Cardiovascular NCLEX questions

When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. 1.Reflects electrical impulse beginning at the SA node 2.Indicated electrical impulse beginning at the AV node 3.Reflects atrial muscle depolarization 4.Identifies ventricular muscle depolarization 5.Has duration of normally 0.11 seconds or less.

1, 3, 5. In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

47) Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch? "Apply the patch to a nonhairy, nonfatty area of the upper torso or arms." "Apply the patch to the same site each day to maintain consistent drug absorption." "If you get a headache, remove the patch for 4 hours and then reapply." "If you get chest pain, apply a second patch right next to the first patch."

1. A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

Which of the following terms describes the force against which the ventricle must expel blood? Afterload Cardiac output Overload Preload

1. Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

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

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

22) The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including: Headache High blood pressure Shortness of breath Stomach cramps

1. Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.

46) A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by: Decreased arterial blood flow secondary to vasoconstriction Decreased arterial blood flow leading to hyperemia Atherosclerotic obstruction of the arteries Trauma to the lower extremities

1. Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.

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

1. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.

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

1. Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA's can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.

Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn't understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is: "Cardiac rehabilitation is not a cure but can help restore you to many of your former activities." "Here we teach you to gradually change your lifestyle to accommodate your heart disease." "You are probably right but we can gradually increase your activities so that you can live a more active life." "Do you feel that you will have to make some changes in your life now?"

1. Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell upon his negativity about it.

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

1. Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.

19) Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? A change in the pattern of her pain Pain during sex Pain during an argument with her husband Pain during or after an activity such as lawnmowing

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

50) When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: Moderate doses of two different types of diuretics are more effective than a large dose of one type This combination promotes diuresis but decreases the risk of hypokalemia This combination prevents dehydration and hypovolemia Using two drugs increases osmolality of plasma and the glomerular filtration rate

2. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-loosing diuretic. Giving these together minimizes electrolyte imbalance

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

2. Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.

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

2. Cardiac catherization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catherization results.

A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority? Monitoring vital signs Completing a physical assessment Maintaining cardiac monitoring Maintaining at least one IV access site

3. Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished around the MI monitoring.

A client is experiencing tachycardia. The nurse's understanding of the physiological basis for this symptom is explained by which of the following statements? The demand for oxygen is decreased because of pleural involvement The inflammatory process causes the body to demand more oxygen to meet its needs. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension. Respirations are labored.

3. The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart's having to beat faster to meet the body's needs for oxygen. .

27) A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this? Aortic Mitral Pulmonic Tricupsid

3. Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.

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

3. Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.

The most important long-term goal for a client with hypertension would be to: Learn how to avoid stress Explore a job change or early retirement Make a commitment to long-term therapy Control high blood pressure

3. Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.

37) One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? Hypocalcemia Hypermagnesemia Hypokalemia Hypernatremia

3. Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

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

3. Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

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

3. Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse: In all extremities At the insertion site Distal to the catheter insertion Above the catheter insertion

3. Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

36) A 57-year-old client with a history of asthma is prescribed propanolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first? Monitor the apical pulse rate Instruct the client to take medication with food Question the physician about the order Caution the client to rise slowly when standing.

3. Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

28) Which of the following blood tests is most indicative of cardiac damage? Lactate dehydrogenase Complete blood count (CBC) Troponin I Creatine kinase (CK)

3. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury.

35) Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole? Afterload Cardiac index Cardiac output Preload

4. Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload. Afterload is the force against which the ventricle must expel blood. Cardiac index is the individualized measurement of cardiac output, based on the client's body surface area. Cardiac output is the amount of blood the heart is expelling per minute.

29) Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? Cardiac catherization Cardiac enzymes Echocardiogram Electrocardiogram (ECG)

4. The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catherization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.

