Quiz One: CV Part 1&2
A client who had several episodes of chest pain is scheduled for an exercise ECG. Which explanation should the nurse include when teaching the client about this procedure? a. "This is a noninvasive test to check your heart's response to physical activity." b. "This test is a definitive method to identify the actual cause of your chest pain." c. "The findings of this test will be of minimal assistance in the treatment of angina." d. "The findings of this minimally invasive test will show how your body reacts to exercise."
a
A patient continues to have chest pain despite compliance with medical therapy. The nurse teaches the patient about which diagnostic test? a. Cardiac catheterization b. Percutaneous transluminal coronary angioplasty c. Coronary artery bypass grafting d. Stent placement in coronary artery
a
A patient in the ED with chest pain has a possible myocardial infarction. Which lab test is done to determine this diagnosis? a. Troponin T and I b. Serum potassium c. Homocysteine d. Highly sensitive C-reactive protein
a
A patient is admitted for unstable angina. The patient is currently asymptomatic and all vital signs are stable. Which position does the nurse place the patient in? a. Any position of comfort b. Supine c. Sitting in a chair d. Fowler's
a
A patient is hypertensive and continues to have angina despite therapy with beta blockers. The nurse anticipates which type of drug to be prescribed for this patient? a. Calcium channel blocker b. Potassium channel blocker c. Angiotensin-converting enzyme inhibitor d. Vasopressor
a
For which common complication of MI should the nurse monitor patients in the coronary care unit? a. Dysrhythmias b. Hypokalemia c. Anaphylactic shock d. Cardiac enlargement
a
The advanced practice nurse is assessing vascular status of a patient's lower extremities using the ankle-brachial index. What is the correct technique for this assessment method? a. A blood pressure cuff is applied to the lower extremities and the systolic pressure is measured by Doppler ultrasound at both dorsalis pedis and posterior tibial pulses b. The dorsalis pedis and posterior tibial pulses are manually palpated and compared bilaterally for strength and equality and compared to the standard index c. A blood pressure cuff is applied to the lower extremities to observe for an exaggerated decrease in systolic pressure by more that 10 mmHg during inspiration d. Blood pressure on the legs is measured when the patient supine; then the patient stands for several minutes and the blood pressure is measured in the arms
a
The nurse has identified the priority problem of activity intolerance for a patient who had an acute MI. What is the best expected outcome for this patient? a. Patient will progressively walk up to 200 feet four times a day without chest discomfort or SOB b. Patient will name three or four activities that will not cause SOB or chest pain c. Nurse will teach the patient to exercise and to take their pulse if symptoms or SOB or pain occur d. Nurse will assist the patient with ADLs until SOB or pain resolves
a
The nurse is assessing a cardiac patient and finds a paradoxical pulse, clear lungs, and JVD that occurs when the patient is in a semi-Fowler's position. What are these findings consistent with? a. Right ventricle failure b. Unstable angina c. Coronary artery disease d. Valvular disease
a
The nurse is caring for a patient admitted for an inferior wall MI. The patient develops heart block with bradycardia. Which procedure is the nurse prepared to assist with? a. Temporary pacemaker b. Defibrillation c. 16-lead ECG d. Percutaneous intervention
a
The nurse is caring for a patient who had a percutaneous coronary intervention. Which symptom indicates acute closure of the vessel and warrants immediate notification of the health care provider? a. Chest pain b. Hyperkalemia c. Bleeding at the insertion site d. Cough and shortness of breath
a
The nurse is evaluating a patient with coronary artery disease. What is an expected patient outcome that demonstrates hemodynamic stability? a. Blood pressure and pulse are within range and adequate for metabolic demands b. Urine output increases 15-30 mL per hour c. P waves are regular and there are no abnormal heart sounds d. Patient expresses verbal understanding of risk factors and need for compliance
a
The nurse is performing a cardiac assessment on an older adult. What is a common assessment finding in this patient? a. S4 heart sound b. Leg edema c. Pericardial friction rubs d. Change in point of maximum impulse location
a
The nurse is providing health teaching for a patient at risk for hearth disease. Which factor is the most modifiable, controllable risk factor? a. Obesity b. Diabetes Mellitus c. Ethnic background d. Family history of cardiovascular disease
a
