Cardiovascular System

Question 1

A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is most supportive of the diagnosis?

a. “I can’t get my shoes on at the end of the day.”
b. “I can’t seem to ever get my feet warm enough.”
c. “I have burning leg pains after I walk two blocks.”
d. “I wake up during the night because my legs hurt.”

Answer 1

ANS: A
Because the edema associated with venous insufficiency increases when the patient has been standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of peripheral artery disease (PAD).

Question 2

A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and
coolness in the right leg. The nurse should notify the health care provider and immediately
a. apply a compression stocking to the leg.
b. elevate the leg above the level of the heart.
c. assist the patient in gently exercising the leg.
d. keep the patient in bed in the supine position.

Answer 2

ANS: D
The patient’s history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg

Question 3

An 80-year-old patient with a history of an abdominal aortic aneurysm arrives at the emergency department
(ED) with severe back pain and absent pedal pulses. Which actions should the nurse take first?
a. Obtain the blood pressure.
b. Obtain blood for laboratory testing.
c. Assess for the presence of an abdominal bruit.
d. Determine any family history of kidney disease.

Answer 3

ANS: A
Because the patient appears to be experiencing aortic dissection, the nurse’s first action should be to determine the hemodynamic status by assessing blood pressure. The other actions also may be done, but they will not provide information that will determine what interventions are needed immediately for this patient

Question 4

After receiving report, which patient admitted to the emergency department should the nurse
assess first?
a. 67-year-old who has a gangrenous left foot ulcer with a weak pedal pulse
b. 58-year-old who is taking anticoagulants for atrial fibrillation and has black stools
c. 50-year-old who is complaining of sudden “sharp” and “worst ever” upper back pain
d. 39-year-old who has right calf tenderness, redness, and swelling after a long plane ride

Answer 4

ANS: C
The patient’s presentation is consistent with dissecting
thoracic aneurysm, which will require rapid intervention.
The other patients do not need urgent interventions

Question 5

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital
with venous thromboembolism. Which action by the nurse to elevate the patient’s feet is best?
a. The patient is placed in the Trendelenburg position.
b. Two pillows are positioned under the affected leg.
c. The bed is elevated at the knee and pillows are placed under the feet.
d. One pillow is placed under the thighs and two pillows are placed under the lower legs.

Answer 5

ANS: D
The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee
may cause blood stasis at the calf level

Question 6

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment,
the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled.
Which action should the nurse take first?
a. Notify the surgeon and anesthesiologist.
b. Wrap both the legs in a warming blanket.
c. Document the findings and recheck in 15 minutes.
d. Compare findings to the preoperative assessment of the pulses.

Answer 6

ANS: A
Lower extremity pulses may be absent for a short time after surgery because of vasospasm and hypothermia.
Decreased or absent pulses together with a cool and mottled extremity may indicate embolization or graft
occlusion. These findings should be reported to the physician immediately because this is an emergency
situation. Because pulses are marked prior to surgery, the nurse would know whether pulses were present
prior to surgery before notifying the health care providers about the absent pulses. Because the patient’s symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 15 minutes before taking action. A warming blanket will not improve the circulation to the patient’s legs.

Question 7

The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider?

a. Weak pedal pulses
b. Absent bowel sounds
c. Blood pressure 137/88 mm Hg
d. 25 mL urine output over last hour

Answer 7

ANS: C
The blood pressure is typically kept at less than 120 mm Hg systolic to minimize extension of the dissection. The nurse will need to notify the health care provider so that b-blockers or other antihypertensive medications can
be prescribed. The other findings are typical with aortic dissection and should also be reported but do not require immediate action

Question 8

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after
having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
a. Begin oral intake.
b. Obtain vital signs.
c. Assess pedal pulses.
d. Start discharge teaching.

Answer 8

ANS: B
Bleeding is a possible complication after catheterization of the femoral artery, so the nurse’s first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions are also appropriate but
can be done after determining that bleeding is not occurring

Question 9

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find

a. dilated superficial veins.
b. swollen, dry, scaly ankles.
c. prolonged capillary refill in all the toes.
d. a serosanguineous drainage from the ulcer.

