Cardiac Problems

38. A patient who is at high risk for developing intracardiac thrombi has been placed on long-term anticoagulation. What aspect of the patient's health history creates a heightened risk of intracardiac thrombi? A) Atrial fibrillation B) Infective endocarditis C) Recurrent pneumonia D) Recent surgery

A) Atrial fibrillation

23. A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patient's most recent laboratory results, the nurse should prioritize assessment of which of the following? A) Sodium B) AST, ALT, and bilirubin C) White blood cell differential D) BUN

A) Sodium

23. The nurse is reviewing the medication administration record of a patient diagnosed with systolic HF. What medication should the nurse anticipate administering to this patient? A) A beta-adrenergic blocker B) An antiplatelet aggregator C) A calcium channel blocker D) A nonsteroidal anti-inflammatory drug (NSAID)

A) A beta-adrenergic blocker

37. A cardiac patient's resistance to left ventricular filling has caused blood to back up into the patient's circulatory system. What health problem is likely to result? A) Acute pulmonary edema B) Right-sided HF C) Right ventricular hypertrophy D) Left-sided HF

A) Acute pulmonary edema

26. The nurse is performing a physical assessment on a patient suspected of having HF. The presence of what sound would signal the possibility of impending HF? A) An S3 heart sound B) Pleural friction rub C) Faint breath sounds D) A heart murmur

A) An S3 heart sound

38. Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse? Select all that apply. A) Anxiety B) Fatigue C) Shoulder pain D) Tachypnea E) Palpitations

A) Anxiety B) Fatigue E) Palpitations

22. A patient with HF has met with his primary care provider and begun treatment with an angiotensin-converting enzyme (ACE) inhibitor. When the patient begins treatment, the nurse should prioritize what assessment? A) Blood pressure B) Level of consciousness (LOC) C) Assessment for nausea D) Oxygen saturation

A) Blood pressure

19. An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patient's echocardiogram? A) Blood to flow back from the aorta to the left ventricle B) Obstruction of blood flow from the left ventricle C) Blood to flow back from the left atrium to the left ventricle D) Obstruction of blood from the left atrium to left ventricle

A) Blood to flow back from the aorta to the left ventricle

6. The nurse is caring for an adult patient with HF who is prescribed digoxin. When assessing the patient for adverse effects, the nurse should assess for which of the following signs and symptoms? A) Confusion and bradycardia B) Uncontrolled diuresis and tachycardia C) Numbness and tingling in the extremities D) Chest pain and shortness of breath

A) Confusion and bradycardia

29. The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding? A) Decreased ejection fraction B) Decreased heart rate C) Ventricular hypertrophy D) Mitral valve regurgitation

A) Decreased ejection fraction

25. A patient with a diagnosis of HF is started on a beta-blocker. What is the nurse's priority role during gradual increases in the patient's dose? A) Educating the patient that symptom relief may not occur for several weeks B) Stressing that symptom relief may take up to 4 months to occur C) Making adjustments to each day's dose based on the blood pressure trends D) Educating the patient about the potential changes in LOC that may result from the drug

A) Educating the patient that symptom relief may not occur for several weeks

27. The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should know that complications following this procedure include what? Select all that apply. A) Emboli B) Mitral valve damage C) Ventricular dysrhythmia D) Atrial-septal defect E) Plaque formation

A) Emboli B) Mitral valve damage C) Ventricular dysrhythmia

26. A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty? A) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory. B) Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well. C) Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay. D) It's prudent to get a second opinion before deciding to have valvuloplasty.

A) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.

28. The nurse is performing an initial assessment of a client diagnosed with HF. The nurse also assesses the patient's sensorium and LOC. Why is the assessment of the patient's sensorium and LOC important in patients with HF? A) HF ultimately affects oxygen transportation to the brain. B) Patients with HF are susceptible to overstimulation of the sympathetic nervous system. C) Decreased LOC causes an exacerbation of the signs and symptoms of HF. D) The most significant adverse effect of medications used for HF treatment is altered LOC.

A) HF ultimately affects oxygen transportation to the brain.

32. A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment? A) Heart transplantation B) Balloon valvuloplasty C) Cardiac catheterization D) Stent placement

A) Heart transplantation

21. The nurse is planning the care of a patient with HF. The nurse should identify what overall goals of this patient's care? A) Improve functional status B) Prevent endocarditis. C) Extend survival. D) Limit physical activity. E) Relieve patient symptoms.

A) Improve functional status C) Extend survival. E) Relieve patient symptoms.

11. A patient admitted to the medical unit with HF is exhibiting signs and symptoms of pulmonary edema. The nurse is aware that positioning will promote circulation. How should the nurse best position the patient? A) In a high Fowler's position B) On the left side-lying position C) In a flat, supine position D) In the Trendelenburg position

A) In a high Fowler's position

40. The nurse is caring for a patient with severe left ventricular dysfunction who has been identified as being at risk for sudden cardiac death. What medical intervention can be performed that may extend the survival of the patient? A) Insertion of an implantable cardioverter defibrillator B) Insertion of an implantable pacemaker C) Administration of a calcium channel blocker D) Administration of a beta-blocker

A) Insertion of an implantable cardioverter defibrillator

30. The nurse is providing patient education prior to a patient's discharge home after treatment for HF. The nurse gives the patient a home care checklist as part of the discharge teaching. What should be included on this checklist? A) Know how to recognize and prevent orthostatic hypotension. B) Weigh yourself weekly at a consistent time of day. C) Measure everything you eat and drink until otherwise instructed. D) Limit physical activity to only those tasks that are absolutely necessary.

A) Know how to recognize and prevent orthostatic hypotension.

39. A cardiac surgery patient's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? A) Prepare to assist with pericardiocentesis. B) Reposition the patient into a prone position. C) Administer a dose of metoprolol. D) Administer a bolus of normal saline.

A) Prepare to assist with pericardiocentesis.

35. A cardiovascular patient with a previous history of pulmonary embolism (PE) is experiencing a sudden onset of dyspnea, rapid breathing, and chest pain. The nurse recognizes the characteristic signs and symptoms of a PE. What is the nurse's best action? A) Rapidly assess the patient's cardiopulmonary status. B) Arrange for an ECG. C) Increase the height of the patient's bed. D) Manage the patient's anxiety.

A) Rapidly assess the patient's cardiopulmonary status.

11. A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease? A) Recognizing and promptly treating streptococcal infections B) Prophylactic use of calcium channel blockers in high-risk populations C) Adhering closely to the recommended child immunization schedule D) Smoking cessation

A) Recognizing and promptly treating streptococcal infections

16. A patient with cardiovascular disease is being treated with amlodipine (Norvasc), a calcium channel blocking agent. The therapeutic effects of calcium channel blockers include which of the following? A) Reducing the heart's workload by decreasing heart rate and myocardial contraction B) Preventing platelet aggregation and subsequent thrombosis C) Reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart D) Increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain

A) Reducing the heart's workload by decreasing heart rate and myocardial contraction

20. A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following? A) The need for regularly scheduled testing of the patient's International Normalized Ratio (INR) B) The need to learn to sleep in a semi-Fowler's position for the first 6 to 8 weeks to prevent emboli C) The need to avoid foods that contain vitamin K D) The need to take enteric-coated ASA on a daily basis

A) The need for regularly scheduled testing of the patient's International Normalized Ratio (INR)

12. A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this? A) To prevent bacterial endocarditis B) To prevent hospital-acquired pneumonia C) To minimize the need for antibiotic use during the procedure D) To decrease the need for surgical asepsis

A) To prevent bacterial endocarditis

37. The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what? A) A decrease in gamma globulins B) An insect bite C) Rheumatic heart disease and its sequelae D) Sepsis and its sequelae

C) Rheumatic heart disease and its sequelae

9. The triage nurse in the ED is performing a rapid assessment of a man with complaints of severe chest pain and shortness of breath. The patient is diaphoretic, pale, and weak. When the patient collapses, what should the nurse do first? A) Check for a carotid pulse. B) Apply supplemental oxygen. C) Give two full breaths. D) Gently shake and shout, "Are you OK?"

D) Gently shake and shout, "Are you OK?"

28. The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patient's diagnosis? A) Mitral valve regurgitation B) Aortic stenosis C) Aortic regurgitation D) Mitral valve stenosis

D) Mitral valve stenosis

34. An older adult client with heart failure states, "I don't know what to do. I don't want to be a burden to my daughter, but I can't do it alone. Maybe I should die." What is the nurse's best response? a. "Would you like to talk about this more?" b. "You're lucky to have such a devoted daughter." c. "You must feel as though you are a burden." d. "Would you like an antidepressant medication?"

a. "Would you like to talk about this more?"

26. Which assessment information obtained by the nurse for a patient with aortic stenosis would be most important to report to the health care provider? a. The patient complains of chest pain associated with ambulation. b. A loud systolic murmur is audible along the right sternal border. c. A thrill is palpable at the 2nd intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.

a. The patient complains of chest pain associated with ambulation.

3. The nurse explains to the patient that the implanted cardioverter-defibrillator (ICD) will: a. shock the arrhythmias into sinus rhythm. b. enhance the heart pumping action. c. stimulate an extra beat if the heart rate drops. d. control the rate of the heart at a the present level.

a. shock the arrhythmias into sinus rhythm.

21. A client is on a dopamine infusion via a peripheral line. What action by the nurse takes priority for safety? a. Assess the IV site hourly. b. Monitor the pedal pulses. c. Monitor the client's vital signs. d. Obtain consent for a central line.

a. Assess the IV site hourly.

24. Which assessment finding in a patient who is admitted with infective endocarditis (IE) is most important to communicate to the health care provider? a. Generalized muscle aching b. Sudden onset right flank pain c. Janeway's lesions on the palms d. Temperature 100.7° F (38.1° C)

b. Sudden onset right flank pain

20. When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient a. that sudden cardiac death events rarely reoccur. b. about the purpose of outpatient Holter monitoring. c. how to self-administer low-molecular-weight heparin. d. to limit activities after discharge to prevent future events.

b. about the purpose of outpatient Holter monitoring.

12. The nurse counsels a patient that the administration of thrombolytic drugs would be contraindicated in the patient who is: a. hypotensive. b. being treated for a bleeding ulcer. c. presently taking warfarin (Coumadin). d. prone to asthma attacks.

b. being treated for a bleeding ulcer.

2. The nurse explains that following a myocardial infarction (MI), the pumping efficiency of the heart is altered because there is: a. loss of impulse from the sinoatrial node. b. necrosis of the myocardium. c. diminished blood flow. d. inflammation and swelling of the myocardium.

b. necrosis of the myocardium.

3. The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on the assessment finding of a. fever, chills, and diaphoresis. b. urine output less than 30 mL/hr. c. petechiae of the buccal mucosa and conjunctiva. d. increase in pulse rate of 15 beats/minute with activity.

b. urine output less than 30 mL/hr.

23. The nurse is caring for a client diagnosed with aortic stenosis. What assessment finding does the nurse expect in this client? a. Bounding arterial pulse b. Slow, faint arterial pulse c. Narrowed pulse pressure d. Elevated systolic pressure

c. Narrowed pulse pressure

18. The rehabilitation nurse is assisting a client with heart failure to increase activity tolerance. During ambulation of the client, identification of what symptom causes the nurse to stop the client's activity? a. Decrease in oxygen saturation from 98% to 95% b. Respiratory rate change from 22 to 28 breaths/min c. Systolic blood pressure change from 136 to 96 mm Hg d. Increase in heart rate from 86 to 100 beats/min

c. Systolic blood pressure change from 136 to 96 mm Hg

1. The nurse would anticipate that the patient with right-sided heart failure would exhibit: a. wheezing. b. orthopnea. c. edema. d. pallor.

c. edema.

