Cardiology Review Questions
What are the clinical manifestations of myocardial infarction in women? Select all that apply. A. Anoxia B. Indigestion C. Unusual fatigue D. Sleep disturbances E. Tightness of the chest
B, C, D Rationale Indigestion, unusual fatigue, and sleep disturbances are clinical manifestations of myocardial infarction in women. Anoxia and tightness of the chest are clinical manifestations of angina pectoris, not myocardial infarction.
A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. A. Age B. Height C. Weight D. Smoking E. Family history
C, D Rationale Obesity is a modifiable risk factor that is associated with coronary artery disease (CAD); an increased fat intake contributes to an increased serum cholesterol and atherosclerosis. Smoking, which constricts the blood vessels, is a modifiable risk factor for CAD. The incidence of CAD does increase with age. However, age is not a modifiable risk factor. Height is unrelated to the incidence of CAD. Family history is not a modifiable risk factor for CAD because one cannot control heredity.
A client who just returned from surgery reports shortness of breath and chest pain. Which should the nurse initially administer? A. Supplemental oxygen B. Intravenous morphine C. Endotracheal intubation D. Sublingual nitroglycerin
A Rationale Oxygen supports vital centers of the body while the cause of the problem is investigated. Although an intravenous morphine may be done eventually if the client is experiencing a myocardial infarction, it is not the initial action and requires a prescription. Endotracheal intubation is not implemented by a nurse. Later, endotracheal intubation may be necessary if the client experiences respiratory failure or obstruction. Although a sublingual nitroglycerin may be done eventually if the client is experiencing angina, it is not an initial action and requires a prescription.
Which clinical indicators is the nurse most likely to identify when taking the admission history of a client with right ventricular failure? Select all that apply. A. Edema B. Vertigo C. Polyuria D. Ascites E. Palpitations
A, D Rationale Heart failure is the failure of the heart to pump adequately to meet the needs of the body, resulting in a backward buildup of pressure in the venous system. Clinical manifestations include edema, ascites, hepatomegaly, tachycardia, and fatigue. Dyspnea occurs in left-sided heart failure because of pulmonary congestion and inadequate delivery of oxygen to all body cells. Vertigo generally is not related to right ventricular failure. Because a diminished cardiac output decreases blood flow to the kidneys, there will be a decreased, not increased, urine output (polyuria). Palpitations may indicate dysrhythmias or anxiety.
A nurse is caring for a client with right-sided heart failure. Which assessment findings are key features of right-sided heart failure? Select all that apply. A. Collapsed neck veins B. Distended abdomen C. Dependent edema D. Urinating at night E. Cool extremities
B, C, D Rationale Right-sided heart failure is associated with increased systemic venous pressures and congestion, as manifested by a distended abdomen, dependent edema, and urinating at night. Distended, not collapsed, neck veins occur in right-sided heart failure. Cool extremities are key features of left-sided heart failure.
A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client? A. Prevent dyspnea B. Prevent cyanosis C. Increase oxygen concentration to heart cells D. Increase oxygen tension in the circulating blood
C Rationale Administration of oxygen increases the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, usually is associated with myocardial infarction. Although administering oxygen will increase oxygen tension in the circulating blood, it is not specific to heart cells, which are hypoxic when there is a myocardial infarction from a coronary occlusion.
The nurse provides discharge teaching to a client with a history of angina. The nurse instructs the client to call for emergency services immediately if the client's pain exhibits which characteristic? A. Causes mild perspiration B. Occurs after moderate exercise C. Continues after rest and nitroglycerin D. Precipitates discomfort in the arms and jaw
C Rationale When neither rest nor nitroglycerin relieves the pain, the client may be experiencing an acute myocardial infarction. Angina may cause mild diaphoresis; acute myocardial infarction causes profuse diaphoresis, which should be reported. Chest pain after exercise is expected; activity increases cardiac output, which can cause angina. Anginal pain can, and often does, radiate.
A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? A. "My ankles are swollen." B. "I am tired at the end of the day." C. "When I eat a large meal, I feel bloated." D. "I have trouble breathing when I walk rapidly."
D Rationale Dyspnea on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity. The statement "My ankles are swollen" is more likely with right ventricular heart failure. The statement "I am tired at the end of the day" is not specific to left ventricular heart failure. The statement "When I eat a large meal, I feel bloated" is not specific to left ventricular heart failure.
The nurse is conducting a nutrition class for a group of clients with heart failure (HF). Which information is most important for the nurse to share with the class? A. Restricting fluid intake B. Eating a low caloric diet to reduce weight C. Recognizing which products are high in cholesterol D. Choosing fresh or frozen vegetables instead of canned ones
D Rationale The key principle to teach HF clients is the importance of decreasing sodium in their diet and which foods contain sodium. If sodium is decreased, water retention will decrease also. Fresh or frozen vegetables have less sodium than canned ones. If the client is on a low-sodium diet and receiving diuretics but continues to be fluid overloaded, then fluid restriction may be instituted. A low caloric diet is not indicated for all HF clients. Some are very thin because of various factors, including the work of breathing and rapid heart rate. A low cholesterol diet is important for clients with coronary artery disease and for the American population in general but is not specifically related to HF.
A nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome? A. Allows excess tissue fluid to be excreted B. Helps to control the volume of food intake and thus weight C. Aids the weakened heart muscle to contract and improves cardiac output D. Assists in reducing potassium accumulation that occurs when sodium intake is high
A Rationale A decreased concentration of extracellular sodium causes a decrease in the release of antidiuretic hormone (ADH); this leads to increased excretion of urine. Sodium restriction does not control the volume of food intake; weight is controlled by a low-calorie diet and exercise (if permitted). The resulting elimination of excess fluid reduces the workload of the heart but does not improve contractility. Potassium is retained inefficiently by the body; an adequate intake of potassium is needed.
A client admitted to the hospital for chest pain is diagnosed with stable angina. Which information should the nurse include in the teaching session? A. It is relieved by rest. B. It is precipitated by light activity. C. It is described as sharp or knifelike. D. It is unaffected by the administration of vasodilators.
A Rationale Anginal pain commonly is relieved by immediate rest because rest decreases the cardiac workload and oxygen need. Angina usually is precipitated by exertion, emotion, or a heavy meal. Anginal pain usually is described as tightness, indigestion, or heaviness. Nitroglycerin, a vasodilator and a standard treatment for angina, dilates coronary arteries, which increases oxygen to the myocardium, decreasing pain.
The nurse is assessing a client with the diagnosis of chronic heart failure. Which clinical finding should the nurse expect the client to experience? A. Dependent edema in the evening B. Chest pain that decreases with rest C. Palpitations in the chest when resting D. Frequent coughing with yellow sputum
A Rationale Decreased cardiac output causes fluid retention, which results in dependent edema; this is often noticed in the evening after the client has been standing or sitting for prolonged periods. Chest pain is indicative of cardiac ischemia. Palpitations are indicative of cardiac dysrhythmias. Coughing with yellow sputum is indicative of an infectious process in the respiratory tract; pink, frothy sputum is associated with pulmonary edema that can result from heart failure.
A primary healthcare provider prescribes a heart-healthy diet for a client with angina. The client's spouse says to the nurse, "I guess I'm going to have to cook two meals, one for my spouse and one for myself." Which is the most appropriate response by the nurse? A. "The diet prescribed for your spouse is a healthy diet. It contains guidelines that many of us should follow." B. "I wouldn't bother. For this diet all that you need to do is to reduce the amount of salt you use and fry foods in peanut oil." C. "You're right. Be careful to cook a small portion for each of you to eat to not waste food." D. "This is a difficult diet to follow. I recommend that you shop daily for food so there are no temptations in the kitchen."
A Rationale Heart-healthy diets are low in cholesterol, sodium, and fat, particularly saturated fats, and high in vegetables and fruits; this type of diet is advocated for all individuals. Fried foods are not advocated on a heart-healthy diet; peanut oil is a monounsaturated fatty acid, and these acids should not exceed 15% of the calories of the diet. The responses "You're right. Be careful to cook a small portion for each of you to eat to not waste food" and "This is a difficult diet to follow. I recommend that you shop daily for food so there are no temptations in the kitchen" can be discouraging and encourage noncompliance.
Serum cardiac marker studies are prescribed for a client after a myocardial infarction. Which laboratory test is most important for the nurse to monitor? A. Troponin B. Myoglobin C. Homocysteine D. Creatine kinase (CK)
A Rationale Troponin is the biomarker of choice for a myocardial infarction. Troponin, specifically subtypes cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI), reflects myocardial muscle protein released into circulation soon after injury. Troponin increases as quickly as CK and remains increased for 2 weeks. Although myoglobin is one of the first cardiac markers to increase after a myocardial infarction (MI), it lacks cardiac specificity. Homocysteine is produced when proteins break down, but it is more indicative of cardiovascular disease than a myocardial infarction. CK isoenzyme levels, especially the creatine phosphokinase (MB) subunit, begin to increase in 3 to 6 hours, peak in 12 to 24 hours, and are increased for 48 hours after the occurrence of the infarct. Although reliable in assisting with an early diagnosis of MI, it is not as sensitive or specific as the troponin test.
