practice qs
15. A patient taking Lovenox is having a severe reaction. What is the antidote for this medication? A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate
The answer is D.
22. Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough
The answer is B. Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).
18. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin
The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.
2. Cardiac output is very important for determining if a patient is in cardiogenic shock. What is a normal cardiac output in an adult? . A. 2-5 liters/minute B. 1-3 liters/minute C. 4-8 liters/minute D. 8-10 liters/minute
The answer is C. Cardiac output is the amount of blood the heart pumps per minute. The heart's cardiac output should be anywhere from 4-8 liters of blood per minute.
23. The physician's order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level
The answer is D. Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient.
6. A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis
The answer is D. The physician will probably order a pericardiocentesis. This is a procedure to remove excessive fluid from the pericardial sac.
14. Which medications below are used in cardiogenic shock that provide a positive inotropic effect on the heart? Select all that apply: A. Nitroglycerin B. Sodium Nitroprussidde C. Dobutamine D. Norepinephrine E. Dopamine
The answers are C and E. Dobutamine and Dopamine are vasopressors that have a POSITIVE inotropic effect on the heart. This means these medications increase the strength of the heart's contractions (increases contractility), which increases stroke volume.
8. On physical assessment of a patient with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub
The answer is D. A common sign of pericarditis is being able to auscultate a pericardial friction rub.
6. Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume: A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure
The answers are B, C, and D. Preload, afterload, and contractility all have a role with influencing stroke volume.
8. A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication will? A. Decrease the patient's blood pressure and increase cardiac afterload B. Decrease the patient's blood pressure and decrease cardiac afterload C. Decrease the patient's blood pressure and increase cardiac preload D. Increase the patient's blood pressure but decrease cardiac output
. The answer is B. The patient has a high systemic vascular resistance...as evidence by the patient's blood blood....there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now, the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will go down (hence the systemic vascular resistance).
9. A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next? A. Take another dose of Nitroglycerin in 5 minutes. B. Call 911 immediately C. Lie down and rest to see if that helps with relieving the pain D. Take two doses of Nitroglycerin in 5 minutes
Answer: B. If a patient's chest pain is not relieved with 3 doses of Nitroglycerin, taken 5 minutes apart, they should call 911 immediately. The patient should never exceed more than 3 doses of Nitroglycerin or take 2 doses at one time.
11. A patient taking Zocor is reporting muscle pain. You are evaluating the patient's lab work and note that which of the following findings could cause muscle pain? A. Elevated potassium level B. Elevated CPK (creatine kinase level) C. Decreased potassium level D. Decreased CPK (creatine kinase level)
Answer: B. Zocor (a statin medication used for lowering cholestorl) can cause increased CPK levels which will lead to a patient experiencing muscle pain. Therefore, CPK levels must be monitored while a patient is taking this medication.
4. A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as: A. Unstable angina B. Variant angina C. Stable angina D. Prinzmetal angina
Answer: C. Stable angina occurs during activities but goes away when the patient rests. Variant and Prinzmetal angina are the same and occur at rest during cycles. Unstable angina is chest pain felt during rest and is more severe.
7. A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction? A. absent Q wave B. QRS widening C. absent P-wave D. ST segment elevation
Answer: D This is a common finding on an EKG when a patient is having a myocardial infraction due to muscle damage.
10. Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you educate the patient on how this drugs works on the body? A. Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and triglyceride levels. B. Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels. C. Lipitor increases HDL levels, total cholesterol, and triglyceride levels. D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.
Answer: D. Lipitor is a common "statin" medication used to lower cholesterol in CAD. It works by increasing HDL levels (the "good" cholesterol") and decreases LDL (the "bad" cholesterol"), total cholesterol, and triglyceride levels.
12. A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication? A. Check your heart rate regularly because Metoprolol can cause an irregular heart rate. B. Check your glucose regularly because this medication can cause hyperglycemia. C. Check your blood pressure regularly because this medication can cause hypertension. D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.
Answer: D. This patient needs to be educated to check their glucose levels regularly because this medication can mask the typical signs and symptoms of hypoglycemia. This is very important since the patient is diabetic.
