NCLEX Questions: Coronary Artery Disease & Hypertension

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: A. The same as the client's own baseline level B. Lower than the needed therapeutic level C. Within the therapeutic range D. Higher than the therapeutic range

C. Within the therapeutic range The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus.

The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: A. Headache B. High BP C. Shortness of breath D. Stomach cramps

A. Headache Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, & dizziness. The client should lie or sit down to avoid fainting.

A 60 year old male client comes into the ER with complaints of crushing chest pain that radiates to his shoulder & left arm. The admitting diagnosis is acute MI. Immediate admission orders include oxygen by NC at 4L/min, blood work, chest x-ray, an ECG, & 2 mg of morphine given intravenously. The nurse should first: A. Administer the morphine B. Obtain a 12-lead ECG C. Obtain the lab work D. Order the chest x-ray

A. Administer the morphine Although obtaining the ECG, chest x-ray, & blood work are all important, the nurse's priority action would be to relieve the crushing chest pain.

Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? A. A change in the pattern of her pain B. Pain during sex C. Pain during an argument with her husband D. Pain during or after an activity such as lawn mowing

A. A change in the pattern of her pain A client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: A. Blocks beta-adrenergic stimulation & thus causes decreased heart rate, myocardial contractility, & conduction B. Increases norepinephrine secretion & thus decreases BP & HR C. Is a potent arterial & venous vasodilator that reduces peripheral vascular resistance & lowers BP D. Is an angiotensin-converting enzyme inhibitor that reduces BP by blocking the conversion of angiotensin I to angiotensin II

A. Blocks beta-adrenergic stimulation & thus causes decreased heart rate, myocardial contractility, & conduction Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing HR, decreasing myocardial contractility, & slowing conduction

Hypertension is known as the silent killer. This phrase is associated with the fact that HTN often goes undetected until symptoms of other system failures occur. This may occur in the form of: A. Cerebrovascular accident B. Liver disease C. Myocardial infarction D. Pulmonary disease

A. Cerebrovascular accident HTN is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the HTN may go undetected. CVA's can be related to long-term HTN. Myocardial infarction is generally related to coronary artery disease

A client wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: A. Check the client status & lead placement B. Press the recorder button on the electrocardiogram console C. Call the physician D. Call a code blue

A. Check the client status & lead placement Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client & equipment is necessary to determine the cause & identify the appropriate intervention.

When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. A. Reflects electrical impulse beginning at the SA node. B. Indicated electrical impulse beginning at the AV node. C. Reflects atrial muscle depolarization. D. Identifies ventricular muscle depolarization. E. Has duration of normally 0.11 seconds or less.

A. Reflects electrical impulse beginning at the SA node. C. Reflects atrial muscle depolarization. E. Has duration of normally 0.11 seconds or less. In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. The P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less & 2.5 mm or more in height.

A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? A. Review the intake and output records for the last 2 days. B. Change the time of diuretic administration from morning to evening. C. Request a sodium restriction of 1 g/day from the physician. D. Order daily weights starting the following morning.

A. Review the intake & output records for the last 2 days. Edema, the accumulation of excess fluid in the interstitial spaces can be measured by intake greater than output & a sudden increase in weight. Diuretics should not be given in the evening. Strict sodium restrictions are reserved for clients with severe symptoms

The physician refers the client with unstable angina for a cardiac catherization. The nurse explains to the client that this procedure is being used in this specific case to: a. Open and dilate the blocked coronary arteries b. Assess the extent of arterial blockage c. Bypass obstructed vessels d. Assess the functional adequacy of the valves and heart muscle.

B. Assess the extent of arterial blockage Cardiac catheterization is done in clients with angina primarily to assess the extent & severity of coronary artery blockage.

A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. The nurse should plan to allow for which client activity? A. Strict bed rest for 24 hours after transfer B. Bathroom privileges and self-care activities C. Ad lib activities because the client is monitored D. Unsupervised hallway ambulation with distances under 200 feet

B. Bathroom privileges & self-care activities On transfer from the CCU, the client is allowed self-care activities & bathroom privileges. Supervised ambulation for brief distances are encouraged and the distances are gradually increased.