Answer 9

ANS: C
Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease

Question 10

The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today.
Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/LVN)?
a. Patient who has been complaining of increased edema and skin changes in the legs
b. Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg
c. Patient who has a history of venous thromboembolism and is complaining of some dyspnea
d. Patient who needs teaching about the use of elastic compression stockings for venous insufficiency

Answer 10

ANS: B
LPN education and scope of practice includes wound
care. The other patients, which require more complex
assessments or education, should be managed by the RN.

Question 11

A patient at the clinic says, “I have always taken a walk after dinner, but lately my leg cramps and hurts after
just a few minutes of starting. The pain goes away after I stop walking, though.” The nurse should
a. check for the presence of tortuous veins bilaterally on the legs.
b. ask about any skin color changes that occur in response to cold.
c. assess for unilateral swelling, redness, and tenderness of either leg.
d. assess for the presence of the dorsalis pedis and posterior tibial pulses.

Answer 11

ANS: D
The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud’s phenomenon. Tortuous veins on the legs suggest venous
insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism (VTE).

Question 12

A patient has a 6-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When
obtaining an admission history from the patient, it will be most important for the nurse to ask about
a. low back pain.
b. trouble swallowing.
c. abdominal tenderness.
d. changes in bowel habits.

Answer 12

ANS: B
Difficulty swallowing may occur with a thoracic aneurysm
because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms

Question 13

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of
medications will the nurse plan to include when providing patient teaching about PAD management?
a. Statins
b. Antibiotics
c. Thrombolytics
d. Anticoagulants

Answer 13

ANS: A
Current research indicates that statin use by patients with
PAD improves multiple outcomes. There is no research
that supports the use of the other medication categories in PAD.

Question 14

A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the
vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient
requires the registered nurse (RN) to intervene?
a. The LPN/LVN has the patient sit in a chair for 90 minutes.
b. The LPN/LVN assists the patient to walk 40 feet in the hallway.
c. The LPN/LVN gives the ordered aspirin 160 mg after breakfast.
d. The LPN/LVN places the patient in a Fowler’s position for meals.

Answer 14

ANS: A
The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate

Question 15

Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 40 mL. The nurse notifies the health care provider and
anticipates an order for a(n)
a. hemoglobin count.
b. additional antibiotic.
c. decrease in IV infusion rate.
d. blood urea nitrogen (BUN) level.

Answer 15

ANS: D
The decreased urine output suggests decreased renal perfusion, and monitoring of renal function is needed. There is no indication that infection is a concern, so antibiotic therapy and a WBC count are not needed. The IV rate may be increased because hypovolemia may be contributing to the patient’s decreased urinary output

Question 16

When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which
assessment finding is most important for the nurse to communicate to the health care provider?
a. Presence of flatus
b. Loose, bloody stools
c. Hypoactive bowel sounds
d. Abdominal pain with palpation

Answer 16

ANS: B
Loose, bloody stools at this time may indicate intestinal ischemia or infarction, and should be reported immediately because the patient may need an emergency bowel resection. The other findings are normal on the first postoperative day after abdominal surgery

Question 17

When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery disease (PAD), which instructions should the nurse include?

a. “Exercise only if you do not experience any pain.”
b. “It is very important that you stop smoking cigarettes.”
c. “Try to keep your legs elevated whenever you are sitting.”
d. “Put elastic compression stockings on early in the morning.”

Answer 17

ANS: B
Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD

Question 18

When discussing risk factor modification for a 63-year-old patient who has a 5-cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor?

a. Male gender
b. Turner syndrome
c. Abdominal trauma history
d. Uncontrolled hypertension

Answer 18

ANS: D
All of the factors contribute to the patient’s risk, but only
hypertension can potentially be modified to decrease the
patient’s risk for further expansion of the aneurysm.

