacco use
4: keeping extremeties warm

Answer 51

3: cessation of tobacco use

Question 52

An 83-year-old patient is diagnosed with venous stasis ulcers. The medical management includes the use of an Unna’s paste boot. An Unna’s boot: (Select All That Apply)

1: hardens into a “boot” that may be left on for 1 to 2 weeks
2: is a moist, impregnated gauze wrapped around the patient’s foot and leg
3: applies intermittent external pressure to the lower extremities; it pushes blood from the superficial veins into the deep veins
4: protects the ulcer and provides constant and even support to the area

Answer 52

1: hardens into a “boot” that may be left on for 1 to 2 weeks
2: is a moist, impregnated gauze wrapped around the patient’s foot and leg
4: protects the ulcer and provides constant and even support to the area

Question 53

A 58-year-old patient is admitted with Raynaud’s disease. The correct patient teaching information includes: (Select All That Apply)

1: avoid cold
2: warm hands and feet with heating pad
3: practice stress-reduction techniques
4: comply with smoking cessation

Answer 53

1: avoid cold
3: practice stress-reduction techniques
4: comply with smoking cessation

Question 54

A patient is admitted with HF and chronic arterial fibrillation. What medication is his physician likely to order to prevent thrombus formation?

1: an ACE inhibitor
2: nitroglycerin
3: an antihypertensive
4: an anticoagulant

Answer 54

4: an anticoagulant

Question 55

This disorder of the peripheral vascular system involves narrowing or occlusion of the blood vessels with plaque formation which results to little/no blood flow to the affected areas.  Common in iliac & femoral arteries, distal popliteal and tibial arteries.
A.  Arteriosclerosis obliterans
B.  Venous Stasis
C.  Burger's disease
D.  Raynaud's disease

Answer 55

A. Arteriosclerosis obliterans

Question 56

The following are symptoms of Right-Sided heart failure EXCEPT:
A.  Peripheral edema
B.  Weight gain
C.  Tachycardia
D.  Distended neck veins
E.  Anorexia, nausea

Answer 56

A.  Peripheral edema
B.  Weight gain
D.  Distended neck veins
E.  Anorexia, nausea
**Also Nocturia and Weakness
Tachycardia is a symptom of Left-Sided heart failure