CV 2
A patient is scheduled to have percutaneous coronary intervention (PCI). The nurse anticipates that an initial dose of which medication will be given before the procedure? a. Clopidogrel b. Nitroglycerin c. Isosorbide mononitrate d. Carvedilol
a. Clopidogrel
For which common complication of myocardial infarction should the nurse monitor clients in the coronary care unity? a. Dysrhythmia b. Hypokalemia c. Anaphylactic shock d. Cardiac enlargement
a. Dysrhythmia
At 10:00 AM, a hospitalized client receives a new order for transesophageal echocardiography as soon as possible. Which action will the nurse take FIRST? a. Put the client on "nothing by mouth" (NPO) status b. Teach the client about the procedure c. Insert an IV catheter in the client's forearm d. Attach the client to a cardiac monitor
a. Put the client on "nothing by mouth" (NPO) status
Which finding in a client with aortic stenosis will be MOST important for the nurse to report to the health care provider? a. Temperature of 102.1 F (38.9 C) b. Loud systolic murmur over sternum c. Blood pressure of 110/88 mm HG d. Weak radial and pedal pulses to palpation
a. Temperature of 102.1 F (38.9 C)
After surgery for insertion of a coronary artery bypass graft (CABG), a client develops a temperature of 102 F (38.8 C). What PRIORITY concern related to elevated temperatures does a nurse consider when notifying the health care provider about he client's temperature? a. A fever may lead to diaphoresis. b. A fever increases the cardiac output. c. An increased temperature indicates cerebral edema. d. An increased temperature may be a sign of hemorrhage.
b. A fever increases the cardiac output.
Which drug is given within 1 to 2 hours of a myocardial infarction (MI), when the patient is hemodynamically stable, to help the heart to perform more work without ischemia? a. Vasodilators, such as sublingual or spray nitroglycerin b. Beta-adrenergic blocking agents, such as metoprolol c. Antiplatelet agents, such as clopidogrel d. Calcium channel blockers, such as diltiazem
b. Beta-adrenergic blocking agents, such as metoprolol
The nurse is caring for a patient who had a minimally invasive direct coronary artery bypass (MIDCAB). Which sign/symptom prompts the nurse to immediately contact the health care provider? a. Acute incisional pain b. ST-segment changes on the monitor c. Drainage from the chest tubes d. Problems with coughing
b. ST-segment changes on the monitor
During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes stool from the client's rectum. What response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate the client's bowel movements? a. Increased pulse rate b. Slowing of the heart c. Dilation of the bronchioles d. Coronary artery vasodilation
b. Slowing of the heart
The patient received thrombolytic therapy. Which manifestation indicates that the clot has been dissolved? a. The patient continues to have chest pain but the intensity is much less. b. There is a sudden onset of nonsustained ventricular dysrhythmias c. ST segment remains elevated with inverted T waves d. Cardiac markers peak 3 to 4 hours after thrombolytic therapy
b. There is a sudden onset of nonsustained ventricular dysrhythmias
A client who has just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be MOST useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol. a. Creatine kinase MG level b. Troponin I level c. Myoglobin level d. C-reatcive protein level
b. Troponin I level
A patient in a cardiac rehabilitation program is having difficulty coping with the changes in her health status. Which statement by the patient is the STRONGEST indicator of ineffective or harmful coping? a. "I don't mind going to therapy, but I'm not sure if I'm getting any benefit from it." b. "I'll take the pills and just do whatever you want me to do." c. "I don't want to go to therapy; I had a bad experience yesterday with the therapist." d. I know I need to talk about going home soon, but could we discuss it later?"
c. "I don't want to go to therapy; I had a bad experience yesterday with the therapist."
After coronary artery bypass graft (CABG) surgery, a postoperative patient suddenly has a decrease in mediastinal drainage, jugular vein distention with clear lung sounds, pulsus paradoxus, and equalizing pulmonary artery wedge pressure (PAWP) and right atrial pressure. What doe these signs suggest to the nurse? a. Acute myocardial infarction (MI) b. Occlusion at the donor site c. Cardiac tamponade d. Prinzmetal's angina
c. Cardiac tamponade
The nurse is developing a standardized care plan for the postoperative care of clients undergoing cardiac surgery. The unit is staffed with RNs, LPN/LVNs, and unlicensed assistive personnel. Which nursing activity will need to be performed by RN staff members? a. Removing chest and leg dressings on the second postoperative day and cleaning the incisions with antibacterial swabs b. Reinforcing client and family teaching about the need to deep breathe and cough at least every 2 hours while awake c. Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes d. Administering oral analgesic medications as needed before helping the client out of bed on the first postoperative day
c. Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes
An 80 year old client on the coronary step-down unit tells the nurse "I do not need to take that docusate. I never get constipated!" Which action by the nurse is MOST appropriate? a. Document the medication on the client's chart as "refused" b. Mix the medication with food and administer it to the client c. Explain that his decreased activity level may cause constipation d. Reinforce that the docusate has been prescribed for a good reason
c. Explain that his decreased activity level may cause constipation
The nurse is caring for a hospitalized patient being treated initially with IV nitroglycerin. What intervention must the nurse include in this patient's care? a. Increase the dose rapidly to achieve pain relief b. Restrict the patient to bedrest with bedpan use c. Monitor blood pressure continuously d. Elevate the head of the bed 90 degrees
c. Monitor blood pressure continuously