Question 19

When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse
determines a need for further instruction when the patient says, “I will
a. have to buy some loose clothes that do not bind across my legs or waist.”
b. use a heating pad on my feet at night to increase the circulation and warmth in my feet.”
c. change my position every hour and avoid long periods of sitting with my legs crossed.”
d. walk to the point of pain, rest, and walk again until the pain returns for at least 30 minutes 3 times a week.”

Answer 19

ANS: B
Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful

Question 20

Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?

a. Record hourly chest tube drainage.
b. Monitor fluid intake and urine output.
c. Check the abdominal incision for any redness.
d. Teach the reason for a prolonged recovery period.

Answer 20

ANS: B
Because renal artery occlusion can occur after endovascular repair, the nurse should monitor parameters of renal function such as intake
and output. Chest tubes will not be needed for endovascular surgery, the recovery period will be short, and there will not be an abdominal wound

Question 21

Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

a. Monitor the quality and presence of the pedal pulses.
b. Teach the patient the signs of possible wound infection.
c. Check the lower extremities for strength and movement.
d. Help the patient to use a pillow to splint while coughing.

Answer 21

ANS: D
Assisting a patient who has already been taught how to cough is part of routine postoperative care and within the education and scope of practice for UAP. Patient teaching and assessment of essential postoperative functions such as circulation and movement should be done by RNs

Question 22

A 56-year-old patient who has no previous history of hypertension or other health problems suddenly
develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
a. a BP recheck should be scheduled in a few weeks.
b. dietary sodium and fat content should be decreased.
c. there is an immediate danger of a stroke and hospitalization will be required.
d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed

Answer 22

ANS: D
A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a
stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level

Question 23

During change-of-shift report, the nurse obtains the following information about a hypertensive patient
who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates
that the patient needs immediate intervention?
a. The patient’s most recent blood pressure (BP) reading is 158/91 mm Hg.
b. The patient’s pulse has dropped from 68 to 57 beats/minute.
c. The patient has developed wheezes throughout the lung fields.
d. The patient complains that the fingers and toes feel quite cold.

Answer 23

ANS: C
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective b-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with b-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm

Question 24

The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed?

a. “A little swelling around my lips and face is okay.”
b. “The medication may not work as well if I take any aspirin.”
c. “The doctor may order a blood potassium level occasionally.”
d. “I will call the doctor if I notice that I have a frequent cough.”

Answer 24

ANS: A
Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be
immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy

Question 25

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a
hypertensive emergency. Which finding is most important to report to the health care provider?
a. Urine output over 8 hours is 250 mL less than the fluid intake.
b. The patient cannot move the left arm and leg when asked to do so.
c. Tremors are noted in the fingers when the patient extends the arms.
d. The patient complains of a headache with pain at level 8/10 (0 to 10 scale).

Answer 25

ANS: B
The patient’s inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes

Question 26

The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?

a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain
b. 52-year-old with a BP of 212/90 who has intermittent claudication
c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL
d. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria

Answer 26

ANS: A
The patient with chest pain may be experiencing acute
myocardial infarction, and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes

Question 27

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme
(ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and
has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first?
a. “Did you take any acetaminophen (Tylenol) today?”
b. “Have you been consistently taking your medications?”
c. “Have there been any recent stressful events in your life?”
d. “Have you recently taken any antihistamine medications?”

Answer 27

ANS: B
Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not
increase BP. Stressful events will increase BP but not usually to the level seen in this patient

Question 28

The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium
nitroprusside (Nipride). Which nursing action can the nurse delegate to an experienced licensed
practical/vocational nurse (LPN/LVN)?
a. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg.
b. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).
c. Set up the automatic blood pressure machine to take BP every 15 minutes.
d. Assess the patient’s environment for adverse stimuli that might increase BP.

Answer 28

ANS: C
LPN/LVN education and scope of practice include the correct use of common equipment such as automatic blood pressure machines. The other actions require advanced nursing judgment and education, and should be done by RNs

Question 29

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving
nicardipine (Cardene) to treat a hypertensive emergency?
a. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting.
b. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night.
c. Assist the patient up in the chair for meals to avoid complications associated with immobility.
d. Use an automated noninvasive blood pressure machine to obtain frequent blood pressure (BP)
measurements.

