Chapter 48 (Test 1)

Question 1

The nurse is aware that which layer is the muscle layer of the heart, which is responsible for the heart’s contraction?
a. endocardium.
b. pericardium.
c. mediastinum.
d. myocardium.

Answer 1

ANS: D

Question 2

The nurse clarifies that which is the area of the heart that normally initiates electrical impulses?
a. left ventricle.
b. atrioventricular (A V) node.
c. sinoatrial (SA) node.
d. bundle of His.

Answer 2

ANS: C

Question 3

The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women because acute chest pain is not present. Women are frequently misdiagnosed as having which disorder? :
a. hepatitis A.
b. indigestion.
c. urinary infection.
d. menopausal complications.

Answer 3

ANS: B

Question 4

The nurse identifies the “lub” sound of the “lub/dub” of the cardiac cycle as the sound of which event?
a. AV valves closing.
b. closure of the semilunar valves.
c. contraction of the papillary muscles.
d. contraction of the ventricles.

Answer 4

ANS: A

Question 5

A patient is admitted from the emergency department. The emergency department health care provider notes the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV. This indicates the patient has which class of heart failure?
a. moderate heart failure.
b. severe heart failure.
c. congestive heart failure.
d. negligible heart failure.

Answer 5

ANS: B

Question 6

The nurse assesses that the home health patient has no signs or symptoms of heart failure, but does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The nurse is aware that using the American College of Cardiology and the American Heart Association (ACC/AHA) staging, this patient would be in which stage?
a. stage A.
b. stage B.
c. stage C.
d. stage D.

Answer 6

ANS: A

Question 7

The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry recognizes the need for added instruction when the patient makes which statement?
a. “I can ambulate in the hallway with this gadget on.”
b. “I always take off the telemetry device when I shower.”
c. “My EKG is being watched by one of the nurses in CCU on the home unit.”
d. “I am able to sleep just fine with this device on.”

Answer 7

ANS: B

Question 8

The nurse assesses pitting edema that can be depressed approximately 4 mm and refills in 15 seconds. The nurse would document this assessment as:
a. +1 edema.
b. +2 edema.
c. +3 edema.
d. +4 edema.

Answer 8

ANS: B

Question 9

What do dark or “cold” spots on a thallium scan indicate?
a. Tissue with adequate blood supply
b. Dilated vessels
c. Areas of neoplastic growth
d. Tissue that has inadequate perfusion

Answer 9

ANS: D

Question 10

The nurse recognizes the echocardiogram report that shows an ejection factor of 42% as an indication of which situation?
a. normal heart action.
b. mild heart failure.
c. moderate heart failure.
d. severe heart failure.

Answer 10

ANS: C

Question 11

The nurse takes into consideration that age-related changes can affect the peripheral circulation because of which factor?
a. sclerosed blood vessels.
b. hypotension.
c. inactivity.
d. poor nutrition.

Answer 11

ANS: A

Question 12

The nurse assessing a cardiac monitor notes that the cardiac complexes each have a P wave followed by a QRS and a T. The rate is 120. The nurse recognizes this as whicharrhythmia?
a. sinus bradycardia.
b. atrial fibrillation.
c. sinus tachycardia.
d. ventricular tachycardia.

Answer 12

ANS: C

Question 13

After an influenza-like illness, the patient reports chills and small petechiae in his mouth and his legs. A heart murmur is detectable. These are characteristic signs of whichdisorder?
a. congestive heart failure.
b. heart block.
c. aortic stenosis.
d. infective endocarditis.

Answer 13

ANS: D

Question 14

The nurse notes a run of three ventricular contractions (PVC) that are not preceded by a P wave. This particular arrhythmia can progress into which complication?
a. atrial fibrillation and possible emboli.
b. sinus tachycardia and syncope.
c. ventricular tachycardia and death.
d. sinus bradycardia and fatigue.