13. True or False: ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin II to Angiotensin I which causes vasodilation. True False
Answer: False. ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin I to Angiotensin II (not Angiotensin II to Angiotensin I as stated in the question) which causes vasodilation.
5. Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient's symptoms? Select-all-that-apply: A. EKG B. Stress test C. Heart catheterization D. Balloon angioplasty
Answers: A and B. If the patient is experiencing STABLE angina (which in question 4 the patient's symptoms are stable) an EKG or stress test would be ordered to investigate if there are any EKG changes (ST depression) during exercise. These tests are usually ordered first and then the doctor may proceed with a heart catheterization. A balloon angioplasty is sometimes performed during a heart cath.
8. A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix. What important information will you include in the patient's teaching? Select-all-that-apply: A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure. B. A normal side effect of this medication is a dry cough. C. Avoid green leafy vegetables while taking Plavix. D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.
Answers: A and D. Patients on Plavix should let their doctor know that they are taking Plavix because it should be discontinued 5 to 7 days before a surgical procedure due to increased risk of bleeding. Also, option D represents signs and symptoms of Thrombotic Thrombocytopenic Purpura a clotting disorder where clots form in the vessels of the body which is a complication of Plavix.
6. You're providing education to a patient who will be undergoing a heart catheterization. Which statement by the patient requires you to re-educate the patient about this procedure? A. "The brachial artery is most commonly used for this procedure." B. "A dye is injected into the coronary arteries to assess for blockages." C. "Not all patients who have a heart catheterization will need a stent placement." D. "I will not be completely asleep and will be able to breathe on my own during the procedure."
Answers: A. The femoral or radial artery is used during a heart cath...not the brachial.
Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply: A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer. B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes.
Answers: B,C, D. Remember risk factors for developing CAD include: smoking, family history, diabetes, being overweight or obese, and high cholesterol.
7. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation? A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.
Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.
21. A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action? A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.
The answer is C. The patient is Digoxin toxic. A normal Digoxin level is <2 ng/mL. Therefore, the nurse should not administer the dose but hold it and notify the doctor for further orders.
14. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind D.No medication because this is a normal Digoxin level.
The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind.
2. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."
Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema.
5. 24-36 hours after a myocardial infarction _____________ congregate at the site during the inflammation phase. A. Neutrophils B. Eosinophils C. Platelets D. Macrophages
The answer is A.
11. A patient is receiving treatment for an acute myocardial infarction. The nurse is closely monitoring the patient for signs and symptoms associated with cardiogenic shock. Which value below is associated with cardiogenic shock? A. Cardiac index 1.5 L/min/m2 B. Pulmonary capillary wedge pressure (PCWP) 10 mmHg C. Central venous pressure (CVP) 4 mmHg D. Troponin <0.01 ng/mL
The answer is A. A patient who has experienced an acute myocardial infarction is at risk for cardiogenic shock. A normal cardiac index should be 2.5-4 L/min/m2. Cardiac index is the specific cardiac output based on the patient's size. Any number less than 2.2 L/min/m2 can be associated with cardiogenic shock. All the other values are within normal limits. PCWP would be >18 mmHg in cardiogenic shock, and CVP would be high.
15. A patient with cardiogenic shock has an intra-aortic balloon pump. As the nurse you know that during ________ the balloon deflates and during _____ the balloon inflates in a section of the aorta. A. systole, diastole B. diastole, systole C. inspiration, expiration D. expiration, inspiration
The answer is A. An intra-aortic balloon pump is a balloon attached to the catheter inside a section of the aorta. It will inflate and deflate during systole (contraction) and diastole (relaxation). When the balloon deflates during systole it creates a suction-like pressure that will draw blood out of the weak heart and into the coronary arteries and systemic circulation (hence increasing cardiac output and blood supply to the heart muscle). When the balloon inflates during diastole it will create pressure that will push blood into the coronary arteries (hence further increasing blood supply to the heart muscle).
14. A patient is experiencing Heparin-Induced Thrombocytopenia from Heparin therapy. The doctor orders Heparin to be discontinued. The patient will most likely be placed on what other medication? A. Argatroban B. Lovenox C. Levophed D. Tridil
The answer is A. Argatroban or Angiomax may be prescribed in place of Heparin for a patient experiencing HIT (heparin-induced thrombocytopenia).