A client who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. the nurse notes that no pulse is palpable in the left foot and that it is cold and pale. Which action should the nurse take next? a. Lower the client's left foot below heart level b. Administer oxygen at 4 L/min to the client c. Notify the health care provider about the change in status d. Reassure the client that embolization is common in endocarditis
c. Notify the health care provider about the change in status
At 9:00 PM, the nurse admits a 63 year old client with a diagnosis of acute myocardial infarction. Which finding is MOST important to communicate to the health care provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator (alteplase) for the client? a. The client was treated with alteplase about 8 months ago. b. The client take famotidine for gastroesophageal reflux disease c. The client has ST-segment elevations on the electrocardiogram (ECG) d. The client reports having continuous chest pain since 8:00 AM
d. The client reports having continuous chest pain since 8:00 AM
A client is admitted with the diagnosis of possible myocardial infarction, and a series of diagnostic tests is ordered. Which blood level should the nurse expect will increase FIRST if this client has had a myocardial infarction? a. ALT b. AST c. Total LDH d. Troponin T
d. Troponin T
The nurse is caring for a patient who had a percutaneous coronary intervention (PCI). Which post-procedure interventions are included in the care for this patient? SATA a. Monitor for acute closure of the vessel b. Observe for bleeding from the insertion site c. Maintain bedrest for 48 hours d. Observe for hypotension, hypokalemia, and dysrhythmias e. Teach about medications such as aspirin and beta blockers or ACE inhibitors f. Instruct about lifestyle changes relating to CAD
a. Monitor for acute closure of the vessel b. Observe for bleeding from the insertion site d. Observe for hypotension, hypokalemia, and dysrhythmias e. Teach about medications such as aspirin and beta blockers or ACE inhibitors f. Instruct about lifestyle changes relating to CAD
The nurse is reviewing medication orders for several cardiac patients. There is an order for beta-adrenergic blocking agent metoprolol XL once a day. According to the Killip classification, this drug order is most appropriate for which classes of patient? a. All classes b. Class I only c. Classes II and III d. Class IV only
c. Classes II and III
During a home visit to an 88 year old client who is taking digoxin 0.25 mg/day to treat heart failure and atrial fibrillation, the nurse obtains this assessment information. Which finding is MOST important to communicate to the health care provider? a. Apical pulse 68 beats/min and irregular b. Digoxin taken with meals c. Vision that is becoming "fuzzy" d. Lung crackles that clear after coughing
c. Vision that is becoming "fuzzy"
A client with acute coronary syndrome is receiving a continuous heparin infusion. The client is to receive 700 units/hr. Based on the heparin concentration on the label, the nurse will set the infusion pump to deliver __________________________ mL/hr. (pg 69 Prioritization).
17.5 mL/hr
A patient is hypertensive and continues to have angina despite therapy with beta blockers. The nurse anticipates which type of drug will be prescribed for this patient? a. Calcium channel blocker b. Potassium channel blocker c. Angiotensin-converting enzyme inhibitor d. Vasopressor
a. Calcium channel blocker
A nurse is teaching a group of clients about risk factors for heart disease. Which factors increase a client's risk for a myocardial infarction? SATA a. Obesity b. Hypertension c. Increased HDL d. Diabetes insipidus e. Asian-American ancestry
a. Obesity b. Hypertension
People should seek treatment for symptoms of myocardial infarction (MI) rather than delay because physical changes will occur approximately how many hours after an infarction? a. 3 hours b. 6 hours c. 12 hours d. 24 hours
b. 6 hours
A patient with chronic stable angina is taking calcium channel blockers. For which complication does the nurse monitor with this patient? a. Wheezes b. Hypotension c. Tachycardia d. Forgetfulness
b. Hypotension
The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which laboratory value will be MOST important to monitor? a. Sodium level b. Blood glucose level c. Potassium level d. Alkaline phosphatase level
c. Potassium level
The nurse is evaluating a patient with coronary artery disease (CAD). What is an expected patient outcome that demonstrates hemodynamic stability? a. Blood pressure and pulse are within range and adequate for metabolic demands b. Urine output increases from 15 to 30 mL per hour c. P waves are regular and there are no abnormal heart sounds d. Patient expresses verbal understanding of risk factors and need for compliance
a. Blood pressure and pulse are within range and adequate for metabolic demands
A client in the emergency department who is being monitored with a portable cardiac monitor/defibrillator develops this rhythm? Which action will the nurse take first? (pg. 68 in prioritization) a. Defibrillate at 200 joules b. Start cardiopulmonary resuscitation (CPR) c. Administer epinephrine 1 mg IV d. Intubate and manually ventilate
a. Defibrillate at 200 joules
The nurse is assessing a cardiac patient and finds a paradoxical pulse, clear lungs, and jugular venous distention that occurs when the patient is in semi-Fowler's position. What are these findings consistent with? a. Right ventricle failure b. Unstable angina c. Coronary artery disease (CAD) d. Valvular disease
a. Right ventricle failure
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. Heart muscle ischemia
Which class of drugs has a strong FDA warning about increased risk for stroke or heart attack? a. Beta blockers b. Non-aspirin NSAIDs c. Calcium channel blockers d. ACE inhibitors
b. Non-aspirin NSAIDs
What instructions about the use of nitroglycerin should the nurse provide to a client with angina? a. "Identify when pain occurs, and place 2 tablets under the tongue." b. "Place 1 tablet under the tongue, and swallow another when pain is intense." c. "Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs." d. "Place 1 tablet under the tongue when pain occurs, and use an additional tablet after the attack to prevent recurrence."
c. "Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs."
