Passpoint pratice questions cardiac
A physician in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. Physical findings include bilateral crackles, a third heart sound (S3), distended neck veins, elevated blood pressure, and pitting edema of the ankles. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? A. a depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling B. detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours C. barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours D. a 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling
C. barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours
A physician has scheduled a client with mitral stenosis for mitral valve replacement. Which condition may arise as a complication of mitral stenosis? A. myocardial ischemia B. pulmonary hypertension C. left-sided heart failure D. left ventricular hypertrophy
pulmonary hypertension
Which assessment finding supports the administration of protamine sulfate? A. INR 8 B. platelets of 152 C. RBCs of 5.4 million/mm3 D. aPTT 3.5-5 times normal
aPTT 3.5-5 times normal
The health care provider (HCP) has prescribed metoprolol for a client with stage 2 hypertension who has been initially treated with furosemide and ramipril. The nurse should evaluate the client for which expected therapeutic effect of the metoprolol? A. increase in urine output B. improvement in blood sugar levels C. decrease in heart rate D. lessening of fatigue
decrease in heart rate
A nurse on the telemetry unit is faced with various monitor rhythms. Which rhythm takes priority? A. A client's monitor shows sinus tachycardia with frequent premature atrial contractions (PACs). B. A client's monitor shows frequent paced beats with capture. C. A client's cardiac rhythm suddenly changes from normal sinus rhythm to uncontrolled atrial fibrillation. D. A client's cardiac monitor suddenly reveals sinus tachycardia with isolated premature ventricular contractions.
A client's cardiac rhythm suddenly changes from normal sinus rhythm to uncontrolled atrial fibrillation.
A nurse is preparing a client for an exercise stress test the following morning. Which client statement indicates a need for additional teaching? A. "I won't eat or drink anything after midnight tonight." B. "I won't smoke for 2 to 3 hours before the test." C. "I'll likely be able to take my regular medications before the test." D. "I'll have to sign a consent form before the test."
A. "I won't eat or drink anything after midnight tonight." The client requires additional teaching if they state that they'll fast from midnight until the test. Clients need to abstain from eating and drinking for only 4 hours before the test. The client should refrain from smoking for several hours before the test. Although the physician may direct the client to avoid certain medications, it's more likely that the physician will direct the client to take all their normal medications. The client must sign a consent form before the test.
A client is ordered hydralazine for blood pressure management. The nurse is teaching the client about hydralazine therapy. The nurse should instruct the client to take hydralazine A. upon arising in the morning. B. with food. C. on an empty stomach. D. just before bedtime.
with food.
A client is prescribed lisinopril for the treatment of hypertension. The client asks a nurse about possible adverse effects. Which common adverse effects of angiotensin-converting enzyme (ACE) inhibitors would the nurse include in the teaching? Select all that apply. A. cough B. hyperglycemia C. hypotension D. impotence E. headache F. hyperkalemia
A. cough C. hypotension E. headache F. hyperkalemia
During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client? A. Measure the urine output. B. Monitor the radial pulse. C. Evaluate the B-type natriuretic peptide level (BNP). D. Assess the digoxin level.
Assess the digoxin level. After digoxin is metabolized, the kidneys eliminate the remaining digoxin. Kidney disease will prevent elimination of digoxin causing potential toxicity; measuring the digoxin level, especially in the presence of bradycardia, a side effect of digoxin, is indicated. The nurse monitors the apical pulse when administering digoxin, as atrial fibrillation or other dysrhythmia that causes a pulse deficit may lead the nurse to hold the medication when the true pulse is above 60 beats/min. Renal impairment does not always decrease urine output; therefore, monitoring for toxicity is the priority. Although the BNP level will correlate to the client's heart failure, the most important assessment is for digoxin toxicity.
Before discharge, which instruction should a nurse give to a client receiving digoxin? A. "Take an extra dose of digoxin if you miss one dose." B. "Call the physician if your heart rate is above 90 beats/minute." C. "Call the physician if your pulse drops below 80 beats/minute." D. "Take digoxin with meals."
B. "Call the physician if your heart rate is above 90 beats/minute." The nurse should instruct the client to notify the physician if their heart rate is greater than 90 beats/minute because cardiac arrhythmias may occur with digoxin toxicity. To prevent toxicity, the nurse should instruct the client never to take an extra dose of digoxin if they miss a dose. The nurse should show the client how to take their pulse and tell the client to call the physician if their pulse rate drops below 60 beats/minute — not 80 beats/minute, which is a normal pulse rate and doesn't warrant action. The client shouldn't take digoxin with meals; doing so slows the absorption rate.