The patient is scheduled to have a percutaneous coronary intervention. The nurse anticipates that an initial dose of which medication should be given before the procedure? a. Clopidogrel b. Nitroglycerin c. Isosorbide mononitrate d. Carvedilol
a
What is the most important nursing action when measuring a client's pulmonary capillary wedge pressure (PCWP)? a. Deflate the balloon as soon as the PCWP is measured b. Have the patient bear down when measuring the PCWP c. Place the client in a supine position before measuring the PCWP d. Flush the catheter with a heparin solution after the PCWP is determined
a
When the nurse assesses a patient with cardiovascular disease, there is difficulty auscultating the first heart sound (S1). What is the nurse's best action? a. Ask the patient to lean forward or roll to his or her left side b. Instruct the patient to take a deep breath and hold it c. Auscultate with the bell instead of the diaphragm d. Ask the UAP to complete a 12-lead ECG immediately
a
Which patient has the highest risk for death because of ventricular failure and dysrhythmias related to damage to the left ventricle? a. Patient with an anterior wall MI b. Patient with a posterior wall MI c. Patient with a lateral wall MI d. Patient with an inferior wall MI
a
Which statement about the peripheral vascular system is true? a. Veins are equipped with valves that direct blood flow to the heart and prevent backflow b. The velocity of blood flow depends on the diameter of the vessel lumen c. Blood flow decreases and blood tends to clot as the viscosity decreases d. The parasympathetic nervous system has the largest effect on blood flow to organs
a
The nurse is caring for a patient who had a percutaneous coronary intervention. Which postprocedural interventions are included in the care for this patient? SATA a. Monitor for acute closure of the vessel b. Observe for bleeding from the insertion site c. Maintain bedrest for 48 hours d. Observe for hypotension, hypokalemia, and dysrhythmias e. Teach about medications such as aspirin and beta blockers or ACE inhibitors f. Instruct about lifestyle changes relating to CAD
a,b,d,e,f
A patient has been discharged after a coronary artery bypass graft surgery and is to start a simple walking program at home. What does the nurse teach the patient about a home walking program? SATA a. Begin by walking 400 ft twice a day at the rate of one mile per hour the first week after discharge b. Each week increase the distance and rate as tolerates until you can walk 2 miles at 3-4 miles per hour c. Take a break after walking each mile to avoid pain or SOB d. Check your pulse reading before, halfway through, and after exercise e. Walk even when the weather is either hot or cold f. Stop exercising if your pulse rate increases more than 20 bpm or if you develop SOB or angina
a,b,d,f
The nurse is providing discharge instructions for a patient who had a cardiac catheterization. Which instructions must the nurse include? SATA a. Notify the health care provider for increased swelling, redness, warmth, or pain b. Leave the dressing in place for the first day c. Limit activity for at least 2-3 weeks d. Avoid lifting and exercise for a few days e. Report any bruise or hematoma to the healthcare provider f. Bruising or a small hematoma is expected
a,b,d,f
The nurse is assessing a middle-aged woman with diabetes who denies any history of known heart problems. Which are gender considerations for woman with coronary artery disease? SATA a. Microvascular disease is likely a cause of CAD in woman b. Woman typically have smaller coronary arteries than men c. Woman are often 5-10 years younger than men when CAD develops d. Women with CAD have a lower risk of death when hospitalized than men e. In postmenopausal women the incidence of CAD is equal to that of men f. Women with CAD manifest with atypical signs and symptoms
a,b,e,f
Which blood pressure readings require further assessment? SATA a. 90 mmHg systolic b. 139 mmHg systolic c. 115 mmHg systolic d. 66 mmHg diastolic e. 100 mmHg diastolic f. 96 mmHg diastolic
a,b,e,f
Microalbuminuria has been shown to be a clear marker of widespread endothelial dysfunction in cardiovascular disease. Which conditions should prompt patients to be tested annually for microalbuminuria? a. Hypertension b. Metabolic syndrome c. Smoking cigarettes d. Use of anticoagulant therapy e. Sedentary lifestyle f. Diabetes mellitus
a,b,f
The nurse is assessing a patient's nicotine dependance. Which questions does the nurse ask for an accurate assessment? SATA a. "How soon after you wake up in the morning do you smoke?" b. "What kind of cigarette do you smoke?" c. "Do you wake up in the middle of the night to smoke?" d. "Do you find it difficult not to smoke in places where smoking is prohibited?" e. "Do you smoke when you're ill?" f. "What happened the last time you tried to quit smoking?"