What should the nurse teach a client to expect when preparing for discharge after surgery for a coronary artery bypass graft? a. Mild fever and extreme fatigue for several weeks after surgery b. Cessation of drainage from the incisions after hospitalization c. Mild incisional pain and tenderness up to three weeks after surgery d. Some edema in the leg used for the donor graft is expected with activity
d. Some edema in the leg used for the donor graft is expected with activity
A patient is admitted for unstable angina. The patient is currently asymptomatic and all vital signs are stable. Which position does the nurse place the patient in? a. Any position of comfort b. Supine c. Sitting in a chair d. Fowler's
a. Any position of comfort
A patient continue to have chest pain despite compliance with medical therapy. The nurse teaches the patient about which diagnostic test? a. Cardiac catheterization b. Percutaneous transluminal coronary angioplasty (PTCA) c. Coronary artery bypass grafting (CABG) d. Stent placement in coronary artery
a. Cardiac catheterization
The nurse is caring for a patient who had percutaneous coronary intervention (PCI). Which symptom indicates acute closure of the vessel and warrants immediate notification of the health care provider? a. Chest pain b. Hyperkalemia c. Bleeding at the insertion site d. Cough and shortness of breath
a. Chest pain
A patient is currently pain- and symptom-free but reports having intermittent episodes of chest pain over the past week. The nurse asks about which associated symptoms? SATA a. Nausea b. Diarrhea c. Diaphoresis d. Dizziness e. Joint pain f. Shortness of breath
a. Nausea c. Diaphoresis d. Dizziness f. Shortness of breath
The nurse is preparing to implement teaching about a heart-healthy diet and activity levels for a client who has had a myocardial infarction and the client's spouse. The client says, "I don't see why I need any teaching. I don't think I need to change anything right." Which response is MOST appropriate? a. "Do you think your family may want you to make some lifestyle changes?" b. "Can you tell me why you don't feel that you need to make any changes?" c. "You are still in the stage of denial, but you will want this information late on." d. "Even though you don't want to change, it's important that you have this teaching."
b. "Can you tell me why you don't feel that you need to make any changes?"
A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible dignosis of heart failure. Which laboratory result will be MOST useful to monitor? a. Serum potassium b. B-type natriuretic peptide c. Blood urea nitrogen d. Hematocrit
b. B-type natriuretic peptide
A patient comes to the walk-in clinic reporting left anterior chest discomfort with mild shortness of breath. The patient is alert, oriented, diaphoretic, and anxious. What is the FIRST PRIORITY action for the nurse? a. Obtain a complete cardiac history to include a full description of the presenting symptoms b. Place the patient in semi-Fowler's position and start supplemental oxygen c. Instruct the patient to go immediately to the closest full service hospital d. Immediately alert the physician and establish IV access
b. Place the patient in semi-Fowler's position and start supplemental oxygen
The emergency department nurse is caring for a client who was just admitted with left anterior chest pain, possible acute myocardial infarction (MI). Which action will the nurse take first? a. Insert an IV catheter b. Auscultate heart sounds c. Administer sublingual nitroglycerin d. Draw blood for troponin I measurement
c. Administer sublingual nitroglycerin
The nurse is participating as a team member in the resuscitation of a client who has had a cardiac arrest. The health care provider who is directing the resuscitation ask the nurse to administer epinephrine 1 mg IV. After giving the medication, which action should the nurse take next? a. Prepare to defibrillate the client b. Offer to take over chest compressions c. State: "epinephrine 1 mg IV has been given." d. Continue to monitor the client's responsiveness
c. State: "epinephrine 1 mg IV has been given."
Which is the PRIMARY medical-surgical concept for a patient with unstable angina or myocardial infarction? a. Comfort b. Tissue integrity c. Gas exchange d. Perfusion
d. Perfusion
The nurse is interviewing a patient who reports chest discomfort that occurs with moderate to prolonged exertion. The patient describes the pain as being "about the same over the past several months and going away with nitroglycerin or est." Based on the patient's description of symptoms, what does the nurse suspect in this patient? SATA a. Chronic stable angina (CSA) b. Unstable angina c. Acute coronary syndrome (ACS) d. Acute myocardial infarction (MI) e. Coronary artery disease (CAD) f. Variant (Prinzmetal's) angina
a. Chronic stable angina (CSA) e. Coronary artery disease (CAD)
Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? SATA a. Tachycardia b. Hypertension c. Increased CVP d. Increased urine output e. Jugular vein distention
a. Tachycardia c. Increased CVP e. Jugular vein distention
A patient has been admitted for acute angina. Which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or a myocardial infarction (MI)? a. Exercise tolerance test b. Cardiac catheterization c. Thallium scan d. Multigated angiogram (MUGA) scan
b. Cardiac catheterization
A nurse is leading a discussion in a senior citizen center about the risk factors for developing coronary heart disease (CHD) for women versus men. What should the nurse respond when asked to identify the MOST significant risk factor? a. Obesity b. Diabetes c. Elevated CRP levels d. High levels of HDL-C
b. Diabetes
The health care provider telephones the nurse with new prescriptions for a client with angina who is already taking aspirin. Which medication is MOST important to clarify further with the health care provider? a. Clopidogrel 75 mg/day b. Ibuprofen 200 mg every 4 hours as needed c. Metoprolol succinate 50 mg/day d. Nitroglycerin patch 0.4 mg/hr
b. Ibuprofen 200 mg every 4 hours as needed
A client is admitted with chest pain unrelieved by nitroglycerin, an elevated temperature, decreased blood pressure, and diaphoresis. A myocardial infarction is diagnosed. Which should the nurse consider as a valid reason for one of this client's physiologic responses? a. Parasympathetic reflexes from the infarcted myocardium cause diaphoresis. b. Inflammation in the myocardium causes a rise in the systemic body temperature. c. Catecholamines released at the site of the infarction cause intermittent localized pain. d. Constriction of central and peripheral blood vessels causes a decrease in blood pressure.
b. Inflammation in the myocardium causes a rise in the systemic body temperature.