A woman comes to the emergency department reporting signs and symptoms that are determined by the primary healthcare provider to be caused by a myocardial infarction. The nurse obtains a health history. Which reported symptoms does the nurse determine are specifically related to a myocardial infarction in women? Select all that apply. A. Severe fatigue B. Sense of unease C. Choking sensation D. Chest pain relieved by rest E. Pain radiating down the left arm
A, B Rationale A myocardial infarction in women may be asymptomatic, atypical, or mild. Unique symptoms include overwhelming fatigue, a sense of uneasiness, indigestion, and shoulder tenderness. A sense of unease is a unique characteristic of a myocardial infarction in women. The client knows something is not right but cannot identify what it is. This uneasiness often is disregarded by the client. A choking sensation occurs in both men and women with a myocardial infarction. Chest pain relieved by rest occurs in both men and women with angina; it is caused by coronary artery spasms leading to myocardial ischemia. Angina frequently is a precursor to a myocardial infarction. Pain radiating down the left arm occurs in both men and women. It can radiate also to the neck, lower jaw, left arm, left shoulder, and, less frequently, the right arm and back.
A nurse is teaching a group of clients about risk factors for heart disease. Which factors will the nurse include that increase a client's risk for a myocardial infarction (MI)? Select all that apply. A. Obesity B. Hypertension C. Diabetes insipidus D. Asian-American ancestry E. Increased high-density lipoprotein (HDL)
A, B Rationale Obesity increases cardiac workload associated with vascular changes that lead to ischemia, which causes an MI. Hypertension damages blood vessels and increases peripheral resistance and cardiac workload, which may lead to an MI. Diabetes mellitus, not insipidus, is a risk factor for an MI. The risk is higher for African-Americans, not Asian-Americans. Increased levels of low-density lipoprotein (LDL), not HDL, increase the risk for heart disease.
An older adult client is diagnosed with left-sided congestive heart failure. Which assessments should the nurse expect to find? Select all that apply. A. Dyspnea B. Crackles C. Hacking cough D. Peripheral edema E. Jugular distention
A, B, C Rationale The left ventricle pumps oxygen-rich blood to the rest of the body. Left-sided heart failure occurs when the left ventricle doesn't pump efficiently. This prevents the body from getting enough oxygen-rich blood. The blood backs up into the lungs instead, which causes a buildup of fluid. Common symptoms may include: dyspnea, shallow respirations, crackles, dry, hacking cough, and frothy, pink-tinged sputum. Right-sided heart failure occurs when the right side of the heart can't perform its job effectively. Common symptoms of right-sided heart failure include peripheral edema, weight gain, and jugular distention.
A nurse is caring for a client with a diagnosis of right ventricular heart failure. The nurse expects what assessment findings associated with right-sided heart failure? Select all that apply. A. Dependent edema B. Swollen hands and fingers C. Collapsed neck veins D. Right upper quadrant discomfort E. Oliguria
A, B, D Rationale With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. Upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly. Jugular venous collapse and oliguria are key features of left-sided heart failure. Left-sided heart failure is associated with decreased cardiac output.
A client is experiencing a myocardial infarction. What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion? A. Arterial spasm B. Heart muscle ischemia C. Blocking of the coronary veins D. Irritation of nerve endings in the cardiac plexus
B Rationale Ischemia causes tissue injury and the release of chemicals, such as bradykinin, that stimulate sensory nerves and produce pain. Arterial spasm, resulting in tissue hypoxia and pain, is associated with angina pectoris. Arteries, not veins, are involved in the pathology of a myocardial infarction. Tissue injury and pain occur in the myocardium.
A client is admitted to the hospital with the diagnosis of myocardial infarction. The nurse should monitor this client for which signs and symptoms associated with heart failure? Select all that apply. A. Weight loss B. Unusual fatigue C. Dependent edema D. Nocturnal dyspnea E. Increased urinary outpu
B, C, D Rationale Unusual fatigue is attributed to inadequate perfusion of body tissues because of decreased cardiac output in response to cardiac ischemia; women more commonly report unusual fatigue than men. Dependent edema occurs with right ventricular failure because of hypervolemia. Dyspnea at night, which usually requires the assumption of the orthopneic position, is a sign of left ventricular failure. Orthopnea, a compensatory mechanism, limits venous return, which decreases pulmonary congestion and promotes ventilation, easing the dyspnea. Weight gain, not loss, occurs because of fluid retention. Urinary output decreases, not increases, with heart failure because the sympathetic nervous system and the renin-angiotensin-aldosterone system stimulate the retention of sodium and water in the kidneys.
The nurse is planning to teach a client with heart failure about the signs and symptoms of cardiac decompensation. What clinical manifestations should the nurse include? Select all that apply. A. Weight loss B. Extreme fatigue C. Coughing at night D. Excessive urination E. Difficulty breathing
B, C, E Rationale Fatigue is caused by a lack of adequate oxygenation of body cells caused by a decreased cardiac output. As the cardiac output decreases, pulmonary congestion increases, resulting in pulmonary edema; coughing, especially when lying down, and blood-tinged sputum occur. Auscultation reveals crackles and rhonchi. Dyspnea is associated with pulmonary edema that occurs as cardiac output decreases and pulmonary congestion increases. Weight gain, not loss, occurs as fluid is retained by the kidneys. Fluid retention, not diuresis, occurs because of decreased circulation to the kidneys, resulting from decreased cardiac output.