a,c,d,e
Which nonspecific signs and symptoms are frequently seen in woman who present with coronary artery disease? SATA a. Malaise b. Hypoventilation c. SOB d. Anxiety e. Fatigue f. Diaphoresis
a,c,d,e
A patient comes to the ED reporting chest pain. In evaluating the patient's pain, which questions does the nurse ask the patient? SATA a. "How long does the pain last and how often does it occur?" b. "How do you feel about the pain?" c. "Is the pain different from any other episodes of pain you have had?" d. "What activities were you doing when the pain first occurred?" e. "Where is the chest pain? What does it feel like?" f. "Have you had other signs and symptoms that occur at the same time?"
a,c,d,e,f
A patient is currently pain and symptom free but reports having intermittent episodes of chest pain over the last week. The nurse asks about which associated symptoms? SATA a. Nausea B. Diarrhea c. Diaphoresis d. Dizziness e. Joint pain f. SOB
a,c,d,f
The patient has a diagnosis of angina. Which assessment data would the nurse expect to find? SATA a. Sudden onset of pain b. Intermittent pain relieved with sitting upright c. Substernal pain that may spread across the chest, back, and arms d. Pain that usually lasts less than 15 minutes e. Sharp, stabbing pain that is moderate to severe f. Pain relieved with rest
a,c,d,f
The nurse interprets a patient's serum lipid tests. Which results suggest an increased risk for cardiovascular disease? SATA a. LDL 160 mg/dL b. HDL 60 mg/dL c. Total cholesterol 180 mg/dL d. Triglycerides 175 mg/dL e. Lp(a) 45 mg/dL f. Total cholesterol 250 mg/dL
a,d,e,f
The nurse is interviewing a patient who reports chest discomfort that occurs with moderate to prolonged exertion. The patient describes the pain as being " about the same over the past several months and going away with nitroglycerin or rest." Based on the patient's description of symptoms, what does the nurse suspect in this patient? SATA a. Chronic stable angina b. Unstable angina c. Acute coronary syndrome d. Acute myocardial infarction e. Coronary artery disease f. Variant (Prinzmetal's) angina
a,e
A client is admitted with chest pain unrelieved by nitroglycerin, an elevated temperature, decreased blood pressure, and diaphoresis. A MI is diagnosed. Which should the nurse consider a valid reason for one of this client's physiologic responses? a. Parasympathetic reflexes from the infarcted myocardium causes diaphoresis b. Inflammation in the myocardium causes a rise in the systemic body temperature c. Catecholamines released at the site of infarction cause intermittent localized pain d. Constriction of central and peripheral blood vessels causes a decrease in blood pressure
b
A patient comes to the walk-in clinic reporting left anterior chest discomfort with mild SOB. The patient is alert, oriented, diaphoretic, and anxious. What is the first priority action for the nurse? a. Obtain a complete cardiac history to include a full description of the presenting symptoms b. Place the patient in semi-Fowler's position and start supplemental oxygen c. Instruct the patient to go immediately to the closest full-service hospital d. Immediately alert the physician and establish IV access
b
A patient entering the cardiac rehabilitation unit seems optimistic and at times unexpectedly cheerful and upbeat. Which statement by the patient causes the nurse to suspect a maladaptive use of denial in the patient? a. "I am sick and tired of talking about these dietary restrictions. Could we talk about it tomorrow?" b. "Oh I don't need that medication information. I'm sure that I'll soon be able to get by without it." c. " This whole episode of heart problems has been an eye-opener for me, but I really can't wait to get out of here." d. That doctor is driving me crazy with all his instructions. Could you put all that information away in my suitcase?"