Answer 29

ANS: D
Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary

Question 30

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral
stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty
over valve replacement to the patient?
a. Biologic valves will require immunosuppressive drugs after surgery.
b. Mechanical mitral valves need to be replaced sooner than biologic valves.
c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement.
d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

Answer 30

ANS: C
Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed

Question 31

After receiving report on the following patients, which patient should the nurse assess first?

a. Patient with rheumatic fever who has sharp chest pain with a deep breath
b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
c. Patient with infective endocarditis who has a murmur and splinter hemorrhages
d. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

Answer 31

ANS: B
Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse should immediately assess this patient for other
findings such as dyspnea or chest pain. The findings in the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and intervention

Question 32

After receiving the following information about four patients during change-of-shift report, which patient should the nurse assess first?

a. Patient with acute pericarditis who has a pericardial friction rub
b. Patient who has just returned to the unit after balloon valvuloplasty
c. Patient who has hypertrophic cardiomyopathy and a heart rate of 116
d. Patient with a mitral valve replacement who has an anticoagulant scheduled

Answer 32

ANS: B
The patient who has just arrived after balloon valvuloplasty will need assessment for complications such as bleeding and hypotension. The information about the other patients is consistent with their diagnoses and does not indicate any complications or need for urgent assessment or intervention.

Question 33

During discharge teaching with a 68-year-old patient who had a mitral valve replacement with
a mechanical valve, the nurse instructs the patient on the
a. use of daily aspirin for anticoagulation.
b. correct method for taking the radial pulse.
c. need for frequent laboratory blood testing.
d. need to avoid any physical activity for 1 month.

Answer 33

ANS: C
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio (INR) testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated

Question 34

The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation. Which information
obtained by the nurse when assessing the patient should be communicated to the health care provider
immediately?
a. The patient has bilateral crackles.
b. The patient has bilateral, 4+ peripheral edema.
c. The patient has a loud systolic murmur across the precordium.
d. The patient has a palpable thrill felt over the left anterior chest

Answer 34

ANS: A
Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral
regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently

Question 35

The nurse is caring for a 78-year-old patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider?

a. The patient complains of chest pressure when ambulating.
b. A loud systolic murmur is heard along the right sternal border.
c. A thrill is palpated at the second intercostal space, right sternal border.
d. The point of maximum impulse (PMI) is at the left midclavicular line.

Answer 35

ANS: A
Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal

Question 36

The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which information obtained by the nurse is most important?

a. The patient has a history of a recent upper respiratory infection.
b. The patient has a family history of coronary artery disease (CAD).
c. The patient reports using cocaine a “couple of times” as a teenager.
d. The patient’s 29-year-old brother died from a sudden cardiac arrest.

Answer 36

ANS: D
About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people. The information about the patient’s brother will be helpful in planning care (such as an automatic implantable cardioverter-defibrillator [AICD]) for the patient and in counseling other family members. The patient should be counseled against the use of stimulant drugs, but the limited past history indicates that the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy, but not for HC

Question 37

The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence
of pulsus paradoxus, the nurse should
a. note when Korotkoff sounds are auscultated during both inspiration and expiration.
b. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).
c. check the electrocardiogram (ECG) for variations in rate during the respiratory cycle.
d. listen for a pericardial friction rub that persists when the patient is instructed to stop breathing.

Answer 37

ANS: A
Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus

Question 38

The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient?

a. Patient admitted with a large acute myocardial infarction.
b. Patient being discharged after an exacerbation of heart failure.
c. Patient who had a mitral valve replacement with a mechanical valve.
d. Patient being treated for rheumatic fever after a streptococcal infection.

Answer 38

ANS: C
Current American Heart Association guidelines recommend the use of prophylactic antibiotics before dental procedures fo patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE

Question 39

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?

a. A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

Answer 39

ANS: D
The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or
end-stage cardiomyopathy may consider heart transplantation

Question 40

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for

a. diastolic murmur.
b. peripheral edema.
c. shortness of breath on exertion.
d. right upper quadrant tenderness

Answer 40

ANS: C
The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia

Question 41

Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG) technicians working on the cardiac unit?
a. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome.
b. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis.
c. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy.
d. Check the heart monitor for changes in rhythm while a patient who had a valve replacement
ambulates.