What medication below can cause an increased potassium level? A. Losartan B. Norvasc C. Aspirin D. Cardizem
The answer is A. Losartan is an ARB. ARBs (angiotensin receptor blockers) and ACE inhibitors (angiotension converting enzyme inhibitors) can cause an INCREASE potassium level because of it affects of decreasing aldosterone. A normal potassium level is 3.5-5.1.
11. In regards to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention? A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders. B. Administer Morphine IV and place the patient in reverse Trendelenburg position. C. Administer Nitroglycerin and monitor the patient's blood pressure. D. All the options are incorrect.
The answer is A. Nitroglycerin can cause hypotension, however, if there is a significant drop in blood pressure with SBP <90, further doses of Nitroglycerin should be held. The doctor should be notified for further orders, especially since the patient is still having chest pain and t-wave inversion. Morphine should NOT be given because it can cause hypotension.
3. ________________ is the amount the ventricle stretches at the end of diastole. A. Preload B. Afterload C. Stroke Volume D. Contractility
The answer is A. Preload is the amount the ventricle stretches at the end of diastole (hence it's the amount the ventricles stretches once it's filled with blood and right before the contraction of the ventricle ....so it's the end-diastolic volume).
8. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time? A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Last consumption of caffeine D. CK result and when the next CK level is due to be collected
The answer is A. The key words in this question are "chest pain" and "been in the ER for 5 hours". The patient should have already had one troponin level drawn since it starts to elevate 2-4 hours after injury and has been in the ER for 5 hours. Therefore, it is essential you know what the level is and when the next level is due. If the patient's chest pain is caused by a myocardial event the troponin levels will trend upward. Troponin levels are usually ordered every 6 hours x 3. CK results are not as specific as a troponin levels. This question wanted to know the MOST important, and the troponin level for this patient/when it is drawn next is MOST important. Diet status and last consumption of caffeine are things the nurse needs to know but not the MOST important.
8. You're caring for a patient with cardiogenic shock. Which finding below suggests the patient's condition is worsening? Select all that apply: A. Blood pressure 95/68 B. Urinary output 20 mL/hr C. Cardiac Index 3.2 L/min/m2 D. Pulmonary artery wedge pressure 30 mmHg
The answer is B and D. When answering this question look for values that are abnormal and that point to worsening tissue perfusion (urinary output should be 30 mL/hr or greater....if it's lower than this it show the kidneys are not being perfused) and worsening cardiac output (the blood pressure and cardiac index are within normal limits BUT pulmonary artery wedge pressure is NOT). A pulmonary artery wedge pressure (also called pulmonary capillary wedge pressure) is the pressure reading of the filling pressure in the left atrium. A normal PAWP is 4-12 mmHg and if it's >18 mmHg this indicates cardiogenic shock. If it reads high, that means there is back-flowing of blood into the heart and lungs (hence the left ventricle is failing to pump efficiently and increasing the pressure in the left atrium).
17. A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect? A. Losartan B. Lisinopril C. Cardizem D. Lipitor
The answer is B. ACE inhibitors, such as Lisinopril, can cause a nagging cough that is continuous. The patient may be switched to an ARB (angiotensin receptor blocker) if the cough is troublesome. 18. A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction.
Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole. C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.
The answer is B. Cardiac preload is the amount the ventricles stretch at the end of diastole (the filling or relaxation phase of the heart).
4. A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility
The answer is B. IV fluids will increase venous return to the heart. This will increase the amount of fluid that will fill the ventricles at the end of diastole...hence increasing preload and increasing cardiac output.
. 2. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage? A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease.
The answer is B. The LCA (if blocked) can cause the MOST amount of damage to the heart muscle. It affects the ANTERIOR part of the heart which affects the LEFT ventricle. The left descending artery is MOST likely to be affected by coronary artery disease.
20. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.
The answer is B. The best answer for this particular question is option B. All the options are important for the nurse to perform. However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling.
