Cardiovascular

A nurse cares for a patient recovering from prosthetic valve replacement surgery. The patient asks, "Why will I need to take anticoagulants for the rest of my life?" What is the best response by the nurse? a. "Blood clots form more easily in artificial replacement valves." b. "The vein taken from your leg reduces circulation in the leg." c. "The prosthetic valve places you at greater risk for a heart attack." d. "The surgery left a lot of small clots in your heart and lungs."

A. "Blood clots form more easily in artificial replacement valves."

While assessing a patient on a cardiac unit, a nurse identifies the presence of an S3 gallop (extra heart sound). What action would the nurse take next? a. Assess for symptoms of left-sided heart failure. b. Transfer the patient to the intensive care unit. c. Document this as a normal finding. d. Call the healthcare provider immediately.

A. Assess for symptoms of left-sided heart failure.

The nurse is reviewing the lipid panel of a male patient who has atherosclerosis. Which finding is most concerning? a. Triglycerides: 198 mg/dL b. Cholesterol: 126 mg/dL c. High-density lipoprotein cholesterol (HDL-C): 48 mg/dL d. Low-density lipoprotein cholesterol (LDL-C): 122 mg/dL

A. Triglycerides: 198 mg/dL

The nurse is caring for a patient on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm. After calling for assistance and a defibrillator, what action would the nurse take next? a. Ask the patient's family about code status. b. Initiate cardiopulmonary resuscitation (CPR). c. Start an 18-gauge intravenous line. d. Perform a pericardial thump.

B. Initiate cardiopulmonary resuscitation (CPR)

A patient had a percutaneous transluminal coronary angioplasty for peripheral arterial disease. What assessment finding by the nurse indicates that a priority outcome for this patient has been met? a. Pain rated as 2/10 after medication b. Remains on bedrest as directed c. Verbalizes understanding of procedure d. Distal pulse on affected extremity 2+/4+

D. Distal pulse on affected extremity 2+/4+

A nurse is caring for a patient with a deep vein thrombosis (DVT). What nursing assessment indicates that a priority outcome has been met? a. Verbalizing risk factors b. Pain of 2/10 after medication c. Ambulates with assistance d. Oxygen saturation of 98%

D. Oxygen saturation of 98%

A nurse assesses a patient in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? a. "I must stop halfway up the stairs to catch my breath." b. "I am awakened by the need to urinate at night." c. "I have been drinking more water than usual." d. "I have experienced blurred vision on several occasions."

A. "I must stop halfway up the stairs to catch my breath."

After teaching a patient who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the patient's understanding. Which statement by the patient indicates a correct understanding of the teaching? a. "I will avoid sources of strong electromagnetic fields." b. "I should participate in a strenuous exercise program." c. "Now I can discontinue my antidysrhythmic medication." d. "I should wear a snug-fitting shirt over the ICD."

A. "I will avoid sources of strong electromagnetic fields."

The new registered nurse (RN) is orienting on the cardiac unit. Which statement by the new RN indicates an understanding of an early indication of fluid volume deficit due to blood loss? a. "Pulse rate will increase." b. "Crackles in the lungs will be present." c. "Edema will be present in the legs." d. "Blood pressure will decrease."

A. "Pulse rate will increase." Rationale: The cardiac output is determined by the volume of the circulating blood, the pumping action of the heart, and the tone of the vascular bed. Early decreases in fluid volume are compensated for by an increase in the pulse rate. Although the blood pressure will decrease, it is not the earliest indicator. Edema and crackles in the lungs indicate an increase in fluid overload. Test-Taking Strategy: Note the strategic word, early. Eliminate options 3 and 4 first because they both indicate an increase in fluid volume. Regarding the remaining options, think about the physiology of the cardiovascular system and the inherent means of compensation available in that system.

A patient is 4 hours postoperative after a femoral-popliteal bypass. The patient reports throbbing leg pain on the affected side, rated as 7/10. What action by the nurse takes priority? a. Assess distal pulses and skin color. b. Notify the surgeon immediately. c. Administer pain medication as ordered. d. Document the findings in the patient's chart.

A. Assess distal pulses and skin color.

A nurse is interested in providing community education and screening on hypertension. In order to reach a priority population, to what target audience would the nurse provide this service? a. Asian-American groceries b. Women's health clinics c. African-American churches d. High school sports camps

C. African-American churches

A nurse cares for a patient who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate? a. "Make certain that your bath water is warm." b. "Avoid straining while having a bowel movement." c. "Avoid strenuous exercise such as running." d. "Limit your intake of caffeinated drinks to one a day."

