Cardiac Lippincott

10. A 60-year-old male client comes into the emergency department with a complaint of crushing substernal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myo- cardial infarction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocar- diogram (ECG), and 2 mg of morphine sulfate given I.V. The nurse should first: ■ 1. Administer the morphine. ■ 2. Obtain a 12-lead ECG. ■ 3. Obtain the blood work. ■ 4. Order the chest radiograph.

1

14. If the client who was admitted for myocar- dial infarction (MI) develops cardiogenic shock, which characteristic sign should the nurse expect to observe? ■ 1. Oliguria. ■ 2. Bradycardia. ■ 3. Elevated blood pressure. ■ 4. Fever.

1

15. The physician orders continuous I.V. nitro- glycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the medica- tion. 2. Monitoring blood pressure every 4 hours. 3. Monitoring urine output hourly. 4Obtaining serum potassium levels daily.

1

27. After the administration of t-PA, the assess- ment priority is to: Observe the client for chest pain. Monitor for fever. Monitor the 12-lead electrocardiogram (ECG) every 4 hours. Monitor breath sounds.

1

28. When monitoring a client who is receiv- ing tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following? ■ 1. Cardiac arrhythmias. ■ 2. Hypertension. ■ 3. Seizure. ■ 4. Hypothermia.

1

3. The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago. Upon assessment, the nurse identifies a new systolic murmur at the apex. The nurse should first: 1. Assess for changes in vital signs. 2. Draw an arterial blood gas. 3. Evaluate heart sounds with the client leaning forward. 4. Obtain a 12 Lead electrocardiogram.

1

32. A 68-year-old female client on day 2 after hip surgery has no cardiac history but reports hav- ing chest heaviness. The first nursing action should be to: ■ 1. Inquire about the onset, duration, severity, and precipitating factors of the heaviness. ■ 2. Administer oxygen via nasal cannula. ■ 3. Offer pain medication for the chest heaviness. ■ 4. Inform the physician of the chest heaviness.

1

34. An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: ■ 1. Left ventricular atrophy. ■ 2. Irregular heartbeats. ■ 3. Peripheral vascular occlusion. ■ 4. Pacemaker placement.

1

37. Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? ■ 1. A change in the pattern of her pain. ■ 2. Pain during sexual activity. ■ 3. Pain during an argument with her husband. ■ 4. Pain during or after an activity such as lawn-mowing.

1

42. A client has a throbbing headache when nitroglycerin is taken for angina. The nurse should instruct the client that: ■ 1. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect. ■ 2. Nitroglycerin should be avoided if the client is experiencing this serious side effect. ■ 3. Taking the nitroglycerin with a few glasses of water will reduce the problem. ■ 4. The client should lie in a supine position to alleviate the headache.

1

74. A client has mitral stenosis and is a prospec- tive valve recipient. The nurse is instructing the client about health maintenance prior to surgery. Inability to follow which of the following regimens would pose the greatest health hazard to this client at this time? ■ 1. Medication therapy. ■ 2. Diet modification. ■ 3. Activity restrictions. ■ 4. Dental care.

1

77. The most effective measure the nurse can use to prevent wound infection when changing a client's dressing after coronary artery bypass surgery is to: ■ 1. Observe careful hand-washing procedures. ■ 2. Clean the incisional area with an antiseptic. ■ 3. Use prepackaged sterile dressings to cover the incision. ■ 4. Place soiled dressings in a waterproof bag before disposing of them.

1

78. For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery, which of the following measures should the nurse institute to help prevent complica- tions associated with excessive calcium excretion? ■ 1. Ensure a liberal fluid intake. ■ 2. Provide an alkaline-ash diet. ■ 3. Prevent constipation. ■ 4. Enrich the client's diet with dairy products.

1

80. Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include demonstration of the proper use of: ■ 1. A manual toothbrush. ■ 2. An electric toothbrush. ■ 3. An irrigation device. ■ 4. Dental floss.

1

82. Three days after mitral valve surgery, a 45-year-old female comments that she hears a "clicking" noise coming from her chest and her "rather large" chest incision. The nurse's response should reflect the understanding that the client may be experiencing which of the following? ■ 1. ■ 2. ■ 3. ■ 4. Anxiety related to altered body image. Anxiety related to altered health status. Altered tissue perfusion. Lack of knowledge regarding the postopera- tive course.

1

83. Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diag- nosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: ■ 1. Decrease in heart rate. ■ 2. Lessening of fatigue. ■ 3. Improvement in blood sugar levels. ■ 4. Increase in urine output.