When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the: Impulse to begin atrial contraction Impulse to transverse the atria to the AV node SA node to discharge the impulse to begin atrial depolarization Impulse to travel to the ventricles

4. The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

30) Which of the following types of pain is most characteristic of angina? Knifelike Sharp Shooting Tightness

4. The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.

1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? Intake and output Baseline peripheral pulse rates Height and weight Allergy to iodine or shellfish

4. This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.

A client's physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect: Normal vs. abnormal tissue Damage in areas of the heart Ventricular function Myocardial scarring and perfusion

4. This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a more specific answer than (1) or (2). Specific ventricular function is tested by a gated cardiac blood pool scan.

A patient with chronic congestive heart failure and atrial fibrillation is treated with a digitalis preparation and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to A. monitor serum potassium levels. B. keep an accurate measure of intake and output. C. teach the patient about dietary restriction of potassium. D. withhold the digitalis and notify the health care provider if the heart rate is irregular. A. monitor serum potassium levels.

A. monitor serum potassium levels.

An important nursing responsibility for a patient having an invasive cardiovascular diagnostic study is A. checking the peripheral pulses and percutaneous site. B. instructing the patient about radioactive isotope injection. C. informing the patient that general anesthesia will be given. D. assisting the patient to do a surgical scrub of the insertion site.

A. checking the peripheral pulses and percutaneous site.

When assessing the patient, the nurse notes a palpable precordial thrill. This finding may be caused by A. heart murmurs. B. gallop rhythms. C. pulmonary edema. D. right ventricular hypertrophy.

A. heart murmurs.

The primary causes of death in patients with heart transplants in the first year include A. infection and rejection. B. rejection and arrhythmias. C. arrhythmias and infection. D. myocardial infarction and lymphoma.

A. infection and rejection.

A patient with newly diagnosed hypertension has a blood pressure of 158/98 after 12 months of exercise and diet modifications. The nurse advises the patient that A. medication may be required because the BP is still not within the normal range. B. continued monitoring of the BP every 3 to 6 months is all that will be necessary for treatment. C. because lifestyle modifications were not effective they do not need to be continued and drugs will be used. D. he will have to make more vigorous changes in his lifestyle if he wants to stay off medication for his hypertension.

A. medication may be required because the BP is still not within the normal range.

The drug used in the management of a patient with acute pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is A. morphine. B. amrinone. C. dobutamine. D. aminophylline.

A. morphine.

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to A. notify the physician. B. elevate the leg to promote venous return. C. wrap the leg in a blanket to provide warmth. D. perform passive range of motion to stimulate circulation to the leg.

A. notify the physician.

When providing discharge instructions to a patient with a new permanent pacemaker, the nurse teaches the patient to A. take and record a daily pulse rate. B. request special hand scanning at airport and other security gates. C. immobilize the arm and shoulder on the side of the pacemaker insertion for 6 weeks. D. avoid microwave ovens because they emit radio waves that alter pacemaker function.

A. take and record a daily pulse rate.

Nursing interventions indicated in the plan of care for the patient with acute lower extremity deep vein thrombosis include A. applying elastic compression stockings. B. administering anticoagulants as ordered. C. positioning the leg dependently to promote arterial circulation. D. encouraging walking and leg exercises to promote venous return.

B. administering anticoagulants as ordered.

A P wave on an ECG represents an impulse A. arising at the SA node and repolarizing the atria. B. arising at the SA node and depolarizing the atria. C. arising at the AV node and depolarizing the atria. D. arising at the AV node and spreading to the bundle of His.

B. arising at the SA node and depolarizing the atria.

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is A. hyperlipidemia. B. excessive alcohol intake. C. a family history of hypertension. D. consumption of a high-carbohydrate, high-calcium diet

B. excessive alcohol intake.

An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient? Observe electrocardiogram readings and report deviations to the nurse. Assist the client with ambulation three times during the shift. Monitor vital signs every 15 minutes and report each reading to the nurse. Accurately weigh the patient, and report and record the readings.

Accurately weigh the patient, and report and record the readings. Rationale: Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients also should be instructed about the need to perform daily weights upon discharge to monitor body water. It is not within the role of the CNA to monitor ECG readings, and ambulation is not an assessment. Vital signs every 15 minute are not necessary for this level of patient care.