Answer 14

ANS: C

Question 15

The nurse reminds the patient who is taking warfarin for the treatment of peripheral artery disease not to eat excessive green and yellow vegetables for which reason?
a. Potassium in the vegetables can cause additional bleeding
b. Green and yellow vegetables cause loose bowel movements
c. Vitamin K in the vegetables counteracts the anticoagulant effect
d. Potassium in the vegetables can cause hyperkalemia to develop

Answer 15

ANS: C

Question 16

A patient with unstable angina should be provided with instructions to avoid which activity?
a. Walking outside
b. Eating red meat
c. Swimming in warm pool
d. Shoveling snow

Answer 16

ANS: D

Question 17

The older adult patient with angina pectoris says she is unsure how she should take nitroglycerin when she has an attack. The nurse should reinforce whichinstruction?
a. “Continue to take nitroglycerin sublingually at 5-minute intervals until the pain is
relieved.”
b. “If the pain is not relieved after three doses of nitroglycerin at 5-minute intervals,
call your health care provider and come to the hospital.”
c. “When nitroglycerin is not relieving the pain, lie down and rest.”
d. “Use oxygen at home to relieve pain when nitroglycerin is not successful.”

Answer 17

ANS: B

Question 18

A patient questions “Why all the fuss about a little high blood pressure? My father had it and he lived to be 65 years old.” The nurse bases the answer, knowing that which complication can occur due to untreated blood pressure?
a. Chronic Obstructive Pulmonary Disease (COPD)
b. Frequent and severe infectious disease of the lungs
c. Increased risk of myocardial infarctions (MI) and stroke
d. Severe corneal abrasions, requiring corneal transplants

Answer 18

ANS: C

Question 19

What is the major cause of cardiac valve disease in past years?
a. Rheumatic fever
b. Long history of malnutrition
c. Drug abuse
d. Obesity

Answer 19

ANS: A

Question 20

The patient has a total cholesterol of 190 with a high-density lipid (HDL) of 110 and a low-density lipid (LDL) of 80. The nurse reinforces which instruction?
a. Good job! Continue with your low fat diet.
b. These levels are borderline: you still aren’t eating properly.
c. The dietician will need to talk to you about lowering your cholesterol a lot more.
d. Your cholesterol level needs to be lowered a great deal to improve your survival
chances.

Answer 20

ANS: A

Question 21

A patient, age 72, was admitted to the medical unit with a diagnosis of angina pectoris. Which is a characteristic signs and symptoms of angina pectoris?
a. substernal pain that radiates down the left arm.
b. epigastric pain that radiates to the jaw.
c. indigestion, nausea, and eructation.
d. fatigue, shortness of breath, and dyspnea.

Answer 21

ANS: A

Question 22

A patient admitted to the emergency room with a possible myocardial infarction (MI) has reports back from the laboratory. Which laboratory report is specific for myocardial damage?
a. CK-MB
b. Elevated white count
c. Elevated sedimentation rate
d. Low level of sodium

Answer 22

ANS: A

Question 23

The patient, age 26, is hospitalized with cardiomyopathy. While assisting with data collection from the patient, the nurse recognizes that the increased incidence of cardiomyopathy in young adults who have minimal risk factors for cardiovascular disease is related to which factor?
a. Cocaine use
b. Viral infection
c. Vitamin B1 deficiency
d. Pregnancy

Answer 23

ANS: A

Question 24

The patient has become very dyspneic, respirations are 32, and the pulse is 100. The patient is coughing up frothy red sputum. What should be the initial nursing intervention?
a. Lay the patient flat to reduce hypotension and the symptoms of cardiogenic shock.
b. Place patient in side-lying position to reduce the symptoms of atrial fibrillation.
c. Place patient upright with legs in dependent position to reduce the symptoms of pulmonary edema.
d. Lay the patient flat and elevate the feet to increase venous return in cardiogenic shock.

Answer 24

ANS: C

Question 25

The nurse caring for a patient recovering from a myocardial infarction (MI) administers stool softeners for which reason?
a. Prevent enema dependence in the hospitalized patient
b. Prevent fecal impactions which can lead to bowel obstruction
c. Stool softeners reduce the need for laxatives once the patient is discharged
d. Reduce the necessity to strain at the stool to lessen the effect of Valsalva’s maneuver

Answer 25

ANS: D

Question 26

The nurse reminds the patient that the American Heart Association recommends a lipid study how frequently? .
a. Every 2 years
b. Every 2 to 3 years
c. At least every 4 years
d. Every 4 to 6 years

Answer 26

ANS: D

Question 27

During a health interview by the home health nurse, which patient report suggests left-sided heart failure?
a. “I have to sleep in my recliner and I have this hacking cough.”
b. “I have no appetite and I have lost 3 lb in the last week.”
c. “I have to urinate every 2 hours, even during the night.”
d. “I go barefoot most of the time because my feet are so hot.”

