Cardiac Practice Questions
The health care provider prescribes esmolol for a client with supraventricular tachycardia. During esmolol therapy, what should the nurse monitor?
heart rate and blood pressure
Which is not a common cause of heart failure?
hypothyroidism
A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?
immediate CPR
What is the treatment of choice for ventricular fibrillation?
immediate bystander CPR
The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation?
in many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output
Expected abnormalities in serum studies confirming angina include which of the following options?
increased CRP
Exercise does what to the body?
increases HR and myocardial O2 demand
Purpose of Aspirin (ASA)
inhibits platelet aggregation
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first?
initiate transcutaneous pacing
What expectation should the nurse have regarding Ms. Anderson's chest tube drainage?
it will change in color from sanguinous to serosanguinous to serous
Which of the following statements is uncharacteristic of adenosine (Adenocard)?
the onset of the action of adenosine is 10 min and the duration is 1-2 hrs
A patient has an ejection fraction (EF) of 35%. What does this indicate?
the patient is in systolic heart failure
What is the reason Mrs. Melnik is being started on warfarin (Coumadin)?
to prevent atrial fibrillation from forming thrombus in the atria
What is the primary reason of adding Captopril (ACE inhibitor) to Mrs. Melnick's medication regimen?
to prevent further left ventricular hypertrophy
Which cardiac enzyme is the most cardiac specific?
troponin
What is the main cause of myocardial infarction (MI)?
coronary artery disease (CAD)
How could you estimate heart rate using a 1-minute ECG strip?
divide the total number of squares in the 1-min strip by the number of similar squares between one R-R interval
Heavy meals do what to the body?
diverts blood, decreasing blood flow in the coronary artery system
The nurse is assessing the client's cardiovascular system. The client asks the nurse why the nurse presses on the toenails. Which is the best reply by the nurse?
"I can see how quickly the blood returns to assess blood flow."
Mrs. Milhouse's husband asks the nurse to explain what a SVT is. What would the nurse's best answer be?
"She has extra pathways from the node in the atrium to the node in the ventricle; this causes her heart to beat much faster."
Ms. Anderson asks the nurse to explain chronic, stable angina. What are accurate responses from the nurse?
"The primary cause is coronary artery disease (CAD)."
A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?
"Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
How did the nurse determine that Mrs. Milhouse was having a run of SVT upon analyzing the ECG strip?
P waves were absent, her ventricular rate was 200, and the run began and ended abruptly
A patient is prescribed a beta-blocker. What must be assessed prior to administration of the medication?
blood pressure and heart rate
What is the initial treatment for a patient experiencing myocardial infarction (MI)?
aspirin, oxygen, morohine, nitroglycerin
You are taking the VS of your patient and determine that the patient's cardiac rhythm is irregularly, irregular. What are you thinking?
atrial fibrillation
Upon assessment, the nurse notes a patient has crackles and dyspnea. What does this indicate?
the patient's left side of the heart is affected
How do anticoagulants work?
thin the blood to prevent clots and stops clots from getting bigger
What is the best way to treat sinus tachycardia?
treat the underlying cause
What questions should the nurse as Ms. Anderson to assess her pain and chest discomfort?
use the PQRST mnemonic to assess complete pain symptoms
A nurse finds a client with absent breathing and prepares to begin one-person cardiopulmonary resuscitation. What will the nurse do first?
establish unresponsiveness
Mr. Gruppman asks why his "heart labs" keep increasing and wonders if he is having another heart attack. What is the ideal response that the nurse should provide?
"Cardiac marker labs continue to risk for 24-48 hrs after your heart attack. They should start to fall tomorrow."
The nurse notes that Ms. Anderson's K+ level is 6.0 (high). What is the most likely cause for this?
hemolysis from the cardiopulmonary bypass machine
A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order?
heparin
A nurse is completing a head to toe assessment on a client diagnosed with right-sided heart failure. To assess peripheral edema, which of the following areas should be examined?
feet and ankles
What is not a symptom of myocardial infarction (MI)?
headache
The nurse is administering propranolol to a client on a telemetry unit. What will the nurse monitor the client for?
heart block
The nurse is caring for a client who has been diagnosed with supraventricular tachycardia. The client is experiencing occasional episodes lasting up to several minutes at a time, during which the client becomes lightheaded but does not lose consciousness. What should the nurse instruct the client to do while in the hospital to interrupt the supraventricular tachycardia?
perform the Valsalva maneuver
Which factor is an absolute contraindication in receiving a thrombolytic?
pregnancy
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of arrhythmia would the cardiologist likely diagnose?
sinus tachycardia
A nurse in the critical care unit is caring for a client with heart failure who has developed an intracardiac thrombus. The nurse should assess for signs and symptoms of which sequela?
stroke
Your next patient has a HR of 150 and BP 78/48 and feels "sleepy and dizzy". What needs to be done?
synchronized cardioversion (RRT)
The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason?
the defibrillator won't deliver a shock if the synchronizer switch is turned on
Prior to his discharge, Mr. Gruppman has a low-level treadmill test without evidence of ischemia. Based on this result, what information should he be given about his target heart rate during physical activity?
the most important factor to consider is his symptoms in response to activity
Which of the following statements about Mrs. Melnik's current symptoms is false?