Which of the following are direct causes of chronic ischemic pain? (Select all that apply.) Aortic stenosis Acid reflux Pulmonary embolus Herpes zoster (shingles)

Aortic stenosis Acid reflux Pulmonary embolus Rationale: Herpes zoster (shingles) manifests as a vesicular rash along a dermatome, not chronic ischemic pain. Integrated Process: Nursing Process; Evaluation Cognitive Level: Evaluation NCLEX-RN Test Plan: Physiological Integrity; Physiological Adaptation Rationale: Herpes zoster (shingles) manifests as a vesicular rash along a dermatome, not chronic ischemic pain.

The nurse plans care for the patient with an implantable cardioverter-defibrillator based on the knowledge that A. antiarrhythmia drugs can be discontinued. B. all members of the patient's family should learn CPR. C. the patient should not drive until 1 month after the ICD has been implanted. D. the patient is usually relieved to have the device implanted to prevent arrhythmias.

B. all members of the patient's family should learn CPR.

The nurse suspects left-sided heart failure in a newly admitted client when the nurse notes which of the following symptoms? (Select all that apply.) A. Distended neck veins B. Bilateral crackles in the lungs C. Weight gain of 2 lb in past 2 days D. Shortness of breath, especially at night .

B. Bilateral crackles in the lungs D. Shortness of breath, especially at night Left-sided heart failure results in ineffective ejection of blood from the left ventricle. This causes a backup of blood into the lungs. Thus, symptoms of left-sided heart failure are usually related to the lungs

The patient who is most likely to have the highest risk for deep vein thrombosis is a A. 25-year-old obese woman who is 3 days postpartum. B. 40-year-old woman who smokes and uses oral contraceptives. C. 62-year-old man who has had a stroke with left-sided hemiparesis. D. 72-year-old man who had a suprapubic prostatectomy for cancer of the prostate.

B. 40-year-old woman who smokes and uses oral contraceptives.

A high-risk population that should be targeted in the primary prevention of hypertension is A. smokers. B. African Americans. C. business executives. D. middle-aged women.

B. African Americans.

A patient is admitted to the hospital in hypertensive crisis. The nurse recognizes that the hypertensive urgency differs from hypertensive emergency in that A. the BP is always higher in a hypertensive emergency. B. hypertensive emergencies are associated with evidence of target organ damage. C. hypertensive urgency is treated with rest and tranquilizers to lower the BP. D. hypertensive emergencies require intraarterial catheter measurement of the BP.

B. hypertensive emergencies are associated with evidence of target organ damage.

The nurse is caring for a client who has undergone cardiac catheterization. The client says to the nurse, "The doctor said my cardiac output was 5.5 L/min. What is normal cardiac output?" Which of the following is the nurse's best response? A. "It is best to ask your doctor." B. "Did the test make you feel upset?" C. "The normal cardiac output for an adult is 4 to 6 L/min." D. "Are you able to explain why are you asking this question?"

C. "The normal cardiac output for an adult is 4 to 6 L/min."

The nurse is concerned when a client's heart rate, which is normally 95 beats per minute, rises to 220 beats per minute, because a rate this high will: A. Exhaust the client B. Decrease metabolic rate C. Reduce coronary artery perfusion D. Provide too much blood flow to major organs

C. Reduce coronary artery perfusion Coronary arteries fill and perfuse the myocardium (heart muscle) during diastole. When the heart rate is elevated, more time is spent in systole and less in diastole; hence, the myocardium may not be perfused adequately. The client may be exhausted, but the primary concern is myocardial perfusion. Major organs will adjust to increased blood flow. This is usually not a problem. With a heart rate this high, metabolic rate will be increased, not decreased.

The most common pathologic finding in individuals with sudden cardiac death is A. cardiomyopathies. B. mitral valve disease. C. atherosclerotic heart disease. D. left ventricular hypertrophy.

C. atherosclerotic heart disease.

The nurse suspects the presence of a deep vein thrombosis based on the findings of A. paresthesia and coolness of the leg. B. pain in the calf that occurs with exercise. C. generalized edema of the involved extremity. D. pallor and cyanosis of the involved extremity.