5. The nurse caring for a patient with congestive heart failure (CHF) will include which intervention in the plan of care? a. Perform all care at one time to allow more time to rest. b. Keep the patient as flat as possible to prevent venous pooling. c. Encourage eating large meals at regular times. d. Alternate rest with activity.

d. Alternate rest with activity.

14. When the client who had a myocardial infarction develops dependent edema, the nurse would assess that this could be an early manifestation of a. fluid deficit. b. left ventricular failure. c. renal failure. d. right ventricular failure.

d. right ventricular failure.

32. The nurse is addressing exercise and physical activity during discharge education with a patient diagnosed with HF. What should the nurse teach this patient about exercise? A) "Do not exercise unsupervised." B) "Eventually aim to work up to 30 minutes of exercise each day." C) "Slow down if you get dizzy or short of breath." D) "Start your exercise program with high-impact activities."

B) "Eventually aim to work up to 30 minutes of exercise each day."

15. A patient with HF is placed on a low-sodium diet. Which statement by the patient indicates that the nurse's nutritional teaching plan has been effective? A) "I will have a ham and cheese sandwich for lunch." B) "I will have a baked potato with broiled chicken for dinner." C) "I will have a tossed salad with cheese and croutons for lunch." D) "I will have chicken noodle soup with crackers and an apple for lunch."

B) "I will have a baked potato with broiled chicken for dinner."

22. In preparation for cardiac surgery, a patient was taught about measures to prevent venous thromboembolism. What statement indicates that the patient clearly understood this education? A) "I'll try to stay in bed for the first few days to allow myself to heal." B) "I'll make sure that I don't cross my legs when I'm resting in bed." C) "I'll keep pillows under my knees to help my blood circulate better." D) "I'll put on those compression stockings if I get pain in my calves."

B) "I'll make sure that I don't cross my legs when I'm resting in bed."

6. A patient with pericarditis has just been admitted to the CCU. The nurse planning the patient's care should prioritize what nursing diagnosis? A) Anxiety related to pericarditis B) Acute pain related to pericarditis C) Ineffective tissue perfusion related to pericarditis D) Ineffective breathing pattern related to pericarditis

B) Acute pain related to pericarditis

10. A patient presents to the ED complaining of increasing shortness of breath. The nurse assessing the patient notes a history of left-sided HF. The patient is agitated and occasionally coughing up pink-tinged, foamy sputum. The nurse should recognize the signs and symptoms of what health problem? A) Right-sided heart failure B) Acute pulmonary edema C) Pneumonia D) Cardiogenic shock

B) Acute pulmonary edema

22. A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patient's symptoms, the nurse should teach the patient to do which of the following? A) Eat a high-protein, low-carbohydrate diet. B) Avoid activities that cause an increased heart rate. C) Avoid large crowds and public events. D) Perform deep breathing and coughing exercises.

B) Avoid activities that cause an increased heart rate.

7. A patient with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The patient is admitted to the cardiac critical care unit after the PTCA. For what complication should the nurse most closely monitor the patient? A) Hyperlipidemia B) Bleeding at insertion site C) Left ventricular hypertrophy D) Congestive heart failure

B) Bleeding at insertion site

10. A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physician's choice of antibiotics would be primarily based on what diagnostic test? A) Echocardiography B) Blood cultures C) Cardiac aspiration D) Complete blood count

B) Blood cultures

5. The nurse is assessing a patient who is known to have right-sided HF. What assessment finding is most consistent with this patient's diagnosis? A) Pulmonary edema B) Distended neck veins C) Dry cough D) Orthopnea

B) Distended neck veins

34. The critical care nurse is caring for a patient who is in cardiogenic shock. What assessments must the nurse perform on this patient? Select all that apply. A) Platelet level B) Fluid status C) Cardiac rhythm D) Action of medications E) Sputum volume

B) Fluid status C) Cardiac rhythm D) Action of medications

40. The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis? A) Wheezes B) Friction rub C) Fine crackles D) Coarse crackles

B) Friction rub

17. The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what? A) Cardiac tamponade B) Left ventricular hypertrophy C) Right-sided heart failure D) Ventricular insufficiency

B) Left ventricular hypertrophy

16. The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following? A) Use of patient-controlled analgesia B) Long-term anticoagulant therapy C) Steroid therapy D) Use of IV diuretics

B) Long-term anticoagulant therapy

7. A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient? A) Aortic regurgitation B) Mitral stenosis C) Mitral valve prolapse D) Aortic stenosis

B) Mitral stenosis

4. Which assessment would be most appropriate for a patient who is receiving a loop diuretic for HF? A) Monitor liver function studies B) Monitor for hypotension C) Assess the patient's vitamin D intake D) Assess the patient for hyperkalemia

B) Monitor for hypotension

8. The nurse is caring for a 68-year-old patient the nurse suspects has digoxin toxicity. In addition to physical assessment, the nurse should collect what assessment datum? A) Skin turgor B) Potassium level C) White blood cell count D) Peripheral pulses

B) Potassium level

8. The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite? A) The procedure can be performed on an outpatient basis in a physician's office. B) Repaired valves tend to function longer than replaced valves. C) The procedure is not associated with a risk for infection. D) Lower doses of antirejection drugs are required than with valve replacement.

B) Repaired valves tend to function longer than replaced valves.

31. The nurse is educating an 80-year-old patient diagnosed with HF about his medication regimen. What should the nurse to teach this patient about the use of oral diuretics? A) Avoid drinking fluids for 2 hours after taking the diuretic. B) Take the diuretic in the morning to avoid interfering with sleep. C) Avoid taking the medication within 2 hours consuming dairy products. D) Take the diuretic only on days when experiencing shortness of breath.

B) Take the diuretic in the morning to avoid interfering with sleep.

17. The nurse overseeing care in the ICU reviews the shift report on four patients. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock? A) The patient admitted with acute renal failure B) The patient admitted following an MI C) The patient admitted with malignant hypertension D) The patient admitted following a stroke

B) The patient admitted following an MI

11. A patient with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the patient about what potential adverse effects? A) Nervousness or paresthesia B) Throbbing headache or dizziness C) Drowsiness or blurred vision D) Tinnitus or diplopia

B) Throbbing headache or dizziness

3. The triage nurse in the ED is assessing a patient with chronic HF who has presented with worsening symptoms. In reviewing the patient's medical history, what is a potential primary cause of the patient's heart failure? A) Endocarditis B) Pleural effusion C) Atherosclerosis D) Atrial-septal defect

C) Atherosclerosis

14. The nurse is caring for an 84-year-old man who has just returned from the OR after inguinal hernia repair. The OR report indicates that the patient received large volumes of IV fluids during surgery and the nurse recognizes that the patient is at risk for left-sided heart failure. What signs and symptoms would indicate left-sided heart failure? A) Jugular vein distention B) Right upper quadrant pain C) Bibasilar fine crackles D) Dependent edema

C) Bibasilar fine crackles

39. Diagnostic imaging reveals that the quantity of fluid in a client's pericardial sac is dangerously increased. The nurse should collaborate with the other members of the care team to prevent the development of what complication? A) Pulmonary edema B) Pericardiocentesis C) Cardiac tamponade D) Pericarditis

C) Cardiac tamponade

24. The nurse is caring for a patient with systolic HF whose previous adverse reactions preclude the safe use of ACE inhibitors. The nurse should anticipate that the prescriber may choose what combination of drugs? A) Loop diuretic and antiplatelet aggregator B) Loop diuretic and calcium channel blocker C) Combination of hydralazine and isosorbide dinitrate D) Combination of digoxin and normal saline

C) Combination of hydralazine and isosorbide dinitrate

39. A patient who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurse's most appropriate action? A) Document the patient's low urine output and monitor closely for the next several hours. B) Contact the dietitian and suggest the need for increased oral fluid intake. C) Contact the patient's physician and suggest assessment of fluid balance and renal function. D) Increase the infusion rate of the patient's IV fluid to prompt an increase in renal function.

C) Contact the patient's physician and suggest assessment of fluid balance and renal function.

2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following? A) Exposure to immunocompromised individuals B) Future hospital admissions C) Dental procedures D) Live vaccinations

C) Dental procedures

13. The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patient's ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy? A) Cardiac catheterization B) Arterial blood gases C) Echocardiogram D) Exercise stress test

C) Echocardiogram

30. A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy? A) Dilated cardiomyopathy (DCM). B) Arrhythmogenic right ventricular cardiomyopathy (ARVC) C) Hypertrophic cardiomyopathy (HCM) D) Restrictive or constrictive cardiomyopathy (RCM)

C) Hypertrophic cardiomyopathy (HCM)

3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurse's admission interview, the patient states that she takes over-the-counter water pills on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics? A) Encourage the patient to drink at least 2 liters of fluid daily. B) Increase the patient's oral sodium intake. C) Inform the care provider because diuretics are contraindicated. D) Ensure that the patient's fluid balance is monitored vigilantly.

C) Inform the care provider because diuretics are contraindicated.

21. The nurse is assessing a patient who was admitted to the critical care unit 3 hours ago following cardiac surgery. The nurse's most recent assessment reveals that the patient's left pedal pulses are not palpable and that the right pedal pulses are rated at +2. What is the nurse's best response? A) Document this expected assessment finding during the initial postoperative period. B) Reposition the patient with his left leg in a dependent position. C) Inform the patient's physician of this assessment finding. D) Administer an ordered dose of subcutaneous heparin.

C) Inform the patient's physician of this assessment finding.

13. The nurse is providing discharge education to a patient diagnosed with HF. What should the nurse teach this patient to do to assess her fluid balance in the home setting? A) Monitor her blood pressure daily B) Assess her radial pulses daily C) Monitor her weight daily D) Monitor her bowel movements

C) Monitor her weight daily

24. A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse? A) Arrange for an alternative bed. B) Measure the degree of the curvature. C) Notify the surgeon immediately. D) Note the scoliosis on the intake assessment.

C) Notify the surgeon immediately.

1. The nurse notes that a patient has developed a cough productive for mucoid sputum, is short of breath, has cyanotic hands, and has noisy, moist-sounding, rapid breathing. These symptoms and signs are suggestive of what health problem? A) Pericarditis B) Cardiomyopathy C) Pulmonary edema D) Right ventricular hypertrophy

C) Pulmonary edema

34. The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications? A) The nurse keeps the patient isolated to prevent nosocomial infections. B) The nurse encourages coughing and deep breathing. C) The nurse helps the patient with activities until the pain and fever subside. D) The nurse encourages increased fluid intake until the infection resolves.

C) The nurse helps the patient with activities until the pain and fever subside.

15. A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurse's interview is most suggestive of this valvular disorder? A) I get chest pain from time to time, but it usually resolves when I rest. B) Sometimes when I'm resting, I can feel my heart skip a beat. C) Whenever I do any form of exercise I get terribly short of breath. D) My feet and ankles have gotten terribly puffy the last few weeks.

C) Whenever I do any form of exercise I get terribly short of breath.

18. When assessing the patient with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by what assessment finding? A) A diastolic blood pressure that is lower during exhalation B) A diastolic blood pressure that is higher during inhalation C) A systolic blood pressure that is higher during exhalation D) A systolic blood pressure that is lower during inhalation

D) A systolic blood pressure that is lower during inhalation

12. The nurse has entered a patient's room and found the patient unresponsive and not breathing. What is the nurse's next appropriate action? A) Palpate the patient's carotid pulse. B) Illuminate the patient's call light. C) Begin performing chest compressions. D) Activate the Emergency Response System (ERS).

D) Activate the Emergency Response System (ERS).