B. "Avoid straining while having a bowel movement."

A patient has peripheral arterial disease (PAD). What statement by the patient indicates misunderstanding about self-management activities? a. "I should not cross my legs when sitting or lying down." b. "I can use a heating pad on my legs if it's set on low." c. "I will go out and buy some warm, heavy socks to wear." d. "It's going to be really hard but I will stop smoking."

B. "I can use a heating pad on my legs if it's set on low."

A nurse evaluates laboratory results for a patient with heart failure. Which results would the nurse expect? (Select all that apply.) a. Serum potassium: 4.0 mEq/L (4.0 mmol/L) b. Serum sodium: 130 mEq/L (130 mmol/L) c. Serum creatinine: 1.0 mg/dL (88.4 mcmol/L) d. Proteinuria e. Hematocrit: 32.8%

B. Serum sodium: 130 mEq/L D. Proteinuria E. Hematocrit: 32.8%

The home health nurse makes a home visit to a client who has an implanted cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary? a. "My wife knows how to call the emergency medical services (EMS) if I need it." b. "If I feel an internal defibrillator shock, I should sit down." c. "I won't be able to have a magnetic resonance imaging test (MRI)." d. "I can stop taking my antidysrhythmic medicine now because I have a pacemaker."

D. "I can stop taking my antidysrhythmic medicine now because I have a pacemaker." Rationale: Clients with an ICD usually continue to receive antidysrhythmic medications after discharge from the hospital. The nurse should stress the importance of continuing to take these medications as prescribed. The nurse should provide clear instructions about the purposes of the medications, dosage schedule, and side effects or adverse effects to report. Clients should sit down if they feel an internal defibrillator shock. They cannot have an MRI because of the possible magnetic properties of the device. Also, knowledge of how to reach EMS is important.

A patient has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? a. "You are lucky; most people get severe morning headaches." b. "You need to take your medicine or you will get kidney failure." c. "Do you have trouble affording your medications?" d. "Most people with hypertension do not have symptoms."

D. "Most people with hypertension do not have symptoms."

A nurse assesses a patient admitted to the cardiac unit. Which statement by the patient alerts the nurse to the possibility of right-sided heart failure? a. "I wake up coughing every night." b. "I have trouble catching my breath." c. "I sleep with four pillows at night." d. "My shoes fit really tight lately."

D. "My shoes fit really tight lately."

The registered nurse (RN) is educating a new RN about the use of oxygen for clients with angina pectoris. Which statement by the new nurse indicates that the teaching has been effective? a. "The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells." b. "Oxygen will prevent the development of any thrombus." c. "Oxygen has a calming effect." d. "Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle."

A. "The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells." Rationale: The pain associated with angina results from ischemia of myocardial cells. The pain often is precipitated by activity that places more oxygen demand on heart muscle. Supplemental oxygen will help meet the added demands on the heart muscle. Oxygen does not dilate blood vessels or prevent thrombus formation and does not directly calm the client. Test-Taking Strategy: Note the strategic word, effective. Focus on the subject, the action of oxygen. Eliminate option 1 because it does not address the physiological necessity of oxygen. Eliminate options 2 and 3 because oxygen does not prevent clot formation or cause vessel dilation.

A home care nurse is visiting a client to provide follow-up evaluation and care of a leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is pale and deep and that the surrounding tissue is cool to the touch. The nurse should document that these findings identify which type of ulcer? a. An arterial ulcer b. A stage 1 pressure ulcer c. A venous stasis ulcer d. A vascular ulcer

A. An arterial ulcer Rationale: Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients. A stage 1 ulcer indicates a reddened area with an intact skin surface. A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of venous congestion.

A nurse is caring for a patient with a history of renal insufficiency who is scheduled for a cardiac catheterization. What actions would the nurse take prior to the catheterization? (Select all that apply.) a. Assess for allergies to iodine. b. Administer intravenous fluids. c. Administer a prophylactic antibiotic. d. Assess blood urea nitrogen (BUN) and creatinine results. e. Insert a Foley catheter.

A. Assess for allergies to iodine. B. Administer intravenous fluids D. Assess blood urea nitrogen (BUN) and creatinine results.