C. generalized edema of the involved extremity.

A patient with a tricuspid valve disorder will have impaired blood flow between the A. vena cava and right atrium. B. left atrium and left ventricle. C. right atrium and right ventricle. D. right ventricle and pulmonary artery.

C. right atrium and right ventricle.

The nurse plans care for the patient with dilated cardiomyopathy based on the knowledge that A. family members may be at risk because of the infectious nature of the disease. B. medical management of the disorder focuses on treatment of the underlying cause. C. the prognosis of the patient is poor, and emotional support is a high priority of care. D. the condition may be successfully treated with surgical ventriculomyotomy and myectomy.

C. the prognosis of the patient is poor, and emotional support is a high priority of care.

If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the A. atria. B. AV node. C. ventricles. D. bundle of His.

C. ventricles.

A patient receiving the drug simvastatin (Zocor) should be taught this medication helps to prevent coronary heart disease by: Increasing lower-density lipoprotein. Controlling lower-density lipoprotein. Increasing triglycerides. Increasing very low-density lipoprotein.

Controlling lower-density lipoprotein. Rationale: The Heart Protective Study has also shown that controlling low-density lipoprotein (LDL) with simvastatin (Zocor) assists in the prevention of coronary heart disease by raising HDL. Responses 1, 3, and 4 are incorrect.

Left-sided heart failure is characterized by: A. Increased cardiac output B. Lowered cardiac pressures C. Decreased functioning of the left atrium D. Decreased functioning of the left ventricle

D. Decreased functioning of the left ventricle Left-sided heart failure is an abnormal condition characterized by decreased functioning of the left ventricle. If left ventricular failure is significant, the amount of blood ejected from the left ventricle drops greatly, which results in decreased cardiac output. Progress

The nurse instructs the patient discharged on anticoagulant therapy to A. limit intake of vitamin C. B. report symptoms of nausea to the physician. C. have blood drawn routinely to check electrolytes. D. be aware of and report signs or symptoms of bleeding.

D. be aware of and report signs or symptoms of bleeding.

The nurse prepares a patient for electrical cardioversion knowing that cardioversion differs from defibrillation in that A. defibrillation requires a greater dose of electrical current. B. defibrillation is synchronized to countershock during the QRS complex. C. cardioversion is indicated only for treatment of atrial tachyarrhythmias. D. cardioversion may be done on a nonemergency basis with sedation of the patient.

D. cardioversion may be done on a nonemergency basis with sedation of the patient.

A patient with a stable blood pressure and no symptoms has the following electrocardiogram characteristics: atrial rate—74 and regular; ventricular rate—62 and irregular; P wave—normal contour; PR interval—lengthens progressively until a P wave is not conducted; QRS—normal contour. The nurse would expect that treatment would involve A. epinephrine 1 mg IV push. B. isoproterenol IV continuous drip. C. immediate insertion of a temporary pacemaker. D. careful observation for symptoms of hypotension.

D. careful observation for symptoms of hypotension.

A patient with a deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest pain. Initially the most appropriate action by the nurse is to A. auscultate for abnormal lung sounds. B. administer oxygen and notify the physician. C. ask the patient to cough and deep breathe to clear the airways. D. elevate the head of the bed 30 to 45 degrees to facilitate breathing.

D. elevate the head of the bed 30 to 45 degrees to facilitate breathing.

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that A. all patients with elevated BP require medication. B. it is not necessary to limit salt in the diet if taking a diuretic. C. obese persons must achieve a normal weight in order to lower BP. D. lifestyle modifications are indicated for all persons with elevated BP.

D. lifestyle modifications are indicated for all persons with elevated BP.

Target organ damage that can occur from hypertension includes A. headache and dizziness. B. retinopathy and diabetes. C. hypercholesterolemia and renal dysfunction. D. renal dysfunction and left ventricular hypertrophy.

