555 Cardiovascular Practice Tests
Afterload increases in case of vasodilation and decreases in case of vasoconstriction. A. True B. False
B. False ??
Calculation MAP for a patent with BP of 140/83. _____
102 (140+83+83)/ 3 = 102
The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate? A. "Have you been to the dentist lately?" B. "Do you have a history of a heart attack?" C. "Is there a family history of endocarditis?" D. "Have you had any recent immunizations?"
A. "Have you been to the dentist lately?"
The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says, A. "I should increase the amount of green, leafy vegetables that I eat." B. "I should wear a Medic Alert bracelet stating that I take Coumadin." C. "I will need to have blood tests routinely to monitor the effects of the Coumadin." D. "I will check with my health care provider before I begin or stop any medication."
A. "I should increase the amount of green, leafy vegetables that I eat." Vitamin K - which is found in leafy greens - is the antidote for Coumadin ..
A 19-year-old has a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate? A. Allow the student to participate on the swim team. B. Refer the student to a cardiologist for further assessment. C. Obtain more detailed information about the student's health history. D. Tell the student to stop swimming immediately if any dyspnea occurs.
A. Allow the student to participate on the swim team. In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the health history. Dyspnea during an aerobic activity such as swimming is normal.
A few days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first? A. Auscultate the heart sounds. B. Check the patient's oral temperature. C. Notify the patient's health care provider. D. Give the ordered acetaminophen (Tylenol).
A. Auscultate the heart sounds. To check for suspected pericarditis
A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient? A. Cessation of smoking B. Control of serum lipid levels C. Maintenance of appropriate weight D. Demonstration of meticulous foot care
A. Cessation of smoking
A patient's cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? A. Defibrillate at 200 joules. B. Give O2 per bag-valve-mask. C. Give epinephrine (Adrenalin) IV. D. Prepare for endotracheal intubation.
A. Defibrillate at 200 joules. The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, the other actions may be appropriate.
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)
After the nurse administers IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? A. Increase in the patient's heart rate B. Decrease in premature contractions C. Increase in peripheral pulse volume D. Decrease in ventricular ectopic beats
A. Increase in the patient's heart rate Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have ventricular ectopy or premature contractions.
Which information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? A. No change in the patient's chest pain B. A large bruise at the patient's IV insertion site C. A decrease in ST segment elevation on the electrocardiogram (ECG) D. An increase in cardiac enzyme levels since admission
A. No change in the patient's chest pain
To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patient's A. P wave. B. PR interval. C. QT interval. D. QRS complex.
A. P wave. The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS represents ventricular depolarization. The Q-T interval represents depolarization and repolarization of the entire conduction system.
The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? A. Serum creatinine of 2.6 mg/dL B. Serum potassium of 3.8 mEq/L C. Serum hemoglobin of 14.7 g/dL D. Blood glucose level of 98 mg/dL
A. Serum creatinine of 2.6 mg/dL Could indicate kidney damage. Normal serum creatinine is around 1.3
A patient whose cardiac monitor shows sinus tachycardia, rate 102, is apneic and no pulses are palpable by the nurse. What is the first action that the nurse should take? A. Start CPR. B. Defibrillate. C. Administer atropine per hospital protocol. D. Give 100% oxygen per non-rebreather mask.
A. Start CPR. The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.
Which action by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? A. The nurse assists the patient to do active range of motion exercises for all extremities. B. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet. C. The nurse gives atenolol (Tenormin) to the patient without consulting first with the health care provider. D. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.
A. The nurse assists the patient to do active range of motion exercises for all extremities. The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.
The most sensitive test for myocardial infarction is A. Troponin B. BNP C. Myoglobin D. CK-MB
A. Troponin Troponin = MI BNP = Heart Failure
During inhalation, the BP decreases slightly due to increase in the intrathoracic pressure, which decreases cardiac output. A. True B. False
A. True
During inspiration, the chest wall expands and causes the intrathoracic pressure to become more negative like a vacuum, which induces a reduction in blood volume returning from the lungs into the left ventricle and therefore decrease cardiac output. A. True B. False
A. True
Large heart (cardiomegaly) may be seen in patient with heart failure and cardiomyopathy. A. True B. False
A. True
One of the major factors that affect the myocardial blood flow is changes in oxygen demands. A. True B. False
A. True
SA node is consider the natural pacemaker of the conduction system of the heart. A. True B. False
A. True
The apical pulse is located in the 5th ICS and MCL. A. True B. False
A. True
The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increasing blood flow. A. True B. False
A. True
Low preload is seen in dehydration while high preload is seen in over hydration? A. True B. False
A. True Preload = volume of blood in ventricles at the end of diastole
A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of A. asthma. B. peptic ulcer disease. C. alcohol dependency. D. myocardial infarction (MI).