A patient is having a coronary artery bypass graft (CABG) with the traditional surgical procedure. What does the nurse include in the preoperative teaching? SATA a. Coughing will be avoided to keep stress of the sternal incision b. There will be a sternal incision. c. Expect one, two, or three chest tubes d. An indwelling urinary catheter will be placed e. An endotracheal tube will prevent talking. f. You will be on bedrest for up to 48 hours after surgery.
b. There will be a sternal incision. c. Expect one, two, or three chest tubes d. An indwelling urinary catheter will be placed e. An endotracheal tube will prevent talking.
Which statement is true about postpericardiotomy syndrome? a. It is a psychological disorder for which the patient needs emotional support. b. It is mild and self-limiting for all patients. c. It places the patient at risk for acute cardiac tamponade. d. It can be prophylactically managed with antibiotics.
c. It places the patient at risk for acute cardiac tamponade.
The nurse assesses a client who has just returned to the recovery area after undergoing coronary arteriography. Which information is of MOST concern? a. Blood pressure is 154/78 mm Hg b. Pedal pulses are palpable at +1 c. Left groin has a 3-cm bruised area d. Apical pulse is 122 beats/min and regular
d. Apical pulse is 122 beats/min and regular
Based on this information in a client's medical record, which topic is the highest priority for the nurse to include in the initial teaching plan for a 26 year old client who has blood pressures ranging from 150/84 to 162/90 mm Hg. a. symptoms of acute stroke and myocardial infarction b. Adverse effects of alcohol on blood pressure c. Methods for decreasing dietary caloric intake d. Low-sodium food choices when eating out
d. Low-sodium food choices when eating out
Following coronary artery bypass graft (CABG) surgery, a patient has a body temperature below 96.8 F (36 C). What measure should be used to rewarm the patient? a. Infuse warm IV fluids b. Do not rewarm; cold cardioplegia is protective c. Place the patient in a warm fluid bath d. Use lights or thermal blankets
d. Use lights or thermal blankets
A client who had several episodes of chest pain is scheduled for an exercise electrocardiogram. Which explanation should the nurse include when teaching the client about this procedure? a. "This is a noninvasive test to check your heart's response to physical activity." b. "This test is the definitive method to identify the actual cause of your chest pain." c. "The findings of this test will be of minimal assistance in the treatment of angina." d. "The findings from this minimally invasive test will show how your body reacts to exercise."
a. "This is a noninvasive test to check your heart's response to physical activity."
The nurse is working with an experienced unlicensed assistive personnel (UAP) and an LPN/LVN on the telemetry unit. A client who had an acute myocardial infarction 3 days ago has been reporting fatigue and chest discomfort when ambulating. Which nursing activity included in the care plan is BEST assigned to the LPN/LVN? a. Administering nitroglycerin 0.4 mg sublingually if chest discomfort occurs during client activities b. Monitoring pulse, blood pressure, and oxygen saturation before and after client ambulation c. Teaching the client energy conservation techniques to decrease myocardial oxygen demand d. Explaining the rationale for alternating rest periods with exercise to the client and family
a. Administering nitroglycerin 0.4 mg sublingually if chest discomfort occurs during client activities
During the initial postoperative assessment of a client who has just been transferred to the post-anesthesia care unit after repair of an abdominal aortic aneurysm, the nurse obtains these data. Which finding has the MOST immediate implications for the client's care? a. Arterial line indicates a blood pressure of 190/112 mm Hg. b. Cardiac monitor shows frequent premature atrial contractions. c. there is no response to verbal stimulation. d. Urine output is 40 mL of amber urine.
a. Arterial line indicates a blood pressure of 190/112 mm Hg.
The health care provider prescribes these actions for a client who was admitted with acute substernal chest pain. Which actions are appropriate to assign to an experienced LPN/LVN who is working in the emergency department? SATA a. Attaching cardiac monitor leads b. Giving heparin 5000 units IV push c. Administering morphine sulfate 4 mg IV d. Obtaining a 12-lead electrocardiogram (ECG) e. Asking the client about pertinent medical history f. Having the client chew and swallow aspirin 162 mg
a. Attaching cardiac monitor leads d. Obtaining a 12-lead electrocardiogram (ECG) f. Having the client chew and swallow aspirin 162 mg
A patient has been discharged after CABG surgery and is to start a simple walking program at home. What does the nurse teach the patient about a home walking program? SATA a. Begin by walking 400 feet twice a day at the rate of 1 mile/hr the first week after discharge b. Each week increase the distance and rate as tolerated until you can walk 2 miles at 3 to 4 miles/hr c. Take a break after walking each mile to avoid pain or shortness of breath. d. Check your pulse reading before, halfway through, and after exercise. e. Walk even when the weather is either hot or cold. f. Stop exercising if your pulse rate increases more than 20 beats per minute or if you develop dyspnea or angina.
a. Begin by walking 400 feet twice a day at the rate of 1 mile/hr the first week after discharge b. Each week increase the distance and rate as tolerated until you can walk 2 miles at 3 to 4 miles/hr d. Check your pulse reading before, halfway through, and after exercise. f. Stop exercising if your pulse rate increases more than 20 beats per minute or if you develop dyspnea or angina.