D. renal dysfunction and left ventricular hypertrophy.

A major consideration in the management of the older adult with hypertension is to A. prevent pseudohypertension from converting to true hypertension. B. recognize that the older adult is less likely to comply with the drug therapy than a younger adult. C. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

Which of the following diagnostic tests is preferred for evaluating heart valve function? Chest x-ray Duplex Doppler Echocardiogram Electrocardiogram

Echocardiogram Rationale: The echocardiogram is the preferred test to evaluate heart valves, because it allows the visualization of the valves as they open and close. A chest x-ray will determine the size of the heart, the duplex measures blood flow through major arteries, and an electrocardiogram identifies electrical activity.

Nurses can best help older clients prevent hypertension by teaching: Low-fat, low-cholesterol diets. The importance of exercise. How to handle stressful situations. How to maintain a normal blood pressure.

How to maintain a normal blood pressure. Rationale: Hypertension is a major risk factor for other cardiovascular conditions. In persons older than 50, systolic blood pressure greater than 140 mm Hg is a much more important cardiovascular disease risk factor than is diastolic blood pressure. The risk of cardiovascular disease, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg. Answers 1, 2, and 3 are important elements to include in education of a patient with blood pressure elevation, and are included in the correct answer.

Which of the following assessments would be an important finding for a patient with arterial disease? Intermittent claudication with exercise Brownish discoloration around the ankles Non-pitting edema on the lower extremities Altered sensation to touch

Intermittent claudication with exercise Rationale: Intermittent claudication is a common finding in persons with arterial disease, usually due to progression of atherosclerosis and alteration of tissue perfusion to the extremities. In venous disease, valves of the veins in the extremities become incompetent, resulting in higher pressures than normal in the veins. The pressure is transmitted to the capillaries of the lower extremities, resulting in thickening and non-pitting edema of tissues around the ankles. Prolonged thickening results in the red blood cells' being pressed outside the capillaries. The cells eventually break down, resulting in collection of hemosiderin deposits being collected in the area. Altered sensation to touch would be due to neuropathic changes commonly found with diabetes mellitus.

Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.) Mental status changes Agitation Frequent falls Sudden changes in GI function

Mental status changes Agitation Frequent falls Rationale: Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem.

A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of the heart receives blood from systemic circulation? Left atrium Right atrium Right ventricle Left ventricle

Right atrium Rationale: The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus.

Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication? Sublingual nitroglycerin Cardiac glycosides HMG-CoA reductase inhibitors Morphine sulfate

Sublingual nitroglycerin Rationale: Angina frequently is managed with sublingual nitroglycerin, which causes vasodilation and increases blood flow to the coronary arteries. Cardiac glycosides are used to treat heart failure, and morphine is used to treat myocardial infarction. The HMG-CoA reductase inhibitors are used for patients with type 2 diabetes mellitus.

A client with post-myocardial infarction develops acute bacterial pericarditis. Which of the following medications would the physician most likely prescribe as the primary drug? Ticarcillin disodium (Ticar) Acetaminophen (Tylenol) Ibuprofen (Motrin) Trioxsalen (Trisoralen)

Ticarcillin disodium (Ticar) Rationale: Acute bacterial pericarditis is a complication that can occur post-myocardial infarction. Acute bacterial pericarditis usually requires antibiotics. NSAIDs usually are prescribed to relieve pain from the inflammatory process. If the NSAIDs do not relieve pain within 48 to 96 hours, corticosteroids are ordered. There is no mention of pain in the stem of the question. Trisoralen is used to repigment skin for persons with vitiligo.

Which of the following diagnostic studies most likely would confirm a myocardial infarction? Serum myoglobin level Creatinine kinase (CK) White blood cell count (WBC) Troponin T levels

Troponin T levels Rationale: CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6-8 hours after the infarct (tissue necrosis) but also can occur with other types of tissue damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an inflammatory response. Troponin levels are more elevated than are the other cardiac enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue necrosis).

A common arrhythmia found in some older clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered? Aspirin (acetylsalicylic acid) Warfarin sodium (Coumadin) Simvastatin (Zocor) Vinorelbine tartrate (Navelbine)

Warfarin sodium (Coumadin) Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation. Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL. Navelbine is an anti-neoplastic.