A nurse is assessing a patient with left-sided heart failure. For which clinical manifestations would the nurse assess? (Select all that apply.) a. Confusion, restlessness b. Dependent edema c. Cough that worsens at night d. Pulmonary crackles e. Pulmonary hypertension

A. Confusion, restlessness C. Cough that worsens at night D. Pulmonary crackles

A nurse assesses a patient's electrocardiogram (ECG) and observes the reading. How would the nurse document this patient's ECG strip? a. Sinus rhythm with premature ventricular contractions (PVCs) b. Ventricular tachycardia c. Sinus rhythm with premature atrial contractions (PACs) d. Ventricular fibrillation

A. Sinus rhythm with premature ventricular contractions (PVCs)

A nurse assesses a patient with atrial fibrillation. Which manifestation would alert the nurse to the possibility of a serious complication from this condition? a. Speech alterations b. Sinus tachycardia c. Fatigue d. Dyspnea with activity

A. Speech alterations

A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator (TPA). What assessment finding should the nurse identify as an indicator that the client is experiencing complications of this therapy? a. Tar-like stools b. Nausea and vomiting c. Decreased urine output d. Orange-colored urine

A. Tar-like stools Rationale: Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood. Test-Taking Strategy: Focus on the subject, complications of thrombolytic therapy. Note the word thrombolytic, meaning to dissolve clots, and focus your attention on blood coagulation. Look for the option that has a hematological connection, in this case, tar-like stools, which indicate bleeding from the GI tract.

A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse provides education to the client based on which physiological concept? a. Vagus nerve stimulation causes a decrease in heart rate and cardiac contractility. b. Sympathetic nerve stimulation causes a decrease in heart rate and cardiac contractility. c. Sympathetic nerve stimulation causes an increase in heart rate and cardiac contractility. d. Vagus nerve stimulation causes an increase in heart rate and cardiac contractility.

A. Vagus nerve stimulation causes a decrease in HR and cardiac contractility Rationale: Bearing down as if straining to have a bowel movement can stimulate a vagal reflex. Stimulation of the vagus nerve causes a decrease in heart rate and cardiac contractility. Stimulation of the sympathetic nervous system has the opposite effect. These two branches of the autonomic nervous system oppose each other to maintain homeostasis.

The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. a. Walk each day to increase circulation to the legs. b. Soak the feet in hot water daily. c. Be careful not to injure the legs or feet. d. Cut down on the amount of fats consumed in the diet. e. Use a heating pad on the legs to aid vasodilation.

A. Walk each day to increase circulation to the legs C. Be careful not to injure the legs or feet D. Cut down on the amount of fats consumed in the diet Rationale: Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Soaking the feet in hot water and application of a heating pad to the extremity are contraindicated. The affected extremity may have decreased sensitivity and is at risk for burns. Also, the affected tissue does not obtain adequate circulation at rest. Direct application of heat raises oxygen and nutritional requirements of the tissue even further. Test-Taking Strategy: Note the subject, teaching for the client with peripheral arterial disease. Focus on the client's diagnosis and the words measures to limit disease progression. Recalling that the client is at risk for altered tissue integrity will assist you in answering correctly. Also, note the words hot and heating in the incorrect options, recalling that this is a risk for injury.

The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's (HCP's) prescriptions? Select all that apply. a. Ambulation in around the nursing unit every hour b. Monitoring for signs of pulmonary embolism c. Administration of acetaminophen d. Application of moist heat to the right leg e. Elevation of the right leg

ANS: B, C, D, E Rationale: Standard management of the client with deep vein thrombosis includes possible bed rest for 5 to 7 days or as prescribed; limb elevation; relief of discomfort with warm, moist heat and analgesics as needed; anticoagulant therapy; and monitoring for signs of pulmonary embolism. Although the health care provider may allow ambulation, hourly ambulation around the nursing unit is not encouraged because it increases the likelihood of dislodgement of the tail of the thrombus, which could travel to the lungs as a pulmonary embolism.

The nurse educator is teaching the new registered nurse (RN) how to care for clients with a decrease in blood pressure. Which statement by the new RN indicates the need for further instruction? a. "Decreased contractility occurs." b. "Decreased myocardial blood flow is not a concern." c. "Decreased heart rate is not a side effect." d. "Increased resistance to electrical stimulation often occurs."

