Cumulative Final

Question 1

The patient is brought to the emergency department after a motor vehicle accident. The patient is diagnosed with internal bleeding. What is the priority of care for this patient?

A. Mental alertness
B. Perfusion
C. Pain
D. Reaction to medications

Answer 1

B. Perfusion

Rationale: With internal bleeding, the nurse should monitor vital signs to be sure perfusion is happening. Mental alertness, pain, and medication reaction are important but not primary concerns.

Question 2

A nurse is explaining the concept of perfusion to a student nurse. The nurse knows the student understands the concept of perfusion when the student makes which statement?

A. Perfusion is a normal function of the body, and I don’t have to be concerned about it
B. Perfusion is monitored by the physician
C. Perfusion is monitored by vital sign and capillary refill
D. Perfusion varies as a person ages, so I would expect changes in the body

Answer 2

C. Perfusion is monitored by vital sign and capillary refill

Rationale: The best method to monitor perfusion is to monitor vital sign and cap refill. This allows the nurse to know if perfusion is adequate to maintain vital organs. The nurse does have to be concerned about perfusion. Perfusion is not only monitored by the physician, but the nurse too. Perfusion does not always change as the person ages.

Question 3

The nurse notes that a patient has bilateral lower extremity edema. For which health problem should the nurse assess further?

A. Pericarditis
B. Cardiac tamponade
C. Lymph obstruction
D. Venous insufficiency

Answer 3

D. Venous insufficiency

Rationale: Bilateral lower extremity edema generally indicates venous insufficiency or heart failure

Question 4

A patient is being evaluated for a possible myocardial infarction, but the patient is not sure when the pain started because he has a history of GERD. He has intermittent chest pain, with some episodes of dizziness and fatigue, over the last week. Which diagnostic result will be most helpful in determining whether the patient has suffered cardiac injury?

A. Elevated creatine kinase (CK)
B. Elevated creatine kinase myocardial bands (CK-MB)
C. Elevated myoglobin
D. Elevated troponin

Answer 4

D. Elevated troponin

Question 5

The nurse is conducting a patient assessment. The patient tells the nurse that he has smoked two packs of cigarettes per day for 27 years. The nurse may find which data upon assessment?

A. Elevated blood pressure
B. Bounding pedal pulses
C. Night blindness
D. Reflux disease

Answer 5

A. Elevated blood pressure

Rationale: Smokes have a constriction of blood vessels due to the tar and nicotine in cigarettes’. This constriction may lead to hypertension. Bounding pulses, night blindness, and reflux disease do not have a direct link to smoking.

Question 6

The nurse correlates which blood pressure readings with stage 2 hypertension?

A. The patient with average blood pressure readings of 128/70 on three separate occasions
B. The patient with average blood pressure readings of 128/90 on three separate occasions
C. The patient with average blood pressure readings of 138/88 on three separate occasions
D. The patient with average blood pressure readings of 142/92 on three separate occasions

Answer 6

D. The patient with average blood pressure readings of 142/92 on three separate occasions

Question 7

A patient’s serum electrolytes are being monitored. The nurse notices that the potassium level
is low. The nurse knows that the patient should be observed for?

A. Tissue ischemia
B. Brain malformations
C. Intestinal blockage
D. Cardiac dysrhythmia

Answer 7

D. Cardiac dysrhythmia

Rationale: Cardiac dysrhythmia is a possibility when serum potassium is high or low. Tissue ischemia, brain malformations, or intestinal blockage do not have a direct correlation to potassium irregularities.

Question 8

A patient was diagnosed with hypertension. The patient asks the nurse how this disease could have happened to them. The nurse’s best response is “Hypertension….”

A. Happens to everyone sooner or later. Don’t be concerned about it.”
B. Can happen from eating a poor diet, so change what you are eating.”
C. Can happen from arterial changes that impede the blood flow.”
D. Happens when people do not exercise, so you should walk every day.”

Answer 8

C. Can happen from arterial changes that impede the blood flow.”

Rationale: Hardening of the arteries from atherosclerosis can cause hypertension in the patient. Hypertension does not happen to everyone. Changing the patient’s diet and exercising may be a positive life change, but these answers do not explain to the patient how the disease could have happened.