5. A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs? A) Enoxaparin (Lovenox) B) Metoprolol (Lopressor) C) Azathioprine (Imuran) D) Amoxicillin (Amoxil)

D) Amoxicillin (Amoxil)

20. The nurse is reviewing a newly admitted patient's electronic health record, which notes a history of orthopnea? What nursing action is most clearly indicated? A) Teach the patient deep breathing and coughing exercises. B) Administer supplemental oxygen at all times. C) Limit the patient's activity level. D) Avoid positioning the patient supine.

D) Avoid positioning the patient supine.

4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond? A) Azathioprine decreases the risk of thrombus formation. B) Azathioprine ensures adequate cardiac output. C) Azathioprine increases the number of white blood cells. D) Azathioprine minimizes rejection of the transplant.

D) Azathioprine minimizes rejection of the transplant.

2. A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause? A) Decreased cardiac output B) Decreased cardiac contractility C) Infarction of the myocardium D) Coronary arteriosclerosis

D) Coronary arteriosclerosis

27. An older adult patient with HF is being discharged home on an ACE inhibitor and a loop diuretic. The patient's most recent vital signs prior to discharge include oxygen saturation of 93% on room air, heart rate of 81 beats per minute, and blood pressure of 94/59 mm Hg. When planning this patient's subsequent care, what nursing diagnosis should be identified? A) Risk for ineffective tissue perfusion related to dysrhythmia B) Risk for fluid volume excess related to medication regimen C) Risk for ineffective breathing pattern related to hypoxia D) Risk for falls related to hypotension

D) Risk for falls related to hypotension

2. The nurse is assessing an older adult patient with numerous health problems. What assessment datum indicates an increase in the patient's risk for heart failure (HF)? A) The patient takes Lasix (furosemide) 20 mg/day. B) The patient's potassium level is 4.7 mEq/L. C) The patient is an African American man. D) The patient's age is greater than 65.

D) The patient's age is greater than 65.

31. The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient? A) To eat a small meal before taking nitroglycerin B) To drink a glass of milk before taking nitroglycerin C) To engage in 15 minutes of light exercise before taking nitroglycerin D) To rest and relax before taking nitroglycerin

D) To rest and relax before taking nitroglycerin

12. A client with heart failure is prescribed enalapril (Vasotec). What is the nurse's priority teaching for this client? a. "Avoid using salt substitutes." b. "Take your medication with food." c. "Avoid using aspirin-containing products." d. "Check your pulse daily."

a. "Avoid using salt substitutes."

17. The nurse is teaching a client who is prescribed a calcium channel blocking agent after a percutaneous transluminal coronary angioplasty (PTCA). Which instruction does the nurse include in this client's teaching? a. "Change position slowly." b. "Avoid crossing your legs." c. "Weigh yourself daily." d. "Decrease salt intake."

a. "Change position slowly."

19. The nurse is teaching a client prescribed sublingual nitroglycerin for chest pain. Which statement indicates that the client needs further teaching? a. "I carry my medicine around in a clear plastic bag so that I can get to it easily if I have chest pain." b. "Even if I have not used any of the nitroglycerin from one refill, I get another refill every 3 months." c. "If I still have chest pain after I have taken 3 nitroglycerin tablets, I will go to the hospital." d. "When my nitroglycerin tablet tingles under my tongue, I know that it is strong enough to work."

a. "I carry my medicine around in a clear plastic bag so that I can get to it easily if I have chest pain."

5. A client with a history of myocardial infarction calls the clinic to report the onset of a cough that is troublesome only at night. What direction does the nurse give to the client? a. "Please come into the clinic for an evaluation." b. "Increase your fluid intake during waking hours." c. "Use an over-the-counter cough suppressant." d. "Sleep on two pillows to facilitate postnasal drainage."

a. "Please come into the clinic for an evaluation."

9. A client asks the nurse why it is important to be weighed every day if he has right-sided heart failure. What is the nurse's best response? a. "Weight is the best indication that you are gaining or losing fluid." b. "Daily weights will help us make sure that you're eating properly." c. "The hospital requires that all inpatients be weighed daily." d. "You need to lose weight to decrease the incidence of heart failure."

a. "Weight is the best indication that you are gaining or losing fluid."

21. A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? a. "What do you think caused your chest pain?" b. "Where are you planning to go for your vacation?" c. "Sometimes plans need to change after a heart attack." d. "Recovery from a heart attack takes at least a few weeks."

a. "What do you think caused your chest pain?"

20. The nurse reading admission data on a patient recognizes information that puts the patient at risk for coronary artery disease (CAD). Which characteristic place the patient at risk? (Select all that apply.) a. 38-year-old African American b. Low-density lipoprotein (LDL) 120, high-density lipoprotein (HDL) 68 c. Taking oral birth control pills d. Nonsmoker for 10 years e. Diagnosed with diabetes 2 years ago

a. 38-year-old African American c. Taking oral birth control pills e. Diagnosed with diabetes 2 years ago

20. After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

a. A patient who is cool and clammy, with new-onset confusion and restlessness

16. The nurse is caring for a client who had a myocardial infarction. The client develops increased pulmonary congestion; an increase in heart rate from 80 to 102 beats/min; and cold, clammy skin. Which action does the nurse implement before notifying the health care provider? a. Administer oxygen. b. Increase the IV flow rate. c. Place the client in supine position. d. Prepare the client for surgery.

a. Administer oxygen.

12. The nurse is administering thrombolytic therapy to a client who had a myocardial infarction. Which intervention does the nurse implement to reduce the risk of complications in this client? a. Administer prescribed heparin. b. Apply ice to the injection site. c. Place the client in Trendelenburg position. d. Instruct the client to take slow deep breaths.

a. Administer prescribed heparin.

38. A client with heart failure is due to receive enalapril (Vasotec) and has a blood pressure of 98/50 mm Hg. What is the nurse's best action? a. Administer the Vasotec. b. Recheck the blood pressure. c. Hold the Vasotec. d. Notify the health care provider.

a. Administer the Vasotec.

8. The nurse assesses a client and notes the presence of an S3 gallop. What is the nurse's best intervention? a. Assess for symptoms of left-sided heart failure. b. Document this as a normal finding. c. Call the health care provider immediately. d. Transfer the client to the intensive care unit.

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

21. A client has been admitted to the acute care unit for an exacerbation of heart failure. Which is the nurse's priority intervention? a. Assess respiratory status. b. Monitor electrolyte levels. c. Administer intravenous fluids. d. Insert a Foley catheter.

a. Assess respiratory status.

27. Two days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patient's temperature. c. Notify the patient's health care provider. d. Give the PRN acetaminophen (Tylenol).

a. Auscultate the heart sounds.

17. The patient in the emergency room with a myocardial infarction (MI) becomes pale, diaphoretic, and hypotensive and complains of feeling cold. The nurse recognizes that these signs are which post-MI complication? a. Cardiogenic shock b. Pleural effusion c. Ventricular fibrillation d. Pulmonary embolus

a. Cardiogenic shock

19. The nurse is concerned that an older adult client with heart failure is developing pulmonary edema. What manifestation alerts the nurse to further assess the client for this complication? a. Confusion b. Dysphagia c. Sacral edema d. Irregular heart rate

a. Confusion

4. A client is hospitalized after a myocardial infarction. Which hemodynamic parameters does the nurse correlate with cardiogenic shock? (Select all that apply.) a. Decreased cardiac output b. Increased cardiac output c. Increased mean arterial pressure (MAP) d. Decreased MAP e. Increased afterload f. Decreased afterload

a. Decreased cardiac output d. Decreased MAP e. Increased afterload

35. An older adult client is admitted with fluid volume excess. Which diagnostic study does the nurse facilitate as a priority? a. Echocardiography b. Chest x-ray c. T4 and thyroid-stimulating hormone (TSH) d. Arterial blood gas

a. Echocardiography

37. A patient who has chest pain is admitted to the emergency department (ED), and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first? a. Electrocardiogram (ECG) b. Computed tomography (CT) scan c. Chest x-ray d. Troponin level

a. Electrocardiogram (ECG)

21. The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium, which is brought on by which factors? (Select all that apply.) a. Exertion b. Emotional excitement c. Eating heavy meals d. Exposure to cold e. Allergic reaction

a. Exertion b. Emotional excitement c. Eating heavy meals d. Exposure to cold

29. When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Give the scheduled aspirin and lipid-lowering medication. b. Perform the initial assessment of the catheter insertion site. c. Teach the patient about the usual postprocedure plan of care. d. Titrate the heparin infusion according to the agency protocol.

a. Give the scheduled aspirin and lipid-lowering medication.

2. The nurse is evaluating the laboratory results for a client with heart failure. What results does the nurse expect? (Select all that apply.) a. Hematocrit (Hct), 32.8% b. Serum sodium, 130 mEq/L c. Serum potassium, 4.0 mEq/L d. Serum creatinine, 1.0 mg/dL e. Proteinuria f. Microalbuminuria

a. Hematocrit (Hct), 32.8% b. Serum sodium, 130 mEq/L e. Proteinuria f. Microalbuminuria

36. The nurse is caring for a client with severe heart failure. What is the best position in which to place this client? a. High Fowler's, pillows under arms b. Semi-Fowler's, with legs elevated c. High Fowler's, with legs elevated d. Semi-Fowler's, on the left side

a. High Fowler's, pillows under arms

1. Based on the Joint Commission Core Measures for patients with heart failure, which topics should the nurse include in the discharge teaching plan for a patient who has been hospitalized with chronic heart failure (select all that apply)? a. How to take and record daily weight b. Importance of limiting aerobic exercise c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

a. How to take and record daily weight c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

39. A client in severe heart failure has a heparin drip infusing. The health care provider prescribes nesiritide (Natrecor) to be given intravenously. Which intervention is essential before administration of this medication? a. Insert a separate IV access. b. Prepare a test bolus dose. c. Prepare the piggyback line. d. Administer furosemide (Lasix) first.

a. Insert a separate IV access.

3. The nurse is assessing clients on a cardiac unit. Which client does the nurse assess most carefully for developing left-sided heart failure? a. Middle-aged woman with aortic stenosis b. Middle-aged man with pulmonary hypertension c. Older woman who smokes cigarettes daily d. Older man who has had a myocardial infarction

a. Middle-aged woman with aortic stenosis

14. Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide slowly before stopping. d. Teach patient about home use of the drug.

a. Monitor blood pressure frequently.

21. Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

a. Oxygen saturation of 88%

11. A client with heart failure is experiencing acute shortness of breath. What is the nurse's priority action? a. Place the client in a high Fowler's position. b. Perform nasotracheal suctioning of the client. c. Auscultate the client's heart and lung sounds. d. Place the client on a 1000 mL fluid restriction.

a. Place the client in a high Fowler's position.

1. The nurse is assessing a client with left-sided heart failure. What conditions does the nurse assess for? (Select all that apply.) a. Pulmonary crackles b. Confusion, restlessness c. Pulmonary hypertension d. Dependent edema e. S3/S4 summation gallop f. Cough worsens at night

a. Pulmonary crackles b. Confusion, restlessness e. S3/S4 summation gallop f. Cough worsens at night

27. A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Sildenafil (Viagra) b. Furosemide (Lasix) c. Captopril (Capoten) d. Warfarin (Coumadin)

a. Sildenafil (Viagra)

27. The nurse is providing care to a client with infective endocarditis. What infection control precautions does the nurse use? a. Standard Precautions b. Bleeding Precautions c. Reverse isolation d. Contact isolation

a. Standard Precautions

24. The nurse is aware that certain risk factors increase the chance of a person developing cardiomyopathy. Which of the circumstances increase the risk for cardiomyopathy? (Select all that apply.) a. Systemic hypertension b. Chronic excessive alcohol consumption c. Pregnancy d. Diabetes e. Systemic infection

a. Systemic hypertension b. Chronic excessive alcohol consumption c. Pregnancy e. Systemic infection

26. The nurse is caring for a 78-year-old patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider? a. The patient complains of chest pressure when ambulating. b. A loud systolic murmur is heard along the right sternal border. c. A thrill is palpated at the second intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.

a. The patient complains of chest pressure when ambulating.