How can the nurse best describe heart failure to a client? A. A cardiac condition caused by inadequate circulating blood volume B. An acute state in which the pulmonary circulation pressure decreases C. An inability of the heart to pump blood in proportion to metabolic needs D. A chronic state in which the systolic blood pressure drops below 90 mm Hg
C Rationale As the heart fails, cardiac output decreases; eventually the decrease will reach a level that prevents tissues from receiving adequate oxygen and nutrients. Heart failure is related to an increased, not decreased, circulating blood volume. The condition may be acute or chronic; the pulmonary pressure increases and capillary fluid is forced into the alveoli. The blood pressure usually does not drop.
Metoprolol is prescribed for a client. Which condition in the client's electronic medical record will cause the nurse to question the prescription? A. Hypertension B. Angina pectoris C. Sinus bradycardia D. Myocardial infarction
C Rationale Metoprolol is a beta blocker; it decreases the heart rate and thus is contraindicated with bradycardia. Metoprolol is an antihypertensive agent and is given for hypertension. By reducing cardiac output, metoprolol reduces myocardial oxygen consumption, which helps prevent ischemia from anginal pain and myocardial infarction.
A client with an inferior myocardial infarction has a heart rate of 120 beats per minute. Which goal achievements are priority? A. Increase left ventricular filling and improve cardiac output B. Decrease oxygen needs of the vital organs and prevent cardiac dysrhythmias C. Decrease the workload on the heart and promote maximum coronary artery filling D. Increase venous return to the right atrium and increase pulmonary arterial blood flow
C Rationale With a myocardial infarction, circulation of blood to cardiac muscle is reduced, depriving it of oxygen; therefore the oxygen demands of the body need to be decreased to reduce stress on the heart and reduce cardiac output. Increased coronary artery filling allows more blood and therefore oxygen to reach cardiac muscle; this increases myocardial efficiency. Increasing left ventricular filling increases the workload of the heart. Oxygenation of vital organs must be maintained. Decreasing oxygen to vital organs of the body may interfere with their ability to function. Increasing venous return to the right atrium increases the workload of the heart.
A client with heart disease has been reading on the Internet about the anatomy and physiology of the heart and tells the nurse, "I'm so confused." The nurse reinforces the pattern of circulation in the body. Which client statement indicates a correct understanding? A. "Blood enters the heart through the ductus arteriosus, flows into the left side of the heart, and exits via the aorta into the systemic circulation." B. "Blood enters the heart from the inferior vena cava; it then flows through the left atrium into the left ventricle, then into the lungs, and back into the aorta." C. "Blood enters the heart from the aorta, flows into the right atrium and right ventricle, through the lungs, then into the left atrium and left ventricle, and finally exits through the superior vena cava." D. "Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta."
D Rationale "Blood enters the right atrium via the superior and inferior vena cava, flows to the right ventricle and then into the lungs, returns from the lungs to the left atrium and left ventricle, and exits out the aorta" correctly describes the flow of blood through the heart after birth. The ductus arteriosis is a fetal structure that is not present in the adult heart. Blood enters the right side of the heart via the inferior and superior vena cava; blood flows from the right atrium, to the right ventricle, to the lungs, and then to the left atrium. Blood exits, not enters, the heart from the aorta.
A nurse is caring for a client with a myocardial infarction. What is most important for the nurse to assess that has a direct relationship to the action potential of the heart? A. Heart rate B. Refractory period C. Pulmonary pressure D. Strength of contractions
D Rationale A direct relationship exists between the strength of cardiac contractions and electrical conductions through the myocardium. The heart rate is related to such factors as sinoatrial (SA) node function, partial pressures of oxygen and carbon dioxide, and emotions. Refractory period is the period when the heart is at rest, not when it is contracting. Pulmonary pressure does not influence action potential; it becomes increased in the presence of left ventricular failure.
A nurse is caring for a client with the diagnosis of right ventricular failure. Which condition unrelated to cardiac disease is the major cause of right ventricular failure? A. Renal disease B. Hypovolemic shock C. Severe systemic infection D. Chronic obstructive pulmonary disease (COPD)
D Rationale COPD causes destruction of capillary beds around the alveoli, interfering with blood flow to the lungs from the right side of the heart. As the heart continues to strain against this resistance, heart failure eventually results. Renal disease causes stress on the left side of the heart. Hypovolemic shock will not cause stress on the right side of the heart. Severe systemic infection probably will produce greater stress on the left side of the heart.