Question 9

The nurse notes that a patient is scheduled for a brain natriuretic peptide level to be drawn. What patient teaching should the nurse prepare for this client?

A. Low fat diet
B. Signs of heart failure
C. Symptoms of a heart attack
D. Lung versus heart problems

Answer 9

B. Signs of heart failure

Question 10

The nurse is preparing content for a community health fair on risk factor for heart disease. What should the nurse include as nonmodifiable risk factors? SATA

A. Age
B. Weight
C. Alcohol intake
D. Ethnic background
E. Parent's health history

Answer 10

A. Age
D. Ethnic background
E. Parent’s health history

Question 11

In a patient with coronary artery disease with elevated liver function test results, it is a priority for the nurse to follow up with the healthcare provider about which prescription?

A. Aspirin (Ecotrin)
B. Atorvastatin (Lipitor)
C. Metoprolol (Lopressor)
D. Cholestyramine (Questran)

Answer 11

B. Atorvastatin (Lipitor)

Question 12

The nurse is evaluating teaching provided to a patient with coronary artery disease. Which patient statement indicated that additional teaching is required?

A. I will adhere to my smoking cessation plan
B. I will reduce my daily intake of saturated fat
C. I can take up to three doses of nitroglycerin 25 minutes apart
D. I am to follow the exercise plan for 30 minutes, 5 days a week

Answer 12

C. I can take up to three doses of nitroglycerin 25 minutes apart

Question 13

The nurse is preparing teaching for a patient being treated for coronary artery disease. What dietary information should the nurse emphasize?

A. Restrict carbohydrate intake
B. Limit calorie intake to less than 1000/day
C. Reduce saturated fat and sodium intake
D. Limit fluid intake

Answer 13

C. Reduce saturated fat and sodium intake

Rationale: A diet that is low in saturated fat and sodium as well as high in fruits, whole grains, and vegetables is important for patients with CAD.

Question 14

In administering oxygen 2 L via nasal cannula to a patient with coronary artery disease, what does the nurse explain as being the primary purpose of the oxygen?

A. Promotes vessel dilation
B. Prevent clot formation
C. Supports myocardial oxygen demand
D. Decreases respiratory complications

Answer 14

C. Support myocardial oxygen demand

Rationale: The patient with CAD is prone to experiencing increased myocardial oxygen consumption. Administering oxygen will help supplement the body’s need for oxygen. The primary purpose of oxygen in patients with CAD is to provide supplement oxygen to the myocardium. SOB may develop in patients with CAD.

Question 15

During an assessment, a patient describes experiencing chest pain with exercise that disappears with rest. The nurse correlates this finding with which health problem?

A. Stable angina
B. Variant Angina
C. Unstable angina
D. Prinzmetal’s Angina

Answer 15

A. Stable angina

Rationale: Stable angina is chest pain or discomfort that is associated with physical activity. Symptoms of stable angina are often alleviated with rest.

Question 16

The nurse monitors for which clinical manifestation in a patient diagnosed with right sided heart failure?

A. Fatigue
B. Shortness of breath
C. Crackles with auscultation
D. Edema in the lower extremities

Answer 16

D. Edema in the lower extremities

Question 17

The nurse is concerned that a patient with heart failure is decompensating. Which assessment finding requires an immediate intervention?

A. Dyspnea at rest
B. Dry persistent cough
C. Weak peripheral pulses
D. Jugular vein distention

Answer 17

A. Dyspnea at rest

Rationale: Dyspnea on exertion indicates decreased cardiac output and worsening heart failure; however, dyspnea at rest indicates even more cardiac decompensation.

Question 18

The nurse provides education to a patient who is diagnosed with atherosclerosis. Which patient statement indicates a need for additional teaching?

A. I will decrease my intake of folic acid
B. I will eat a low-fat, low-cholesterol diet
C. I will increase my daily activity to decrease blood pressure
D. I will quit smoking because nicotine increases the buildup of plaque

Answer 18

A. I will decrease my intake of folic acid.

Rationale: trust

Question 19

The nurse is preparing teaching material to help a patient with atherosclerosis manage lifestyle changes. What should the nurse emphasize in this teaching?