1

87. An industrial health nurse at a large print- ing plant finds a male employee's blood pressure to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25 lb overweight and has smoked a pack of cigarettes daily for more than 20 years. The cli- ent's physician prescribes atenolol (Tenormin) for the hypertension. The nurse should instruct the client to: ■ 1. Avoid sudden discontinuation of the drug. ■ 2. Monitor the blood pressure annually. ■ 3. Follow a 2-g sodium diet. ■ 4. Discontinue the medication if severe head- aches develop.

1

9. A client is admitted with a myocardial infarc- tion and new onset atrial fibrillation. While auscultat- ing the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these findings as: ■ 1. Heart rate irregular with S3. ■ 2. Heart rate irregular with S4. ■ 3. Heart rate irregular with aortic regurgitation. ■ 4. Heart rate irregular with mitral stenosis.

1

95. The client has had hypertension for 20 years. The nurse should assess the client for? ■ 1. Renal insufficiency and failure. ■ 2. Valvular heart disease. ■ 3. Endocarditis. ■ 4. Peptic ulcer disease.

1

96. The nurse is developing a care plan with an older adult and is instructing the client that hyper- tension can be a silent killer. The nurse should instruct the client to be aware of signs and symptoms of other system failures and encourage the client to report signs of which of the following diseases that are often a result of undeteced high blood pressure? ■ 1. Cerebrovascular accidents (CVAs). ■ 2. Liver disease. ■ 3. Myocardial infarction. ■ 4. Pulmonary disease.

1

99. A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60. The nurse should take which of the following actions first? ■ 1.Prepare for transcutaneous pacing. 2. Prepare to defibrillate the client at 200 joules. 3.Administer an I.V. lidocaine infusion. 4. Schedule the operating room for insertion of a permanent pacemaker.

1

During rescue breathing in cardiopulmonary resuscitation (CPR), the victim will exhale by: 1. Normal relaxation of the chest. 2. Gentle pressure of the rescuer's hand on the upper chest. 3. The pressure of cardiac compressions. 4. Turning the head to the side.

1

51. Which of the following nursing diagnoses would be appropriate for a client with systolic heart failure? Select all that apply. 1. Ineffective peripheral tissue perfusion related to a decreased stroke volume. 2. Activity intolerance related to impaired gas exchange and perfusion. 3. Dyspnea related to pulmonary congestion and impaired gas exchange. 4. Decreased cardiac output related to impaired cardiac filling. 5. Impaired renal perfusion related to a decreased cardiac output.

1, 2, 3, 5

66. When teaching a client with heart failure about preventing complications and future hospi- talizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply. 1. Becoming increasingly short of breath at rest. 2. Weight gain of 2 lb or more in 1 day. 3. High intake of sodium for breakfast. 4. Having to sleep sitting up in a reclining chair. 5. Weight loss of 2 lb in 1 day.

1, 2, 4,

The nurse is preparing the client for cardio- version. The nurse should do which of the follow- ing? Select all that apply. 1. Use a conducting agent between the skin and the paddles. 2. Place the paddles over the client's clothing. 3. Call "clear" before discharging the electrical current. 4. Record the delivered energy and the resulting rhythm. 5. Exert 5 to 10 lb of pressure on each paddle to ensure good skin contact.

1, 3, 4

48. A nurse is assessing a client with heart failure. The nurse should assess the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply. ■ 1. Ventricular hypertrophy. ■ 2. Parasympathetic nervous stimulation. ■ 3. Renin-angiotensin-aldosterone system. ■ 4. Jugular venous distention. ■ 5. Sympathetic nervous stimulation.

1, 3, 5

84. A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? Select all that apply. ■ 1. Dry mouth. ■ 2. Hyperkalemia. ■ 3. Impotence. ■ 4. Pancreatitis. ■ 5. Sleep disturbance.

1, 3, 5

4. A client with acute chest pain is receiving I.V. morphine sulfate. Which of the following results are intended effects of morphine in this client? Select all that apply. ■ 1. Reduces myocardial oxygen consumption. ■ 2. Promotes reduction in respiratory rate. ■ 3. Prevents ventricular remodeling. ■ 4. Reduces blood pressure and heart rate. ■ 5. Reduces anxiety and fear.

1, 4, 5

8. When teaching a client about self-care fol- lowing placement of a new permanent pacemaker to his left upper chest, the nurse should include which information? Select all that apply. 1. Take and record daily pulse rate. 2. Avoid air travel because of airport security alarms. 3. Immobilize the affected arm for 4 to 6 weeks. 4. Avoid using a microwave oven. 5. Avoid lifting anything heavier than 3 lb.