A. asthma.
To assess the patient with pericarditis for the presence of a pericardial friction rub, the nurse should: A. auscultate with the stethoscope diaphragm at the lower left sternal border. B. listen for a rumbling, low-pitched, systolic sound over the left anterior chest. C. feel the precordial area with the palm of the hand to detect vibration with cardiac contraction. D. ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.
A. auscultate with the stethoscope diaphragm at the lower left sternal border. Its the hallmark finding in acute pericarditis - its a rub that is a scratching, grating, high-pitched sound. It's best heard at the lower left sternal border of the chest with the patient leaning forward. It does not vary from the heartbeat, it times with pulse not respirations (pleural friction rub).
The health care provider prescribes an infusion of argatroban (Acova) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to: A. avoid giving any IM medications to prevent localized bleeding. B. discontinue the infusion for PTT values greater than 50 seconds. C. monitor posterior tibial and dorsalis pedis pulses with the Doppler. D. have vitamin K available in case reversal of the argatroban is needed.
A. avoid giving any IM medications to prevent localized bleeding. Vitamin K is the antidote for Coumadin ..
A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patient's care? A. sildenafil (Viagra) B. furosemide (Lasix) C. diazepam (Valium) D. captopril (Capoten)
A. sildenafil (Viagra) Viagra is contraindicated for nitroglycerin treatment
When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 140/80 and an ankle pressure of 112/70. The nurse calculates the patient's ankle-brachial index (ABI) as ____________________.
ABI = divide ankle systolic by higher of the brachial systolic Bps 112 / 140 = .8 A normal ABI = 0.91-1.30 0.71-0.90 = mild PAD 0.41-0.70 = moderate PAD < 0.40 = severe PAD
In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, A. "I will have to buy some loose clothing that does not bind across my legs or waist." B. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." C. "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily." D. "I will change my position every hour and avoid long periods of sitting with my legs down."
B. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." This is contraindicated because there is loss of sensation in the lower extremities and they might get burned. the rest are correct
When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include? A. "Exercise only if you do not experience any pain." B. "It is very important that you stop smoking cigarettes. C. "Try to keep your legs elevated whenever you are sitting." D. "Put on support hose early in the day before swelling occurs."
B. "It is very important that you stop smoking cigarettes.
A patient with ST segment elevation in several 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 fibrinolytic therapy? A. "Do you take aspirin on a daily basis?" B. "What time did your chest pain begin?" C. "Is there any family history of heart disease?" D. "Can you describe the quality of your chest pain?"
B. "What time did your chest pain begin?" fibrinolytic therapy dissolves thrombus in the coronary artery. It's given as soon as possible, within six hours of onset
Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? A. 108/64 mm Hg B. 128/76 mm Hg C. 140/90 mm Hg D. 136/ 82 mm Hg
B. 128/76 mm Hg 108/64 might be too low and the others too high
Which of these patients admitted to the emergency department should the nurse assess first? A. 62-year-old who has gangrenous ulcers on both feet B. 50-year-old who is complaining of "tearing" chest pain C. 45-year-old who is taking anticoagulants and has bloody stools D. 36-year-old who has right calf tenderness, redness, and swelling
B. 50-year-old who is complaining of "tearing" chest pain Could mean a thoracic aneurysm
A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? A. Continue to monitor the rhythm and BP. B. Apply the transcutaneous pacemaker (TCP). C. Have the patient perform the Valsalva maneuver. D. Give the scheduled dose of diltiazem (Cardizem).
B. Apply the transcutaneous pacemaker (TCP). The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva maneuver will further decrease the rate.
When admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first? A. Obtain the blood pressure. B. Attach the cardiac monitor. C. Assess the peripheral pulses. D. Auscultate the breath sounds.