Stroke volume plays an important part in cardiac output. Select all the factors below that influence stroke volume: A. Heart rate B. Preload C. Contractility D. Afterload E. Blood pressure
B. Preload D. Afterload
Which statement below best describes the term cardiac preload? A. The pressure the ventricles stretch at the end of systole. B. The amount the ventricles stretch at the end of diastole. C. The pressure the ventricles must work against to pump blood out of the heart. D. The strength of the myocardial cells to shorten with each beat.
B. The amount the ventricles stretch at the end of diastole.
A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by: A. decrease; decreasing preload B. increase, increasing preload C. increase, decreasing afterload D. decrease, increasing contractility
B. increase, increasing preload
Select the statement below that best describes cardiac afterload: A. It's the volume amount that fills the ventricles at the end of diastole. B. It's the volume the ventricles must work against to pump blood out of the body. C. It's the amount of blood the left ventricle pumps per beat. D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.
D. It's the pressure the ventricles must work against to open the semilunar valves so blood can be pumped out of the heart.
A nurse assesses a client after administering a prescribed beta blocker. Which assessment should the nurse expect to find? A. Blood pressure increased from 98/42 mm Hg to 132/60 mm Hg B. Respiratory rate decreased from 25 breaths/min to 14 breaths/min C. Oxygen saturation increased from 88% to 96% D. Pulse decreased from 100 beats/min to 80 beats/min
D. Pulse decreased from 100 beats/min to 80 beats/min
The nurse is caring for a client receiving digoxin who has begun vomiting and reports seeing colorful halos around the lights in the room. Which actions should the nurse implement? Select all that apply. A. Determine serum digoxin and electrolyte levels. B. Begin continuous electrocardiographic monitoring. C. Discontinue administration of digoxin. D. Insert nasogastric tube. E. Administer low flow oxygen.
Determine serum digoxin and electrolyte levels. Begin continuous electrocardiographic monitoring. Discontinue administration of digoxin.
A nurse is monitoring a client on the telemetry unit. The electrocardiogram tracing shows a PR interval of 0.22 seconds. What is the appropriate action of the nurse? A. Administer epinephrine. B. Administer oxygen via nasal cannula. C. Contact the healthcare provider. D. Document the findings and continue to monitor the client.
Document the findings and continue to monitor the client. 1st degree heart block
An adult with hypertension is taking propranolol hydrochloride. What should the nurse instruct the client to do? A. Measure partial thromboplastin time weekly to evaluate blood clotting status. B. Discontinue the drug if nausea occurs. C. Monitor blood pressure every week, and adjust the medication dose accordingly. D. Notify the health care provider of an irregular or slowed pulse rate.
Notify the health care provider of an irregular or slowed pulse rate.
When a client has a troponin level of 0.9 ng/mL, which nursing intervention should be implemented? A. Document the finding as the only action. B. Apply oxygen at 2 L/minute per nasal cannula. C. Encourage the client to ambulate. D. Notify the healthcare provider.
Notify the healthcare provider. Troponin is a myocardial cell protein that is elevated in the serum when myocardial damage has occurred during a myocardial infarction. The healthcare provider should be immediately notified when the troponin level is > 0.1 ng/mL. The client should not be ambulated at this time. Applying oxygen is appropriate, although the use of a nasal cannula is not recommended.
The nurse prepares to administer digoxin to a client. For which reason should the nurse question the prescribed dose? A. The client has eczema. B. The client has chronic kidney disease (CKD). C. The client has chronic constipation. D. The client has chronic obstructive pulmonary disease (COPD).
The client has chronic kidney disease (CKD).
A nurse is teaching a client about maintaining a healthy heart. The nurse should include which point in teaching? A. Exercise one or two times per week. B. Smoke in moderation. C. Consume a diet high in saturated fats and low in cholesterol. D. Use alcohol in moderation.
Use alcohol in moderation. The nurse should advise the client that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.
A client is receiving digoxin, and the pulse range is normally 70 to 76 bpm. After assessing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should do what first? A. Administer the digoxin. B. Notify the health care provider (HCP). C. Withhold the digoxin. D. Notify the charge nurse.