1, 5

100. A 74-year-old female is admitted to the telemetry unit for placement of a permanent pace- maker because of sinus bradycardia. A priority goal for the client within 24 hours after insertion of a permanent pacemaker is to: ■ 1. Maintain skin integrity. ■ 2. Maintain cardiac conduction stability. ■ 3. Decrease cardiac output. ■ 4. Increase activity level.

2

11. When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), the nurse explains that the purpose of the drug is to: ■ 1. Help keep him well hydrated. ■ 2. Dissolve clots that he may have. ■ 3. Prevent kidney failure. ■ 4. Treat potential cardiac arrhythmias.

2

13. A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders should the nurse question? ■ 1. Call for urine output < 30 mL/hour for 2 con- secutive hours. ■ 2. Metoprolol (Lopressor) 5 mg I.V. push. ■ 3. Prepare for a pulmonary artery catheter inser- tion. ■ 4. Titrate Dobutamine (Dobutrex) to keep sys- tolic BP > 100.

2

18. While caring for a client who has sustained a myocardial infarction (MI), the nurse notes eight premature ventricular contractions (PVCs) in 1 minute on the cardiac monitor. The client is receiv- ing an I.V. infusion of 5% dextrose in water (D5W) and oxygen at 2 L/minute. The nurse's first course of action should be to: ■ 1. Increase the I.V. infusion rate. ■ 2. Notify the physician promptly. ■ 3. Increase the oxygen concentration. ■ 4. Administer a prescribed analgesic.

2

2. A client with chest pain is prescribed intrave- nous nitroglycerin (Tridil). Which assessment is of greatest concern for the nurse initiating the nitro- glycerin drip? ■ 1.Serum potassium is 3.5 mEq/L. 2. Blood pressure is 88/46. 3. ST elevation is present on the electrocardiogram. 4. Heart rate is 61.

2

20. Which of the following is an expected out- come when a client is recieving an I.V. administra- tion of furosemide? ■ 1. Increased blood pressure. ■ 2. Increased urine output. ■ 3. Decreased pain. ■ 4. Decreased premature ventricular contractions.

2

22. Which of the following reflects the prin- ciple on which a client's diet will most likely be based during the acute phase of myocardial infarction? ■ 1. Liquids as desired. ■ 2. Small, easily digested meals. ■ 3. Three regular meals per day. ■ 4. Nothing by mouth.

2

29. Contraindications to the administration of tissue plasminogen activator (t-PA) include which of the following? ■ 1. Age greater than 60 years. ■ 2. History of cerebral hemorrhage. ■ 3. History of heart failure. ■ 4. Cigarette smoking.

2

30. A client has driven himself to the emer- gency department. He is 50 years old, has a history of hypertension, and informs the nurse that his father died from a heart attack at age 60. The client is presently complaining of indigestion. The nurse connects him to an electrocardiogram monitor and begins administering oxygen at 2 L/minute per nasal cannula. The nurse's next action would be to: ■ 1. Call for the physician. ■ 2. Start an I.V. line. ■ 3. Obtain a portable chest radiograph. ■ 4. Draw blood for laboratory studies.

2

38. 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: ■ 1. Open and dilate blocked coronary arteries. ■ 2. Assess the extent of arterial blockage. ■ 3. Bypass obstructed vessels. ■ 4. Assess the functional adequacy of the valves and heart muscle.

2

40. Which of the following is not a risk factor for the development of atherosclerosis? ■ 1. Family history of early heart attack. ■ 2. Late onset of puberty. ■ 3. Total blood cholesterol level greater than 220 mg/dL. ■ 4. Elevated fasting blood glucose concentration.

2

47. A client has a history of heart failure and has been taking several medications, including furo- semide (Lasix), digoxin (Lanoxin) and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first- degree atrioventricular block. The nurse should assess the client for signs of which condition? ■ 1. Hyperkalemia. ■ 2. Digoxin toxicity. ■ 3. Fluid deficit. ■ 4. Pulmonary edema.

2

54. A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following? ■ 1. Dilated coronary arteries. ■ 2. Increased myocardial contractility. ■ 3. Decreased cardiac arrhythmias. ■ 4. Decreased electrical conductivity in the heart.

2

57. Clients with heart failure are prone to atrial fibrillation. During physical assessment, the nurse should suspect atrial fibrillation when palpation of the radial pulse reveals: ■ 1. Two regular beats followed by one irregular beat. ■ 2. An irregular pulse rhythm. ■ 3. Pulse rate below 60 bpm. ■ 4. A weak, thready pulse.

2

61. Which of the following foods should the nurse teach a client with heart failure to limit when following a 2-g sodium diet? ■ 1. Apples. ■ 2. Tomato juice. ■ 3. Whole wheat bread. ■ 4. Beef tenderloin.