Answer 41

ANS: D
Under the supervision of registered nurses (RNs), UAP check the patient’s cardiac monitor and obtain information about changes in heart rate and rhythm with exercise. Teaching and obtaining information about home medications (prescribed or complementary) and selecting
the best leads for monitoring patients require more critical thinking and should be done by the RN

Question 42

Which statement by a patient with restrictive cardiomyopathy indicates that the nurse’s discharge teaching about self-management has been most effective?

a. “I will avoid taking aspirin or other antiinflammatory drugs.”
b. “I will need to limit my intake of salt and fluids even in hot weather.”
c. “I will take antibiotics when my teeth are cleaned at the dental office.”
d. “I should begin an exercise program that includes things like biking or swimming.”

Answer 42

ANS: C
Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use prophylactic antibiotics for any procedure that may cause bacteremia. The other statements indicate a need for more teaching by the nurse. Dehydration and vigorous exercise impair
ventricular filling in patients with restrictive cardiomyopathy. There is no need to avoid salt
(unless ordered), aspirin, or NSAIDs

Question 43

While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the
nurse determines that discharge teaching has been effective when the patient states that it will be
necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

Answer 43

ANS: D
Use of stimulant medications should be avoided by patients with MVP because these may exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic
prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient

Question 44

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to

a. promote rest to decrease myocardial oxygen demand.
b. teach the patient about the need for anticoagulant therapy.
c. teach the patient to use sublingual nitroglycerin for chest pain.
d. raise the head of the bed 60 degrees to decrease venous return.

Answer 44

ANS: A
Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to
decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation

Question 45

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following?

a. “They will circulate my blood with a machine during the surgery.”
b. “I will have small incisions in my leg where they will remove the vein.”
c. “They will use an artery near my heart to go around the area that is blocked.”
d. “I will need to take an aspirin every day after the surgery to keep the graft open.”

Answer 45

b. “I will have small incisions in my leg where they will remove the vein.”

When the internal mammary artery is used there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.

Question 46

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider?

a. Complaints of incisional chest pain
b. Pallor and weakness of the right hand
c. Fine crackles heard at both lung bases
d. Redness on both sides of the sternal incision

Answer 46

b. Pallor and weakness of the right hand

The changes in the right hand indicate compromised blood flow, which requires immediate evaluation and actions such as prescribed calcium channel blockers or surgery. The other changes are expected and/or require nursing interventions.

Question 47

When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

a. Give the scheduled aspirin and lipid-lowering medication.
b. Perform the initial assessment of the catheter insertion site.
c. Teach the patient about the usual postprocedure plan of care.
d. Titrate the heparin infusion according to the agency protocol.

Answer 47

a. Give the scheduled aspirin and lipid-lowering medication.

Administration of oral medications is within the scope of practice for LPNs/LVNs. The initial assessment of the patient, patient teaching, and titration of IV anticoagulant medications should be done by the registered nurse (RN).

Question 48

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about
anticoagulant therapy.
permanent pacemakers.
electrical cardioversion.
IV adenosine (Adenocard).

Answer 48

ANS: A
Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate.

Question 49

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for 
diastolic murmur.
peripheral edema.
shortness of breath on exertion. 
right upper quadrant tenderness.

Answer 49

ANS: C
The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia.

Question 50

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?
Biologic valves will require immunosuppressive drugs after surgery.
Mechanical mitral valves need to be replaced sooner than biologic valves.
Lifelong anticoagulant therapy will be needed after mechanical valve replacement.
Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

Answer 50

ANS: C
Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed

Question 51

While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to
take antibiotics before any dental appointments.
limit physical activity to avoid stressing the heart.
take an aspirin a day to prevent clots from forming on the valve.
avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

Answer 51

ANS: D
Use of stimulant medications should be avoided by patients with MVP because these may exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.

