Perfusion Practice Assessment: CAD/MI

A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? A) Coronary artery disease B) Raynaud's disease C) Cardiogenic shock D) Venous occlusive disease

A) Coronary artery disease

Which term describes the amount of blood ejected per heartbeat? A) cardiac output B) ejection fraction C) stroke volume D) afterload

C) stroke volume

The nurse is teaching a client about the functionality of heart muscle. What factor may decrease a client's myocardial contractility? A) acidosis B) alkalosis C) sympathetic activity D) administration of digoxin

A) acidosis

Which test used to diagnose heart disease is least invasive? A) transthoracic echocardiography B) magnetic resonance imaging C) cardiac catheterization D) coronary arteriography

A) transthoracic echocardiography

The nurse cares for a client with diabetes who is scheduled for a cardiac catheterization. Prior to the procedure, it is most important for the nurse to ask which question? A) "Are you allergic to shellfish?" B) "Are you having chest pain?" C) "When was the last time you ate or drank?" D) "What was your morning blood sugar reading?"

A) "Are you allergic to shellfish?"

The nurse is administering a stool softener to a client who experienced a myocardial infarction. The client says, "I had a heart attack; I don't have a problem with constipation." What explanation will the nurse use to answer the client's question? A) "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous." B) "The heart attack sets you up for limited activity, so constipation is often a problem for clients after a heart attack." C) "Please talk this over with your healthcare provider for further information." D) "The prescribed stool softener will decrease stress with a bowel movement and protect your heart from further injury."

A) "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous."

The nurse is conducting patient teaching about cholesterol levels in the body. When discussing the patient's elevated low-density lipoprotein (LDL) and lowered high-density lipoprotein (HDL) levels, the patient shows an understanding of the significance of these levels by stating what? A) "Increased LDL and decreased HDL increase my risk of coronary artery disease." B) "Increased LDL and decreased HDL decrease my risk of coronary artery disease." C) "The decreased HDL level will increase the amount of cholesterol moved away from the artery walls." D) "The increased LDL will decrease the amount of cholesterol deposited on the artery walls."

A) "Increased LDL and decreased HDL increase my risk of coronary artery disease."

The nurse is calculating a cardiac patient's pulse pressure. If the patient's blood pressure is 122/76 mm Hg, what is the patient's pulse pressure? A) 46 mm Hg B) 99 mm Hg C) 198 mm Hg D) 76 mm Hg

A) 46 mm Hg

The nurse is assisting the client to manage the cardiovascular risk factors of hyperlipidemia and hypertension. The client asks the nurse what type of a diet would be best to follow. What is the best response by the nurse? A) A diet low in sodium, fat, cholesterol B) A diet high in transfats and potassium C) A diet with restricted fruits and fluids D) A diet with high sodium, fruits, vegetables

A) A diet low in sodium, fat, cholesterol

The nurse working on a cardiac care unit is caring for a patient whose stroke volume has increased. The nurse is aware that afterload influences a patient's stroke volume. The nurse recognizes that afterload is increased when there is what? A) Arterial vasoconstriction B) Venous vasoconstriction C) Arterial vasodilation D) Venous vasodilation

A) Arterial vasoconstriction

A patient had a cardiac catheterization and is now in the recovery area. What nursing interventions should be included in the plan of care? (Select all that apply.) A) Assessing the peripheral pulses in the affected extremity B) Checking the insertion site for hematoma formation C) Evaluating temperature and color in the affected extremity D) Assisting the patient to the bathroom after the procedure E) Assessing vital signs every 8 hours

A) Assessing the peripheral pulses in the affected extremity B) Checking the insertion site for hematoma formation C) Evaluating temperature and color in the affected extremity

The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. What explanation will the nurse offer to explain the urination? A) Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys. B) When the client is in the recumbent position, more pressure is put on the bladder, with the result of increased need to urinate. C) The blood pressure is lower when the client is recumbent, which causes the kidneys to work harder; therefore, more urine is produced. D) Fluid that is held in the lungs during the day becomes part of the circulation at night, causing the kidneys to produce an increased amount of urine.

A) Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys.

The nurse is caring for a client newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the client to address modifiable risk factors for CAD, the nurse will include which factor(s)? Select all that apply. A) Elevated blood pressure B) Decreased LDL level C) Obesity D) Alcohol use E) Drug use

A) Elevated blood pressure C) Obesity

The nurse has just admitted a 66-year-old patient for cardiac surgery. The patient tearfully admits to the nurse that she is afraid of dying while undergoing the surgery. What is the nurse's best response? A) Explore the factors underlying the patient's anxiety. B) Teach the patient guided imagery techniques. C) Obtain an order for a PRN benzodiazepine. D) Describe the procedure in greater detail.

A) Explore the factors underlying the patient's anxiety.