Two weeks ago, a client with heart failure received a new prescription for carvedilol 12.5 mg orally. Which finding by the nurse who is evaluating the client in the cardiology clinic is the MOST concern? a. Reports of increased fatigue and activity intolerance b. Weight increase of 0.5 kg over a 1 week period c. Sinus bradycardia at a rate of 48 beats/min d. Traces of edema noted over both ankles
a. Defibrillate at 200 joules
Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? SATA a. How to monitor and record daily weight b. Importance of stopping exercise if heart rate increases c. Symptoms of worsening heart failure d. Purpose of chronic antibiotic therapy e. How to read food labels for sodium content f. Date and time for follow-up appointments
a. How to monitor and record daily weight c. Symptoms of worsening heart failure e. How to read food labels for sodium content f. Date and time for follow-up appointments
The nurse is working in an outpatient clinic where many vascular diagnostic tests are performed. Which task associated with vascular testing is MOST appropriate to delegate to experienced unlicensed assistive personnel (UAP)? a. Measuring ankle and brachial pressures in a client for whom the ankle-brachial index is to be calculated b. Checking blood pressure and pulse every 10 minutes in a client who is undergoing exercise testing c. Obtaining information about allergies from a client who is scheduled for left leg contrast venography d. Providing brief client teaching for a client who will undergo a right subclavian vein Doppler study
a. Measuring ankle and brachial pressures in a client for whom the ankle-brachial index is to be calculated
The nurse is assessing a middle-aged woman with diabetes who denies any history of known heart problems. Which are gender considerations for women with coronary artery disease (CAD)? SATA a. Microvascular disease is a likely cause of CAD in women b. Women typically have smaller coronary arteries than men c. Women are often 5 to 10 years younger than men when CAD develops d. Women with CAD have a lower risk of death when hospitalized than men e. In postmenopausal women the incidence of CAD is equal to that of men f. Women with CAD manifest with atypical signs and symptoms
a. Microvascular disease is a likely cause of CAD in women b. Women typically have smaller coronary arteries than men e. In postmenopausal women the incidence of CAD is equal to that of men f. Women with CAD manifest with atypical signs and symptoms
The nurse had identified the priority problem of activity intolerance for a patient who had an acute myocardial infarction (MI). What is the best expected outcome for this patient? a. Patient will progressively walk up to 200 feet four times a day without chest discomfort or shortness of breath b. Patient will name three or four activities that will not cause shortness of breath or pain c. Nurse will teach the patient to exercise and to take the pulse if symptoms of shortness of breath or pain occur. d. Nurse will assist the patient with ADLs until shortness of breath or pain resolves
a. Patient will progressively walk up to 200 feet four times a day without chest discomfort or shortness of breath
Which patient has the highest risk for death because of ventricular failure and dysrhythmias related to damage to the left ventricle? a. Patient with an anterior wall MI (AWMI) b. Patient with posterior wall MI (PWMI) c. Patient with lateral wall MI (LWMI) d. Patient with an inferior wall MI (IWMI)
a. Patient with an anterior wall MI (AWMI)
While reviewing a hospitalized client's medical record, the nurse obtains this information about cardiovascular risk factors. Which interventions will be important to include in the discharge plan for this client? SATA a. Referral to community programs that assist in smoking cessation b. Teaching about the impact of family history on cardiovascular risk c. Education about the need for a change in antihypertensive d. Assistance in reducing emotional stress e. Discussion of the risks associated with having a sedentary lifestyle
a. Referral to community programs that assist in smoking cessation b. Teaching about the impact of family history on cardiovascular risk
The clinic nurse is evaluating a client who had coronary artery stenting through the right femoral artery a week previously and is taking metoprolol, clopidogrel, and aspirin. Which information reported by the client is MOST important to report to the health care provider? a. Stools have been black in color. b. Bruising is present at the right groin. c. Home blood pressure today was 104/52 mm Hg. d. Home radial pulse rate has been 55 to 60 beats/min.
a. Stools have been black in color.
The nurse is caring for a patient admitted for an inferior wall myocardial infarction (IWMI). The patient develops heart block with bradycardia. Which procedure is the nurse prepared to assist with? a. Temporary pacemaker b. Defibrillation 16-lead ECG d. Percutaneous intervention
a. Temporary pacemaker
The nurse is ambulating a cardiac surgery client whose hart rate suddenly increases to 146 beats/min. In which order will the nurse take the following actions? a. Call the client's health care provider b. Have the client sit down c. Check the client's blood pressure d. Administer as needed (PRN) oxygen by nasal cannula
b, d, c, a
A patient reports chest pain after coronary artery bypass graft (CABG) surgery. Which statement by the patient suggest that the pain is related to the sternotomy and NOT anginal in origin? a. "The pain goes down my arm or sometimes into my jaw." b. "My pain increases when cough or take a deep breath." c. "The nitroglycerin helped to relieve the pain." d. "I feel nausea and shortness of breath when the pain occurs."
b. "My pain increases when cough or take a deep breath."
A patient had severe chest pain several hours ago but is currently pain-free and has a normal ECG. Which statement by the patient indicates a correct understanding of the significance of the ECG results? a. "I'll go home and make an appointment to see my family doctor next week." b. "The ECG could be normal since I am currently pain-free." c. "A normal ECG menas I am okay." d. "I have always had a strong heart, low blood pressure, and a normal ECG."
b. "The ECG could be normal since I am currently pain-free."