1. You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them? A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.
The answer is B. The most common cause of a myocardial infarction is CORONARY ARTERY DISEASE...not coronary spasm which is uncommon
A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis? A. Pericardial effusion B. Acute pericarditis C. Constrictive pericarditis D. Effusion-Constrictive pericarditis
The answer is C. This describes constrictive pericarditis. The key words in this question are: the patient's signs and symptoms which indicate heart failure (a common finding with patients who have constrictive pericarditis) and that the echo showed "thickening" of the pericardium.
9. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers. A. Myoglobin B. CK-MB C. CK D. Troponin
The answer is D.
9. A patient with cardiogenic shock has a blood pressure of 70/38. In addition, the patient is experiencing dyspnea with a respiratory rate of 32 breaths per minute and has an oxygen saturation of 82% on room air. On auscultation, you note crackles throughout the lung fields. You notify the physician. What order below would you ask for an order clarification? A. Dopamine IV stat B. Normal saline IV bolus stat C. Furosemide IV stat D. Place patient on CPAP (continuous positive airway pressure)
The answer is B. This patient with cardiogenic shock is experiencing a decrease in cardiac output (hence the blood pressure), so an order for Dopamine can help provide a positive inotropic effect (increase the contractility of the heart which will increase stroke volume and cardiac output). The patient is also experiencing pulmonary congestion due to the cardiogenic shock. The heart is failing to pump blood forward, so it is backing up in the lungs. This is leading to an increased respiratory rate, dyspnea, and low oxygen saturation. The order for Furosemide (which is a diuretic) will help remove the extra fluid volume from the lungs and the CPAP (continuous positive airway pressure) will help with oxygenation. The nurse would question the order for a normal saline IV bolus. This bolus would add more fluid to the lungs and further congest the fluids.
4. After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue? A. 24 hours B. 2 days C. 10 days D. 6 hours
The answer is C.
13. They physician orders a Dobutamine IV drip on a patient in cardiogenic shock. After starting the IV drip, the nurse would make it priority to monitor for? A. Rebound hypertension B. Ringing in the ears C. Worsening hypotension D. Severe headache
The answer is C. Dobutamine increases contractility and cardiac output, BUT causes vasodilation due to the way it acts on receptors and this may make hypotension WORSE. The patient may be started on norepinephrine or dopamine if worsening of hypotension occurs.
11. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.
The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier.
12. A patient who has cardiogenic shock is experiencing labored breathing and low oxygen levels. A STAT chest x-ray is ordered. The x-ray results show pulmonary edema. The physician orders Furosemide IV. What finding would require immediate nursing action? A. Blood pressure 98/54 B. Urinary output 45 mL/hr C. Potassium 1.8 mEq/L D. Heart rate 110 bpm
The answer is C. Furosemide (Lasix) is a diuretic which wastes potassium. The nurse would want to ensure the potassium level is normal (3.5 to 5 mEq/L) before administering IV Furosemide. The nurse would need to notify the physician of the potassium level so supplementation can be provided.
7. You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication? A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food
The answer is C. Ibuprofen should be taken with a full glass of water to prevent GI problems, such as ulcers or bleeding.
16. A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug? A. "I will take this medication at night." B. "I will take this medication as needed." C. "I will monitor my heart rate and blood pressure while taking this medication." D. "I will take this medication in the morning with grapefruit juice."
The answer is C. It is the only correct option that reflects Coreg. This medication doesn't have to be taken at night, preferably in the morning. It is taken daily (not as needed), and must be avoided with grapefruit juice because it slow down the absorption of Coreg.
17. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5=
The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).
12. A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this? A. Coreg B. Cardizem C. Lovenox D. Lipitor
The answer is C. Lovenox is an antithrombotic. An adverse side effect of this medication is bleeding. Coreg (beta-blocker), Cardizem (calcium channel blocker), and Lipitor (statin) do NOT cause excessive bleeding.
5. You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicates the patient did NOT understand the education you provided? A. "I can take this medication with or without food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take all my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."
The answer is C. Patients should not take Colchicine with grapefruit juice because it increases the amount of Colchicine the body absorbs (causing an increased chance of Colchicine toxicity). This medication can be taken WITH or WITHOUT food.
4. You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient? A. Monitor the patient for complications of cardiac tamponade. B. Administer Ibuprofen as scheduled. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds.