Which of the following is a true statement regarding the role of baroreceptors? A) Initiates the parasympathetic response B) Increases blood pressure C) Initiates the sympathetic response D) Increases in heart rate

A) Initiates the parasympathetic response

Which assessments should a nurse perform when caring for a client following a cardiac catheterization? Select all that apply. A) Monitor BP and pulse frequently. B) Inspect pressure dressing for signs of bleeding. C) Palpate the pulse in different locations. D) Inspect the color in every extremity. E) Palpate the insertion site for tenderness.

A) Monitor BP and pulse frequently. B) Inspect pressure dressing for signs of bleeding. C) Palpate the pulse in different locations.

The student nurse is preparing a teaching plan for a patient being discharged status post MI. What should the student include in the teaching plan? (Mark all that apply.) A) Need for careful monitoring for cardiac symptoms B) Need for carefully regulated exercise C) Need for dietary modifications D) Need for early resumption of prediagnosis activity E) Need for increased fluid intake

A) Need for careful monitoring for cardiac symptoms B) Need for carefully regulated exercise C) Need for dietary modifications

A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. What other client report increases the likelihood of a cardiovascular disorder? A) Shortness of breath B) Insomnia C) Irritability D) Lower substernal abdominal pain

A) Shortness of breath

A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what? A) Systole B) Diastole C) Repolarization D) Ejection fraction

A) Systole

The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. What priority reason will the nurse notify the healthcare provider? A) The client is at risk for renal failure due to the contrast agent that will be given during the procedure. B) These values show a risk for dysrhythmias. C) The client is overhydrated, which puts him at risk for heart failure during the procedure. D) The client is at risk for bleeding.

A) The client is at risk for renal failure due to the contrast agent that will be given during the procedure.

A client is seen in the emergency department and reports left arm pain, fatigue, palpitations, and shortness of breath. Which condition would the nurse suspect? A) acute coronary syndrome B) renal failure C) diabetes mellitus D) diabetes insipidus

A) acute coronary syndrome

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? A) anterior. B) posterior. C) lateral. D) inferior.

A) anterior.

The nurse is preparing a client for transesophageal echocardiography (TEE). This procedure is used for which indication? A) determination of atrial thrombi B) determination of electrical activity of the heart C) evaluation of the response of the cardiovascular system to D) increased oxygen demands E) evaluation of myocardial perfusion at rest and after exercise

A) determination of atrial thrombi

Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue? A) endocardium B) myocardium C) pericardium D) epicardium

A) endocardium

The nurse is monitoring a client experiencing a decrease in cardiac output. What medical conditions will lead to a decrease in preload? A) hemorrhage, sepsis, and anaphylaxis B) myocardial infarction, fluid overload, and diuresis C) fluid overload, sepsis, and vasodilation D) third spacing, heart failure, and diuresis

A) hemorrhage, sepsis, and anaphylaxis

Each chamber of the heart has a particular role in maintaining cellular oxygenation. Which chamber is responsible for pumping blood to the lungs to be oxygenated? A) right ventricle B) left ventricle C) right atrium D) left atrium

A) right ventricle

An obese client describes symptoms of palpitations, chronic fatigue, and dyspnea on exertion to the cardiologist. Upon completing the examination, the cardiologist schedules a procedure to confirm the suspected diagnosis. What diagnostic procedure would the nurse expect to be prescribed? A) transesophageal echocardiography B) chest radiograph C) radionuclide angiography D) electrocardiography

A) transesophageal echocardiography (TEE)

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? A) To dilate coronary arteries B) To decrease workload of the heart C) To decrease homocysteine levels D) To prevent angiotensin II conversion

B) To decrease workload of the heart

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? A) Myoglobin B) Troponin C) Total creatine kinase D) CK-MB

B) Troponin

The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why he has to take an aspirin every day if he doesn't have any pain. What would be the nurse's best response? A) "Taking an aspirin every day is an easy way to help restore the normal function of your heart." B) "An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks." C) "Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely." D) "An aspirin a day eventually helps your blood carry more oxygen that it would otherwise."

B) "An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks."

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."

While auscultating a patient's heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what patient? A) An older adult B) A 20-year-old patient C) A patient who has undergone valve replacement D) A patient who takes a beta-adrenergic blocker

B) A 20-year-old patient

The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output? A) A change in position from standing to sitting B) A heart rate of 54 bpm C) A pulse oximetry reading of 94% D) An increase in preload related to ambulation

B) A heart rate of 54 bpm

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? A) Potassium B) B-type natriuretic peptide (BNP) C) C-reactive protein (CRP) D) Platelet count

B) B-type natriuretic peptide (BNP)

Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? A) Hyperlipidemia B) Hypertension C) Glucose intolerance D) Obesity

B) Hypertension

The physician has ordered a high-sensitivity C-reactive protein (hs-CRP) drawn on a client. The results of this test will allow the nurse to evaluate the role of what process that is implicated in the development of atherosclerosis? A) Immunosuppression B) Inflammation C) Infection D) Hemostasis

B) Inflammation

During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where should the nurse best palpate the PMI? A) Left midclavicular line of the chest at the level of the nipple B) Left midclavicular line of the chest at the fifth intercostal space C) Midline between the xiphoid process and the left nipple D) Two to three centimeters to the left of the sternum