Withhold the digoxin.
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as A. a first heart sound (S1). B. a third heart sound (S3). C. a murmur. D. a fourth heart sound (S4).
a third heart sound (S3).
A client is returning from the operating room after inguinal hernia repair. The nurse notes that the client has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? A. right upper quadrant pain B. bibasilar crackles C. dependent edema D. jugular vein distention
bibasilar crackles
A nurse is preparing a teaching plan for a male client newly prescribed atenolol. Which information is important for the nurse to teach this client? A. causes and treatments for erectile dysfunction B. management of incontinence C. control of excessive flatus D. prevention of constipation
causes and treatments for erectile dysfunction
A client is prescribed furosemide to manage heart failure. What laboratory values should the nurse monitor while the client receives this medication? Select all that apply. A. complete blood count B. serum potassium C. thrombin time D. prothrombin time (PT) E. international normalized ratio
complete blood count serum potassium Complete blood count should be monitored, because furosemide can cause agranulocytosis, anemia, leukopenia, and thrombocytopenia. Because loop diuretics such as furosemide promote excretion of potassium, the nurse should also monitor serum potassium levels. Potassium replacement therapy may be necessary to prevent hypokalemia. Thrombin time, PT, and INR do not have to be monitored in a client receiving furosemide.
A fourth heart sound (S4) indicates a A. failure of the ventricle to eject all blood during systole. B. normally functioning heart. C. decreased myocardial contractility. D. dilated aorta.
failure of the ventricle to eject all blood during systole.
A physician orders digoxin for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? A. calcium level of 7.5 mg/dl (0.4 mmol/L) B. magnesium level of 2.5 mg/dl (0.1 mmol/L) C. sodium level of 152 mEq/L (152 mmol/L) D. potassium level of 3.1 mEq/L (3.1 mmol/L)
potassium level of 3.1 mEq/L (3.1 mmol/L)
A nurse is assessing a client with heart failure. To assess hepatojugular reflux, the nurse should A. press the left upper abdomen. B. elevate the client's head to 90 degrees. C. press the right upper abdomen. D. lay the client flat in bed.
press the right upper abdomen.
A nurse is interpreting a client's ECG strip. If the PR interval measures four small blocks, how many seconds is the PR interval? Record your answer using two decimal places.
0.16
___________ is the amount of blood pumped by the left ventricle with each beat. A. Cardiac output B. Preload C. Afterload D. Stroke volume
D. Stroke volume
A nurse is caring for a client with frequent episodes of ventricular tachycardia. The lab calls with a critically high magnesium level of 11 mg/dL on this client. What is the nurse's priority action? A. Obtain an order for furosemide 80 mg I.V. push. B. Increase the rate of the client's I.V. fluid to 150 ml/hour. C. Arrange for an emergency hemodialysis session. D. Obtain an order for calcium gluconate 2 g I.V. push over 2-5 minutes.
Obtain an order for calcium gluconate 2 g I.V. push over 2-5 minutes.
A nurse is caring for a client with a new prescription of digoxin. Which client statement would require further teaching about digoxin? Select all that apply. A. "I will take the digoxin with my antacids at night." B. "If I forget a dose, I will catch-up by doubling the next dose." C. "I will take the digoxin at 9 AM daily." D. "I understand that I will need annual blood work to check therapeutic levels." E. "I will notify my health care provider if experiencing increased fatigue or muscle weakness." F. "I will take my pulse before each dose of digoxin."
"I will take the digoxin with my antacids at night." "If I forget a dose, I will catch-up by doubling the next dose." "I understand that I will need annual blood work to check therapeutic levels." Digoxin is a cardiac glycoside which slows and strengthens the heart, providing a more regular rhythm. Digoxin has a narrowed therapeutic window requiring every 2 weeks-monthly serum blood level monitoring initially. It is usually helpful for a client to take digoxin at a specific time each day to establish its blood level and routine for administration. The nurse would teach the client to take the pulse before each dose of digoxin and to notify the practitioner if the rate or rhythm changes, specifically if the rate drops to less than 60 beats/minute. The client would also be instructed to report increasing fatigue or muscle weakness immediately, as these are signs of digitalis (digoxin) toxicity. Antacids inhibit the absorption of digoxin, so digoxin would not be taken with these drugs. If a dose of digoxin is forgotten, the client may take the missed dose only up to 12 hours later.