Question 52

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to
promote rest to decrease myocardial oxygen demand.
teach the patient about the need for anticoagulant therapy.
teach the patient to use sublingual nitroglycerin for chest pain. raise the head of the bed 60 degrees to decrease venous return.

Answer 52

ANS: A
Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

Question 53

During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on the
use of daily aspirin for anticoagulation.
correct method for taking the radial pulse.
need for frequent laboratory blood testing.
need to avoid any physical activity for 1 month.

Answer 53

ANS: C
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio (INR) testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.

Question 54

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?
A heart transplant should be scheduled as soon as possible.
Elevating the legs above the heart will help relieve dyspnea.
Careful compliance with diet and medications will prevent heart failure.
Notify the doctor about any symptoms of heart failure such as shortness of breath.

Answer 54

ANS: D
The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.

Question 55

The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which information obtained by the nurse is most important?
The patient has a history of a recent upper respiratory infection.
The patient has a family history of coronary artery disease (CAD).
The patient reports using cocaine a “couple of times” as a teenager.
The patient’s 29-year-old brother died from a sudden cardiac arrest.

Answer 55

ANS: D.
About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people. The information about the patient’s brother will be helpful in planning care (such as an automatic implantable cardioverter-defibrillator [AICD]) for the patient and in counseling other family members. The patient should be counseled against the use of stimulant drugs, but the limited past history indicates that the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy, but not for HC.

Question 56

The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately?
The patient has bilateral crackles.
The patient has bilateral, 4+ peripheral edema.
The patient has a loud systolic murmur across the precordium. The patient has a palpable thrill felt over the left anterior chest.

Answer 56

ANS: A
Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

Question 57

Which statement by a patient with restrictive cardiomyopathy indicates that the nurse’s discharge teaching about self-management has been most effective?
“I will avoid taking aspirin or other antiinflammatory drugs.”
“I will need to limit my intake of salt and fluids even in hot weather.”
“I will take antibiotics when my teeth are cleaned at the dental office.”
“I should begin an exercise program that includes things like biking or swimming.”

Answer 57

ANS: C
Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use prophylactic antibiotics for any procedure that may cause bacteremia. The other statements indicate a need for more teaching by the nurse. Dehydration and vigorous exercise impair ventricular filling in patients with restrictive cardiomyopathy. There is no need to avoid salt (unless ordered), aspirin, or NSAIDs.

Question 58

After receiving report on the following patients, which patient should the nurse assess first? Patient with rheumatic fever who has sharp chest pain with a deep breath
Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
Patient with infective endocarditis who has a murmur and splinter hemorrhages Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

Answer 58

ANS: B
Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse should immediately assess this patient for other findings such as dyspnea or chest pain. The findings in the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and intervention.

Question 59

When discussing risk factor modification for a 63 year old patient who has a 5 cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor?

a. Male gender
b. Turner syndrome
c. Abdominal trauma history
d. Uncontrolled hypertension

Answer 59

ANS: D
All of the factors contribute to the patient’ s risk, but only hypertension can potentially be modified to decrease the patient’ s risk for further expansion of the aneurysm.

Question 60

A patient has a 6cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining an admission history from the patient, it will be most important for the nurse to ask about

a. low pain
b. trouble swallowing
c. abdominal tenderness
d. changes in bowel habits

Answer 60

AN S: B
Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms.

Question 61

Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse the urinary output for the past 2 hours has been 40ml. The nurse notifies the health care provider and anticipates an order for an:

a. hemoglobin count
b. additional antibiotic
c. decrease in IV infusion rate
d. blood urea nitrogen (BUN) level

Answer 61

ANS: D
The decreased urine output suggests decreased renal perfusion, and monitoring of renal function is needed. There is no indication that infection is a concern, so antibiotic therapy and a WBC count are not needed. The IV rate may be increased because hypovolemia may be contributing to the patient’ s decreased urinary output

Question 62

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find
dilated superficial veins.
swollen, dry, scaly ankles.
prolonged capillary refill in all the toes.
a serosanguineous drainage from the ulcer.