B. "Decreased myocardial blood flow is not a concern." Rationale: The primary effect of a decrease in blood pressure is reduced blood flow to the myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase, not decrease, in response to this change. The effects of tissue ischemia lead to decreased contractility over time.

A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client about the dietary restrictions required with HF. Which statement by the client indicates that further teaching is needed? a. "I can have most fresh fruits and vegetables." b. "I'm going to have a ham and cheese sandwich and potato chips for lunch." c. "I'm going to weigh myself daily to be sure I don't gain too much fluid." d. "I'm not supposed to eat cold cuts."

B. "I'm going to have a ham and cheese sandwich and potato chips for lunch." Rationale: When a client has HF, the goal is to reduce fluid accumulation. One way that this is accomplished is through sodium reduction. Ham (and most cold cuts), cheese, and potato chips are high in sodium. Daily weighing is an appropriate intervention to help the client monitor fluid overload. Most fresh fruits and vegetables are low in sodium. Test-Taking Strategy: Note the strategic words, further teaching is needed. This phrasing indicates a negative event query and asks you to select an incorrect statement. Recalling that the goal for clients with HF is to reduce fluid accumulation will direct you to the correct option.

The nurse educator is lecturing new registered nurses (RNs) about serum calcium levels. Which statement by one of the new RNs indicates that teaching has been effective? a. "Low calcium levels cause high blood pressure." b. "Low calcium levels can lead to cardiac arrest." c. "Calcium has no effect on the risk for stroke." d. "Calcium has no effect on urinary stone formation."

B. "Low calcium levels can lead to cardiac arrest." Rationale: The normal calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions move across cell membranes into cardiac cells during depolarization and move back during repolarization. Depolarization is responsible for cardiac contraction. Options 1 and 3 are unrelated to calcium levels. Elevated calcium levels can lead to urinary stone formation. The nurse would take action and contact the health care provider when a calcium level is abnormal. Test-Taking Strategy: Note the strategic word, effective. Eliminate options 1 and 3 because they are unrelated to calcium levels. Next recall the effects of calcium on the cardiac system and that urinary stone formation could result from hypercalcemia. This will assist in answering correctly.

The new registered nurse (RN) is reviewing cardiac rhythms with a mentor. Which statement by the new RN indicates that teaching about ventricular fibrillation has been effective? a. "Ventricular fibrillation has recognizable P waves, QRS complexes, and T waves." b. "Ventricular fibrillation does not have P waves or QRS complexes." c. "Ventricular fibrillation is a regular pattern of wide QRS complexes." d. "Ventricular fibrillation appears as irregular beats within a rhythm."

B. "Ventricular fibrillation does not have P waves or QRS complexes." Rationale: Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Premature ventricular contractions (PVCs) appear as irregular beats within a rhythm. Ventricular tachycardia is a regular pattern of wide QRS complexes. Sinus tachycardia has a recognizable P wave, QRS complex, and T wave. Each of the incorrect options has a recognizable complex that appears on the monitoring screen. Test-Taking Strategy: Note the strategic word, effective, and focus on the subject, the characteristics of ventricular fibrillation. Note the description of the pattern in each option. Thinking about the word fibrillation and about what fibrillation may produce will direct you to the correct option. Remember that no true complexes are present in ventricular fibrillation.

A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point? a. Just after each P wave b. Before each QRS complex c. During each P wave d. Just after each T wave

B. Before each QRS complex Rationale: If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted. Test-Taking Strategy: Focus on the subject, proper pacemaker function. Note the word ventricular, and use knowledge of the normal cardiac conduction pathway as represented on the ECG tracing to answer this question. Knowing that the QRS complex signals ventricular depolarization will direct you to the correct option.

A nurse cares for a patient with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations would the nurse assess? (Select all that apply.) a. Increase in urine output b. Decrease in cardiac output c. Increase in cardiac output d. Decrease in urine output

B. Decrease in cardiac output D. Decrease in urine output

The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? a. Assessing for peripheral and sacral edema b. Listening to lung sounds c. Palpating for organomegaly (organ enlargement) d. Assessing for jugular vein distention

B. Listening to lung sounds Rationale: The client with heart failure may present with different symptoms, depending on whether the right or the left side of the heart is failing. Peripheral and sacral edema, jugular vein distention, and organomegaly all are manifestations of problems with right-sided heart function. Lung sounds constitute an accurate indicator of left-sided heart function. Test-Taking Strategy: Focus on the subject, left-sided heart failure. Correlate left and lungs. Options 2, 3, and 4 reflect right-sided heart failure.