Fatigue is a late manifestation of HF and is caused by increased cardiac output and decreased oxygenation of the tissues
The provider has given the patient a new prescription for losartan. Which current medication order would cause the nurse to question the new order for losartan?
Lisinopril 10 mg PO daily
Your next patient has a HR of 150 and BP 78/48 and feels "sleepy and dizzy". What are you thinking?
SVT
What disease process(es) contributes to chronic heart failure? Select the 3 that apply. a) tachyarrhythmias b) valvular disease c) pancreatic disease d) renal failure e) pulmonary insufficiency
a, b and d
What is the drug of choice to treat supraventricular tachycardia (SVT)?
adenosine
What is the priority intervention for a patient in ventricular fibrillation?
defibrillation
A patient is prescribed propranolol. Other than hypertension, for what condition might this patient be taking the medication?
migraines
Which intervention should be implemented for patients on any medications that increase the risk of bleeding?
monitor for dark stools
The emergency department nurse is caring for a patient who has gone into cardiac arrest. The nurse is performing external defibrillation. Which of the following is a vital step in the procedure?
no one is to be touching the patient at the time shock is delivered
Which medication is an example of an antiplatelet?
clopidogrel
Which of the following do Mrs. Melnick's diagnostic test results indicate? EF is 55%
diastolic heart failure
Purpose of Nitroglycerin
reduces angina pain, and improves coronary blood flow
Purpose of Atenolol (beta blocker)
reduces myocardial O2 demand
Purpose of Morphine sulfate
reduces pain and workload of the heart and enhances oxygenation
The nurse is discharging a client after a cardiac catheterization. What would the nurse include in the discharge teaching?
report any numbness, tingling, or sharp pain in the extremity
The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial flutter?
sawtooth
Stress does what to the body?
stimulates the sympathetic NS and increases cardiac workload
A patient has been diagnosed with atrial fibrillation. What class of medications is expected to be prescribed?
anticoagulants
Mr. Gruppman wonders why his blood sugar is so high, exclaiming "I don't need diabetes on top of everything else!" What should the nurse tell him?
"Your nervous system is causing increased levels of sugars and fats to help your damaged heart muscle function."
A nurse is administering a beta blocker to a patient who has heart failure. Which statement may be part of the nurse's patient education?
"this medication will improve your survival and symptoms of heart failure."
Which of the following pathways does normal cardiac electrical conduction follow?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
A patient is prescribed captopril. About what adverse effect should the nurse educate the patient?
angioedema
Client reports fluttering feelings in the chest for the past week and a pulse that feels "all over the place." The client is a college student and states feeling stressed about final exams. The client has been staying up late and drinking a lot of coffee and high-energy drinks to stay awake and focused. Breath sounds clear. Heart rate 150 bpm, irregularly irregular heart rhythm. RR: 18 breaths/min; temp: 98.2°F (36.7°C). BP 104/60 mm Hg standing, 104/60 mm Hg lying down. O2 sat: 97% on room air. Heart sounds normal. Skin warm and dry. Strong peripheral pulses. Denies chest, arm, or back pain; shortness of breath; or diaphoresis. Has had several episodes of dizziness, without loss of consciousness, which resolved spontaneously. Select 2 actions to take: a) perform EKG b) discuss low-cholesterol diet c) encourage exercise w/ rest periods d) teach stress management e) teach pt to rise slowly from a lying/seated position
a and d
A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, what actions should the nurse perform? Select the 2 that apply. a) administer oxygen b) have the client take deep breaths c) perform chest physiotherapy d) instruct the client to cough e) place the client in an upright position
a and e
The nurse is caring for an adult client with heart failure who is prescribed digoxin. When assessing the client for adverse effects, the nurse should assess for which of the following signs and symptoms? Select the 2 that apply. a) confusion b) shortness of breath c) numbness and tingling in the extremities d) chest pain e) bradycardia f) diuresis
a and e
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 diet low in sodium, fat, cholesterol
An emergency department nurse is admitting four patients. Which patient is a candidate for immediate percutaneous coronary intervention (PCI)?
a patient with a STEMI who reports severe left arm pain
Which of the following nursing measures are priorities for Mrs. Melnik? Select the 3 that apply. a) semi-fowler's position b) daily weights c) administer morphine sulfate 2 mg IV push d) VS every shift
a, b and c
Which nursing interventions should the nurse undertake for Mrs. Milhouse when she returns to the unit? Select the 8 that apply. a) take VS, including apical pulse b) monitor ECG strips c) auscultate for pericardial friction rub and lung sounds d) monitor neuro signs e) ambulate the pt as soon as possible f) monitor catheter insertion sites for bleeding g) monitor CMS and pulses in the affected leg h) maintain bedrest with head elevated 30 degrees i) discontinue pulse ox j) maintain affected leg straight for at least 4 hrs
a, b, c, d, f, g, h, and j
What additional assessments related to possible heart failure do you think the nurse should make? Select the 9 that apply. a) heart rate b) evidence of edema c) weight changes d) sonambulism e) skin color f) temperature g) behavioral changes h) chest pain i) pavor nocturnus j) lung sounds k) paroxysmal nocturnal dyspnea (PND)
a, b, c, e, f, g, h, j and k
Mrs. Anderson is worried that she might have a heart attack while exercising at her health club. As the nurse, what could you tell Ms. Anderson about exercise and angina? Select the 3 that apply. a) "Medications and modification of your exercise program will help reduce your angina attacks." b) "You are experiencing irreversible ischemia, a precursor for heart attacks." c) "Continuing to exercise will reduce your risk factors for CAD, the primary cause of angina." d) "You should stop exercising and take your sublingual NTG if you experience angina while exercising."