B) Left midclavicular line of the chest at the fifth intercostal space

During a shift assessment, the nurse is identifying the client's point of maximum impulse (PMI). Where will the nurse best palpate the PMI? A) Left midclavicular line of the chest at the level of the nipple B) Left midclavicular line of the chest at the fifth intercostal space C) Midline between the xiphoid process and the left nipple D) Two to three centimeters to the left of the sternum

B) Left midclavicular line of the chest at the fifth intercostal space

The physical therapist notifies the nurse that a client with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a client with CAD may result in what? A) Development of an atrial-septal defect B) Myocardial ischemia C) Formation of a pulmonary embolism D) Release of potassium ions from cardiac cells

B) Myocardial ischemia

A nurse is aware that the patient's heart rate is influenced by many factors. The nurse understands that the heart rate can be decreased by: A) An excess level of thyroid hormone. B) Stimulation of the vagus nerve. C) An increased level of catecholamines. D) Sympathetic nervous system stimulation.

B) Stimulation of the vagus nerve.

A resident of a long-term care facility has reported chest pain to the nurse. What aspect of the resident's pain would be most suggestive of angina as the cause? A) The pain is worse when the resident inhales deeply. B) The pain occurs immediately following physical exertion. C) The pain is worse when the resident coughs. D) The pain is most severe when the resident moves his upper body.

B) The pain occurs immediately following physical exertion.

A patient tells the nurse, "I was straining to have a bowel movement and felt like I was going to faint. I took my pulse and it was so slow." What does the nurse understand occurred with this patient? A) The patient may have had a myocardial infarction. B) The patient had a vagal response. C) The patient was anxious about being constipated. D) The patient may have an abdominal aortic aneurysm.

B) The patient had a vagal response.

The nurse cares for a client in the ICU diagnosed with coronary artery disease (CAD). Which assessment data indicates the client is experiencing a decrease in cardiac output? A) BP 108/60 mm Hg, ascites, and crackles B) disorientation, 20 mL of urine over the last 2 hours C) reduced pulse pressure and heart murmur D) elevated jugular venous distention and postural changes in BP

B) disorientation, 20 mL of urine over the last 2 hours

The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to: A) decrease anxiety. B) enhance myocardial oxygenation. C) administer sublingual nitroglycerin. D) educate the client about his symptoms.

B) enhance myocardial oxygenation.

The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected? A) Wheezes B) Rhonchi C) Crackles D) Coarseness

C) Crackles

The nurse is caring for a client who is diagnosed with an infarction of the posterior wall of the right atrium. Which assessment finding would the nurse anticipate relating to the infarction location? A) Respiratory compromise B) Chronic chest pain C) Irregular heart rate D) Cyanosis

C) Irregular heart rate

The nurse is educating a patient at risk for atherosclerosis. What nonmodifiable risk factor does the nurse identify for the patient? A) Stress B) Obesity C) Positive family history D) Hyperlipidemia

C) Positive family history

The nurse is caring for a client with nursing diagnosis of ineffective tissue perfusion. Which area of the heart would the nurse anticipate being compromised? A) Right atrium B) Pulmonary artery C) Right ventricle D) Aorta

C) Right ventricle

The nurse is caring for a client admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this client. The nurse should recognize what implication of this assessment finding? A) This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours. B) Because the client has a history of unstable angina, this is a poor indicator of myocardial injury. C) This is an accurate indicator of myocardial injury. D) This result indicates muscle injury, but does not specify the source.

C) This is an accurate indicator of myocardial injury.

The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment? A) Whether the patient and involved family members understand the role of genetics in the etiology of the disease B) Whether the patient and involved family members understand dietary changes and the role of nutrition C) Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately D) Whether the patient and involved family members understand the importance of social support and community agencies

C) Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? A) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. B) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider. C) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. D) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

D) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

The OR nurse is explaining to a patient that cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues. What technique for achieving these simultaneous goals should the nurse describe? A) Coronary artery bypass graft (CABG) B) Percutaneous transluminal coronary angioplasty (PTCA) C) Atherectomy D) Cardiopulmonary bypass

D) Cardiopulmonary bypass

The nurse is reviewing the results of the patient's echocardiogram and observes that the ejection fraction is 35%. The nurse anticipates that the patient will receive treatment for what condition? A) Pulmonary embolism B) Myocardial infarction C) Pericarditis D) Heart failure

D) Heart failure

The critical care nurse is caring for clients in an emergency department. When caring for a variety of clients, when is the presence of a third heart sound normal? A) In clients with heart valve replacement B) In geriatric clients C) In clients with an indwelling pacemaker D) In pediatric clients

D) In pediatric clients

The public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. The client denies any of the most common manifestations of CAD. The nurse should expect the focuses of CAD treatment to be: A) drug therapy and smoking cessation. B) diet and drug therapy. C) diet therapy only. D) diet therapy and smoking cessation.

D) diet therapy and smoking cessation.