A nurse assesses a patient with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? a. Mild orthostatic hypotension b. Midsternal chest pain c. Increased urine output d. P wave touching the T wave

B. Midsternal chest pain

A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise? a. Blood pressure decreased from 140/86 to 112/72 mm Hg. b. Respiratory rate increased from 16 to 19 breaths per minute. c. Oxygen saturation decreased from 96% to 91%. d. Pulse rate increased from 80 to 104 beats per minute.

B. Respiratory rate increased from 16 to 19 breaths per minute. Rationale: Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. In addition, it reflects a minimal increase. A pulse rate increase to a rate more than 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity. Test-Taking Strategy: Note the strategic word, best, and focus on the subject, the indicator that the client is tolerating exercise. The only option that identifies values that remain within the normal range is the correct one.

A nurse assesses a patient with pericarditis. Which assessment finding would the nurse expect to find? a. Presence of a regular gallop rhythm b. Coarse crackles in bilateral lung bases c. Friction rub at the left lower sternal border d. Heart rate that speeds up and slows down

C. Friction rub at the left lower sternal border

The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL (4.9 mmol/L), and fasting blood glucose level of 184 mg/dL (10.2 mmol/L). The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)? a. Hyperlipidemia b. Hypertension c. Glucose Intolerance d. Age

C. Glucose intolerance Rationale: Hypertension, cigarette smoking, and hyperlipidemia are modifiable risk factors that are predictors of CAD. Glucose intolerance, obesity, and response to stress are contributing modifiable risk factors for CAD. Age is a nonmodifiable risk factor. The nurse places priority on risk factors that can be modified. In this scenario, the abnormal value is the fasting blood glucose level, indicating glucose intolerance as the priority risk factor. Test-Taking Strategy: Note the subject, modifiable risk factors for CAD. Options 2 and 3 can be eliminated first because the client's blood pressure and cholesterol level are within normal ranges. From the remaining options, eliminate option 1 because it is a nonmodifiable risk factor.

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse should next assess the client for which finding? a. Flat neck veins. b. Complaints of headache. c. Hypotension. d. Complaints of nausea.

C. Hypotension Rationale: The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. Test-Taking Strategy: Note the strategic word, next. Focus on the dual subjects, atrial fibrillation and a rapid ventricular rate. Eliminate option 2 first because flat neck veins are normal or indicate hypovolemia. Eliminate option 3 next because nausea and vomiting would be associated with vagus nerve activity, which does not correlate with a tachycardic state. Regarding the remaining choices, recall that a falling cardiac output will result in hypotension.

The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding? a. The client is not experiencing nausea or vomiting. b. The client is not experiencing dyspnea. c. The pain has not been relieved by rest and nitroglycerin tablets. d. The client says the pain began while she was trying to open a stuck dresser drawer.

C. The pain has not been relieved by rest and nitroglycerin tablets. Rationale: The pain of MI is not relieved by rest and nitroglycerin and requires opioid analgesics, such as morphine sulfate, for relief. The pain of angina may radiate to the left shoulder, arm, neck, or jaw. It often is precipitated by exertion or stress, is accompanied by few associated symptoms, and is relieved by rest and nitroglycerin. The pain of MI also may radiate to the left arm, shoulder, jaw, and neck. It typically begins spontaneously, lasts longer than 30 minutes, and frequently is accompanied by associated symptoms (such as nausea, vomiting, dyspnea, diaphoresis, or anxiety). Test-Taking Strategy: Note the strategic words, most likely. Seek the option that differentiates anginal pain from that of MI. Recalling that a classic hallmark of the pain from MI is that it is unrelieved by rest and nitroglycerin will direct you to the correct option.

A nurse assesses a patient's electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How would the nurse interpret this observation? a. The patient's chest leads are not making sufficient contact with the skin. b. The patient has hyperkalemia causing irregular QRS complexes. c. Ventricular and atrial depolarizations are initiated from different sites. d. Ventricular tachycardia is overriding the normal atrial rhythm.