A patient with angina is prescribed nitroglycerin tablets. What information does the nurse include when teaching the patient about this drug? SATA a. "If one tablet does not relieve the angina after 5 minutes, take two pills." b. "You can tell the pills are active when your tongue feels a tingling sensation." c. "Keep your nitroglycerin with you at all times." d. "The prescription should last about 6 months before a refill is necessary." e. "If the pain doesn't go away, just wait; the medication will eventually take effect." f. "The medication can cause a temporary headache."
b. "You can tell the pills are active when your tongue feels a tingling sensation." c. "Keep your nitroglycerin with you at all times." f. "The medication can cause a temporary headache."
A nurse is providing discharge instructions to a client who experienced an anterior septal myocardial infarction. What statement by the client indicates to the nurse that there is a need for further teaching? a. "I want to stay as pain-free as possible." b. 'I am not good at remembering to take medications." c. "I should not have any problems in reducing my salt intake." d. "I wrote down my medication information for future reference."
b. 'I am not good at remembering to take medications."
While working on a cardiac step-down unit, the nurse is precepting a newly graduated RN who has been in a 6 week orientation program. Which client will be BEST to assign to the new graduate? a. A 19 year old client with rheumatic fever who needs discharge teaching before going home with a roommate today b. A 33 year old client admitted a week ago with endocarditis who will be receiving a scheduled dose of ceftriaxone 2 g IV c. A 50 year old client with newly diagnosed stable angina who has many questions about medications and nurse care d. a 75 year old client who has just been transferred to the unit after undergoing coronary artery bypass grafting yesterday
b. A 33 year old client admitted a week ago with endocarditis who will be receiving a scheduled dose of ceftriaxone 2 g IV
The nurse has just received a change of shift report about these clients on the coronary step-down unit. Which one will the nurse assess FIRST? a. A 26 year old client with heart failure caused by congenital mitral stenosis who is scheduled for balloon valvuloplasty later today b. A 45 year old client with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before shift change c. A 56 year old client who underwent coronary angioplasty and stent placement yesterday and has reported occasional chest pain since the procedure d. a 77 year old client who was transferred from the intensive care unit 2 days ago after coronary artery bypass grafting and ahs a temperature of 100.6 F (38.1 C)
b. A 45 year old client with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before shift change
The health care provider s considering use of thrombolytic therapy for a patient. What is the criterion for this therapy? a. Chest pain of greater than 15 minutes' duration that is unrelieved by nitroglycerin b. Chest pain lasting longer than 30 minutes that is unrelieved by nitroglycerin with ST segment elevation on the ECG c. Ventricular dysrhythmias shown on the cardiac monitor d. History of chronic, severe, poorly controlled hypertension
b. Chest pain lasting longer than 30 minutes that is unrelieved by nitroglycerin with ST segment elevation on the ECG
The home health nurse receives a call from a patient with coronary artery disease (CAD) who reports having new onset of chest pain and shortness of breath. What does the nurse instruct the patient to do? a. Rest quietly until the nurse can arrive at the house to check the patient. b. Chew 325 mg of aspirin and immediately call 911. c. Use supplemental home oxygen until symptoms resolve. d. Take three nitroglycerin tablets and have family drive the patient to the hospital
b. Chew 325 mg of aspirin and immediately call 911.
A nurse asks a client with ischemic heart disease to identify the foods that are most important to restrict. The nurse determines that the client understands the dietary instructions when the client identifies the following foods. SATA a. Olive oil b. Chicken broth c. Enriched whole milk d. Red meats, such as beef e. Vegetables and whole grains f. Liver and other glandular organ meats
b. Chicken broth c. Enriched whole milk d. Red meats, such as beef f. Liver and other glandular organ meats
Which client is BEST for the coronary care charge nurse to assign to a float RN who has come for the day from the general medical surgical unit? a. Client requiring discharge teaching about coronary artery stenting before going home today b. Client receiving IV furosemide to treat acute left ventricular failure c. Client who just transferred in from the radiology department after a coronary angioplasty d. Client just admitted with unstable angina who has orders for a heparin infusion and aspirin
b. Client receiving IV furosemide to treat acute left ventricular failure
The nurse in the cardiovascular clinic receives telephone calls from four clients. Which client should be scheduled to be seen MOST urgently? a. Client with peripheral arterial disease who complains of leg cramps when walking. b. Client with atrial fibrillation who reports episodes of lightheadedness and syncope. c. Client with anew permanent pacemaker who has severe itchiness at the wound site. d. Client with angina who took nitroglycerin twice in the alst week while exercising.
b. Client with atrial fibrillation who reports episodes of lightheadedness and syncope.
The health care provider orders potassium 80 mEq in 100 mL of IV bolus at a rate of 40 mEq/hr for a patient in the critical care unit through a central line. What does the nurse do next? a. Contact the health care provider because the order exceeds the recommended amount. b. Give the infusion; the order exceeds the recommended amount but is within acceptable standards of practice for critical care patients c. Contact the health care provider because even though the dosage is acceptable, the rate is too fast. d. Consult with the pharmacist because even though the rate is acceptable, the mixture is too concentrated.