b
A patient had coronary artery bypass graft surgery with a vein graft. To help prevent collapse of the graft, what assessment does the nurse perform? a. Auscultate lung sounds b. Monitor for hypotension c. Assess for motion and sensation d. Observe for generalized hypothermia
b
A patient had severe chest pain several hours ago but is currently pain free and has a normal ECG. Which statement by the patient indicates a correct understanding of the significance of he ECG results? a. "I'll go home and make an appointment to see my family doctor next week." b. "The ECG could be normal since I am currently pain free." c. "A normal ECG means I am okay." d. "I have always had a strong heart, low BP, and a normal ECG."
b
A patient has been admitted for acute angina. Which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or a MI? a. Exercise tolerance test b. Cardiac catheterization c. Thallium scale d. Multigated angiogram (MUGA) scan
b
A patient reports chest pain after coronary bypass graft surgery. Which statement by the patient suggests that the pain is related to the sternotomy and not anginal in origin? a. "The pain is goes down my arm or sometimes into my jaw." b. "My pain increases when I cough or take a deep breath." c. "The nitroglycerin helped to relieve the pain." d. "I feel nausea and SOB when the pain occurs."
b
A patient with chronic stable angina is taking calcium channel blockers. For which complication does the nurse monitor with this patient? a. Wheezes b. Hypotension c. Tachicardia d. Forgetfulness
b
After surgery for insertion of a coronary artery bypass graft, a client develops a temperature of 102. What priority concern related to elevated temperatures does the nurse consider when notifying the health care provider about the client's temperature? a. A fever may lead to diaphoresis b. A fever increases the cardiac output c. An increased temperature indicated cerebral edema d. An increased temperature may be a sign of hemorrhage
b
During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes the stool from the client's rectum. What response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate bowel movements? a. Increased pulse rate b. Slowing of the heart c. Dilation of the bronchioles d. Coronary artery vasodilation
b
Following coronary bypass graft surgery, a patient in the ICU on a mechanical vent suddenly decompensates. The health care provider makes a diagnosis of cardiac tamponade. The nurse prepares the patient for which emergency procedure? a. Chest tube b. Sternotomy c. Pericardiocentesis d. Thoracentesis
b
In a hypovolemic patient, stretch receptors in the blood vessels sense a reduced volume or pressure and send fewer impulses to the CNS. As a result, which signs/symptoms does the nurse expect to observe in the patient? a. Reddish mottling to the skin and a blood pressure elevation b. Cool, pale skin and tachycardia c. Warm, flushed skin with low blood pressure d. Pale pink skin with bradycardia
b
People should seek treatment for symptoms of MI rather than delay because physical changes will occur approx how many hours after an infarction? a. 3 hours b. 6 hours c. 12 hours d. 24 hours
b
The health care provider is considering use of thrombolytic therapy for a patient. What is the criterion for this therapy? a. Chest pain greater than 15 minutes' duration that is unrelieved by nitroglycerin b. Chest pain lasting longer than 30 minutes that is unrelieved by nitroglycerin with ST segment elevation on the ECG c. Ventricular dysrhythmias shown on the cardiac monitor d. History of chronic, severe, poorly controlled hypertension
b
The health care provider orders potassium 80 mEq in 100 mL of IV bolus at a rate of 40 mEq/hr for a patient in the critical care unit through a central line. What does the nurse do next? a. Contact the health care provider because the order exceeds the recommended amount b. Give the infusion; the order exceeds the recommended amount but is within acceptable standards of practice in critical care patients c. Contact the health care provider because the dosage is acceptable but the rate is too fast d. Consult with the pharmacist because even though the rate is acceptable, the mixture is too concentrated
b
The home health nurse receives a call from a patient with coronary artery disease who reports having new onset of chest pain and SOB. What does the nurse instruct the patient to do? a. Rest quietly until the nurse can arrive at the house to check on the patient b. Chew 325 mg of aspirin and immediately call 911 c. Use supplemental home O2 until the symptoms resolve d. Take three nitroglycerin tablets and have the family drive the patient to the hospital
b