28. The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? a. The patient has bilateral crackles. b. The patient has bilateral, 4+ peripheral edema. c. The patient has a loud systolic murmur across the precordium. d. The patient has a palpable thrill felt over the left anterior chest.

a. The patient has bilateral crackles.

2. A client is scheduled to have a PTCA. The nurse brings the consent forms and the client questions why he/she has to sign a consent form for possible coronary artery bypass grafting too. The nurse's response should be based on understanding that (Select all that apply) a. a separate consent must be signed for each procedure. b. education will only have to be done one time if the client signs both now. c. in case of a complication, there may not be time to have a consent signed. d. the client will be sedated during the PTCA and cannot sign another consent form.

a. a separate consent must be signed for each procedure. c. in case of a complication, there may not be time to have a consent signed. d. the client will be sedated during the PTCA and cannot sign another consent form.

6. During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of "feeling too tired to get out of bed." Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion.

a. activity intolerance related to fatigue.

12. A client is admitted to the intensive care unit with severe dyspnea, fear, noisy respirations, sweating, and tachypnea. The nurse would recognize that the client is exhibiting manifestations of a. acute pulmonary edema. b. acute myocardial infarction. c. chronic congestive heart failure. d. right ventricular failure.

a. acute pulmonary edema.

1. The nursing actions that would most help to prevent cardiogenic shock in a client after a myocardial infarction are (Select all that apply) a. administering vasopressor agents. b. enhancing the heart's pumping function. c. giving the client IV lidocaine. d. providing adequate IV fluids. e. treating pain rapidly.

a. administering vasopressor agents. b. enhancing the heart's pumping function. d. providing adequate IV fluids. e. treating pain rapidly.

20. Examining the electrocardiogram strips of a client with mitral stenosis, the nurse would recognize the characteristic dysrhythmia of a. atrial fibrillation. b. artial flutter. c. sinus tachycardia. d. ventricular tachycardia

a. atrial fibrillation.

8. The nurse caring for a client with acute infective endocarditis would frequently assess for a. cardiac murmurs. b. elevation of blood pressure. c. pulse oximetry. d. urine output.

a. cardiac murmurs.

13. In caring for a client considering mechanical mitral valve replacement, the essential determination for the nurse (and physician) to make would be whether the client can or will a. comply with the lifelong requirement for anticoagulant therapy. b. cooperate fully and participate in a cardiac rehabilitation program. c. experience body image problems from the sternal scar. d. require a high level of physical energy at work.

a. comply with the lifelong requirement for anticoagulant therapy.

11. When auscultating the respirations of a client in left ventricular heart failure, the nurse would most likely detect a. crackling sounds. b. diminished sounds. c. grunting. d. wheezing.

a. crackling sounds.

12. A client with mitral stenosis tells the nurse that she will not seek treatment for this disorder because she "doesn't really feel that bad." The nurse's best response would be that untreated mitral stenosis can result in a. creation of small emboli. b. frequent bouts of pericarditis. c. potentially fatal myocardial infarcts. d. pulmonary effusion.

a. creation of small emboli.

19. When caring for the patient with infective endocarditis of the tricuspid valve, the nurse will plan to monitor the patient for a. dyspnea. b. flank pain. c. hemiparesis. d. splenomegaly.

a. dyspnea.

5. A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of a. echocardiography. b. daily blood cultures. c. cardiac catheterization. d. 24-hour Holter monitor.

a. echocardiography.

19. A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurse's priority action will be to a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

a. give IV morphine sulfate 4 mg.

21. The independent interventions the nurse may employ when the 80-year-old patient in the long-term health care facility develops acute pulmonary edema are to: (Select all that apply.) a. give oxygen at 2 L/min. b. give morphine to relieve respiratory distress. c. give diuretics to relieve excess fluid. d. position in high Fowler's position. e. apply compression stockings.

a. give oxygen at 2 L/min. d. position in high Fowler's position.

4. The post-myocardial infarction (MI) patient is placed on a low-fat diet as well as daily simvastatin (Zocor). The nurse instructs that while on this drug, the patient should: a. have blood work every 2 months to check for liver damage. b. drink grapefruit juice daily to help metabolize the drug. c. take medication with a meal to diminish gastrointestinal discomfort. d. report any rash on the face or neck to the physician.

a. have blood work every 2 months to check for liver damage.

4. The nurse would explain to a client that the catabolism related to the hypermetabolic state caused by the client's rheumatic fever can be avoided by eating a a. high-carbohydrate, high-protein diet. b. high-fat, high-protein diet. c. high-protein, low-carbohydrate diet. d. high-protein, low-sodium diet

a. high-carbohydrate, high-protein diet.

7. The nurse would explain the etiology of heart failure after myocardial infarction (MI) as a. impairment of the contractile function of the ventricle. b. inability of the heart chambers to fill adequately. c. increased myocardial workload. d. increased oxygen demands of the myocardium.

a. impairment of the contractile function of the ventricle.

5. The nurse would recognize that splinter hemorrhages in the nails, painful swollen nodules on the fingertips, and splenomegaly indicate a. infective endocarditis. b. mitral stenosis. c. mitral valve prolapse. d. pericarditis.

a. infective endocarditis.

1. The nurse would assess a heart rate of 55 beats/min as a normal finding in a client who a. is an athlete. b. is obese. c. takes a diuretic. d. weighs less than 90 pounds.

a. is an athlete.

10. When a client is hospitalized with dilated cardiomyopathy, the nurse would examine the client's record for the characteristic history of a. long-term alcohol abuse. b. previous streptococcal infection. c. resistant hypertension. d. uncontrolled diabetes.

a. long-term alcohol abuse.

7. The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should a. note when Korotkoff sounds are auscultated during both inspiration and expiration. b. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP). c. check the electrocardiogram (ECG) for variations in rate during the respiratory cycle. d. listen for a pericardial friction rub that persists when the patient is instructed to stop breathing.

a. note when Korotkoff sounds are auscultated during both inspiration and expiration.

19. To encourage a client recovering from endocarditis, the nurse would stress that new guidelines for home care are less restrictive than in the past and the client no longer needs to a. observe complete bed rest. b. restrict the amount of activity. c. take 2 to 5 weeks of antibiotic therapy. d. take precautions against emboli formation.

a. observe complete bed rest.

16. While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to a. promote rest to decrease myocardial oxygen demand. b. teach the patient about the need for anticoagulant therapy. c. teach the patient to use sublingual nitroglycerin for chest pain. d. raise the head of the bed 60 degrees to decrease venous return.

a. promote rest to decrease myocardial oxygen demand.

2. The nurse anticipates that, on auscultation of the chest of an older adult with left-sided congestive heart failure (CHF), the major adventitious sound will be: a. wheezing. b. crackles. c. rhonchi. d. friction rub.

a. wheezing.

7. A nurse prepares to discharge a client who has heart failure. Which questions should the nurse ask to ensure this client's safety prior to discharging home? (Select all that apply.) a. "Are your bedroom and bathroom on the first floor?" b. "What social support do you have at home?" c. "Will you be able to afford your oxygen therapy?" d. "What spiritual beliefs may impact your recovery?" e. "Are you able to accurately weigh yourself at home?"

a. "Are your bedroom and bathroom on the first floor?" b. "What social support do you have at home?" e. "Are you able to accurately weigh yourself at home?"

4. A nursing student is caring for a client who had a myocardial infarction. The student is confused because the client states nothing is wrong and yet listens attentively while the student provides education on lifestyle changes and healthy menu choices. What response by the faculty member is best? a. "Continue to educate the client on possible healthy changes." b. "Emphasize complications that can occur with noncompliance." c. "Tell the client that denial is normal and will soon go away." d. "You need to make sure the client understands this illness."

a. "Continue to educate the client on possible healthy changes."

9. A client is in the clinic a month after having a myocardial infarction. The client reports sleeping well since moving into the guest bedroom. What response by the nurse is best? a. "Do you have any concerns about sexuality?" b. "I'm glad to hear you are sleeping well now." c. "Sleep near your spouse in case of emergency." d. "Why would you move into the guest room?"

a. "Do you have any concerns about sexuality?"

4. After teaching a client with congestive heart failure (CHF), the nurse assesses the client's understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.) a. "I'll read the nutritional labels on food items for salt content." b. "I will drink at least 3 liters of water each day." c. "Using salt in moderation will reduce the workload of my heart." d. "I will eat oatmeal for breakfast instead of ham and eggs." e. "Substituting fresh vegetables for canned ones will lower my salt intake."

a. "I'll read the nutritional labels on food items for salt content." d. "I will eat oatmeal for breakfast instead of ham and eggs." e. "Substituting fresh vegetables for canned ones will lower my salt intake."

5. A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client with congestive heart failure. Which instructions should the nurse provide to the UAP when delegating care for this client? (Select all that apply.) a. "Reposition the client every 2 hours." b. "Teach the client to perform deep-breathing exercises." c. "Accurately record intake and output." d. "Use the same scale to weigh the client each morning." e. "Place the client on oxygen if the client becomes short of breath."

a. "Reposition the client every 2 hours." c. "Accurately record intake and output." d. "Use the same scale to weigh the client each morning."

1. A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure? a. A 36-year-old woman with aortic stenosis b. A 42-year-old man with pulmonary hypertension c. A 59-year-old woman who smokes cigarettes daily d. A 70-year-old man who had a cerebral vascular accident

a. A 36-year-old woman with aortic stenosis

3. A nurse assesses clients on a cardiac unit. Which clients should the nurse identify as at greatest risk for the development of acute pericarditis? (Select all that apply.) a. A 36-year-old woman with systemic lupus erythematosus (SLE) b. A 42-year-old man recovering from coronary artery bypass graft surgery c. A 59-year-old woman recovering from a hysterectomy d. An 80-year-old man with a bacterial infection of the respiratory tract e. An 88-year-old woman with a stage III sacral ulcer

a. A 36-year-old woman with systemic lupus erythematosus (SLE) b. A 42-year-old man recovering from coronary artery bypass graft surgery d. An 80-year-old man with a bacterial infection of the respiratory tract

3. A nursing student studying acute coronary syndromes learns that the pain of a myocardial infarction (MI) differs from stable angina in what ways? (Select all that apply.) a. Accompanied by shortness of breath b. Feelings of fear or anxiety c. Lasts less than 15 minutes d. No relief from taking nitroglycerin e. Pain occurs without known cause

a. Accompanied by shortness of breath b. Feelings of fear or anxiety d. No relief from taking nitroglycerin e. Pain occurs without known cause

5. A nursing student planning to teach clients about risk factors for coronary artery disease (CAD) would include which topics? (Select all that apply.) a. Advanced age b. Diabetes c. Ethnic background d. Medication use e. Smoking

a. Advanced age b. Diabetes c. Ethnic background e. Smoking

18. A nurse is caring for a client who is intubated and has an intra-aortic balloon pump. The client is restless and agitated. What action should the nurse perform first for comfort? a. Allow family members to remain at the bedside. b. Ask the family if the client would like a fan in the room. c. Keep the television tuned to the client's favorite channel. d. Speak loudly to the client in case of hearing problems.

a. Allow family members to remain at the bedside.

11. An older adult is on cardiac monitoring after a myocardial infarction. The client shows frequent dysrhythmias. What action by the nurse is most appropriate? a. Assess for any hemodynamic effects of the rhythm. b. Prepare to administer antidysrhythmic medication. c. Notify the provider or call the Rapid Response Team. d. Turn the alarms off on the cardiac monitor.

a. Assess for any hemodynamic effects of the rhythm.