b. Give the infusion; the order exceeds the recommended amount but is within acceptable standards of practice for critical care patients
The patient who was diagnose with acute coronary syndrome (ACS) will be discharged soon. Which type of drug that will reduce the risk of developing recurrent myocardial infarction (MI), stroke, and mortality does the nurse expect the health care provider to prescribe prior to discharge? a. Stool softener b. High-intensity statin therapy c. Anti-inflammatory d. Central vasodilator
b. High-intensity statin therapy
A patient is receiving beta-blocker therapy for treatment of myocardial infarction (MI). What does the nurse monitor for in relation to this therapy? SATA a. Tachycardia b. Hypotension c. Decreased level of consciousness d. Chest discomfort e. Increased urinary output f. Auscultate lungs for crackles or wheezes
b. Hypotension c. Decreased level of consciousness d. Chest discomfort f. Auscultate lungs for crackles or wheezes
The patient with left ventricular myocardial infarction (MI) is to have coronary artery bypass graft (CABG) surgery. Which interventions does the nurse perform to protect against sternal wound infection? SATA a. Shave the patient's body from neck to knees b. Instruct the patient to shower with 4% chlorhexidine gluconate (CHG) c. Prepare the surgical site by clipping hair and applying CHG with isopropyl alcohol (either 0.5% or 2%). d. Send urine and sputum to the lab for culture and sensitivity e. Administer IV antibiotics one hour prior to the surgical procedure f. Wear gown, gloves, and a mask while preparing the patient for surgery
b. Instruct the patient to shower with 4% chlorhexidine gluconate (CHG) c. Prepare the surgical site by clipping hair and applying CHG with isopropyl alcohol (either 0.5% or 2%). e. Administer IV antibiotics one hour prior to the surgical procedure
The clinic nurse obtains this information about a client who is taking warfarin after having a deep vein thrombosis. Which finding is MOST indicative of a need for a change in therapy? a. Blood pressure is 106/54 mm Hg. b. International normalized ration (INR) is 1.2. c. Bruises are noted at sites where blood has been drawn. d. Client reports eating a green salad for lunch every day.
b. International normalized ration (INR) is 1.2.
The charge nurse in a long-term care facility that employs RNs, LOPNs/LVNs, and unlicensed assistive personnel (UAP) has developed a plan for the ongoing assessment of all residents with a diagnosis of heart failure. Which activity included in the plan is MOST appropriate to assign to an LPN/LVN team member? a. Weighing all residents with heart failure each morning b. Listening to lung sounds and checking for edema each week c. Reviewing all heart failure medications with residents every month d. Updating activity plans for residents with heart failure every quarter
b. Listening to lung sounds and checking for edema each week
A patient had coronary artery bypass graft (CABG) surgery with a vein graft. To help prevent collapse of the graft, what assessment does the nurse perform? a. Auscultate lung sounds b. Monitor for hypotension c. Assess for motion and sensation d. Observe for generalized hypothermia
b. Monitor for hypotension
Which statement about coronary artery disease (CAD) is accurate? a. Ischemia that occurs with angina lasts more than 30 minutes and does not cause permanent damage of myocardial tissue b. Postmenopausal women in their 70s have the same incidence of myocardial infarction (MI) as men c. Many patients suffering sudden cardiac arrest die before reaching the hospital because of atrial fibrillation d. Studies have shown that CAD in women manifests with the same symptoms as with men
b. Postmenopausal women in their 70s have the same incidence of myocardial infarction (MI) as men
The emergency department (ED) nurse is caring for a patient with acute pain associated with myocardial infarction (MI). What are the goals of collaborative management that address the patient's pain? SATA a. Return the vital signs and cardiac rhythm to baseline so the patient can resume activities of daily living b. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increasing myocardial oxygen supply c. Aggressively diagnose and treat life-threatening cardiac dysrhythmias and restore pulmonary wedge pressure d. Closely monitor the patient for accompanying symptoms such as nausea and vomiting or indigestion e. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demand, and increase myocardial oxygen supply f. Teach the patient about alternative therapies that can help decrease or replace the need for pain drugs.
b. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increasing myocardial oxygen supply e. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demand, and increase myocardial oxygen supply
The nurse is auscultating the heart of a patient who had a myocardial infarction (MI). Which finding most strongly indicates heart failure? a. Murmur b. S3 gallop c. Split S1 and S2 D. Pericardial friction rub
b. S3 gallop
Following coronary artery bypass graft (CABG) surgery, a patient in the ICU on a mechanical ventilator suddenly decompensates. The health care provider makes a diagnosis of cardiac tamponade. the nurse prepares the patient for which emergency procedure? a. Chest tube b. Sternotomy c. Pericardiocentesis d. Thoracentesis
b. Sternotomy
The nurse is caring for a client who has heart failure and has a new prescription for sacubitril-valsartan. Which client information is MOST important to discuss with the health care provider before administration of the medication? a. The client's oxygen saturation is 92% b. The client receives lisinopril 10 mg/day c. The client's blood pressure is 150/90 mm Hg d. The client's potassium is 3.3 mEq/L (3.3 mmol/L)
b. The client receives lisinopril 10 mg/day
A client who had a myocardial infarction is in the coronary care unit on a cardiac monitor. The nurse observes ventricular irritability on the screen. What medication should the nurse prepare to administer? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Amiodarone (Cordarone) d. Norepinephrine (Levophed)
c. Amiodarone (Cordarone)
A client whose systolic blood pressure is always higher than 140 mm Hg in the clinic tells the nurse, "My blood pressure at home is always fine!" What action should the nurse take next? a. Instruct the client about the effects of untreated high blood pressure on the cardiovascular and cerebrovascular systems b. Educate the client about lifestyle changes such as low-sodium diet, daily exercise, and restricting alcohol use to no more than 2 beers per day c. Ask the client to obtain blood pressures twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week d. Provide the client with a handout describing the various types of antihypertensive medications with the medication effects and adverse effects
c. Ask the client to obtain blood pressures twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week
A patient had coronary artery bypass graft (CABG) surgery with the radial artery used as a graft. The nurse performs which assessment specific to this patient? a. Check the blood pressure every hour on the unaffected arm or use the legs. b. Check the fingertips, hand, and arm for sensation and mobility every shift. c. Assess hand color temperature, ulnar/radial pulses, and capillary refill every hour initially. d. Note edema, bleeding, and swelling at the donor site, which are expected.
c. Assess hand color temperature, ulnar/radial pulses, and capillary refill every hour initially.