The nurse is auscultating the heart of a patient who had a MI. Which finding most strongly indicates heart failure? a. Murmur b. S3 gallop c. Split S1 and S2 d. Pericardial friction rub
b
The nurse is caring for a patient who had a minimally invasive direct coronary artery bypass. Which sign/symptom prompts the nurse to immediately contact the health care provider? a. Acute incisional pain b. ST-segment changes on the monitor c. Drainage from the chest tubes d. Problems with coughing
b
The nurse is performing an assessment on a patient brought in by emergency personnel. The nurse immediately observes that the patient has spontaneous respirations and the skin is cool, pale, and moist. What is the priority patient problem? a. Abnormal body temperature b. Decreased perfusion c. Altered skin integrity d. Potential for peripheral neurovascular dysfunction
b
The patient has a history of allergy to iodine- based contrast dyes is scheduled for a cardiac catheterization. What action does the nurse expect with regard to the scheduled test? a. Delay the test for a week or more b. Administer an antihistamine and/or steroid before the test c. The test will be performed without administration of contrast dye d. The patient will receive anticoagulation therapy before the test
b
The patient is admitted to the ED with sudden of chest pain that is intense, is substernal radiating to the left arm, and has lasted over an hour. What is the most likely cause of this chest pain? a. Angina b. Myocardial infarction c. Pericarditis d. Pleuropulmonary
b
The patient received thrombolytic therapy. Which manifestation indicates that the clot has been dissolved? a. The patient continues to have chest pain but the intensity is much less b. There is sudden onset of nonsustained ventricular dysrhythmias c. ST segment remains elevated with inverted T waves d. Cardiac markers peak 3-4 hours after thrombolytic therapy
b
The patient who was diagnosed with acute coronary syndrome will be discharged soon. Which type of drug that will reduce the risk of developing recurrent MI, stroke, and mortality does the nurse expect the healthcare provider to prescribe prior to discharge? a. Stool softener b. High intensity statin therapy c. Anti-inflammatory d. Central vasodilator
b
What is the significance of a sodium level of 130 mEq/L for a patient with heart failure? a. Increased risk for ventricular dysrhythmias b. Dilutional hyponatremia and fluid retention c. Potential for electrical instability of the heart d. Slowed conduction of impulse through the heart
b
What should the nurse identify as the primary cause of pain experienced by a client with a coronary occlusion? a. Arterial spasm b. Heart muscle ischemia c. Blocking of the coronary veins d. Irritation of nerve endings in the cardiac plexus
b
Which class of drugs has a strong FDA warning about increased risk of stroke or heart attack? a. Beta blockers b. Non-aspirin NSAIDs c. Calcium channel blockers d. ACE inhibitors
b
Which description best defines the cardiovascular concept of afterload? a. Degree of myocardial fiber stretch at end of diastole and just before the heart contracts b. Amount of resistance the ventricles must overcome to eject blood through the semi-lunar valves and into the peripheral blood vessels c. Pressure that the ventricle must overcome to open the tricuspid valve d. Force of contraction independent of preload
b
Which drug is given 1-2 hours of a MI, when the patient is hemodynamically stable, to help the heart to perform more work without ischemia? a. Vasodilators, such as sublingual or spray nitroglycerin b. Beta-adrenergic blocking agents, such as metoprolol c. Antiplatelet agents, such as clopidogrel d. Calcium channel blockers, such as diltiazem
b
Which measure is most accurate when assessing a patient's fluid retention? a. Documenting edema as mild, moderate, or severe b. Measuring and monitoring daily patient weight c. Assessing peripheral swelling as 1+ to 4+ d. Auscultating lungs for abnormal sounds such as crackles
b
Which statement about coronary artery disease is accurate? a. Ischemia that occurs with angina lasts more than 30 minutes and does not cause permanent damage of myocardial tissue b. Postmenopausal women in their 70s have the same incidence of MI as men c. Many patients suffering sudden cardiac arrest die before reaching the hospital because of atrial fibrillation d. Studies have shown that CAD in woman manifests with the same symptoms as men
b
Which statement about veterans and risk for heart disease is most accurate? a. Veterans are not at increased risk for heart disease because most are young b. Veterans' increased risk of heart disease may be independent of health behaviors and chronic medical conditions c. Venterals are at increased risk for heart disease because many are homeless and without proper health care d. Veterans are at increased risk for heart disease because of increased incidence of poor physical and mental health