2. A nurse is caring for a client who had coronary artery bypass grafting yesterday. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assist the client to the chair for meals and to the bathroom. b. Encourage the client to use the spirometer every 4 hours. c. Ensure the client wears TED hose or sequential compression devices. d. Have the client rate pain on a 0-to-10 scale and report to the nurse. e. Take and record a full set of vital signs per hospital protocol.

a. Assist the client to the chair for meals and to the bathroom. c. Ensure the client wears TED hose or sequential compression devices. e. Take and record a full set of vital signs per hospital protocol.

8. A nurse assesses a client who is recovering from a heart transplant. Which assessment findings should alert the nurse to the possibility of heart transplant rejection? (Select all that apply.) a. Shortness of breath b. Abdominal bloating c. New-onset bradycardia d. Increased ejection fraction e. Hypertension

a. Shortness of breath b. Abdominal bloating c. New-onset bradycardia

6. A nurse prepares to discharge a client who has heart failure. Based on the Heart Failure Core Measure Set, which actions should the nurse complete prior to discharging this client? (Select all that apply.) a. Teach the client about dietary restrictions. b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor. c. Encourage the client to take a baby aspirin each day. d. Confirm that an echocardiogram has been completed. e. Consult a social worker for additional resources.

a. Teach the client about dietary restrictions. b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor. d. Confirm that an echocardiogram has been completed.

33. The nurse is assessing a client with a history of heart failure. What priority question assists the nurse to assess the client's activity level? a. "Do you have trouble breathing or chest pain?" b. "Are you able to walk upstairs without fatigue?" c. "Do you awake with breathlessness during the night?" d. "Do you have new-onset heaviness in your legs?"

b. "Are you able to walk upstairs without fatigue?"

31. A client is being discharged home after a heart transplant with a prescription for cyclosporine (Sandimmune). What priority education does the nurse provide with the client's discharge instructions? a. "Use a soft-bristled toothbrush and avoid flossing." b. "Avoid large crowds and people who are sick." c. "Change positions slowly to avoid hypotension." d. "Check your heart rate before taking the medication."

b. "Avoid large crowds and people who are sick."

24. A client who has had a prosthetic valve replacement asks the nurse why he must take anticoagulants for the rest of his life. What is the nurse's best response? a. "The prosthetic valve places you at greater risk for a heart attack." b. "Blood clots form more easily in artificial replacement valves." c. "The vein taken from your leg reduces circulation in the leg." d. "The surgery left a lot of small clots in your heart and lungs."

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

2. The nurse is assessing a client who has a history of stable angina. The client describes a recent increase in the number of attacks and in the intensity of the pain. Which question does the nurse ask to assess the client's change in condition? a. "How many cigarettes do you smoke daily?" b. "Do you have pain when you are resting?" c. "Do you have abdominal pain or nausea?" d. "How frequently are you having chest pain?"

b. "Do you have pain when you are resting?"

19. The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which is the correct response by the nurse? a. "I'm not really sure. It is better if you ask your surgeon." b. "Every patient has different circumstances, but the average 5-year survival rate is 70%." c. "The survival rate is excellent. Almost all patients with a heart transplant live past 10 years." d. "There are not any really good statistics for me to give you an accurate estimate."

b. "Every patient has different circumstances, but the average 5-year survival rate is 70%."

37. The nurse is instructing a client with heart failure about energy conservation. Which is the best instruction? a. "Walk until you become short of breath and then walk back home." b. "Gather everything you need for a chore before you begin." c. "Pull rather than push or carry items heavier than 5 pounds." d. "Take a walk after dinner every day to build up your strength."

b. "Gather everything you need for a chore before you begin."

9. The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history will be most pertinent to ask? a. "Do you use any illegal IV drugs?" b. "Have you had a recent sore throat?" c. "Have you injured your chest in the last few weeks?" d. "Do you have a family history of congenital heart disease?"

b. "Have you had a recent sore throat?"

25. The nurse is discharging a client home following mitral valve replacement. What statement indicates that the client requires further education? a. "I will be able to carry heavy loads after 6 months of rest." b. "I will have my teeth cleaned by the dentist in 2 weeks." c. "I will avoid eating foods high in vitamin K, like spinach." d. "I will use an electric razor instead of a straight razor to shave."

b. "I will have my teeth cleaned by the dentist in 2 weeks."

22. When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following? a. "They will circulate my blood with a machine during the surgery." b. "I will have small incisions in my leg where they will remove the vein." c. "They will use an artery near my heart to go around the area that is blocked." d. "I will need to take an aspirin every day after the surgery to keep the graft open."

b. "I will have small incisions in my leg where they will remove the vein."

7. After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. "Carvedilol will help my heart muscle work harder." b. "It is important not to suddenly stop taking the carvedilol." c. "I can expect to feel short of breath when taking carvedilol." d. "Carvedilol will increase the blood flow to my heart muscle."

b. "It is important not to suddenly stop taking the carvedilol."

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

b. "My shoes fit really tight lately."

10. A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. Based on these findings, which nursing diagnosis would be most appropriate? a. Pain related to permanent joint fixation b. Activity intolerance related to arthralgia c. Risk for infection related to open skin lesions d. Risk for impaired skin integrity related to pruritus

b. Activity intolerance related to arthralgia

4. When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is a priority for the nurse to include? a. Monitor labs for streptococcal antibodies. b. Arrange for placement of a long-term IV catheter. c. Teach the importance of completing all oral antibiotics. d. Encourage the patient to begin regular aerobic exercise.

b. Arrange for placement of a long-term IV catheter.

22. A nurse is preparing to administer IV digoxin to an elderly client in heart failure. Which nursing action takes priority? a. Ask the client if he/she has ever had digoxin before. b. Assess the client's pulse rate and hold the medication if it is less than 60 beats/min. c. Prepare the client for any side effects of the medication. d. Provide instruction to the client on the medication's expected effects.

b. Assess the client's pulse rate and hold the medication if it is less than 60 beats/min.

1. The nurse is taking the history of a client with suspected coronary artery disease (CAD). Which situation correlates with stable angina? a. Chest discomfort at rest and inability to tolerate mowing the lawn b. Chest discomfort when mowing the lawn and subsiding with rest c. Indigestion and a choking sensation when mowing the lawn d. Jaw pain that radiates to the shoulder after mowing the lawn

b. Chest discomfort when mowing the lawn and subsiding with rest

2. A client with systolic dysfunction has an ejection fraction of 38%. The nurse assesses for which physiologic change? a. Increase in stroke volume b. Decrease in tissue perfusion c. Increase in oxygen saturation d. Decrease in arterial vasoconstriction

b. Decrease in tissue perfusion

22. The nurse is assessing a client who has a serum potassium level of 4.5 mEq/L after coronary artery bypass graft (CABG) surgery. Which action does the nurse take? a. Notify the health care provider. b. Document the finding. c. Administer prescribed diuretics. d. Administer prescribed potassium replacements.

b. Document the finding.

6. The patient with tachycardia who has a heart rate of 115 complains of shortness of breath. The nurse interprets this complaint as being related to which problem? a. Pulmonary edema b. Drop in cardiac output c. Impending pneumonia d. Increasing anxiety

b. Drop in cardiac output

22. The nurse is caring for a client with mitral valve stenosis. What clinical manifestation alerts the nurse to the possibility that the client's stenosis has progressed? a. Oxygen saturation of 92% b. Dyspnea on exertion c. Muted systolic murmur d. Upper extremity weakness

b. Dyspnea on exertion

28. A client with pericarditis is admitted to the cardiac unit. What assessment finding does the nurse expect in this client? a. Heart rate that speeds up and slows down b. Friction rub at the left lower sternal border c. Presence of a regularly gallop rhythm d. Coarse crackles in bilateral lung bases

b. Friction rub at the left lower sternal border

10. The nurse caring for a patient who is taking amiodarone (Cordarone) will plan to assess the vital signs carefully for which common side effect? a. Sudden increase in temperature b. Hypotension c. Bradycardia d. Depressed ventilation

b. Hypotension

21. A nurse is caring for a client in the intensive care unit who underwent a CABG earlier this morning. Which nursing diagnosis takes priority? a. Decreased Cardiac Output b. Impaired Gas Exchange c. Pain d. Risk for Hemorrhage

b. Impaired Gas Exchange

3. The nurse administers intravenous dobutamine (Dobutrex) to a client who has heart failure. Which clinical manifestations indicate that the client's status is improving? (Select all that apply.) a. Decreased heart rate b. Increased heart rate c. Increased contractility d. Decreased contractility e. Increased respiratory rate

b. Increased heart rate c. Increased contractility

13. The nurse is administering captopril (Capoten) to a client with heart failure. What is the priority intervention for this client? a. Administer this medication before meals to aid absorption. b. Instruct the client to ask for assistance when arising from bed. c. Give the medication with milk to prevent stomach upset. d. Monitor the potassium level and check for symptoms of hypokalemia.

b. Instruct the client to ask for assistance when arising from bed.

31. The nurse is assessing a patient with myocarditis before administering the scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider? a. Leukocytosis b. Irregular pulse c. Generalized myalgia d. Complaint of fatigue

b. Irregular pulse

15. The client with heart failure has been prescribed intravenous nitroglycerin and furosemide (Lasix) for pulmonary edema. Which is the priority nursing intervention? a. Insert an indwelling urinary catheter. b. Monitor the client's blood pressure. c. Place the nitroglycerin under the client's tongue. d. Monitor the client's serum glucose level.

b. Monitor the client's blood pressure.

23. Which admission order written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever would be a priority for the nurse to implement? a. Administer ceftriaxone (Rocephin) 1 g IV. b. Order blood cultures drawn from two sites. c. Give acetaminophen (Tylenol) PRN for fever. d. Arrange for a transesophageal echocardiogram.

b. Order blood cultures drawn from two sites.

28. Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision

b. Pallor and weakness of the right hand

a. Patient with acute pericarditis who has a pericardial friction rub b. Patient who has just returned to the unit after balloon valvuloplasty c. Patient who has hypertrophic cardiomyopathy and a heart rate of 116 d. Patient with a mitral valve replacement who has an anticoagulant scheduled

b. Patient who has just returned to the unit after balloon valvuloplasty

25. After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58 b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L c. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache d. Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L

32. After receiving report on the following patients, which patient should the nurse assess first? a. Patient with rheumatic fever who has sharp chest pain with a deep breath b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg c. Patient with infective endocarditis who has a murmur and splinter hemorrhages d. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg

40. Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

b. Patient with stable angina whose chest pain has recently increased in frequency

24. Which assessment finding in a patient who is hospitalized with infective endocarditis (IE) is most important to communicate to the health care provider? a. Generalized muscle aching b. Sudden onset left flank pain c. Janeway's lesions on the palms d. Temperature 100.5° F (38.1° C)

b. Sudden onset left flank pain

12. When developing a community health program to decrease the incidence of rheumatic fever, which action would be most important for the community health nurse to include? a. Vaccinate high-risk groups in the community with streptococcal vaccine. b. Teach community members to seek treatment for streptococcal pharyngitis. c. Teach about the importance of monitoring temperature when sore throats occur. d. Teach about prophylactic antibiotics to those with a family history of rheumatic fever.

b. Teach community members to seek treatment for streptococcal pharyngitis.

7. The nurse notes that the client's apical pulse is displaced to the left. What conclusion can be drawn from this assessment? a. This is a normal finding. b. The heart is hypertrophied. c. The left ventricle is contracted. d. The client has pulsus alternans.

b. The heart is hypertrophied.

a. The patient complains of moderate shortness of breath after walking 1 mile on the treadmill. b. The nurse notes a 3-lb weight gain over the course of a week. c. The patient reports an increase of heart rate of 10 beats per minute after vacuuming the floor. d. The patient reports an increase in urinary output.

b. The nurse notes a 3-lb weight gain over the course of a week.

3. Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms.

b. The pain has lasted longer than 30 minutes.