2

63. The nurse finds the apical impulse below the fifth intercostal space. The nurse suspects: ■ 1. Left atrial enlargement. ■ 2. Left ventricular enlargement. ■ 3. Right atrial enlargement. ■ 4. Right ventricular enlargement.

2

7. The nurse has completed an assessment on a client with a decreased cardiac output. Which find- ings should receive the highest priority? 1. BP 110/62, atrial fibrillation with HR 82, bibasilar crackles. 2. Confusion, urine output 15 mL over the last 2 hours, orthopnea. 3. SpO2 92 on 2 liters nasal cannula, respirations 20, 1+ edema of lower extremities. 4. Weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with exercise.

2

72. A client experiences initial indications of excitation after having an I.V. infusion of lidocaine hydrochloride started. The nurse should further assess the client when the client reports having: ■ 1. Palpitations. ■ 2. Tinnitus. ■ 3. Urinary frequency. ■ 4. Lethargy.

2

73. A pulmonary artery catheter is inserted in a client with severe mitral stenosis and regurgitation. The nurse administers furosemide (Lasix) to treat pulmonary congestion and begins a Nitroprusside (Nipride) drip for afterload reduction per physi- cian orders. The nurse notices a sudden drop in the pulmonary artery diastolic pressure and pulmonary artery wedge pressure. Which of the following has the highest priority? ■ 1. Assess the 12-lead EKG. ■ 2. Assess the blood pressure. ■ 3. Assess the lung sounds. ■ 4. Assess the urine output

2

81. Before a client's discharge after mitral valve replacement surgery, the nurse should evaluate the client's understanding of postsurgery activity restric- tions. Which of the following should the client not engage in until after the 1-month postdischarge appointment with the surgeon? ■ 1. Showering. ■ 2. Lifting anything heavier than 10 lb. ■ 3. A program of gradually progressive walking. ■ 4. Light housework.

2

97. A client treated for hypertension with furo- semide (Lasix), atenolol (Tenormin), and ramipril (Altace) develops a second degree heart block Mob- itz type 1. Which of the following actions should the nurse take? ■ 1. Administer a 250 mL fluid bolus. ■ 2. Withhold the atenolol. ■ 3. Prepare for cardioversion. ■ 4. Set up for an arterial line.

2

A client who has been given cardiopulmonary resuscitation (CPR) is transported by ambulance to the hospital's emergency department, where the admitting nurse quickly assesses the client's condi- tion. The most effective way to determine the effec- tiveness of CPR is noting whether the: ■ 1. Pulse rate is normal. ■ 2. Pupils are reacting to light. ■ 3. Mucous membranes are pink. ■ 4. Systolic blood pressure is at least 80 mm Hg.

2

A nurse is helping a suspected choking vic- tim. The nurse should perform the Heimlich maneu- ver when the victim: ■ 1. Starts to become cyanotic. ■ 2. Cannot speak due to airway obstruction. ■ 3. Can make only minimal vocal noises. ■ 4. Is coughing vigorously.

2

During cardiopulmonary resuscitation (CPR), the xiphoid process at the lower end of the sternum should not be compressed when performing cardiac compressions. Which of the following organs would be most likely at risk for laceration by forceful com- pressions over the xiphoid process? ■ 1. Lung. ■ 2. Liver. ■ 3. Stomach. ■ 4. Diaphragm.

2

The monitor technician informs the nurse that the client has started having premature ven- tricular contractions every other beat. Which is the priority nursing action? 1. Activate the rapid response team. 2. Assess the client's orientation and vital signs. 3. Call the physician. 4. Administer a bolus of lidocaine.

2

The nurse is assessing a client with heart failure who is receiving home health care monitor- ing using electronic devices including scales, blood pressure monitoring, and structured questions to which the client responds daily on a touch-screen monitor. The nurse reviews data obtained within the last 3 days. Weight Blood Pressure April 3 2010 160 120/80 April 4 2010 162 130/88 April 5 2010 165 140/90 The nurse calls the client to follow up. The nurse should ask the client which of the following first: 1. "How are you feeling today?" 2. "Are you having shortness of breath?" 3."Did you calibrate the scales before using them?" 4. "How much fluid did you drink during the last 24 hours?"

2

The nurse is caring for a client whose con- dition has been deteriorating. The client becomes unresponsive, the blood pressure is 80/40, and SpO2 is 90% on 50% face mask. The nurse should: ■ 1. Begin chest compressions. ■ 2. Call the rapid response team. ■ 3. Remove the family from the room. ■ 4. Ventilate the client with an ambu bag.