b
A patient is having a coronary artery bypass graft with the traditional procedure. What does the nurse include in the preoperative teaching? SATA a. Coughing will be avoided to keep stress off the sternal incision b. There will be a sternal incision c. Expect one, two, or three chest tubes d. An indwelling urinary catheter will be placed e. An endotracheal tube will prevent talking f. You will be on bedrest for up to 48 hours after surgery
b,c,d,e
A patient is receiving beta-blocker therapy for treatment of MI. What does the nurse monitor for in relation to this therapy? SATA a. Tachycardia b. Hypotension c. Decreased level of consciousness d. Chest discomfort e. Increased urinary output f. Auscultate lungs for crackles or wheezes
b,c,d,f
A nurse asks a client with ischemic heart disease to identify the foods that are most important to restrict. The nurse determines that the client understands the dietary instructions when the client identifies which of the following foods? SATA a. Olive oil b. Chicken broth c. Enriched whole milk d. Red meats, such as beef e. Vegetables and whole grains f. Liver and other glandular organ meats
b,c,d,f,
Syncope in the aging person can likely occur with which actions by the patient? (SATA) a. Laughing b. Turning the head c. Performing a Valsalva maneuver d. Walking briskly for 20 to 30 minutes e. shrugging the shoulders f. Swallowing fluids
b,c,e
The patient with left ventricular MI is to have coronary artery bypass graft surgery. Which intervention does the nurse perform to protect against sternal wound infection? SATA a. Shave the patient's body from neck to knees b. Instruct the patient to shower with 4% CHG c. Prepare the surgical site by clipping hair and applying CHG with isopropyl alcohol (either 0.5% or 2%) d. Send urine and sputum to the lab for culture and sensitivity e. Administer IV antibiotics one hour prior to surgical procedure f. Wear gown, gloves, and a mask while preparing the patient for surgery
b,c,e
A patient with angina is prescribed nitroglycerin tablets. What information does the nurse include when teaching the patient about this drug? SATA a. "If one tablet does not relieve the angina after two minutes, take two pills." b. "You can tell the pills are active when your tongue feels a tingling sensation." c. "Keep your nitroglycerin with you at all times." d. "The prescription should last about 6 months before a refill is necessary." e. "If the pain doesn't go away, just wait; the medication will eventually take effect." f. "The medication can cause a temporary headache."
b,c,f
What different pathophysiologic conditions can the healthy heart adapt to? SATA a. Menses b. Stress c. Gastroesophageal reflux disease d. Infection e. Hemorrhage f. Kidney stones
b,d,e
The nurse is assessing a 62-year-old native Hawaiian woman. She is post-menopausal, has had diabetes for 10 years, has smoked one pack of cigarettes for 20 years, walks twice a week for 30 minutes, is an administrator, and describes her lifestyle as sedentary. For her weight and height she has a BMI of 32. Which risk factors for this patient are controllable for cardiovascular disease? SATA a. Ethnic background b. Smoking c. Age d. Obesity e. Postmenopausal f. Sedentary lifestyle
b,d,f
The nurse is caring for a patient at risk for heart problems. What are normal findings for cardiovascular assessment of this patient? SATA a. Presence of a thrill b. Splitting of S2; decrease with expiration c. Jugular venous distention to level of the mandible d. Point of maximal impulse in fifth intercostal space at midclavicular line e. Paradoxical chest movement with inspiration and expiration f. Accentuated or intensified S1 after exercise
b,d,f
The ED nurse is caring for a patient with acute pain associated with MI. What are the goals of collaborative management that address the patient's pain? SATA a. Return the vital signs and cardiac rhythm to baseline so the patient can resume ADLs b. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increasing myocardial oxygen supply c. Aggressively diagnose and treat life threatening cardiac dysrhythmias and restore pulmonary wedge pressure d. Closely monitor the patient for accompanying symptoms such as nausea and vomiting or indigestion e. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demands, and increase myocardial oxygen supply f. Teach the patient about alternative therapies that can help decrease or replace the need for pain drugs
b,e