a, c and d
Administration of the fibrolytic agent alteplase includes certain tasks like ECG and heart and lung assessments. Which of the following are the other expected tasks in nursing assessments and interventions during the administration of the fibrolytic agent alteplace? a) expect reperfusion dysrhythmias b) expect increase in chest pain as "clot buster" takes effect c) monitor for evidence of internal/external bleeding d) expect spike in ST segment e) assess neuro signs every 15-30 min
a, c and e
The nurse understands that asystole can be caused by several conditions. Select the 4 that apply. a) hypoxia b) alkalosis c) acidosis d) hypovolemia e) hypothermia
a, c, d and e
A patient is on a heparin infusion. Which lab value is used to titrate this medication?
activated partial thromboplastin clotting time (aPTT)
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?
acute coronary syndrome
Based on the information given, what do you think the admitting nurse suspects Mrs. Melnik to be experiencing? - bilateral +2 pitting edema - HR 104 - Resp 32 - BP 192/94 - SPO2 88%
acute decompensated heart failure
The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment?
an automatic external defibrillator
Client reports fluttering feelings in the chest for the past week and a pulse that feels "all over the place." The client is a college student and states feeling stressed about final exams. The client has been staying up late and drinking a lot of coffee and high-energy drinks to stay awake and focused. Breath sounds clear. Heart rate 150 bpm, irregularly irregular heart rhythm. RR: 18 breaths/min; temp: 98.2°F (36.7°C). BP 104/60 mm Hg standing, 104/60 mm Hg lying down. O2 sat: 97% on room air. Heart sounds normal. Skin warm and dry. Strong peripheral pulses. Denies chest, arm, or back pain; shortness of breath; or diaphoresis. Has had several episodes of dizziness, without loss of consciousness, which resolved spontaneously. What is the potential condition occurring?
arrythmia
Which medication is the drug of choice for sinus bradycardia?
atropine
Client reports fluttering feelings in the chest for the past week and a pulse that feels "all over the place." The client is a college student and states feeling stressed about final exams. The client has been staying up late and drinking a lot of coffee and high-energy drinks to stay awake and focused. Breath sounds clear. Heart rate 150 bpm, irregularly irregular heart rhythm. RR: 18 breaths/min; temp: 98.2°F (36.7°C). BP 104/60 mm Hg standing, 104/60 mm Hg lying down. O2 sat: 97% on room air. Heart sounds normal. Skin warm and dry. Strong peripheral pulses. Denies chest, arm, or back pain; shortness of breath; or diaphoresis. Has had several episodes of dizziness, without loss of consciousness, which resolved spontaneously. Select 2 parameters to monitor: a) blood glucose level b) BP c) HR and rhythm d) cholesterol levels e) leg pain
b and c
Which are causes of bradycardia? Select the 3 that apply. a) fever b) sleeping c) infection d) vagal nerve stimulation e) spinal cord injury
b, d and e
Nursing preparation and patient education for Mrs. Milhouse's EP and ablation procedures included which of the following? Select the 3 that apply. a) inform the pt that the ablation will immediately relieve her palpitations b) advise the pt to request medication for pain or anxiety during the procedure if needed c) Inform the patient that she will be under conscious sedation during the procedure d) ensure NPO for 8 hrs prior to the procedure e) continue antiarrhythmic medications prior to procedure
b, c and d
The nurse is caring for a client who is receiving a loop diuretic for the treatment of heart failure. What assessment should the nurse prioritize?
blood pressure
Which serum lab value can assist in diagnosing heart failure?
brain natriuretic peptide (BNP)
A client is brought to the emergency department via rescue squad with suspicion of cardiogenic pulmonary edema. What complication should the nurse monitor for? Select the 3 that apply. a) nausea and vomiting b) pulmonary embolism c) cardiac arrhythmias d) respiratory arrest e) cardiac arrest
c, d and e
Which of the following is the most important principle the nurse considers in planning post-MI patient education?
establish the patient's priorities and plan teaching around them
A client with a history of right-sided heart failure lives in a long-term care facility. In the daily assessment, the nurse is required to record the level of this client's peripheral edema. Which would be the main area for examination?
feet and ankles
A patient is due to receive a dose of verapamil. Their heart rate is 98 beats per minute, and their blood pressure two hours ago was 95/46 mmHg. What is the nurse's best action?
obtain current blood pressure