A. You need to limit cigarette smoking
B. You need to follow a low-fat, low-cholesterol diet
C. You should consider adopting an active lifestyle
D. You may have dizziness at times which expected

Answer 19

B. You need to follow a low-fat, low-cholesterol diet

Rationale: A low-fat, low-cholesterol diet helps manage risk factors and slows the progression of atherosclerosis

Question 20

Which statement by the patient with Raynaud’s disease indicates that teaching was effective?

A. Mittens are better than gloves to prevent episodes
B. I need to decrease cigarette smoking
C. I will need to take blood thinners for life
D. I will need to limit fluid intake

Answer 20

A. Mittens are better than gloves to prevent episodes

Question 21

A patient is being evaluated for chest pain in the emergency department. Which laboratory test is the best to determine if this patient has experienced an acute myocardial infarction?

A. Troponin
B. Creatine kinase
C. Creatine kinase MB
D. Serum lactate level

Answer 21

A. Troponin

Question 22

The nurse instructs a patient recovering from an acute myocardial on the Life’s Simple 7 actions. Which patient statement indicates that additional teaching in required?

A. I will not smoke
B. I will eat a heart-healthy diet
C. I will walk for at least 30 minutes three times a week
D. I will make sure my blood sugar level stays under 100 mg/dL

Answer 22

C. I will walk for at least 30 minutes three times a week

Rationale: Exercise should be for at least 50 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity or a combination of each per week.

Question 23

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catherization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?

A. Regular insulin
B. Glipizide (Gluctrol)
C. Repaglinide (Prandin)
D. Metformin (Glucophage)

Answer 23

D. Metformin (Glucophage)

Rationale: Metformin needs to be help for cardiac catherization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function with metformin in the system, the client would be at risk for lactic acidosis

Question 24

A client scheduled for a cardiac catherization tells the nurse, “My mother died during this same procedure 10 years ago. I’m afraid the same thing will happen to me.” Which of the following responses by the nurse is the most appropriate?

A. It is normal to be scared. Let’s discuss the procedure
B. I’ll ask the cardiologist to come and speak with you about your concerns
C. We have the best outcomes of any facility in the area for this procedure
D. Don’t worry. The procedure has improved a lot in the last 10 years

Answer 24

A. It is normal to be scared. Let’s discuss the procedure

Question 25

A patient with atherosclerosis asks why smoking cessation is important. What should the nurse respond to this patient?

A. Tobacco toxins increase your HDL-C
B. Tobacco reduces the effects of cholesterol
C. Tobacco causes the blood pressure to drop and changes the cells with the arteries.
D. Tobacco speeds the growth of atherosclerosis in coronary arteries, aorta, and the legs.

Answer 25

D. Tobacco speeds the growth of atherosclerosis in coronary arteries, aorta, and the legs.

Question 26

A patient’s blood pressure is 140/86 mm Hg; however, previous measurements have been within normal limits. The patient denies any other complaints. Which intervention would be appropriate for this patient?

A. Refer the patient to the emergency department for treatment
B. Prepare teaching on antihypertensive medications
C. Schedule an additional measurement in a few weeks
D. Instruct on the effects of hypertension on major body organs

Answer 26

C. Schedule an additional measurement in a few weeks

Rationale: The diagnosis of hypertension is made on this basis of the average of two or more properly measured BP two or more office visits.

Question 27

In administering a calcium channel block to a patient diagnosed with primary hypertension, the nurse correlates a decrease to which mechanism of action of this medication

A. Block formation of angiotensin II, a potent vasoconstrictor
B. Block the action, not the formation, of angiotensin II
C. Decreased blood vessels’ ability to contract and cause vasoconstriction
D. Relaxes the muscles of the blood vessels

Answer 27

D. Relaxes the muscles of the blood vessels

Rationale: Calcium channel blockers help relax/dilate the muscles of the blood vessels

Question 28

Which assessment finding in a patient with Raynaud’s phenomena requires an immediate intervention by the nurse?

A. Pitting edema in the lower extremities
B. Leg pain when ambulation
C. Numbness and tinging in the lower extremities
D. Weak distal pules audible by doppler only

Answer 28

C. Numbness and tinging in the lower extremities

Question 29

The nurse provides instructions to a patient who is being discharged after treatment for a myocardial infarction. Which patient statement indicates a need for additional teaching?