What measures are taken to prepare a patient for a pharmacological stress echocardiogram? SATA a. Patient can eat his/her diet as ordered b. IV access needs to be present c. Oxygen at 2 L per nasal cannula is placed on the patient 3 hours prior to the test d. An oral laxative is given the day before the test e. Patient is to be NPO for 3-6 hours before the test f. Teach the patient that blood pressure and heart rate will be continuously monitored
b,e,f
A 65-year-old patient comes to the clinic reporting fatigue. The patient would like to start an exercise program but thinks "anemia might be causing fatigue." What is the nurse's first action? a. Advise the patient to start out slowly and gradually build strength and endurance b. Obtain an order for a CBC and nutritional profile c. Assess the onset, duration, and circumstances associated with fatigue d. Perform a physical assessment to include testing of muscle strength and tone
c
A patient had coronary artery bypass graft surgery with the radial artery used as a graft. The nurse performs which assessment specific to this patient? a. Check the blood pressure every hour on the unaffected arm or use the legs b. Check the fingertips, hand, and arm for sensation and mobility every shift c. Assess hand color, temperature, ulnar/radial pulses, and cap refill every hour initially d. Note edema, bleeding, and swelling at the donor site, which are expected
c
A patient in a cardiac rehab program is having difficulty coping with the changes in her health status. Which statement by the patient is the strongest indicator of ineffective or harmful coping? a. "I don't mind going to therapy, but I'm not sure if I am getting any benefit from it." b. "I'll take the pills and do whatever you want me to do." c. "I don't want to go to therapy; I had a bad experience yesterday with the therapist." d. "I know I need to talk about going home soon, but can we talk about it later?"
c
A patient is scheduled to have an exercise ECG test. What instruction does the nurse provide to the patient before the procedure takes place? a. "Have nothing to eat or drink after midnight." b. "Avoid smoking or drinking alcohol for at least two weeks before the test." c. "Wear comfortable, loose clothing and rubber-soled, supportive shoes." d. "Someone must drive you home because of the possible sedative effects of the medications."
c
After coronary artery bypass graft surgery, a post-op patient suddenly has a decrease in mediastinal drainage, JVD with clear lung sounds, pulsus paradoxus, and equalizing pulmonary artery wedge pressure and right atrial pressure. What do these signs suggest to the nurse? a. Acute myocardial infarction b. Occlusion at the donor site c. Cardiac tamponade d. Prinzmetal's angina
c
In assessing a patient who has come to the clinic for a physical exam, the nurse notes that the patient has decreased skin temperature. What is this finding most indicative of? a. Anemia b. Heart failure c. Arterial insufficiency d. Stroke
c
The intensive care nurse is monitoring a patient with a diagnosis of myocardial infarction. The pulmonary artery wedge pressure reading is 30 mmHg. What does the nurse do next? a. Increase fluid rate to 200 ml/hour b. Auscultate the lungs to assess for left sided heart failure c. Perform an ECG using right-sided precordial leads d. Place the patient in semi-Fowler's position
c
The nurse is caring for a hospitalized patient being treated initially with IV nitroglycerin. What intervention must the nurse include in this patient's care? a. Increase the dose rapidly to achieve pain relief b. Restrict the patient to bedrest with bedpan use c. Monitor BP continuously d. Elevate the head of the bed to 90 degrees
c
The nurse is reviewing medications orders for several cardiac patients. There is an order for beta-adrenergic blocking agents metoprolol XL once a day. According the Killip classification, this drug order is most appropriate for which classes of patients? a. All classes b. Class I only c. Classes II and III d. Class IV only
c
The nurse is taking report on a patient who will be transferred from the CICU to the general med-surg unit. The reporting nurse states that S4 is heard on auscultation of the heart. This is most closely associated with which situation? a. Heart murmur b. Pericardial friction rub c. Ventricular hypertrophy d. Normal heart sounds
c
What instructions about the use of nitroglycerin should the nurse provide to a patient with angina? a. "Identify when pain occurs and place two tablets under the tongue." b. "Place one tablet under the tongue, and swallow another when pain is intense." c. "Before physical activity, place one tablet under the tongue, and repeat the dose in 5 minutes if pain occurs." d. "Place one tablet under the tongue when pain occurs, and use an additional tablet after the attack to prevent recurrence."