2

The rapid response team has been called to manage an unwitnessed cardiac arrest. The estimated maximum time a person can be without cardiopulmonary function and still not experience permanent brain damage is: ■ 1. 1 to 2 minutes. ■ 2. 4 to 6 minutes. ■ 3. 8 to 10 minutes. ■ 4. 12 to 15 minutes.

2

86. In teaching the hypertensive client to avoid orthostatic hypotension, the nurse should empha- size which of the following instructions? Select all that apply. ■ 1. Plan regular times for taking medications. ■ 2. Arise slowly from bed. ■ 3. Avoid standing still for long periods. ■ 4. Avoid excessive alcohol intake. ■ 5. Avoid hot baths.

2, 3

62. A client receiving a loop diuretic should be encouraged to eat which of the following foods? Select all that apply. ■ 1. Angel food cake. ■ 2. Banana. ■ 3. Dried fruit. ■ 4. Orange juice. ■ 5. Peppers.

2, 3, 4

69. A client is scheduled for a cardiac catheter- ization. The nurse should do which of the following preprocedure tasks? Select all that apply. 1. Administer all ordered oral medications. 2. Check for iodine sensitivity. 3. Verify that written consent has been obtained. 4. Withhold food and oral fluids before the procedure. 5. Insert a urinary drainage catheter.

2, 3, 4

76. A client who has undergone a mitral valve replacement has persistent bleeding from the sternal incision during the early postoperative period. The nurse should do which of the following? Select all that apply. 1. Begin Warfarin (Coumadin). 2. Check the postoperative CBC, INR, PTT, & platelet levels. 3. Confirm availability of blood products. 4 Monitor the mediastinal chest tube drainage. Start a Dopamine (Intropin) drip for a systolic BP < 100.

2, 3, 4

85. A client with hypertensive emergency is being treated with sodium nitroprusside (Nipride). In a dilution of 50 mg/250 mL, how many micro- grams of Nipride are in each milliliter? ________________________ mcg.

200

5. A client receives fibrinolytic therapy upon admission following a myocardial infarction. He is now receiving an I.V. infusion of heparin sodium at 1,200 units/hour. The dilution is 25,000 units/500 mL. How many milliliters per hour will this client receive? ________________________ mL/hour.

24

12. The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes the car- diac rhythm shown on the electrocardiogram strip below. The nurse identifies this rhythm as which of the following? ■ 1. Atrial fibrillation. ■ 2. Ventricular tachycardia. ■ 3. Premature ventricular contractions (PVCs). ■ 4. Third-degree heart block.

3

21. After a myocardial infarction, the hospital- ized client is taught to move the legs while resting in bed. This type of exercise is recommended pri- marily to help: ■ 1. Prepare the client for ambulation. ■ 2. Promote urinary and intestinal elimination. ■ 3. Prevent thrombophlebitis and blood clot for- mation. ■ 4. Decrease the likelihood of pressure ulcer for- mation.

3

24. A 58-year-old female with a family history of CAD is being seen for her annual physical exam. Fasting lab test results include: Total cholesterol 198; LDL cholesterol 120; HDL cholesterol 58; Triglycerides 148; Blood sugar 102; and C-reactive protein (CRP) 4.2. The health care provider informs the client that she will be started on a statin medica- tion and aspirin. The client asks the nurse why she needs to take these medications. Which is the best response by the nurse? 1. "The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a lowfat diet." 2. "The triglycerides are elevated and will not return to normal without these medications." 3. "The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications ordered." 4. "The medications are not indicated since your lab values are all normal."

3

25. If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by: 1. Explaining how the old behavior leads to poor health. 2. Withholding praise until the new behavior is well established. 3. Rewarding the client whenever the acceptable behavior is performed. 4. Instilling mild fear into the client to extin- guish the behavior.

3

35. During the previous few months, a 56-year- old woman felt brief twinges of chest pain while working in her garden and has had frequent epi- sodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could sug- gest would most likely help the client prevent this problem? 1. Visit her friend early in the day. 2. Rest for at least an hour before climbing the stairs. 3. Take a nitroglycerin tablet before climbing the stairs. 4. Lie down once she reaches the friend's apartment.

3

36. The client who experiences angina has been told to follow a low-cholesterol diet. Which of the following meals should the nurse tell the client would be best on her low-cholesterol diet? ■ 1. Hamburger, salad, and milkshake. ■ 2. Baked liver, green beans, and coffee. ■ 3. Spaghetti with tomato sauce, salad, and coffee. ■ 4. Fried chicken, green beans, and skim milk.

3

41. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tab- lets, 0.3 mg given sublingually. This drug's principal effects are produced by: 1. Antispasmodic effects on the pericardium. 2.Causing an increased myocardial oxygen demand. 3. Vasodilation of peripheral vasculature. 4. Improved conductivity in the myocardium.