B. Attach the cardiac monitor.
Which of the following indicate hemodynamic stability? Select all that apply. A. Stroke volume is 50 mL per beat. B. Cardiac output is 5 L/min. C. Mean arterial pressure (MAP) is 55 mmHg. D. SBP is 120 mmHg E. presence of JVD.
B. Cardiac output is 5 L/min. (normal is 4-8L/min D. SBP is 120 mmHg Normal Stroke Volume = around 70mL? Normal MAP = > 60 JVD is never normal
A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and diaphoresis. Which of these actions that are included in the hospital dysrhythmia protocol should the nurse take first? A. Obtain a 12-lead electrocardiogram (ECG). B. Give O2 at 3 to 4 L/min. C. Take the patient's blood pressure and respiratory rate. D. Notify the health care provider of the change in rhythm.
B. Give O2 at 3 to 4 L/min. Since this patient has dyspnea in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by oxygen
Which of the following may cause changes in ECG rhythms? A. Na is 136 mEq/L B. K is 2.8 mEq/L C. Ca is 8.5 mg/dL D. Creatine 1.0 mg/dL
B. K is 2.8 mEq/L Normal K is 3.5-5.0
When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider? A. Absence of flatus B. Loose, bloody stools C. Hypotonic bowel sounds D. Abdominal pain with palpation
B. Loose, bloody stools
Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? A. Complaint of left calf pain B. New onset shortness of breath C. Red skin color of left lower leg D. Temperature of 100.4° F (38° C)
B. New onset shortness of breath ABCs
A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene? A. The LPN/LVN places the patient in a Fowler's position for meals. B. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. C. The LPN/LVN assists the patient to ambulate 40 feet in the hallway. D. The LPN/LVN administers the ordered aspirin 160 mg after breakfast.
B. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. Too long, blood will pool
Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)? A. The pain increases with deep breathing. B. The pain has persisted longer than 30 minutes. C. The pain worsens when the patient raises the arms. D. The pain is relieved after the patient takes nitroglycerin.
B. The pain has persisted longer than 30 minutes.
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective? A. The patient avoids the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). B. The patient exercises indoors during the winter months. C. The patient places the hands in hot water when they turn pale. D. The patient takes pseudoephedrine (Sudafed) for cold symptoms.
B. The patient exercises indoors during the winter months. Patient should avoid temperature extremes. Immerse hands in warm water, not hot. Avoid vasoconstrictors, like caffeine, tobacco, cocaine, pseudo ephedrine.
When admitting a patient for a coronary arteriogram and angiogram, which information about the patient is most important to communicate to the health care provider? A. The patient's pedal pulses are +1. B. The patient is allergic to shellfish. C. The patient has not eaten anything today. D. The patient had an arteriogram a year ago.
B. The patient is allergic to shellfish. The contrast is iodine
The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How will the nurse document the rhythm? A. Ventricular couplets B. Ventricular bigeminy C. Ventricular R-on-T phenomenon D. Ventricular multifocal contractions
B. Ventricular bigeminy Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.
A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that: A. sitting at the work counter, rather than standing, is recommended. B. compression stockings should be applied before getting out of bed. C. exercises such as walking or jogging cause recurrence of varicosities. D. taking one aspirin daily will help prevent clotting around venous valves.
B. compression stockings should be applied before getting out of bed.
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. Prinzmetal's (variant) angina IS a spasm of the coronary arteries ... the drug will help.
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. It is most useful in determining the presence of pericardial effusion or cardiac tamponade - complications of pericarditis.
Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should: A. check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration. B. note when Korotkoff sounds are audible during both inspiration and expiration. C. auscultate for a pericardial friction rub that increases in volume during inspiration. D. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).
B. note when Korotkoff sounds are audible during both inspiration and expiration. Cardiac tamponade happens when there is an increase in intrapericardial pressure - results in compression of the heart. Plus paradoxus is a decrease in systolic BP with inspiration.
After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? A. "I can expect indigestion as a side effect of nitroglycerin." B. "I can only take the nitroglycerin if I start to have chest pain." C. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." D. "I will help slow down the progress of the plaque formation by taking nitroglycerin."