A. I will take the Lipitor to reduce my cholesterol levels
B. I will take the Lopressor to decrease my heart’s demand for oxygen
C. I will take the Plavix to prevent the platelets from forming new clots
D. I will take the sublingual nitroglycerin each day to prevent chest pain

Answer 29

D. I will take the sublingual nitroglycerin each day to prevent chest pain

Rationale: Sublingual nitroglycerin is taken as needed for chest pain, not each day. This patient statement indicates a need for an additional teaching.

Question 30

Which client teaching should the nurse implement for the client diagnosed with coronary artery disease? SATA

A. Encourage a low fat, low cholesterol, diet
B. Instruct the client to walk 30 minutes a day
C. Decrease the salt intake to 2 g a day
D. Refer to a counselor for stress reduction techniques
E. Teach the client to increase fiber in the diet

Answer 30

A. Encourage a low fat, low cholesterol, diet
B. Instruct the client to walk 30 minutes a day
D. Refer to a counselor for stress reduction techniques
E. Teach the client to increase fiber in the diet

Question 31

The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? SATA

A. Tremors
B. Diarrhea
C. Irritability 
D. Blurred vision
E. Nausea and vomiting

Answer 31

B. Diarrhea
D. Blurred vision
E. Nausea and vomiting

Question 32

The nurse administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?

A. The clients apical pulse is 64
B. The clients calcium is elevated
C. The clients telemetry shows occasional PVC’s
D. The clients blood pressure is 90/58

Answer 32

D. The clients blood pressure is 90/58

Rationale: The client’s blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out

Question 33

A client with congestive heart failure suddenly becomes tachycardia shows sign of air hunger, and begin coughing frothy pink tinged sputum. Which finding would the nurse anticipate when auscultating breath sounds?

A. Stridor
B. Crackles
C. Scattered rhonchi
D. Diminished breath sounds

Answer 33

B. Crackles

Question 34

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse immediately contacts the health care provider and prepares to implement which priority interventions?

A. Administering oxygen
B. Inserting a Foley catheter
C. Administering furosemide
D. Administering morphine sulfate intravenously
E. Placing the client in a low Fowlers side lying position

Answer 34

A. Administering oxygen
B. Inserting a Foley catheter
C. Administering furosemide
D. Administering morphine sulfate intravenously

Question 35

A client receiving thrombolytic therapy with a continuous infusion of alteplase (Activase) suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority?

A. Administer oxygen and protamine sulfate
B. Cut the infusion rate in half and sit the client up in bed
C. Stop the infusion and call the health care provider
D. Administer diphenhydramine (Benadryl) and continue the infusion

Answer 35

C. Stop the infusion and call the health care provider

Rationale: The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the HCP. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed.

Question 36

A client with hypertension asks the nurse to explain how amlodipine besylate (Norvasc) lowers her blood pressure. The nurse gives which explanation to the client?

A. It prevents calcium form entering the smooth muscles, which relaxes the blood vessels to lower heart rate and blood pressure
B. It is a diuretic that works by removing extra sodium and water from the body through the kidneys, which helps lower her blood pressure
C. It causes the body to produce less angiotensin, which allows blood vessels to relax and open up, therefore reducing blood pressure
D. It lowers blood pressure by lowering the heart rate and the workload of the heart and decreases the amount of blood pumped out of the heart

Answer 36

A. It prevents calcium form entering the smooth muscles, which relaxes the blood vessels to lower heart rate and blood pressure

Norvasc is a calcium channel blocker

Question 37

A client with a history of cardiac disease is due for a morning dose of furosemide. Which serum potassium level if noted in the clients laboratory report, should be reported before administering the dose of furosemide?

A. 3.2 mEq/L
B. 3.8 mEq/L
C. 4.2 mEq/L
D. 4.8 mEq/L

Answer 37

A. 3.2 mEq/L

Normal potassium level in adults is 3.5 to 5.0 mEq/L

Question 38

A client brought to the emergency department states that he has accidentally been taking two times his prescribed dose of warfarin for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action?

A. Prepare to administer an antidote
B. Draw a sample for type and crossmatch and transfuse the client
C. Draw a sample for an activate partial thromboplastin time (aPTT) level
D. Draw for a sample for prothrombin time (PT) and international normalized ratio (INR)

Answer 38

D. Draw for a sample for prothrombin time (PT) and international normalized ratio (INR)

Question 39

A client arrives in the emergency department complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained and the results indicate a level of 0.6 ng/mL. The nurse determines that this result indicates which finding?