3

43. 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? ■ 1. Take one tablet every 2 to 5 minutes until the pain stops. ■ 2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. ■ 3. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after three tablets. ■ 4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.

3

44. A client with angina has been taking nife- dipine. The nurse should teach the client to: 1. Monitor blood pressure monthly. 2. Perform daily weights. 3. Inspect gums daily. 4. Limit intake of green leafy vegetables.

3

46. A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15%. The client is taking warfarin (Coumadin). The expected outcome of this drug is to: ■ 1. Decrease circulatory overload. ■ 2. Improve the myocardial workload. ■ 3. Prevent thrombus formation. ■ 4. Regulate cardiac rhythm.

3

49. Which of the following sets of conditions is an indication that a client with a history of left- sided heart failure is developing pulmonary edema? ■ 1. Distended jugular veins and wheezing. ■ 2. Dependent edema and anorexia. ■ 3. Coarse crackles and tachycardia. ■ 4. Hypotension and tachycardia.

3

52. In which of the following positions should the nurse place a client with suspected heart failure? ■ 1. Semi-sitting (low Fowler's position). ■ 2. Lying on the right side (Sims' position). ■ 3. Sitting almost upright (high Fowler's position). ■ 4. Lying on the back with the head lowered (Trendelenburg's position).

3

59. The nurse should teach the client that signs of digoxin toxicity include which of the following? ■ 1. Rash over the chest and back. ■ 2. Increased appetite. ■ 3. Visual disturbances such as seeing yellow spots. ■ 4. Elevated blood pressure.

3

6. A 65-year-old client is admitted to the emer- gency department with a fractured hip. The client has chest pain and shortness of breath. The health care provider orders nitroglycerin tablets. Which should the nurse instruct the client to do? 1. Put the tablet under the tongue until it is absorbed. 2. Swallow the tablet with 120 mL of water. 3. Chew the tablet until it is dissolved. 4. Place the tablet between his cheek and gums.

3

65. The nurse's discharge teaching plan for the client with heart failure should stress the impor- tance of which of the following? 1. Maintaining a high-fiber diet. 2. Walking 2 miles every day. 3. Obtaining daily weights at the same time each day. 4. Remaining sedentary for most of the day.

3

67. A client has returned from the cardiac cath- eterization laboratory after a balloon valvuloplasty for mitral stenosis. Which of the following requires immediate nursing action? 1. A low, grade 1 intensity mitral regurgitation murmur. 2. SpO2 is 94% on 2 liters of oxygen via nasal cannula. 3. The client has become more somnolent. 4. Urine output has decreased from 60 mL/hour to 40 mL over the last hour.

3

70. A client has returned to the medical-surgical unit after a cardiac catheterization. Which is the most important initial postprocedure nursing assess- ment for this client? 1. Monitor the laboratory values. 2. Observe neurologic function every 15 min- utes. 3. Observe the puncture site for swelling and bleeding. 4. Monitor skin warmth and turgor.

3

71. A 70-year-old female is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furo- semide. During the initial interview with the client, the nurse would most likely learn that the client's childhood health history included: ■ 1. Chickenpox. ■ 2. Poliomyelitis. ■ 3. Rheumatic fever. ■ 4. Meningitis.

3

79. The nurse should teach the client who is receiving warfarin sodium that: 1. Partial thromboplastin time values determine the dosage of warfarin sodium. 2. Protamine sulfate is used to reverse the effects of warfarin sodium. 3. International Normalized Ratio (INR) is used to assess effectiveness. 4. Warfarin sodium will facilitate clotting of the blood.

3

88. The nurse teaches a client, who has recently been diagnosed with hypertension, about dietary restrictions: a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? 1. Mixed green salad with blue cheese dressing, crackers, and cold cuts. 2. Ham sandwich on rye bread and an orange. 3. Baked chicken, an apple, and a slice of white bread. 4. Hot dogs, baked beans, and celery and carrot sticks.

3

91. The client realizes the importance of quit- ting smoking, and the nurse develops a plan to help the client achieve this goal. Which of the following nursing interventions should be the initial step in this plan? ■ 1.Review the negative effects of smoking on the body. 2. Discuss the effects of passive smoking on environmental pollution. 3. Establish the client's daily smoking pattern. 4. Explain how smoking worsens high blood pressure.

3

94. The most important long-term goal for a client with hypertension would be to: ■ 1. Learn how to avoid stress. ■ 2. Explore a job change or early retirement. ■ 3. Make a commitment to long-term therapy. ■ 4. Lose weight.