C. "I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin." Indigestion is not a side effect It can be taken as a preventative - before exercise It will not slow plaque formation
Which of these statements made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? A. "I will switch from whole milk to 1% or nonfat milk." B. "I like fresh salmon and I will plan to eat it more often." C. "I will miss being able to eat peanut butter sandwiches." D. "I can have a cup of coffee with breakfast if I want one."
C. "I will miss being able to eat peanut butter sandwiches." Nut butters are considered ok to eat
A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, A. "It will be 6 weeks before I can take a bath or return to my usual activities." B. Incorrect "I will notify the airlines when I make a reservation that I have a pacemaker." C. "I won't lift the arm on the pacemaker side up very high until I see the doctor." D. "I must avoid cooking with a microwave oven or being near a microwave in use."
C. "I won't lift the arm on the pacemaker side up very high until I see the doctor." The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.
A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? A. "Administration of two anticoagulants reduces the risk for recurrent venous thrombosis." B. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from occurring." C. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." D. "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."
C. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation."
A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of how many beats/minute? A. 15 to 20 B. 20 to 40 C. 40 to 60 D. 60 to 100
C. 40 to 60 If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60. The slower rates are typical of the bundle of His and the Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/minute.
A patient who was admitted with a myocardial infarction experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which action should the nurse take next? A. Notify the health care provider. B. Perform synchronized cardioversion. C. Administer the PRN IV lidocaine (Xylocaine). D. Document the rhythm and monitor the patient.
C. Administer the PRN IV lidocaine (Xylocaine). The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medications are administered. Defibrillation is not indicated given that the patient is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.
Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg? A. Adequate carbohydrate intake B. Prophylactic antibiotic therapy C. Application of compression to the leg D. Methods of keeping the wound area dry
C. Application of compression to the leg Protein intake No need for prophylactic antibiotic therapy Wound needs moisture to heal
Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? A. Palpate the radial pulses bilaterally. B. Assess the feet for peripheral edema. C. Auscultate for a pericardial friction rub. D. Check the cardiac monitor for dysrhythmias.
C. Auscultate for a pericardial friction rub.
Which of the following is correct about BNP? A. BNP is released when atria stretch B. BNP is releases when ventricles relax. C. BNP indicates the progression of heart failure. D. High level of BNP indicates myocardial infarction.
C. BNP indicates the progression of heart failure. BNP < 100 = HF is highly improbable BNP 100-500 = HF is probable BNP > 500 = HF is highly probable
A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI? A. Homocysteine B. C-reactive protein C. Cardiac-specific troponin I and troponin T D. High-density lipoprotein (HDL) cholesterol
C. Cardiac-specific troponin I and troponin T
Which information should the nurse include when teaching a patient with newly diagnosed hypertension? A. Dietary sodium restriction will control BP for most patients. B. Most patients are able to control BP through lifestyle changes. C. Hypertension is usually asymptomatic until significant organ damage occurs. D. Annual BP checks are needed to monitor treatment effectiveness.
C. Hypertension is usually asymptomatic until significant organ damage occurs.
Which of the following assessment data 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 166/96 C. Jugular vein distention (JVD) to the level of the jaw D. Level 6 (0 to 10 scale) chest pain with deep inspiration
C. Jugular vein distention (JVD) to the level of the jaw
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.
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 Controls pain and inflammation.
The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use? A. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. B. Count the number of large squares in the R-R interval and divide by 300. C. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. D. Calculate the number of small squares between one QRS complex and the next and divide into 1500.
C. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer
During the administration of the fibrinolytic 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. surface bleeding from the IV site. C. a decrease in level of consciousness. D. a nonsustained episode of ventricular tachycardia.
C. a decrease in level of consciousness. Bleeding is a major complication of fibrinolytic therapy, decrease in consciousness could mean brain bleed
A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about A. electrical cardioversion. B. IV adenosine (Adenocard). C. anticoagulant therapy with warfarin (Coumadin). D. Incorrect insertion of an implantable cardioverter-defibrillator (ICD).
C. anticoagulant therapy with warfarin (Coumadin). Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria. Adenosine is not used to treat atrial fibrillation. Cardioversion may be done after several weeks of Coumadin therapy. ICDs are used for patients with recurrent ventricular fibrillation.