A. A normal level
B. A low value that indicates possible gastritis
C. A level that indicates a myocardial infarction
D. A level that indicates the presence of possible angina

Answer 39

C. A level that indicates a myocardial infarction

Question 40

The nurse is caring for a client with heart failure. On assessment the nurse notes that the client is dyspneic and crackles are audible on auscultation. What additional signs would the nurse expect to note in this client if excess fluid volume in present?

A. Weight loss
B. Flat neck and hand veins
C. An increase in blood pressure
D. Decreased central venous pressure (CVP)

Answer 40

C. An increase in blood pressure

Question 41

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available in the nursing unit?

A. Vitamin K
B. Aminocaproic acid
C. Potassium chloride
D. Protamine sulfate

Answer 41

D. Protamine sulfate

The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Protamine is a medication used to reverse and neutralize the anticoagulant effects of heparin.

Question 42

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:

A. The same as the client’s own baseline level.
B. Lower than the needed therapeutic level.
C. Within the therapeutic range.
D. Higher than the therapeutic range.

Answer 42

C. Within the therapeutic range.

The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client’s control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within the therapeutic range. PT measures the time, in seconds, for plasma to clot after adding thromboplastin, (a mixture of tissue factor, calcium, and phospholipid) to a patient’s plasma sample.

Question 43

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:

A. Stimulates the breakdown of specific clotting factors by the liver, and it takes two (2)- three (3) days for this to exert an anticoagulant effect.
B Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
C. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
D. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

Answer 43

B. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.

Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited. Because of the delay in factor II (prothrombin) suppression, heparin is administered concurrently for four to five days to prevent thrombus propagation. Loading doses of warfarin are not warranted and may result in bleeding complications.

Question 44

A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest X-ray, an ECG, and two (2) mg of morphine given intravenously. The nurse should first:

A. Administer the morphine.
B. Obtain a 12-lead ECG.
C. Obtain the lab work.
D. Order the chest x-ray.

Answer 44

A. Administer the morphine.

Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain. Opioids may be used for pain control in addition to sublingual nitroglycerin if the blood pressure is adequate. All patients with STEMI and NSTEMI require immediately chewed aspirin 160 mg to 325 mg. Furthermore, the patient should have intravenous access and oxygen supplementation if oxygen saturation is less than 91%.

Question 45

When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:

A. Help keep him well hydrated.
B. Dissolve clots he may have.
C. Prevent kidney failure.
D. Treat potential cardiac arrhythmias.

Answer 45

B. Dissolve clots he may have.

Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage. Thrombolytics or fibrinolytics are a group of medications used in the management and treatment of dissolving intravascular clots. They are in the plasminogen activator class of drugs.

Question 46

When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.

A. Reflects electrical impulse beginning at the SA node.
B. Indicated electrical impulse beginning at the AV node.
C. Reflects atrial muscle depolarization.
D. Identifies ventricular muscle depolarization.
E. Has a duration of normally 0.11 seconds or less.

Answer 46

A. Reflects electrical impulse beginning at the SA node.
C. Reflects atrial muscle depolarization.
E. Has a duration of normally 0.11 seconds or less.

In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

Question 47

The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

A. Cancer
B. Hypertension
C. Liver disease
D. Myocardial infarction

Answer 47

D. Myocardial infarction

Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction

Question 48

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:

A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and Conduction.
B. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
C. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
D. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

Answer 48

A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

Question 49

The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:

A. Open and dilate the blocked coronary arteries.
B. Assess the extent of arterial blockage.
C. Bypass obstructed vessels.
D. Assess the functional adequacy of the valves and heart muscle.

Answer 49

B. Assess the extent of arterial blockage

Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results. Cardiac catheterization is performed for both diagnostic and therapeutic purposes. Despite significant advancement in non-invasive cardiac imaging, it remains the standard for the measurement of cardiac hemodynamics.

Question 50

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug’s principal effects are produced by:

A. Antispasmodic effect on the pericardium.
B. Causing an increased myocardial oxygen demand.
C. Vasodilation of peripheral vasculature.
D. Improved conductivity in the myocardium.