28. Which information obtained by the nurse when assessing a patient admitted with mitral valve regurgitation should be communicated to the health care provider immediately? a. The patient has 4+ peripheral edema in both legs. b. The patient has crackles audible to the lung apices. c. The patient has a palpable thrill felt over the left anterior chest. d. The patient has a loud systolic murmur all across the precordium.

b. The patient has crackles audible to the lung apices.

3. The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)? a. Fever, chills, and diaphoresis b. Urine output less than 30 mL/hr c. Petechiae on the inside of the mouth and conjunctiva d. Increase in heart rate of 15 beats/minute with walking

b. Urine output less than 30 mL/hr

2. During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would expect to find a. substernal chest pressure. b. a new regurgitant murmur. c. a pruritic rash on the chest. d. involuntary muscle movement.

b. a new regurgitant murmur.

20. When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that a. sudden cardiac death events rarely reoccur. b. additional diagnostic testing will be required. c. long-term anticoagulation therapy will be needed. d. limited physical activity after discharge will be needed to prevent future events.

b. additional diagnostic testing will be required.

6. To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest. b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border. c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub. d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.

b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border.

1. The physician has expressed concern about the development of rheumatic fever in a client with a throat infection. The nurse would explain to the client that the organism causing the infection is a. a respiratory virus. b. beta-hemolytic streptococcus. c. Escherichia coli. d. Streptococcus pneumoniae.

b. beta-hemolytic streptococcus.

10. The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the a. patient is restless and agitated. b. blood pressure is 90/54 mm Hg. c. patient complains about feeling anxious. d. cardiac monitor shows a heart rate of 61 beats/minute.

b. blood pressure is 90/54 mm Hg.

16. The patient who is taking digitalis for his heart condition becomes extremely dehydrated and has scant urine output. The nurse will assess regularly for the complaint of: a. left arm pain. b. blurred vision. c. itching. d. increasing edema.

b. blurred vision.

10. When a client is admitted to the hospital with clinical manifestations of left ventricular heart failure, the nurse would question the client about a. abdominal pain. b. breathlessness. c. leg swelling. d. nausea.

b. breathlessness.

9. Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will a. reduce the "fight or flight" response. b. decrease spasm of the coronary arteries. c. increase the force of myocardial contraction. d. help prevent clotting in the coronary arteries

b. decrease spasm of the coronary arteries.

9. Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will a. reduce heart palpitations. b. decrease spasm of the coronary arteries. c. increase the force of the heart contractions. d. help prevent plaque from forming in the coronary arteries.

b. decrease spasm of the coronary arteries.

5. A patient is admitted to the hospital with possible acute pericarditis. The nurse will plan to teach the patient about the purpose of a. electrolyte levels. b. echocardiography. c. daily blood cultures. d. cardiac catheterization.

b. echocardiography.

17. For a client waiting for a heart transplant who has been fitted with a left ventricular assist device (LVAD), the nurse would explain that the purpose of this device is to a. electrically stimulate the left ventricle to contract. b. extract blood from the left ventricle and propel it into the systemic circulation. c. measure hemodynamics of cardiac output occurring because of dysrhythmias. d. sound an alarm when the intraventricular pressure drops.

b. extract blood from the left ventricle and propel it into the systemic circulation.

14. For a client who has undergone a tissue valve replacement, the most appropriate anticipatory guidance provided by the nurse would be a. activity should be restricted to reduce stress on the valve. b. follow-up is important, since most tissue valves eventually need replacement. c. long periods of standing decreases venous return to the heart. d. modification of lifestyle can prevent associated dysrhythmias.

b. follow-up is important, since most tissue valves eventually need replacement.

1. The nurse explains that the pain of coronary artery disease (CAD) is related to: a. congestion. b. ischemia. c. edema. d. inflammation.

b. ischemia.

20. Of all the assessments the nurse has made on the new patient, those that may indicate heart failure are: (Select all that apply.) a. flushed skin. b. jugular distention. c. weight gain but eating very little. d. diminished pedal pulses. e. wearing loose house shoes rather than street shoes.

b. jugular distention. c. weight gain but eating very little. d. diminished pedal pulses. e. wearing loose house shoes rather than street shoes.

11. The nurse auscultating heart sounds notes that a client has an opening snap and a low-pitched, rumbling murmur over the apex. This assessment would indicate a. aortic stenosis. b. mitral stenosis. c. pulmonic prolapse. d. tricuspid regurgitation.

b. mitral stenosis.

22. A nurse teaches a client with heart failure about energy conservation. Which statement should the nurse include in this client's teaching? a. "Walk until you become short of breath, and then walk back home." b. "Gather everything you need for a chore before you begin." c. "Pull rather than push or carry items heavier than 5 pounds." d. "Take a walk after dinner every day to build up your strength."

b. "Gather everything you need for a chore before you begin."

15. A client with coronary artery disease (CAD) asks the nurse about taking fish oil supplements. What response by the nurse is best? a. "Fish oil is contraindicated with most drugs for CAD." b. "The best source is fish, but pills have benefits too." c. "There is no evidence to support fish oil use with CAD." d. "You can reverse CAD totally with diet and supplements."

b. "The best source is fish, but pills have benefits too."

2. A client received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin. The client's spouse asks why the client needs this medication. What response by the nurse is best? a. "The t-PA didn't dissolve the entire coronary clot." b. "The heparin keeps that artery from getting blocked again." c. "Heparin keeps the blood as thin as possible for a longer time." d. "The heparin prevents a stroke from occurring as the t-PA wears off."

b. "The heparin keeps that artery from getting blocked again."

3. A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client's O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best? a. Administer oxygen at 2 L/min. b. Allow continued bathroom privileges. c. Obtain a bedside commode. d. Suggest the client use a bedpan.

b. Allow continued bathroom privileges.

7. A client has intra-arterial blood pressure monitoring after a myocardial infarction. The nurse notes the client's heart rate has increased from 88 to 110 beats/min, and the blood pressure dropped from 120/82 to 100/60 mm Hg. What action by the nurse is most appropriate? a. Allow the client to rest quietly. b. Assess the client for bleeding. c. Document the findings in the chart. d. Medicate the client for pain.

b. Assess the client for bleeding.

4. A client is 1 day postoperative after a coronary artery bypass graft. What nonpharmacologic comfort measures does the nurse include when caring for this client? (Select all that apply.) a. Administer pain medication before ambulating. b. Assist the client into a position of comfort in bed. c. Encourage high-protein diet selections. d. Provide complementary therapies such as music. e. Remind the client to splint the incision when coughing.

b. Assist the client into a position of comfort in bed. d. Provide complementary therapies such as music. e. Remind the client to splint the incision when coughing.

24. A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia should the nurse assess? a. Preventricular contractions b. Atrial fibrillation c. Symptomatic bradycardia d. Sinus tachycardia

b. Atrial fibrillation

14. A nurse is in charge of the coronary intensive care unit. Which client should the nurse see first? a. Client on a nitroglycerin infusion at 5 mcg/min, not titrated in the last 4 hours b. Client who is 1 day post coronary artery bypass graft, blood pressure 180/100 mm Hg c. Client who is 1 day post percutaneous coronary intervention, going home this morning d. Client who is 2 days post coronary artery bypass graft, became dizzy this a.m. while walking

b. Client who is 1 day post coronary artery bypass graft, blood pressure 180/100 mm Hg

17. A nurse is caring for four clients. Which client should the nurse assess first? a. Client with an acute myocardial infarction, pulse 102 beats/min b. Client who is 1 hour post angioplasty, has tongue swelling and anxiety c. Client who is post coronary artery bypass, chest tube drained 100 mL/hr d. Client who is post coronary artery bypass, potassium 4.2 mEq/L

b. Client who is 1 hour post angioplasty, has tongue swelling and anxiety

6. A client has hemodynamic monitoring after a myocardial infarction. What safety precaution does the nurse implement for this client? a. Document pulmonary artery wedge pressure (PAWP) readings and assess their trends. b. Ensure the balloon does not remain wedged. c. Keep the client on strict NPO status. d. Maintain the client in a semi-Fowler's position.

b. Ensure the balloon does not remain wedged.

20. A home health care nurse is visiting an older client who lives alone after being discharged from the hospital after a coronary artery bypass graft. What finding in the home most causes the nurse to consider additional referrals? a. Dirty carpets in need of vacuuming b. Expired food in the refrigerator c. Old medications in the kitchen d. Several cats present in the home

b. Expired food in the refrigerator

16. A client has presented to the emergency department with an acute myocardial infarction (MI). What action by the nurse is best to meet The Joint Commission's Core Measures outcomes? a. Obtain an electrocardiogram (ECG) now and in the morning. b. Give the client an aspirin. c. Notify the Rapid Response Team. d. Prepare to administer thrombolytics.

b. Give the client an aspirin.

1. A nursing student learns about modifiable risk factors for coronary artery disease. Which factors does this include? (Select all that apply.) a. Age b. Hypertension c. Obesity d. Smoking e. Stress

b. Hypertension c. Obesity d. Smoking e. Stress

9. A nurse assesses a client who is diagnosed with infective endocarditis. Which assessment findings should the nurse expect? (Select all that apply.) a. Weight gain b. Night sweats c. Cardiac murmur d. Abdominal bloating e. Osler's nodes

b. Night sweats c. Cardiac murmur e. Osler's nodes

19. The nurse is caring for a client with a chest tube after a coronary artery bypass graft. The drainage slows significantly. What action by the nurse is most important? a. Increase the setting on the suction. b. Notify the provider immediately. c. Re-position the chest tube. d. Take the tubing apart to assess for clots.

b. Notify the provider immediately.

4. The nurse is assessing a client in an outpatient clinic. Which client statement alerts the nurse to possible left-sided heart failure? a. "I have been drinking more water than usual." b. "I have been awakened by the need to urinate at night." c. "I have to stop halfway up the stairs to catch my breath." d. "I have experienced blurred vision on several occasions."

c. "I have to stop halfway up the stairs to catch my breath."

5. After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. "I can expect some nausea as a side effect of nitroglycerin." b. "I should only take the nitroglycerin if I start to have chest pain." c. "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart." d. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."

c. "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart."

15. A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. "I will be sure to take the medication with food." b. "I will need to eat more potassium-rich foods in my diet." c. "I will call for help when I need to get up to use the bathroom." d. "I will expect to feel more short of breath for the next few days."

c. "I will call for help when I need to get up to use the bathroom."

18. In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? a. "I will check my pulse rate before I take any nitroglycerin tablets." b. "I will put the nitroglycerin patch on as soon as I get any chest pain." c. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue." d. "I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin."

c. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."

30. Which statement by a patient with restrictive cardiomyopathy indicates that the nurse's discharge teaching about self-management has been most effective? a. "I will avoid taking aspirin or other antiinflammatory drugs." b. "I will need to limit my intake of salt and fluids even in hot weather." c. "I will take antibiotics when my teeth are cleaned at the dental office." d. "I should begin an exercise program that includes things like biking or swimming."

c. "I will take antibiotics when my teeth are cleaned at the dental office."

3. The community health nurse assesses clients at a health fair. Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease? a. "Would you please state your full name and birth date?" b. "Have you ever had an exercise tolerance stress test?" c. "In what activities do you participate on a daily basis?" d. "Does anyone in your family have a history of heart disease?"

c. "In what activities do you participate on a daily basis?"

14. A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. "Do you have any allergies?" b. "Do you take aspirin on a daily basis?" c. "What time did your chest pain begin?" d. "Can you rate your chest pain using a 0 to 10 scale?"

c. "What time did your chest pain begin?"

29. The nurse is providing discharge education to a client with hypertrophic cardiomyopathy (HCM). What priority instruction will the nurse include? a. "Take your digoxin at the same time every day." b. "You should begin an aerobic exercise program." c. "You should report episodes of dizziness or fainting." d. "You may have only two alcoholic drinks daily."

c. "You should report episodes of dizziness or fainting."