Which of the following is correct about ECG? A. it is an invasive procedure in which the patient receive electrical signals. B. ECG is used to evaluate the structure and function of valves. C. it is a non-invasive test done at the bedside used to rule out MI. D. ECG is only indicated for patients with chest pain.
C. it is a non-invasive test done at the bedside used to rule out MI.
When teach the patient being evaluated for rhythm disturbances with a Holter monitor to A. exercise more than usual while the monitor is in place. B. remove the electrodes when taking a shower or tub bath. C. keep a diary of daily activities while the monitor is worn. D. connect the recorder to a telephone transmitter once daily.
C. keep a diary of daily activities while the monitor is worn. It's worn for 48 hours and heart rate is monitored, a journal is kept of activities
The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find: A. a positive Homans' sign. B. swollen, dry, scaly ankles. C. prolonged capillary refill in all the toes. D. a large amount of drainage from the ulcer.
C. prolonged capillary refill in all the toes. Loss of hair on legs, feet, toes Ulcer Tips of toes, foot, or lateral malleolus - min drainage Intermittent claudication or rest pain in foot Ulcer may or may not be painful Thickened; brittle nails Skin Thin, shiny, taut
While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information? A. "When I stand too long, my feet start to swell up." B. "Sometimes I get tired when I climb a lot of stairs." C. "My fingers hurt when I go outside in cold weather." D. "My legs cramp whenever I walk more than a block."
D. "My legs cramp whenever I walk more than a block."
The nurse has received change-of-shift report about the following patients on the telemetry unit. Which patient should the nurse see first? A. A patient with atrial fibrillation, rate 88, who has a new order for warfarin (Coumadin) B. A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating C. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago D. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due
D. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone (Cordarone) due The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.
Which action should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg? A. Turn the synchronizer switch to the "off" position. B. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position. C. Set the defibrillator/cardioverter energy to 300 joules. D. Administer a sedative before cardioversion is implemented.
D. Administer a sedative before cardioversion is implemented. When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). CPR is not indicated for this patient.
When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? A. Check blood pressure. B. Monitor apical pulse rate. C. Monitor for dysrhythmias. D. Ask about chest discomfort.
D. Ask about chest discomfort. Nitroglycerin is expected to decrease chest pain, not bp, apical pulse or dysrhythmias
A patient's cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time? A. Prepare for possible temporary pacemaker insertion. B. Administer atropine sulfate 1 mg IV per agency protocol. C. Document the patient's rhythm and assess the patient's response to the rhythm. D. Call the health care provider before giving the prescribed metoprolol (Lopressor).
D. Call the health care provider before giving the prescribed metoprolol (Lopressor). The patient has progressive first-degree atrioventricular (AV) block, and the â-blocker should be held until discussing the medication with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic.
When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse? A. Pedal pulses 1+ B. Heart rate 100 beats/min C. Blood pressure 104/56 mm Hg D. Chest pain level 8 on a 10-point scale
D. Chest pain level 8 on a 10-point scale All others are normal
When monitoring a patient who is undergoing exercise (stress) testing on a treadmill, which assessment finding requires the most rapid action? A. Patient complaint of feeling tired. B. Pulse change from 80 to 96 beats/minute. C. BP increase from 134/68 to 150/80 mm Hg. D. Electrocardiographic (ECG) changes indicating coronary ischemia.
D. Electrocardiographic (ECG) changes indicating coronary ischemia. Everything else is considered ok
A patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? A. Platelet aggregation is enhanced by IV heparin infusion. B. Heparin will dissolve the clot that is blocking blood flow to the heart. C. Coronary artery plaque size and adherence are decreased with heparin. D. Heparin will prevent the development of new clots in the coronary arteries.
D. Heparin will prevent the development of new clots in the coronary arteries. Heparin doesn't dissolve it prevents future clots
Which of the following patients is having the poorest prognosis? A. Mr. A: BNP 100 pg/mL B. Mr. B: BNP 500 pg/mL C. Mr. C: BNP 1000 pg/mL D. Mr. D: BNP 2000 pg/mL
D. Mr. D: BNP 2000 pg/mL BNP < 100 = HF is highly improbable BNP 100-500 = HF is probable BNP > 500 = HF is highly probable
When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a A. T wave of 0.16 second. B. P-R interval of 0.18 second. C. Q-T interval of 0.34 second. D. QRS interval of 0.14 second.