3

A client is given amiodarone (Cordarone) in the emergency department for a dysrhythmia. Which of the following indicates the drug is having the desired effect? 1. The ventricular rate is increasing. 2. The absent pulse is now palpable. 3. The number of premature ventricular contrac- tions is decreasing. 4. The fine ventricular fibrillation changes to coarse ventricular fibrillation.

3

The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the hospital. The client understands the discharge plan when the client: ■ 1. Selects a low-cholesterol diet to control coro- nary artery disease. ■ 2. States a need for bed rest for 1 week after discharge. ■ 3. Verbalizes safety precautions needed to pre- vent pacemaker malfunction. ■ 4. Explains signs and symptoms of myocardial infarction (MI).

3

The nurse in the intensive care unit is giv- ing a report to the nurse in a cardiac step-down unit about a client who had coronary artery bypass surgery. Which of the following is the most effective way to assure essential information about the client is reported? 1. Give the report face-to-face with both nurses in a quiet room. 2. Audiotape the report for future reference and documentation. 3. Use a printed checklist with information indi- vidualized for the client. 4. Document essential transfer information in the client's electronic health record.

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Upon assessment of third degree heart block on the monitor, the nurse should first: ■ 1. Call a code. ■ 2. Begin cardiopulmonary resuscitation. ■ 3. Have transcutaneous pacing ready at the bed- side. ■ 4. Prepare for defibrillation.

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Ventricular tachycardia is displayed on the cardiac monitor of a client admitted to the telemetry unit. Which should the nurse do first? ■ 1. Prepare for immediate cardioversion. ■ 2. Begin cardiopulmonary resuscitation (CPR). ■ 3. Check for a pulse. ■ 4. Prepare for immediate defibrillation.

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When performing external chest compres- sions on an adult during cardiopulmonary resuscita- tion (CPR), the rescuer should depress the sternum: ■ 1. 0.5 to 1 inch. ■ 2. 1 to 1.5 inches. ■ 3. 1.5 to 2 inches. ■ 4. 2 to 2.5 inches.

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1. A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Tro- ponin levels are elevated. What is the highest priority for nursing management of this client at this time? ■ 1. Monitor daily weights and urine output. ■ 2. Permit unrestricted visitation by family and friends. ■ 3. Provide client education on medications and diet. ■ 4. Reduce pain and myocardial oxygen demand.

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16. When teaching the client with myocardial infarction (MI), the nurse explains that the pain associated with MI is caused by: ■ 1. Left ventricular overload. ■ 2. Impending circulatory collapse. ■ 3. Extracellular electrolyte imbalances. ■ 4. Insufficient oxygen reaching the heart muscle.

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17. The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm shown on the electrocardiogram strip below. The nurse identifies this rhythm as which of the following? ■ 1. Atrial fibrillation. ■ 2. Ventricular tachycardia. ■ 3. Premature ventricular contractions. ■ 4. Sinus tachycardia.

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19. Which of the following is an expected out- come for a client on the second day of hospitaliza- tion after a myocardial infarction (MI)? The client: ■ 1. Has severe chest pain. ■ 2. Can identify risk factors for MI. ■ 3. Agrees to participate in a cardiac rehabilita- tion walking program. ■ 4. Can perform personal self-care activities with- out pain.

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23. The nurse is assessing clients at a health fair. Which client is at greatest risk for coronary artery disease? 1. A 32-year-old female with mitral valve pro- lapse who quit smoking 10 years ago. 2. A 43-year-old male with a family history of CAD and cholesterol level of 158. 3. A 56-year-old male with an HDL of 60 who takes atorvastatin (Lipitor). 4. A 65-year-old female who is obese with an LDL of 188.

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26. Alteplase recombinant, or tissue plasmi- nogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: ■ 1. Control chest pain. ■ 2. Reduce coronary artery vasospasm. ■ 3. Control the arrhythmias associated with MI. ■ 4. Revascularize the blocked coronary artery.

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31. Crackles heard on lung auscultation indicate which of the following? ■ 1. Cyanosis. ■ 2. Bronchospasm. ■ 3. Airway narrowing. ■ 4. Fluid-filled alveoli.

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33. 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? ■ 1. Cancer. ■ 2. Hypertension. ■ 3. Liver disease. ■ 4. Myocardial damage.

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39. The client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) to treat angina. Priority goals for the client immediately after PTCA should include: ■ 1. Minimizing dyspnea. ■ 2. Maintaining adequate blood pressure control. ■ 3. Decreasing myocardial contractility. ■ 4. Preventing fluid volume deficit.