4. The nurse teaches a client who is newly diagnosed with coronary artery disease. Which instruction does the nurse include to minimize complications of this disease? a. "Rest is the best medicine at this time. Do not start an exercise program." b. "You are a man; therefore there is nothing you can do to minimize your risks." c. "You should talk to your provider about medications to help you quit smoking." d. "Decreasing the carbohydrates in your diet will help you lose weight."

c. "You should talk to your provider about medications to help you quit smoking."

10. The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed. Which response by the nurse is most accurate? a. "We will only roll you to the same side as the catheter insertion site." b. "You will lay flat for several hours, and we will place a sandbag over the dressing in the groin." c. "You will most likely be up and about within about 2 hours after the procedure if your doctor uses an arterial closure device at the catheter insertion site." d. "We will encourage you to flex and extend your legs when you return from the procedure to prevent a clot from forming at the insertion site."

c. "You will most likely be up and about within about 2 hours after the procedure if your doctor uses an arterial closure device at the catheter insertion site."

38. The nurse has just received change-of-shift report about the following four patients. Which patient should the nurse assess first? a. 38-year-old who has pericarditis and is complaining of sharp, stabbing chest pain b. 45-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge c. 51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI) d. 60-year-old with variant angina who is to receive a scheduled dose of nifedipine (Procardia)

c. 51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

1. A client is admitted with early-stage heart failure. Which assessment finding does the nurse expect? a. A decrease in blood pressure and urine output b. An increase in creatinine and extremity edema c. An increase in heart rate and respiratory rate d. A decrease in respirations and oxygen saturation

c. An increase in heart rate and respiratory rate

29. Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are effective? a. Assess for the presence of a paradoxical pulse. b. Monitor for changes in the patient's sedimentation rate. c. Assess for the presence of jugular venous distention (JVD). d. Check the electrocardiogram (ECG) for ST segment changes.

c. Assess for the presence of jugular venous distention (JVD).

17. A patient is recovering from a myocardial infarction (MI) and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? a. Assess the feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias.

c. Auscultate for a pericardial friction rub.

17. A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation.

c. Auscultate the breath sounds.

13. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c. B-type natriuretic peptide

3. Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. Need to begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider

c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

23. An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue

c. Blood pressure (BP) of 88/42 mm Hg

11. A client who presented with an acute myocardial infarction is prescribed thrombolytic therapy. The client had a stroke 1 month ago. Which action does the nurse take? a. Administer the medication as prescribed. b. Perform a CT scan before administering the medication. c. Contact the health care provider to discontinue the prescribed therapy. d. Administer the therapy with a normal saline bolus.

c. Contact the health care provider to discontinue the prescribed therapy.

14. Following a cardiac catheterization with coronary angiography, the physician writes an order to increase the patient's fluid intake. The nurse knows that increasing the fluid intake is ordered for what reason? a. Reducing the nausea related to the dye absorption b. Maintaining adequate blood pressure and perfusion c. Diluting the urine to prevent kidney damage d. Making up for fluid lost during the angiogram

c. Diluting the urine to prevent kidney damage

15. Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response to the activity, which assessment data would indicate that the exercise level should be decreased? a. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg. b. Oxygen saturation drops from 99% to 95%. c. Heart rate increases from 66 to 92 beats/minute. d. Respiratory rate goes from 14 to 20 breaths/minute.

c. Heart rate increases from 66 to 92 beats/minute.

2. Which nursing intervention will be most effective when assisting the patient with coronary artery disease (CAD) to make appropriate dietary changes? a. Give the patient a list of low-sodium, low-cholesterol foods that should be included in the diet. b. Emphasize the increased risk for heart problems unless the patient makes the dietary changes. c. Help the patient modify favorite high-fat recipes by using monosaturated oils when possible. d. Inform the patient that a diet containing no saturated fat and minimal salt will be necessary.

c. Help the patient modify favorite high-fat recipes by using monosaturated oils when possible.

25. Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 168/94 c. Jugular venous distention (JVD) to jaw level d. Level 6 (0 to 10 scale) chest pain with a deep breath

c. Jugular venous distention (JVD) to jaw level

14. A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which information will the nurse include? a. Biologic replacement valves require the use of immunosuppressive drugs. b. Mechanical mitral valves require replacement approximately every 5 years. c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.

c. Lifelong anticoagulant therapy is needed after mechanical valve replacement.

14. A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

c. Lifelong anticoagulant therapy will be needed after mechanical valve replacement.

24. A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patient's blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.

c. Monitor the patient's blood pressure and heart rate every hour.

18. A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which ordered PRN medication will be the most appropriate for the nurse to give? a. Fentanyl 1 mg IV b. IV morphine sulfate 4 mg c. Oral ibuprofen (Motrin) 600 mg d. Oral acetaminophen (Tylenol) 650 mg

c. Oral ibuprofen (Motrin) 600 mg

18. A patient who has had recent cardiac surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer? a. Fentanyl 2 mg IV b. IV morphine sulfate 6 mg c. Oral ibuprofen (Motrin) 800 mg d. Oral acetaminophen (Tylenol) 650 mg

c. Oral ibuprofen (Motrin) 800 mg

28. Which assessment finding by the nurse who is caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the physician? a. Complaints of incisional chest pain b. Crackles audible at both lung bases c. Pallor and weakness of the right hand d. Redness on either side of the chest incision

c. Pallor and weakness of the right hand

22. The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for which patient? a. Patient admitted with a large acute myocardial infarction. b. Patient being discharged after an exacerbation of heart failure. c. Patient who had a mitral valve replacement with a mechanical valve. d. Patient being treated for rheumatic fever after a streptococcal infection.

c. Patient who had a mitral valve replacement with a mechanical valve.

22. A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

c. Serum potassium level 3.0 mEq/L after 1 week of therapy

30. The nurse reminds the client who has received a heart transplant to change positions slowly. Why is this instruction a priority? a. Rapid position changes can create shear and friction forces, which can tear out internal vascular sutures. b. The new vascular connections are more sensitive to position changes, leading to increased intravascular pressure. c. The new heart is denervated and is unable to respond to decreases in blood pressure caused by position changes. d. The recovering heart diverts blood flow away from the brain when the client stands, increasing the risk for stroke.

c. The new heart is denervated and is unable to respond to decreases in blood pressure caused by position changes.

15. The nurse is assessing a client who has left ventricular failure secondary to a myocardial infarction. Which clinical manifestation of poor organ perfusion does the nurse monitor for in this client? a. Headache b. Hypertension c. Urine output of less than 30 mL/hr d. Heart rate of 55 to 60 beats/min

c. Urine output of less than 30 mL/hr

16. During the administration of the thrombolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences a. bleeding from the gums. b. increase in blood pressure. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

c. a decrease in level of consciousness.

4. IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

c. a systolic BP <90 mm Hg.

18. A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurse's priority action will be to a. have the patient recall the dietary intake for the last 3 days. b. ask the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of restricting dietary sodium.

c. assess the patient for clinical manifestations of acute heart failure.

7. The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient a. uses an additional pillow to sleep when feeling short of breath at night. b. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. c. calls the clinic when the weight increases from 124 to 130 pounds in a week. d. says that the nitroglycerin patch will be used for any chest pain that develops.

c. calls the clinic when the weight increases from 124 to 130 pounds in a week.

13. When the a client with left ventricular heart failure complains that she has to get up several times during the night to urinate, the nurse would explain that this bothersome event is a. a late clinical manifestation of heart failure. b. an indication that the right ventricle is being affected. c. caused by an increase in blood flow to the kidneys when lying down. d. the result of increased secretion of aldosterone at night.

c. caused by an increase in blood flow to the kidneys when lying down.

6. To prevent a post-procedure complication, nursing care of a client after a percutaneous transluminal coronary angioplasty (PTCA) generally would include a. administering heparin. b. assessing for clinical manifestations of shock. c. forcing fluids. d. maintaining the client flat in bed for 24 hours.

c. forcing fluids.

1. While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. increased right atrial pressure. d. incompetent jugular vein valves.

c. increased right atrial pressure.

15. A client with heart failure has been prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse would explain that this drug alleviates manifestations of heart failure by a. decreasing circulating volume. b. increasing myocardial contractility. c. increasing vasodilation. d. slowing atrioventricular conduction time.

c. increasing vasodilation.

3. In advising a client with higher levels of high-density lipoproteins (HDLs) in proportion to low-density lipoproteins (LDLs), the nurse would suggest that the client a. consult the physician for an anticholesterol prescription. b. initiate a moderate exercise program. c. is less likely to develop CHD. d. should consider a reduced-fat diet.

c. is less likely to develop CHD.

4. The patient with severe congestive heart failure (CHF) does not want to take the morphine ordered, stating that he is not in pain and he is fearful of becoming addicted. The nurse can allay anxiety by explaining that the morphine: a. is given to many people with CHF. b. can be omitted and relief can be obtained with NSAIDs. c. is used to relieve anxiety and air hunger. d. is the only drug that can be used for CHF patients.

c. is used to relieve anxiety and air hunger.

3. When performing cardiac auscultation on a client with mitral valve prolapse, the nurse would anticipate hearing a a. harsh, systolic murmur. b. loud S2 heart sound. c. midsystolic click. d. prominent S4 heart sound.

c. midsystolic click.

1. A client had a PTCA with stent placement. Nursing care that can be delegated to the unlicensed assistive personnel (UAP) after the procedure includes (Select all that apply) a. assessing the distal pulses every 15-30 minutes. b. calling for an ECG immediately if the client has angina. c. monitoring vital signs every 15-30 minutes. d. providing the client with plenty of fluids to drink. e. reminding the client to remain flat in bed.

c. monitoring vital signs every 15-30 minutes. d. providing the client with plenty of fluids to drink. e. reminding the client to remain flat in bed.

9. The change in vital signs that would most strongly suggest cardiac tamponade to the nurse is a. bradycardia. b. muffled heart sounds. c. narrowing pulse pressure. d. tachypnea.

c. narrowing pulse pressure.

17. During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on the a. use of daily aspirin for anticoagulation. b. correct method for taking the radial pulse. c. need for frequent laboratory blood testing. d. need to avoid any physical activity for 1 month.

c. need for frequent laboratory blood testing.

9. The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute.

c. notify the health care provider if nausea develops.

5. A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as a. orthopnea. b. pulsus alternans. c. paroxysmal nocturnal dyspnea. d. acute bilateral pleural effusion.

c. paroxysmal nocturnal dyspnea.

15. The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI). The nurse recognizes this finding as an indicator of: a. a recurrent MI. b. pleural effusion. c. pericarditis. d. angina.

c. pericarditis.

16. When a client with heart failure is receiving loop diuretics, the nurse would be sure to monitor serum a. calcium levels. b. enzyme levels. c. potassium levels. d. sodium levels.

c. potassium levels.

41. A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten). The nurse should teach the patient that the primary purpose of captopril is to a. lower heart rate. b. control blood glucose levels. c. prevent changes in heart muscle. d. reduce the frequency of chest pain.

c. prevent changes in heart muscle.

7. The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is applied when any chest pain develops. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. d. an additional pillow can help her sleep if she is feeling short of breath at night.

c. she will call the clinic if her weight goes from 124 to 128 pounds in a week.

13. When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. shortness of breath on exertion. d. right upper quadrant tenderness.

c. shortness of breath on exertion.

19. When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for the development of a. flank pain. b. splenomegaly. c. shortness of breath. d. mental status changes.

c. shortness of breath.