D. QRS interval of 0.14 second. Because the normal QRS interval is 0.04 to 0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval, Q-T interval, and T wave interval are within the normal range.
A 21-year-old student arrives at the student health center at the end of the quarter complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take first? A. Have the patient transported to the hospital emergency department (ED). B. Administer O2 at 2 to 3 L/min using nasal prongs. C. Ask the patient about any history of coronary artery disease. D. Question the patient about current stress level and coffee use.
D. Question the patient about current stress level and coffee use. In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.
Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first? A. Wrap both the legs in warm blankets. B. Notify the surgeon and anesthesiologist. C. Document that the pulses are absent and recheck in 30 minutes. D. Review the preoperative assessment form for data about the pulses.
D. Review the preoperative assessment form for data about the pulses. Get patient's baseline
Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? A. Blood glucose 228 mg/dL B. Serum chloride 90 mEq/L C. Serum sodium 133 mEq/L D. Serum potassium 2.8 mEq/L
D. Serum potassium 2.8 mEq/L Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patient's PVCs and do not require immediate correction.
Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? A. The pacemaker prevents or minimizes ventricular irritability. B. The pacemaker paces the atria at rates up to 500 impulses/minute. C. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. D. The pacemaker stimulates a heart beat if the patient's heart rate drops too low.
D. The pacemaker stimulates a heart beat if the patient's heart rate drops too low. The permanent pacemaker will discharge when the ventricular rate drops below the set rate. The pacemaker will not decrease ventricular irritability or discharge if the patient develops ventricular fibrillation. Since the patient has a slow ventricular rate, overdrive pacing will not be used.
Which information given by a patient admitted with stable angina will help the nurse confirm this diagnosis? A. The patient rates the pain at a level 3 to 5 (0 to 10 scale). B. The patient states that the pain "wakes me up at night." C. The patient says that the frequency of the pain has increased over the last few weeks. D. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.
D. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.
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. right upper quadrant tenderness. D. complaints of shortness of breath.
D. complaints of shortness of breath. Primary symptom of mitral stenosis is exertional dyspnea due to reduced lung compliance.
A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the PR interval is 0.24 seconds. The appropriate intervention by the nurse is to A. notify the patient's health care provider immediately. B. administer atropine per agency bradycardia protocol. C. prepare the patient for temporary pacemaker insertion. D. document the finding and continue to monitor the patient.
D. document the finding and continue to monitor the patient. First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about
When developing a health teaching plan for a 60-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. high incidence of cardiovascular disease in older people. D. elevation of the patient's serum low density lipoprotein (LDL) level.
D. elevation of the patient's serum low density lipoprotein (LDL) level. It's the only one that's modifiable
A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and: A. elevate the left leg on a pillow. B. apply an elastic wrap to the leg. C. assist the patient in gently exercising the leg. D. keep the patient in bed in the supine position.
D. keep the patient in bed in the supine position. Sounds like an acute arterial ischemia. The six Ps: pain, pallor, paralysis, pulselessness, paresthesia, and poikilothermic (most often cool). Without immediate intervention it could lead to tissue necrosis and gangrene.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The most appropriate intervention by the nurse for this problem is to: A. force fluids to 3000 mL/day to decrease fever and inflammation. B. teach the patient to take deep, slow respirations to control the pain. C. remind the patient to ask for the opioid pain medication every 4 hours. D. position the patient in Fowler's position, leaning forward on the overbed table.
D. position the patient in Fowler's position, leaning forward on the overbed table. This relieves pain.
The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with deep vein thrombosis. The best method for the nurse to use in elevating the patient's feet is to A. place the patient in the Trendelenburg position. B. place two pillows under the calf of the affected leg. C. elevate the bed at the knee and put pillows under the feet. D. put one pillow under the thighs and two pillows under the lower legs.
D. put one pillow under the thighs and two pillows under the lower legs.
The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as A. atrial fibrillation. B. sinus tachycardia. C. ventricular fibrillation. D. ventricular tachycardia.
D. ventricular tachycardia. The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.