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45. Captopril (Capoten), furosemide (Lasix), and metoprolol (Toprol XL) are ordered for a client with systolic heart failure. The client's blood pressure is 136/82 and the heart rate is 65. Prior to medication administration at 9 a.m., the nurse reviews the fol- lowing lab tests (see chart). Which of the following should the nurse do first? ■ 1. Administer the medications. ■ 2. Call the physician. ■ 3. Withhold the captopril. ■ 4. Question the metoprolol dose.

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56. The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to help: 1. Prevent electrolyte imbalances. 2. Retard rapid drug absorption. 3. Excrete excessive fluids accumulated during the night. 4. Prevent sleep disturbances during the night.

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60. The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate that the client has a: ■ 1. Low sodium level. ■ 2. High glucose level. ■ 3. High calcium level. ■ 4. Low potassium level.

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75. In preparing the client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, the nurse should explain that: 1. The client will remain in the ICU for 5 days. 2. The client will sleep most of the time while in the ICU. 3. Noise and activity within the ICU are mini- mal. 4. The client will receive medication to relieve pain.

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89. A client's job involves working in a warm, dry room, frequently bending and crouching to check the underside of a high-speed press, and wearing eye guards. Given this information, the nurse should assess the client for which of the following? ■ 1. Muscle aches. ■ 2. Thirst. ■ 3. Lethargy. ■ 4. Orthostatic hypotension.

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90. An exercise program is prescribed for the client with hypertension. Which intervention would be most likely to assist the client in maintaining an exercise program? 1. Giving the client a written exercise program. 2. Explaining the exercise program to the cli- ent's spouse. 3. Reassuring the client that he or she can do the exercise program. 4. Tailoring a program to the client's needs and abilities.

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If a client is receiving rescue breaths and the chest wall fails to rise during cardiopulmonary resuscitation, the rescuer should first: ■ 1. Try using an ambu bag. ■ 2. Decrease the rate of compressions. ■ 3. Intubate the client. ■ 4. Reposition the airway.

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The nurse is tracking data on a group of clients with heart failure who have been discharged from the hospital and are being followed at a clinic. Which of the following data indicate that nursing interventions of monitoring and teaching have been effective? ■ 1. 90 percent of clients have not gained weight. ■ 2. 75 percent of the clients viewed the educa- tional DVD. ■ 3. 80 percent of the clients reported that they are taking their medications. ■ 4. 5 percent of the clients required hospitaliza- tion in the last 90 days.

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When performing the Heimlich maneuver on a conscious adult victim, the rescuer delivers inward and upward thrusts specifically: ■ 1. Above the umbilicus. ■ 2. At the level of the xiphoid process. ■ 3. Over the victim's midabdominal area. ■ 4. Below the xiphoid process and above the umbilicus.

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Which activity would be appropriate to del- egate to unlicensed personnel for a client diagnosed with a myocardial infarction who is stable? ■ 1. Evaluate the lung sounds. ■ 2. Help the client identify risk factors for CAD. ■ 3. Provide teaching on a 2 g sodium diet. ■ 4. Record the intake and output.

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50. A 69-year-old female has a history of heart failure. She is admitted to the emergency depart- ment with heart failure complicated by pulmonary edema. On admission of this client, which of the following should the nurse assess first? ■ 1. Blood pressure. ■ 2. Skin breakdown. ■ 3. Serum potassium level. ■ 4. Urine output.

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53. The major goal of therapy for a client with heart failure and pulmonary edema should be to: ■ 1. Increase cardiac output. ■ 2. Improve respiratory status. ■ 3. Decrease peripheral edema. ■ 4. Enhance comfort.

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55. Furosemide is administered intravenously to a client with heart failure. How soon after adminis- tration should the nurse begin to see evidence of the drug's desired effect? ■ 1. 5 to 10 minutes. ■ 2. 30 to 60 minutes. ■ 3. 2 to 4 hours. ■ 4. 6 to 8 hours.

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58. When teaching the client about complica- tions of atrial fibrillation, the nurse should instruct the client to avoid which of the following? ■ 1. Stasis of blood in the atria. ■ 2. Increased cardiac output. ■ 3. Decreased pulse rate. ■ 4. Elevated blood pressure.

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4. The nurse is admitting a 68-year-old male to the medical floor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first? ■ 1. Assess respiratory status. ■ 2. Draw blood for laboratory studies. ■ 3. Insert a Foley catheter. ■ 4. Weigh the client.

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8. The nurse notices that a client's heart rate decreases from 63 to 50 beats per minute on the monitor. The nurse should first: 1. Administer Atropine 0.5 mg I.V. push. 2. Auscultate for abnormal heart sounds. 3. Prepare for transcutaneous pacing. 4. Take the client's blood pressure.

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