Answer 50

C. Vasodilation of peripheral vasculature

Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart.

Question 51

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:

A. Headache
B. High blood pressure
C. Shortness of breath
D. Stomach cramps

Answer 51

A. Headache

Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Headaches can be severe, throbbing, and persistent and may occur immediately after use. Nitro does not cause shortness of breath or stomach cramps.

Question 52

Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?

A. Take one (1) tablet every two (2) to five (5) minutes until the pain stops.
B. Take one (1) tablet and rest for ten (10) minutes. Call the physician if pain persists after ten (10) minutes.
C. Take one (1) tablet, then an additional tablet every 5 minutes for a total of three (3) tablets. Call the physician if pain persists after three (3) tablets.
D. Take one (1) tablet. If pain persists after five (5) minutes, take two (2) tablets. If pain persists five (5) minutes later, call the physician.

Answer 52

C. Take one (1) tablet, then an additional tablet every five (5) minutes for a total of three (3) tablets. Call the physician if pain persists after three tablets.

The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of three (3) tablets. Sublingual nitroglycerin appears in the bloodstream within two (2) to three (3) minutes and is metabolized within about 10 minutes.

Question 53

Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

A. Cardiac catheterization
B. Cardiac enzymes
C. Echocardiogram
D. Electrocardiogram (ECG)

Answer 53

D. Electrocardiogram (ECG)

The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. ECG is an effective tool to distinguish between acute MI and the myocardial ischemia that usually precedes it, as not all patients with myocardial ischemia will develop MI.

Question 54

Which of the following terms describes the force against which the ventricle must expel blood?

A. Afterload
B. Cardiac output
C. Overload
D. Preload

Answer 54

A. Afterload

Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles.

Question 55

Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?

A. Afterload
B. Cardiac index
C. Cardiac output
D. Preload

Answer 55

D. Preload

Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of the diastole determines the preload.

Question 56

A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?

A. Monitor the apical pulse rate.
B. Instruct the client to take medication with food.
C. Question the physician about the order.
D. Caution the client to rise slowly when standing.

Answer 56

C. Question the physician about the order.

Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. Propranolol is also contraindicated in those with any lung pathologies, such as COPD, asthma, or emphysema.

Question 57

One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?

A. Hypocalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hypernatremia

Answer 57

C. Hypokalemia

Furosemide is a potassium-depleting diuretic that can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

Question 58

When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:

A. Impulse to begin atrial contraction.
B. Impulse to transverse the atria to the AV node.
C. SA node to discharge the impulse to begin atrial depolarization.
D. Impulse to travel to the ventricles.

Answer 58

D. Impulse to travel to the ventricles.

The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

Question 59

Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:

A. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
B. “Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
C. “You are probably right but we can gradually increase your activities so that you can live a more active life.”
D. “Do you feel that you will have to make some changes in your life now?”

Answer 59

A. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”

Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell on his negativity about it.

Question 60

A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?

A. Creatine kinase (CK or CPK)
B. Lactic dehydrogenase (LDH)
C. LDH-1
D. LDH-2

Answer 60

A. Creatine kinase (CK or CPK)

Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream.

Question 61

Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

A. “Apply the patch to a non-hairy, non-fatty area of the upper torso or arms.”
B. “Apply the patch to the same site each day to maintain consistent drug absorption.”
C. “If you get a headache, remove the patch for 4 hours and then reapply.”
D. “If you get chest pain, apply a second patch right next to the first patch.”

Answer 61

A. “Apply the patch to a non-hairy, non-fatty area of the upper torso or arms.”

A nitroglycerin patch should be applied to a non-hairy, non-fatty area for the best and most consistent absorption rates.

Question 62

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:

A. Moderate doses of two different types of diuretics are more effective than a large dose of one type.
B. This combination promotes diuresis but decreases the risk of hypokalemia.
C. This combination prevents dehydration and hypovolemia.
D. Using two drugs increases osmolality of plasma and the glomerular filtration rate.

Answer 62

B. This combination promotes diuresis but decreases the risk of hypokalemia

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance. A study in children with severe edema secondary to nephrotic syndrome showed that oral spironolactone in conjunction with intravenous furosemide was safe and helpful in treating these children who had edema with volume expansion.