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

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

24. The provider requests the nurse start an infusion of an inotropic agent on a client. How does the nurse explain the action of these drugs to the client and spouse? a. "It constricts vessels, improving blood flow." b. "It dilates vessels, which lessens the work of the heart." c. "It increases the force of the heart's contractions." d. "It slows the heart rate down for better filling."

c. "It increases the force of the heart's contractions."

23. A client presents to the emergency department with an acute myocardial infarction (MI) at 1500 (3:00 PM). The facility has 24-hour catheterization laboratory abilities. To meet The Joint Commission's Core Measures set, by what time should the client have a percutaneous coronary intervention performed? a. 1530 (3:30 PM) b. 1600 (4:00 PM) c. 1630 (4:30 PM) d. 1700 (5:00 PM)

c. 1630 (4:30 PM)

10. A client in the cardiac stepdown unit reports severe, crushing chest pain accompanied by nausea and vomiting. What action by the nurse takes priority? a. Administer an aspirin. b. Call for an electrocardiogram (ECG). c. Maintain airway patency. d. Notify the provider.

c. Maintain airway patency.

22. A client had an acute myocardial infarction. What assessment finding indicates to the nurse that a significant complication has occurred? a. Blood pressure that is 20 mm Hg below baseline b. Oxygen saturation of 94% on room air c. Poor peripheral pulses and cool skin d. Urine output of 1.2 mL/kg/hr for 4 hours

c. Poor peripheral pulses and cool skin

13. A client has an intra-arterial blood pressure monitoring line. The nurse notes bright red blood on the client's sheets. What action should the nurse perform first? a. Assess the insertion site. b. Change the client's sheets. c. Put on a pair of gloves. d. Assess blood pressure.

c. Put on a pair of gloves.

1. A client is receiving an infusion of tissue plasminogen activator (t-PA). The nurse assesses the client to be disoriented to person, place, and time. What action by the nurse is best? a. Assess the client's pupillary responses. b. Request a neurologic consultation. c. Stop the infusion and call the provider. d. Take and document a full set of vital signs.

c. Stop the infusion and call the provider.

16. The nurse is starting a client on digoxin (Lanoxin) therapy. What intervention is essential to teach this client? a. "Avoid taking aspirin or aspirin-containing products." b. "Increase your intake of foods high in potassium." c. "Hold this medication if your pulse rate is below 80 beats/min." d. "Do not take this medication within 1 hour of taking an antacid."

d. "Do not take this medication within 1 hour of taking an antacid."

1. The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? a. "Do you have a history of a heart attack?" b. "Is there a family history of endocarditis?" c. "Have you had any recent immunizations?" d. "Have you had dental work done recently?"

d. "Have you had dental work done recently?"

11. The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when a 30-year-old recovering from rheumatic fever without carditis says which of the following? a. "I will need prophylactic antibiotic therapy for 5 years." b. "I will need to take aspirin or ibuprofen (Motrin) to relieve my joint pain." c. "I will call the doctor if I develop excessive fatigue or difficulty breathing." d. "I will be immune to further episodes of rheumatic fever after this infection."

d. "I will be immune to further episodes of rheumatic fever after this infection."

6. Which statement made by a patient with coronary artery disease after the nurse has completed teaching about therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? a. "I will switch from whole milk to 1% milk." b. "I like salmon and I will plan to eat it more often." c. "I can have a glass of wine with dinner if I want one." d. "I will miss being able to eat peanut butter sandwiches."

d. "I will miss being able to eat peanut butter sandwiches."

7. The nurse evaluates the need for further instruction on reduction of caffeine when the patient who has an arrhythmia says: a. "I've cut my coffee from 10 cups to 2 cups a day." b. "I don't drink regular cola drinks anymore." c. "I have given up drinking those high-energy drinks." d. "I've switched from 5 cups of coffee to 5 cups of tea."

d. "I've switched from 5 cups of coffee to 5 cups of tea."

20. A client with a history of heart failure is being discharged. Which priority instruction will assist the client in the prevention of complications associated with heart failure? a. "Avoid drinking more than 3 quarts of liquids each day." b. "Eat six small meals daily instead of three larger meals." c. "When you feel short of breath, take an additional diuretic." d. "Weigh yourself daily while wearing the same amount of clothing."

d. "Weigh yourself daily while wearing the same amount of clothing."

32. A client with end-stage heart failure is awaiting a transplant. The client appears depressed and states, "I know a transplant is my last chance, but I don't want to become a vegetable." What is the nurse's best response? a. "Would you like to speak with a priest or chaplain?" b. "I will consult a psychiatrist to speak with you." c. "Do you want to come off the transplant list?" d. "Would you like information about advance directives?"

d. "Would you like information about advance directives?"

1. The nurse would assess that the individual most at risk for death from coronary heart disease (CHD) is a a. 30-year-old Hispanic woman. b. 42-year-old Caucasian woman. c. 55-year-old Asian man. d. 62-year-old African American woman.

d. 62-year-old African American woman.

14. The client who just started taking isosorbide dinitrate (Imdur) reports a headache. What is the nurse's best action? a. Titrate oxygen to relieve headache. b. Hold the next dose of Imdur. c. Instruct the client to drink water. d. Administer PRN acetaminophen.

d. Administer PRN acetaminophen.

10. A client has been admitted to the intensive care unit with worsening pulmonary manifestations of heart failure. What is the nurse's best action? a. Place the client in a high Fowler's position. b. Begin cardiopulmonary resuscitation (CPR). c. Promote rest and minimize activities. d. Administer loop diuretics as prescribed.

d. Administer loop diuretics as prescribed.

16. A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. Furosemide (Lasix) 60 mg b. Captopril (Capoten) 25 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg

d. Carvedilol (Coreg) 3.125 mg

34. Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG) technicians working on the cardiac unit? a. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome. b. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis. c. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy. d. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

d. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

9. Heart disease in women is manifested by a variety of subtle signs. Which sign is typically seen in women? a. Fainting b. Chest pain c. Dizziness d. Fatigue

d. Fatigue

24. A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when giving the medication? a. Administer the medication at the patient's bedtime. b. Have the patient take this medication with an aspirin. c. Encourage the patient to take the colesevelam with a sip of water. d. Give the patient's other medications 2 hours after the colesevelam.

d. Give the patient's other medications 2 hours after the colesevelam.

26. The nurse is obtaining the admission health history for a young adult who presents with fever, dyspnea, and a murmur. What priority data does the nurse inquire about? a. Family history of coronary artery disease b. Recent travel to Third World countries c. Pet ownership, especially cats with litter boxes d. History of a systemic infection within the past month

d. History of a systemic infection within the past month

20. A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder? a. A heart transplant should be scheduled as soon as possible. b. Elevating the legs above the heart will help relieve dyspnea. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

17. A client is taking triamterene-hydrochlorothiazide (Dyazide) and furosemide (Lasix). What assessment finding requires action by the nurse? a. Cough b. Headache c. Pulse of 62 beats/min d. Potassium of 2.9 mEq/L

d. Potassium of 2.9 mEq/L

2. The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 pounds in 24 hours b. Hourly urine output greater than 60 mL c. Reduction in patient complaints of chest pain d. Reduced dyspnea with the head of bed at 30 degrees

d. Reduced dyspnea with the head of bed at 30 degrees

4. Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? a. The patient states that the pain "wakes me up at night." b. The patient rates the pain at a level 3 to 5 (0 to 10 scale). c. The patient states that the pain has increased in frequency over the last week. d. The patient states that the pain "goes away" with one sublingual nitroglycerin tablet.

d. The patient states that the pain "goes away" with one sublingual nitroglycerin tablet.

21. The nurse is obtaining a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which information obtained by the nurse is most important? a. The patient has a history of a recent upper respiratory infection. b. The patient has a family history of coronary artery disease (CAD). c. The patient reports using cocaine a "couple of times" as a teenager. d. The patient's 29-year-old brother died from a sudden cardiac arrest.

d. The patient's 29-year-old brother died from a sudden cardiac arrest.

11. Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. b. b-adrenergic blockers. c. calcium channel blockers. d. angiotensin-converting enzyme (ACE) inhibitors.

d. angiotensin-converting enzyme (ACE) inhibitors.

15. While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to a. take antibiotics before any dental appointments. b. limit physical activity to avoid stressing the heart. c. take an aspirin a day to prevent clots from forming on the valve. d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

1. When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the a. family history of coronary artery disease. b. increased risk associated with the patient's gender. c. increased risk of cardiovascular disease as people age. d. elevation of the patient's low-density lipoprotein (LDL) level.

d. elevation of the patient's low-density lipoprotein (LDL) level.

2. The nurse would explain to a client who smokes that the nicotine in cigarette smoke increases the prevalence of CHD by a. causing proliferation of smooth muscle cells. b. decreasing the oxygen-carrying capacity of the blood. c. increasing fat deposits along the intima of blood vessels. d. increasing the heart rate and the risk of dysrhythmia.

d. increasing the heart rate and the risk of dysrhythmia.

8. When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. eggs and other high-protein foods. d. milk, yogurt, and other milk products.

d. milk, yogurt, and other milk products.

16. The nurse would stress in a discharge teaching plan for a client recovering from endocarditis that to avoid further complication, the client should a. become actively involved in social and community activities. b. drink at least 1000 ml of fluid daily to ensure adequate hydration. c. initiate a comprehensive daily exercise program. d. notify the physician when invasive dental procedures are planned.

d. notify the physician when invasive dental procedures are planned.

8. The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The priority intervention by the nurse for this problem is to a. teach the patient to take deep, slow breaths to control the pain. b. force fluids to 3000 mL/day to decrease fever and inflammation. c. remind the patient to request opioid pain medication every 4 hours. d. place the patient in Fowler's position, leaning forward on the overbed table.

d. place the patient in Fowler's position, leaning forward on the overbed table

6. To help relieve the discomfort of a client with pericarditis who is experiencing pain, the nurse would position the client a. flat in bed. b. in semi-Fowler's position. c. prone. d. sitting upright.

d. sitting upright.

11. Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and heart rate. b. fewer complaints of having cold hands and feet. c. improvement in the strength of the distal pulses. d. the ability to do daily activities without chest pain.

d. the ability to do daily activities without chest pain.

10. The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if a. the patient is restless and agitated. b. the blood pressure is 190/110 mm Hg. c. the patient complains about feeling anxious. d. the cardiac monitor shows a heart rate of 45.

d. the cardiac monitor shows a heart rate of 45.

2. The nurse teaching a class on long-term effects of rheumatic fever would stress that the most common problem following bouts of rheumatic fever is a. cardiac tamponade. b. coronary artery disease. c. pericarditis. d. valvular disorders.

d. valvular disorders.

12. The nurse is preparing to change a client's sternal dressing. What action by the nurse is most important? a. Assess vital signs. b. Don a mask and gown. c. Gather needed supplies. d. Perform hand hygiene.

d. Perform hand hygiene.

5. A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 0.5 mm Hg. What action by the nurse is most appropriate? a. Level the transducer at the phlebostatic axis. b. Lay the client in the supine position. c. Prepare to administer diuretics. d. Prepare to administer a fluid bolus.

d. Prepare to administer a fluid bolus.

23. A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side of the neck. Which nonpharmacologic comfort measure should the nurse implement? a. Apply an ice pack to the client's chest. b. Provide a neck rub, especially on the left side. c. Allow the client to lie in bed with the lights down. d. Sit the client up with a pillow to lean forward on.

d. Sit the client up with a pillow to lean forward on.

8. A client is in the preoperative holding area prior to an emergency coronary artery bypass graft (CABG). The client is yelling at family members and tells the doctor to "just get this over with" when asked to sign the consent form. What action by the nurse is best? a. Ask the family members to wait in the waiting area. b. Inform the client that this behavior is unacceptable. c. Stay out of the room to decrease the client's stress levels. d. Tell the client that anxiety is common and that you can help.

d. Tell the client that anxiety is common and that you can help.