When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: A. Help keep him well hydrated B. Dissolve clots he may have C. Prevent kidney failure D. Treat potential cardiac arrhythmias

B. Dissolve clots he may have Thrombolytic drugs are administered within the first 6 hrs after onset of a MI to lyse clots & reduce the extent of myocardial damage

When do coronary arteries primarily receive blood flow? A. During inspiration B. During diastolic C. During expiration D. During systole

B. During diastolic Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow.

As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug's principle effects are produced by: a. Antispasmotic effect on the pericardium b. Causing an increased mycocardial oxygen demand c. Vasodilation of peripheral vasculature d. Improved conductivity in the myocardium

C. Vasodilation of peripheral vasculature Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption & demand. Vasodilation in coronary arteries & collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand.

A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: A. Stimulates the breakdown of specific clotting factors by the liver, & it takes 2-3 days for this to exert to an anticoagulant effect. B. Inhibits synthesis of specific clotting factors in the liver, & it takes 3-4 days for this medication to exert an anticoagulant effect. C. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin D. Has the same mechanism of action as heparin, & the crossover time is needed for the serum level of warfarin to be therapeutic

B. Inhibits synthesis of specific clotting factors in the liver, & it takes 3-4 days for this medication to exert an anticoagulant effect Warfarin works in the liver & inhibits synthesis of four vitamin K-dependent clotting factors. But it takes 3-4 days before the therapeutic effect of warfarin is exhibited.

A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: A. Call for the doctor. B. Start an intravenous line. C. Obtain a portable chest radiograph. D. Draw blood for laboratory studies.

B. Start an intravenous line Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.

A client with no history of cardiovascular disease comes to the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which question should best help a nurse discriminate pain caused by a non-cardiac problem? A. "Can you describe the pain to me?" B. "Have you ever had this pain before?" C. "Does the pain get worse when you breathe in?" D. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"

C. "Does the pain get worse when you breathe in?" Chest pain is assessed by using the standard pain assessment parameters. Pain of pleuropulmonary origin usually worsens on inspiration.

Which of the following arteries primarily feeds the anterior wall of the heart? A. Circumflex artery B. Internal mammary artery C. Left anterior descending artery D. Right coronary artery

C. Left anterior descending artery The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart.

The most important long-term goal for a client with HTN would be to: A. Learn how to avoid stress B. Explore a job change or early retirement C. Make a commitment to long-term therapy D. Control high BP

C. Make a commitment to long-term therapy The priority goal is compliance. In most clients, hypertensive clients require lifelong treatment & their HTN cannot be managed successfully without drug therapy.

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

C. Take a nitroglycerin tablet before climbing the stairs. Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free.

Sublingual Nitroglycerin tablets begin to work within 1-2 mins. How should the nurse instruct the client to use the drug when chest pain occurs? A. Take one tablet every 2-5 mins until the pain stops B. Take one tablet & rest for 10 mins. Call the physician if pain persists after 10 mins. C. Take one tablet, then an additional tablet every 5 mins for a total of 3 tablets. Call the physician if pain persists after 3 tablets. D. Take one tablet. If pain persists after 5 mins, take 2 tablets. If pain still persists 5 mins later, call the physician.

C. Take one tablet, then an additional tablet every 5 mins for a total of 3 tablets. Call the physician if pain persists after 3 tablets. Sublingual nitroglycerin appears in the bloodstream within 2-3 mins & is metabolized within about 10 mins.

A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure? A. Intake & output B. Baseline peripheral pulse rates C. Height & weight D. Allergy to iodine or shellfish

D. Allergy to iodine or shellfish This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction & possible anaphylaxis is serious & must be assessed before the procedure.

The nurse receives emergency lab results for a client with chest pain & immediately informs the physician. An increased myoglobin level suggests which of the following? A. Cancer B. Hypertension C. Liver disease D. Myocardial infarction

D. Myocardial infarction Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced & peaks within 4-6 hours after infarction. (Less than 90 mg/L is normal)

IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? A. Vitamin K B. Aminocaporic acid C. Potassium chloride D. Protamine sulfate

D. Protamine sulfate The antidote to heparin is protamine sulfate & should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for Warfarin.

A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? A. Seating the client with arm bared, supported, and at heart level B. Measuring the blood pressure after the client has been seated quietly for 5 mins C. Using a cuff with a rubber bladder that encircles at least 80% of the limb D. Taking a blood pressure within 15 mins after nicotine or caffeine ingestion

D. Taking a blood pressure within 15 mins after nicotine or caffeine ingestion BP should be taken with the client seated with the arm bared, positioned with support at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 mins preceding the measurement. The client should rest quietly for 5 mins before the reading is taken.