Answer 27

ANS: A

Question 28

The home health nurse caring for a patient with infective endocarditis overhears the patient making a dental appointment for an extraction next month. Which question is most important for the nurse to ask?
a. “Do you have a toothache?”
b. “Have you contacted your health care provider about your dental appointment?”
c. “Is your dentist board certified?”
d. “Do you think you should wait that long for your tooth extraction?”

Answer 28

ANS: B

Question 29

A 70 year female patient arrives to the emergency department, reporting nausea, vomiting, fatigue and abdominal discomfort. The health care provider requests myocardial infarction (MI) protocols to begin. For which reason is this protocol beginning?
a. The provider is concerned a lawsuit could occur due to missed diagnosis.
b. Women tend to have less classic symptoms of a myocardial infarction.
c. Women are more likely to die from breast or cervical cancer than an MI.
d. The troponin I level is not as accurate for females as it is in male patients.

Answer 29

ANS: B

Question 30

What is the difference between primary and secondary hypertension?
a. Secondary hypertension is caused by another disorder like renal disease.
b. Secondary hypertension is related to hereditary factors.
c. Secondary hypertension cannot be treated effectively.
d. Secondary hypertension is no real threat to health.

Answer 30

ANS: A

Question 31

The nurse is treating a patient who had a pacemaker inserted 8 years ago for the correction of atrial fibrillation. Which diagnostic test may no longer be available to the patient because of this older model implanted device?
a. MRI
b. CT scan
c. Thallium scan
d. PET

Answer 31

ANS: A

Question 32

Which assessment would lead the nurse to examine the leg closely for evidence of a stasis ulcer?
a. Cool dry lower limb
b. Darker, thick and toughened skin on medial surface of the leg
c. Lack of hair and shiny appearance of the lower leg
d. Lack of a pedal pulse

Answer 32

ANS: B

Question 33

What is the patient goal of the walking exercise program designed for the rehabilitation of a patient who had a myocardial infarction (MI) 3 weeks ago?
a. Walk 2 miles in less than 60 minutes after 12 weeks.
b. Jog mile in less than 30 minutes after 12 weeks.
c. “Fast walk” 1 mile in less than 20 minutes after 12 weeks.
d. Walk 1 mile in 15 minutes without dyspnea after 12 weeks.

Answer 33

ANS: A

Question 34

The plan of care for a patient recovering from hip surgery mentions prevention of deep vein thrombosis (DVT). Which aspect of the plan of care addresses this concern?
a. Massaging the calves of the leg twice daily
b. Explaining the need for fluid restriction after surgery
c. Assisting the patient to change positions frequently
d. Encouraging the patient to take the anti-embolism stockings off at night for better
sleep.

Answer 34

ANS: C

Question 35

Which intervention is appropriate for a patient who is experiencing an acute attack of Raynaud’s disease?
a. Vigorously rub both the hands in ice or snow.
b. Place the hands in ice water to observe for pallor.
c. Apply hot water over both the hands to rapidly warm the hands.
d. Place mittens on the hands and encourage the patient to move fingers.

Answer 35

ANS: D

Question 36

The nurse reinforcing a teaching plan for a patient with Buerger disease (thromboangiitis obliterans) will focus on the need for which change?
a. reduction of alcohol intake.
b. avoiding cold remedies.
c. cessation of smoking.
d. weight reduction.

Answer 36

ANS: C

Question 37

Which statement would lead the nurse to offer more instruction about taking warfarin?
a. “I eat a banana every morning with breakfast.”
b. “I try to eat more green leafy vegetables, especially broccoli, spinach, and kale.”
c. “I try to eat a well-balanced, low-fat diet.”
d. “I don’t drink alcohol or caffeine.”

Answer 37

ANS: B

Question 38

The nurse caring for a 92-year-old patient with pneumonia who is receiving IV carefully monitors the flow rate of the IV infusion because rapid infusion can cause whichdisorder?
a. hypotension.
b. thrombophlebitis.
c. pulmonary emboli.
d. heart failure.