C. Ventricular and atrial depolarizations are initiated from different sites.

A nurse evaluates prescriptions for a patient with chronic atrial fibrillation. Which medication would the nurse expect to find on this patient's medication administration record to prevent a common complication of this condition? a. Lidocaine (Xylocaine) b. Sotalol (Betapace) c. Warfarin (Coumadin) d. Atropine (Sal-Tropine)

C. Warfarin (Coumadin)

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? a. Withhold prescribed digoxin if slight respiratory distress occurs. b. Take a double dose of the diuretic if peripheral edema is noted. c. Weigh self on a daily basis. d. Sleep with the head of the bed flat.

C. Weigh self on a daily basis Rationale: The client can best determine fluid status at home by weighing himself or herself on a daily basis. Increases of 2 to 3 lb (0.9 to 1.4 kg) in a short period are reported to the health care provider (HCP). The client should sleep with the head of the bed elevated. During recumbent sleep, fluid (which has seeped into the interstitium with the assistance of the effects of gravity) is rapidly reabsorbed into the systemic circulation. Sleeping with the head of the bed flat is therefore avoided. The client does not modify medication dosages without consulting the HCP. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike; also, it is unsafe for clients to regulate their own medication dosages based on symptoms. Knowing that weight is an excellent indicator of fluid volume status will allow you to choose correctly between the remaining options.

A nurse assesses a patient who is scheduled for a cardiac catheterization. Which assessment would the nurse complete prior to this procedure? a. Ability to turn self in bed b. Patient's level of anxiety c. Cardiac rhythm and heart rate d. Allergies to iodine-based agents

D. Allergies to iodine-based agents

A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? a. Urge to cough b. Pressure at insertion site c. Warm, flushed feeling d. Chest pain

D. Chest pain Rationale: The client is taught to report chest pain or any unusual sensations immediately. The client also is told that he or she may be asked to cough or breathe deeply from time to time during the procedure. The client is informed that a warm, flushed feeling may accompany dye injection and is normal. Because a local anesthetic is used, the client is expected to feel pressure at the insertion site. Test-Taking Strategy: Note the strategic words, highest priority. Noting the relationship between the client's diagnosis and the correct option will direct you to answer correctly.

A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted? a. Wheezes b. Crackles throughout the lung fields c. Rhonchi d. Crackles in the bases

D. Crackles in the bases Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. As the client's condition improves, the amount of fluid in the alveoli decreases, which may be detected by crackles in the bases. (Clear lung sounds indicate full resolution of the episode.) Rhonchi and wheezes are not associated with pulmonary edema. Auscultation of the lungs reveals crackles throughout the lung fields when pulmonary edema is at its worst. Test-Taking Strategy: Note the subject, breath sounds associated with an improvement in pulmonary edema. Fluid in the lungs from pulmonary edema produces sounds that are called crackles, which eliminates options 1 and 2. From the remaining options, eliminate option 4, noting the words respiratory status is improving in the question. Crackles throughout the lung fields do not indicate an improvement in the client's condition, but as pulmonary edema resolves the crackles reduce to the bases before disappearing all together.

A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms? a. Right atrium b. Left atrium c. Right ventricle d. Left ventricle

D. Left ventricle Rationale: Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left ventricle to fail, leading to signs and symptoms of heart failure. The remaining options are not the chambers that are primarily responsible for this disease process, although these chambers may be affected as the disease becomes more chronic.

The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit (ICU). The nurse notes that a cardiac troponin T assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition? a. Heart failure. b. Atrial fibrillation. c. Ventricular tachycardia. d. Myocardial infarction.

D. Myocardial infarction Rationale: Cardiac troponin T or cardiac troponin I have been found to be a protein marker in the detection of myocardial infarction, and assay for this protein is used in some institutions to aid in the diagnosis of a myocardial infarction. The test is not used to diagnose heart failure, ventricular tachycardia, or atrial fibrillation. Test-Taking Strategy: Focus on the subject, cardiac troponin levels. Specific knowledge of the cardiac troponin test is needed to answer this question. Think about each condition identified in the options and the method of diagnosing the condition to direct you to the correct option.

The nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? a. Atriventricluar (AV) node b. Bundle of His c. Purkinje fibers d. Sinoatrial (SA) node

D. Sinoatrial (SA) node Rationale: The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node and travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses is called automaticity. Test-Taking Strategy: Focus on the subject, the area of the heart responsible for electrical impulses. Note the words initiating electrical impulses. Use knowledge of anatomy and physiology. Recalling the normal pathways of the cardiac conduction system will direct you to the correct option.