The answer is C. Placing the patient in supine position is not a proper nursing intervention for a patient experiencing pericarditis because this increases pain. The high Fowler's position or leaning forward is the best position for a patient with pericarditis.
3. A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from? A. Cardiac dissection B. Ventricular septum rupture C. Mitral valve prolapse D. Pericarditis
The answer is D. A complication of a myocardial infarction is PERICARDITIS, especially 24-36 hours post MI. This is because of neutrophils being present at the site which causes inflammation. The patient's signs and symptoms are classic pericarditis
5. _____________ is the force the heart has to pump against to get blood out of the ventricle. A. Cardiac output B. Cardiac index C. Preload D. Afterload
The answer is D. Afterload is the pressure the ventricle must pump against to squeeze blood out. In other words, it's the force the heart has to pump against to get blood out of the ventricle.
7. Which patient below is at MOST risk for developing cardiogenic shock? A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish. B. A 25-year-old female who has experienced an upper thoracic spinal cord injury. C. A 72-year-old male who is post-op from a liver transplant. D. A 49-year-old female who is experiencing an acute myocardial infarction.
The answer is D. An acute MI (heart attack) is the main cause of cardiogenic shock. It happens because a coronary artery has become blocked. Coronary arteries supply the heart muscle's cells with oxygenated blood. If they don't receive this oxygenated blood they will die, which causes the heart muscle to quit working (hence pumping efficiently). When the heart muscle fails to pump efficiently, cardiac output fails and cardiogenic shock occur.
4. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.
The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.
2. Select the statement below that best describes cardiac afterload: A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.
The answer is D. Cardiac afterload is the pressure the ventricles must work against to pump blood out of the heart by opening up through the semilunar valves. So, it's the pressure the ventricles must overcome to open the semilunar valves to push blood out of the heart.
9. Which of the following tests/procedures are NOT used to diagnose heart failure? A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring
The answer is D. Options A, B, and C are all used to diagnose heart failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm.
12. You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."
The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.
13. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of Heparin therapy and requires intervention? A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000
The answer is D. Platelet value of <150,000 indicates thrombocytopenia and is found in patients with Heparin-Induced Thrombocytopenia. The potassium and hemoglobin level are normal. The PTT level is therapeutic (60-80 seconds) for Heparin and isn't a cause for concern.
15. Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum
The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.
5. ___________ is the amount of blood pumped by the left ventricle with each beat. A. Cardiac output B. Preload C. Afterload D. Stroke volume
The answer is D. Stroke volume is the amount of blood pumped by the left ventricle with each beat.
16. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors
The answer is D. This is a description of ACE inhibitors
10. What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction
The answer is D. This statement describes left ventricular DIASTOLIC dysfunction.
6. A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.
The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation.
6. True or False: If a patient with cardiogenic shock is given a medication that will decrease cardiac afterload, it will decrease stroke volume. True False
The answer is FALSE. If a patient with cardiogenic shock is given a medication that will decrease cardiac afterload, it will INCREASE (not decrease) stroke volume. HOW? Remember afterload is the resistance the ventricle must pump against to get blood out of the heart. If we DECREASE the resistance the heart must pump against (make it easier for the heart squeeze blood out of the ventricle), it will increase how much blood it will pump out, hence increase the stroke volume.
5. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction. True False
The answer is TRUE. Patient with left-sided DIASTOLIC dysfunction heart failure normally have a normal ejection fraction. However, patients with left-sided SYSTOLIC dysfunction heart failure usually do not because the heart is unable to CONTRACT efficiently rather than fill properly as with diastolic dysfunction.
10. True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac afterload. True False
The answer is True. If pulmonary vascular resistance or systemic vascular resistance is high, it will create an increased cardiac afterload. If pulmonary vascular resistance or systemic vascular resistance is low, it will create a decreased cardiac afterload.
8. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02
The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. <100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe
3. What two factors are used to calculate cardiac output? Select all that apply: A. Heart rate B. Blood pressure C. Stroke volume D. Mean arterial pressure
The answers are A and C. Cardiac output is calculated by taking the heart rate and multiplying it by stroke volume. CO = HR x SV
9. What conditions below can result in an increased cardiac afterload? Select all that apply: A. Vasoconstriction B. Aortic stenosis C. Vasodilation D. Dehydration E. Pulmonary Hypertension
The answers are A, B, and E. Vasoconstriction increases systemic vascular resistance which will increase cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve to get blood out of the heart....all of this increase cardiac afterload.
10. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status: A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time
The answers are A, D, E, G, and H.
19. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.
The answers are B and D.
16. You're precepting a new nurse. You ask the new nurse to list the purpose of why a patient with cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the new nurse understands the purpose of an intra-aortic balloon pump? Select all that apply: A. "This device increases the cardiac afterload, which will increase cardiac output." B. "This device will help increase blood flow to the coronary arteries." C. "The balloon pump will help remove extra fluid from the heart and lungs." D. "The balloon pump will help increase cardiac output."
The answers are B and D. An intra-aortic balloon pump increases coronary artery blood flow and cardiac output.
19. Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY: A. Lengthening p-waves B. ST-segment elevation C. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression
The answers are B, C, D, and F.
13. Select all the correct statements about educating the patient with heart failure: A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.
The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.
3. Select-all-that-apply: Which of the following are NOT typical signs and symptoms of pericarditis? A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain
The answers are B, C, and F. These are findings NOT found in pericarditis. B is wrong because leaning forward actually helps relieve pain felt in pericarditis (supine position makes it worst). C is wrong because ST segment ELEVATION is seen not depression. F is wrong because inspiration (breathing in) increases the pain felt with pericarditis.
10. You're assessing your patient with cardiogenic shock, what signs and symptoms do you expect to find in this condition? Select all that apply: A. Warm, flushed skin B. Prolonged capillary refill C. Urinary output >30 mL/hr D. Systolic blood pressure <90 mmHg E. Crackles in lung fields F. Dyspnea D. Decreased BUN and creatinine G. Strong peripheral pulses H. Chest pain
The answers are B, D, E, F, and H. Signs and symptoms of cardiogenic shock will be related to LOW cardiac output and decreased perfusion to organs/tissues. Capillary refill will be prolonged >2 seconds, urinary output will be <30 mL/hr, systolic blood pressure will be <90 mmHg, pulmonary edema will present with fluid in the lungs (hence crackles in the lungs), dyspnea, and chest pain (due to decreased blood flow to the heart muscle).
4. Cardiac output is equal to the heart rate multiplied by the stroke volume. Treatment for cardiogenic shock includes medications that increase cardiac output. One of the factors that help determine cardiac output is stroke volume. Select all the factors that determine stroke volume? A. Cardiac Index B. Preload C. Pulmonary capillary wedge pressure D. Afterload E. Heart rate F. Contractility
The answers are B, D, and F. Cardiac output is determined by the person's heart rate times the stroke volume. Stroke volume is the amount of blood pumped from the left ventricle with each BEAT (50-100 ml). It's determined by the preload, afterload, and contractility of the heart. These factors in a patient with cardiogenic shock can be manipulated with medications to increase the cardiac output.
3. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea
The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.
7. Which treatments below would decrease cardiac preload? Select all that apply: A. IV fluid bolus B. Norepinephrine C. Nitroglycerin D. Furosemide
The answers are C and D. Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid from the body via the kidneys. This will decrease venous return to the heart and decrease preload. An IV fluid bolus and Norepinephrine (a vasoconstrictor) will increase venous return to the heart and increase preload.
A patient is being treated for cardiogenic shock. Which statement below best describes this condition? Select all that apply: A. "The patient will experience an increase in cardiac output due to an increase in preload and afterload." B. "A patient with this condition will experience decreased cardiac output and decreased tissue perfusion." C. "This condition occurs because the heart has an inadequate blood volume to pump." D. "Cardiogenic shock leads to pulmonary edema."
The answers are: B and D. Cardiogenic shock occurs when the heart can NOT pump enough blood to meet the perfusion needs of the body. The cardiac output will be DECREASED, which will DECREASE tissue perfusion and cause cell injury to organs/tissues. In this condition, the heart is WEAK and can't pump blood out of the heart. This can be due to either a systolic (contraction) or diastolic (filling) issue along with a structural or dysrhythmia issue. In cardiogenic shock, there is NOT an issue with blood volume, but there is a problem with the heart itself.
Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza)