The nurse makes a home visit to evaluate a hypertensive client who has been taking enalapril. Which finding is MOST important to report to the health care provider? a. Client report frequent urination. b. Client's blood pressure is 138/86 mm Hg. c. Client complains about a frequent dry cough. d. Client says, "I get dizzy sometimes if I stand up fast."
c. Client complains about a frequent dry cough.
A client with stable angina has a prescription or ranolazine 50 mg twice a day. Which client finding is MOST important for the nurse to discuss with the health care provider? a. Heart rate is 52 beats/min b. Client is also taking carvedilol for angina c. Client reports having chronic constipation d. Blood pressure is 106/56 mm Hg
c. Client reports having chronic constipation
The nurse is monitoring the cardiac rhythms of clients in the coronary care unit. Which client will need IMMEDIATE intervention? a. Client admitted with heart failure who has atrial fibrillation with a rate of 88 beats/min while at rest b. Client with a newly implanted demand ventricular pacemaker who has occasional periods of sinus rhythm at a rate of 90 to 100 beats/min c. Client who has had an acute myocardial infarction and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions d. Client who recently started taking atenolol and has a first-degree heart block, with a rate of 58 beats/min
c. Client who has had an acute myocardial infarction and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions
Which diagnostic tests are used to assess myocardial damage caused by a myocardial infarction (MI) SATA a. Positive chest X-ray b. ST depression on ECG c. Thallium scan d. Troponin I isoenzyme elevation e. Cardiac catheterization f. Fasting lipid profile
c. Thallium scan d. Troponin I isoenzyme elevation e. Cardiac catheterization
A resident in a long-term care facility who has venous statis ulcers is treated with an Unna boot. Which nursing activity included in the resident's care is BEST for the nurse to delegate to the unlicensed assistive personnel (UAP)? a. Teaching family members the signs of infection b. Monitoring capillary perfusion once every 8 hours c. Evaluating foot sensation and movement each shift d. Assisting the client in cleaning around the Unna boot
d. Assisting the client in cleaning around the Unna boot
When the nurse is monitoring a 53 year old client who is undergoing a treadmill stress test, which finding will require the MOST immediate action? a. Blood pressure 152/88 mm Hg b. Heart rate of 135 beats/min c. Oxygen saturation of 91% d. Chest pain level of 3 (on a scale of 0 to 10)
d. Chest pain level of 3 (on a scale of 0 to 10)
A client who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure. Which client information is MOST important for the nurse to communicate to the health care provider (HCP) before the procedure? a. Blood glucose level is 144 mg/dL (8 mmol/L) b. Cardiac monitor shows sinus bradycardia, rate 56 beats/min c. Client reports chest pain that occurred yesterday d. Client took metformin 500 mg this morning
d. Client took metformin 500 mg this morning
Which early reaction is most common in patients with the chest discomfort associated with unstable angina or myocardial infarction (MI)? a. Depression b. Anger c. Fear d. Denial
d. Denial
A client is returned to the surgical unit immediately after placement of a coronary artery stent that was accomplished via access through the femoral artery. What response should the nurse consider the PRIORITY when assessing this client? a. Acute pain b. Impaired mobility c. Impaired swallowing d. Hematoma formation
d. Hematoma formation
The nurse is giving a community presentation about heart disease. Because many sudden cardiac arrest victims die of ventricular fibrillation before reaching the hospital, which teaching point does the nurse emphasize? a. Controlling alcohol consumption and quitting cigarette smoking b. Modifying risk factors such as diet and weight, and blood pressure medication compliance c. Recognizing the difference between chronic stable angina and unstable angina d. Learning to operate the automatic external defibrillators (AEDs) in the workplace
d. Learning to operate the automatic external defibrillators (AEDs) in the workplace
The nurse is reviewing the laboratory results for a client with an elevated cholesterol level who is taking atorvastatin. Which result is MOST important to discuss with the health care provider? a. Serum potassium is 3.4 mEq/L (3.4 mmol/L) b. Blood urea nitrogen (BUN) is 9 mg/dL (3.2 mmol/L) c. Asparate aminotransferase (AST) is 30 units/L (0.5 ukat/L) d. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL (4.4 mmol/L)
d. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL (4.4 mmol/L)
The nurse has given morphine sufate 4 mg IV to a client who is having an acute myocardial infarction. When evaluating the client's response 5 minutes after giving the medication, which finding indicates a need for IMMEDIATE further action? a. Blood pressure decrease from 114/65 to 106/58 mm Hg b. Respiratory rate drop from 18 to 12 breaths/min c. Cardiac monitor indicating sinus rhythm at a rate of 96 beats/min d. Persisting chest pain at a level of 1 (on a scale of 0 to 10)
d. Persisting chest pain at a level of 1 (on a scale of 0 to 10)
The nurse is preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is MOST important to double-check with another licensed nurse? a. Famotidine 20 mg IV b. Furosemide 40 mg IV c. Digoxin 0.25 mg PO d. Warfarin 2.5 mg PO
d. Warfarin 2.5 mg PO