Answer 62

ANS: C
Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

Question 63

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patient’s feet is best?
The patient is placed in the Trendelenburg position.
Two pillows are positioned under the affected leg.
The bed is elevated at the knee and pillows are placed under the feet.
One pillow is placed under the thighs and two pillows are placed under the lower legs.

Answer 63

ANS: D
The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the calf level.

Question 64

Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?
Record hourly chest tube drainage.
Monitor fluid intake and urine output.
Check the abdominal incision for any redness.
Teach the reason for a prolonged recovery period.

Answer 64

ANS: B
Because renal artery occlusion can occur after endovascular repair, the nurse should monitor parameters of renal function such as intake and output. Chest tubes will not be needed for endovascular surgery, the recovery period will be short, and there will not be an abdominal wound

Question 65

An 80-year-old patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED) with severe back pain and absent pedal pulses. Which actions should the nurse take first?
Obtain the blood pressure.
Obtain blood for laboratory testing.
Assess for the presence of an abdominal bruit. Determine any family history of kidney disease.

Answer 65

ANS: A
Because the patient appears to be experiencing aortic dissection, the nurse’s first action should be to determine the hemodynamic status by assessing blood pressure. The other actions also may be done, but they will not provide information that will determine what interventions are needed immediately for this patient.

Question 66

After receiving report, which patient admitted to the emergency department should the nurse assess first? 67-year-old who has a gangrenous left foot ulcer with a weak pedal pulse.
58-year-old who is taking anticoagulants for atrial fibrillation and has black stools.
50-year-old who is complaining of sudden “sharp” and “worst ever” upper back pain.
39-year-old who has right calf tenderness, redness, and swelling after a long plane ride.

Answer 66

ANS: C
The patient’s presentation is consistent with dissecting thoracic aneurysm, which will require rapid intervention. The other patients do not need urgent interventions.

Question 67

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment, the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first?
Notify the surgeon and anesthesiologist.
Wrap both the legs in a warming blanket.
Document the findings and recheck in 15 minutes.
Compare findings to the preoperative assessment of the pulses.

Answer 67

ANS: A
Lower extremity pulses may be absent for a short time after surgery because of vasospasm and hypothermia. Decreased or absent pulses together with a cool and mottled extremity may indicate embolization or graft occlusion. These findings should be reported to the physician immediately because this is an emergency situation. Because pulses are marked prior to surgery, the nurse would know whether pulses were present prior to surgery before notifying the health care providers about the absent pulses. Because the patient’s symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 15 minutes before taking action. A warming blanket will not improve the circulation to the patient’s legs.

Question 68

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
Begin oral intake.
Obtain vital signs.
Assess pedal pulses. Start discharge teaching.

Answer 68

ANS: B
Bleeding is a possible complication after catheterization of the femoral artery, so the nurse’s first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions are also appropriate but can be done after determining that bleeding is not occurring.

Question 69

A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient requires the registered nurse (RN) to intervene?
The LPN/LVN has the patient sit in a chair for 90 minutes.
The LPN/LVN assists the patient to walk 40 feet in the hallway.
The LPN/LVN gives the ordered aspirin 160 mg after breakfast. The LPN/LVN places the patient in a Fowler’s position for meals.

Answer 69

ANS: A
The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.

Question 70

The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider?
Weak pedal pulses
Absent bowel sounds
Blood pressure 137/88 mm Hg 
25 mL urine output over last hour

Answer 70

ANS: C
The blood pressure is typically kept at less than 120 mm Hg systolic to minimize extension of the dissection. The nurse will need to notify the health care provider so that beta- blockers or other antihypertensive medications can be prescribed. The other findings are typical with aortic dissection and should also be reported but do not require immediate action.

Question 71

The nurse reviews the admission orders shown in the accompanying figure for a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question?

Use of treadmill for exercise
Referral for dietary instruction
Exercising to the point of discomfort
Combined clopidogrel and omeprazole therapy

Answer 71

ANS: D
Because the antiplatelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this prescription with the health care provider. The other interventions are appropriate for a patient with peripheral artery disease.