c
Which category of cardiovascular drugs increases heart rate and contractility? a. Diuretics b. Beta blockers c. Catecholamines d. Benzodiazepines
c
Which statement is true about postpericardiotomy syndrome? a. It is a psychological disorder for which the patient needs emotional support b. It is mild and self-limiting for all patients c. It places the patient at risk for acute cardiac tamponade d. It ca be prophylactically managed with antibiotics
c
What is included in postprocedural care of a patient after a cardiac catheterization? SARA a. Patient remains on bedrest for 12-24 hours b. Patient is placed in a high Fowler's position c. Dressing is assessed for bloody drainage or hematoma d. Peripheral pulses in the affected extremity, as well as skin temp and color, are monitored with every vitals check e. Adequate oral and IV fluids are provided for hydration f. Vitals are monitored every hour for 24 hours
c,d,e
Which diagnostic tests are used to assess myocardial damage caused by a MI? a. Positive chest x-ray b. ST depression on ECG c. Thallium scan d. Troponin I isoenzyme elevation e. Cardiac catheterization f. Fasting lipid profile
c,d,e
A nurse prepares a client for insertion of a pulmonary artery catheter. What information can be obtained from monitoring the pulmonary artery pressure? a. Stroke volume b. Venous pressure c. Coronary artery patency d. Left ventricular functioning
d
Following coronary artery bypass graft surgery, a patient has a body temperature below 96.8. What measure should be used to rewarm the patient? a. Infuse warm IV fluids b. Do not rewarm; cold cardioplegia is protective c. Place the patient in a warm fluid bath d. Use lights or thermal blankets
d
The nurse is assessing a patient with suspected cardiovascular disease. When assessing the precordium, which assessment technique does the nurse begin with? a. Percussion b. Palpation c. Auscultation d. Inspection
d
The nurse is giving a community presentation about heart disease. Because many sudden cardiac arrest victims die of ventricular fibrillations before reaching the hospital, which teaching point does the nurse emphasize? a. Controlling alcohol consumption and quitting cigarette smoking b. Modifying risk factors such as diet and weight, and blood pressure medication compliance c. Recognizing the difference between chronic stable angina and unstable angina d. Learning to operate the AEDs in the workplace
d
The nurse is performing a dietary assessment on a 45-year-old business executive at risk for cardiovascular disease. Which assessment is the most reliable and accurate? a. Ask the patient to identify foods he or she eats that contain sodium, sugar, cholesterol, fiber, and fat b. Ask the patient's spouse, who does the cooking and shopping, to identify the types of food are consumed c. Ask the patient how cultural beliefs and economic status influence the choice of food items d. Ask the patient to recall intake of food, fluids, and alcohol during a typical 24-hour period
d
What should the nurse teach the client to expect when preparing for discharge after surgery for a coronary artery bypass graft? a. Mild fever and extreme fatigue for several weeks following surgery b. Cessation of drainage from the incisions after hospitalization c. Mild incisional pain and tenderness up to three weeks after surgery d. Some edema in the leg used for donor graft is expected with activity
d
Which early reaction is most common in patients with the chest discomfort associated with unstable angina or MI a. Depression b. Anger c. Fear d. Denial
d
Which exercise regimen for an older adult meets the recommended guidelines for physical fitness to promote heart health? a. 6-hour bike ride every Saturday b. Golfing for 4 hours two times a week c. Running for 15 minutes three times a week d. Brisk walk 30 minutes every day
d
Which is the primary medical-surgical concept for a patient with unstable angina or MI? a. Comfort b. Tissue integrity c. Gas exchange d. Perfusion
d
Which medications will the nurse hold until after a patient's cardiac catheterization? a. Daily vitamins and enteric coated aspirin b. Atenolol c. Potassium and folic acid d. Warfarin and furosemide
d
Which statement about hypokinetic pulse is accurate? a. It is a large, "bounding" pulse caused by an increased ejection of blood b. It is caused by high cardiac output as with exercise, sepsis, or thyrotoxicosis c. It may occur with increased sympathetic system activity caused by pain, fever, or anxiety d. It is a weak pulse with a narrow pulse pressure seen with decreased cardiac output
d