Answer 38

ANS: D

Question 39

The nurse making the schedule for the daily dose of furosemide would schedule the administration for which of the following times?
a. Late in the afternoon
b. At bedtime
c. With any meal
d. In the morning

Answer 39

ANS: D

Question 40

What is the third step in the impulse pattern of conduction through the heart?
a. Atrial wall
b. Atrial-ventricular (AV) node
c. Purkinje fibers
d. Sinoatrial (SA) node
e. Bundle branches
f. Bundle of His

Answer 40

ANS: B

Question 41

What is the second step in the path of blood through the coronary circulation?
a. Right atrium
b. Pulmonary artery
c. Tricuspid valve
d. Right ventricle
e. Superior and inferior vena cava
f. Pulmonary vein
g. Left atrium
h. Mitral valve

Answer 41

ANS: A

Question 42

MULT RESP

The nurse would assess closely for which sign of right-sided heart failure? (Select all that apply.)
a. cough.
b. increasing abdominal girth.
c. shortness of breath.
d. edema of feet and ankles.
e. distended jugular veins.
f. orthopnea.

Answer 42

ANS: B, D, E

Question 43

MULT RESP

The nurse would reinforce teaching for a patient with Raynaud disease to include which teaching point? (Select all that apply.)
a. Warming hands and feet with a heating pad
b. Using mittens in cold weather
c. Practicing stress-reducing techniques
d. Complete smoking cessation
e. Using caution when cleaning the refrigerator or freezer

Answer 43

ANS: B, C, D, E

Question 44

MULT RESP

Which information should be taught to patients starting on anticoagulant therapy for a valvular disorder? (Select all that apply.)
a. Increase the dose of aspirin for better therapy.
b. Take medication at the same time each day.
c. Report to health care provider cuts that do not stop bleeding with direct pressure.
d. No restrictions for food or drink.
e. Report for prescribed blood tests (PTT, INR, CBC, blood sugar).

Answer 44

ANS: B, C

Question 45

MULT RESP

What is the transesophageal echocardiogram (TEE) used for? (Select all that apply.)
a. Detect thrombi before a cardioversion.
b. Check for cardiac arrhythmias.
c. Detect the presence of an aneurysm
d. Measure effectiveness of diuretic therapy.
e. Locate obstructions in the coronary artery.

Answer 45

ANS: A, C

Question 46

MULT RESP

Which patient teaching would help to prevent venous stasis? (Select all that apply.)
a. Dangle legs when sitting.
b. Avoid crossing the legs at the knee.
c. Elevate legs when lying in bed or sitting.
d. Massage extremities to help maintain blood flow.
e. Wear elastic stockings when ambulating.

Answer 46

ANS: B, C, E

Question 47

MULT RESP

The nurse points out which factor as a modifiable riskfor coronary artery disease (CAD)? (Select all that apply.)
a. Diabetes mellitus
b. Heredity
c. Smoking
d. Hypertension
e. Hyperlipidemia
f. Age

Answer 47

ANS: A, C, D, E

Question 48

MULT RESP

The nurse outlines which as a condition that would disqualify a candidate for a heart transplant? (Select all that apply.)
a. Recent malignancy
b. Dilated cardiomyopathy
c. Peptic ulcer disease
d. Diabetes type 2
e. Severe obesity
f. Inoperable coronary artery disease

Answer 48

ANS: A, C, E

Question 49

MULT RESP

When assessing a patient with a possible myocardial infarction (MI), which sign or symptom should the nurse assess for? (Select all that apply.)
a. Pain radiating to left arm and jaw
b. Visual Hallucinations
c. Pallor
d. Diaphoresis
e. Apprehension
f. Dyspnea

Answer 49

ANS: A, C, D, E, F

Question 50

The nurse is reinforcing instructions on a patient who will be taking digoxin. Which sign of digoxin toxicity should the nurse include? (Select all that apply.)
a. Ringing in the ears
b. Bradycardia
c. Headache
d. Visual disturbance
e. Hematuria
f. Anorexia

Answer 50

ANS: B, C, D, F

Question 51

The nurse encourages the patient who is recovering from a myocardial infarct (MI) to ask the health care provider to prescribe a cardiac rehabilitation series in order to learn which aspect? (Select all that apply.)
a. improve stamina.
b. strengthen muscles.
c. plan an appropriate diet.
d. select herbal remedies.
e. reduce risk of further problems.
f. understand heart condition.

Answer 51

ANS: A, B, E, F

Question 52

Following an angiogram with the insertion site of the left groin, the nurse will implement which aspect of care? (Select all that apply.)
a. checking pedal pulses.
b. ambulating with assistance 2 hours after recovery.
c. checking color and warmth of left leg frequently.
d. Assessing for bleeding at the puncture site.
e. placing patient in semi-Fowler’s position.

Answer 52

ANS: A, C, D