1)

A client is scheduled for a cardiac catherization using a

radiopaque dye. Which of the following assessments is most critical
before the procedure?
1 Intake and output
2 Baseline peripheral pulse rates
3 Height and weight
4 Allergy to iodine or shellfish
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?
1 Have you ever had this pain before?
2 Can you describe the pain to me?
3 Does the pain get worse when you breathe in?
4 Can you rate the pain on a scale of 1-10, with 10 being the
worst?
3)
A client with myocardial infarction has been transferred from a
coronary care unit to a general medical unit with cardiac monitoring
via telemetry. A nurse plans to allow for which of the following client
activities?
1 Strict bed rest for 24 hours after transfer
2 Bathroom privileges and self-care activities
3 Unsupervised hallway ambulation with distances under 200 feet
4 Ad lib activities because the client is monitored.
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?
1 Review the intake and output records for the last 2 days
2 Change the time of diuretic administration from morning to
evening
3 Request a sodium restriction of 1 g/day from the physician.
4 Order daily weights starting the following morning.
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:
1 Check the client status and lead placement
2 Press the recorder button on the electrocardiogram console.
3 Call the physician
4 Call a code blue
6)
A nurse is assessing the blood pressure of a client diagnosed
with primary hypertension. The nurse ensures accurate measurement
by avoiding which of the following?
1 Seating the client with arm bared, supported, and at heart level.
2 Measuring the blood pressure after the client has been seated
quietly for 5 minutes.

3 Using a cuff with a rubber bladder that encircles at least 80% of

the limb.
4 Taking a blood pressure within 15 minutes after nicotine or
caffeine ingestion.
7)
IV heparin therapy is ordered for a client. While implementing
this order, a nurse ensures that which of the following medications is
available on the nursing unit?
1 Vitamin K
2 Aminocaporic acid
3 Potassium chloride
4 Protamine sulfate
8)
A client is at risk for pulmonary embolism and is on
anticoagulant therapy with warfarin (Coumadin). The clients
prothrombin time is 20 seconds, with a control of 11 seconds. The
nurse assesses that this result is:
1 The same as the clients own baseline level
2 Lower than the needed therapeutic level
3 Within the therapeutic range
4 Higher than the therapeutic range
9)
A client who has been receiving heparin therapy also is started
on warfarin. The client asks a nurse why both medications are being
administered. In formulating a response, the nurse incorporates the
understanding that warfarin:
1 Stimulates the breakdown of specific clotting factors by the liver,
and it takes 2-3 days for this to exert an anticoagulant effect.
2 Inhibits synthesis of specific clotting factors in the liver, and it
takes 3-4 days for this medication to exert an anticoagulant
effect.
3 Stimulates production of the bodys own thrombolytic
substances, but it takes 2-4 days for this to begin.
4 Has the same mechanism of action as Heparin, and the crossover
time is needed for the serum level of warfarin to be therapeutic.
10) 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:
1 Administer the morphine
2 Obtain a 12-lead ECG
3 Obtain the lab work
4 Order the chest x-ray
11) When administered a thrombolytic drug to the client experiencing
an MI, the nurse explains to him that the purpose of this drug is to:
1 Help keep him well hydrated
2 Dissolve clots he may have

3 Prevent kidney failure

4 Treat potential cardiac arrhythmias.
12) 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.
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 nurses next action
would be to:
1 Call for the doctor
2 Start an intravenous line
3 Obtain a portable chest radiograph
4 Draw blood for laboratory studies
14) The nurse receives emergency laboratory results for a client with
chest pain and immediately informs the physician. An increased
myoglobin level suggests which of the following?
1 Cancer
2 Hypertension
3 Liver disease
4 Myocardial infarction
15) When teaching a client about propranolol hydrochloride, the nurse
should base the information on the knowledge that propranolol
hydrochloride:
1 Blocks beta-adrenergic stimulation and thus causes decreased
heart rate, myocardial contractility, and conduction.
2 Increases norepinephrine secretion and thus decreases blood
pressure and heart rate.
3 Is a potent arterial and venous vasodilator that reduces
peripheral vascular resistance and lowers blood pressure.
4 Is an angiotensin-converting enzyme inhibitor that reduces blood
pressure by blocking the conversion of angiotensin I to
angiotensin II.
16) The most important long-term goal for a client with hypertension
would be to:
1 Learn how to avoid stress
2 Explore a job change or early retirement
3 Make a commitment to long-term therapy
4 Control high blood pressure
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:
1 Cerebrovascular accident
2 Liver disease
3 Myocardial infarction
4 Pulmonary disease
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 friends apartment without pain. Which of
the following measures that the nurse could suggest would most likely
help the client deal with this problem?
1 Visit her friend earlier in the day.
2 Rest for at least an hour before climbing the stairs.
3 Take a nitroglycerin tablet before climbing the stairs.
4 Lie down once she reaches the friends apartment.
19) Which of the following symptoms should the nurse teach the
client with unstable angina to report immediately to her physician?
1 A change in the pattern of her pain
2 Pain during sex
3 Pain during an argument with her husband
4 Pain during or after an activity such as lawnmowing
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:
1 Open and dilate the blocked coronary arteries
2 Assess the extent of arterial blockage
3 Bypass obstructed vessels
4 Assess the functional adequacy of the valves and heart muscle.
21) As an initial step in treating a client with angina, the physician
prescribes nitroglycerin tablets, 0.3mg given sublingually. This drugs
principle effects are produced by:
1 Antispasmotic effect on the pericardium
2 Causing an increased mycocardial oxygen demand
3 Vasodilation of peripheral vasculature
4 Improved conductivity in the myocardium
22) The nurse teaches the client with angina about the common
expected side effects of nitroglycerin, including:
1 Headache
2 High blood pressure

3 Shortness of breath
4 Stomach cramps
23) Sublingual nitroglycerin tablets begin to work within 1 to 2
minutes. How should the nurse instruct the client to use the drug when
chest pain occurs?
1 Take one tablet every 2 to 5 minutes until the pain stops.
2 Take one tablet and rest for 10 minutes. Call the physician if pain
persists after 10 minutes.
3 Take one tablet, then an additional tablet every 5 minutes for a
total of 3 tablets. Call the physician if pain persists after three
tablets.
4 Take one tablet. If pain persists after 5 minutes, take two tablets.
If pain still persists 5 minutes later, call the physician.
24) Which of the following arteries primarily feeds the anterior wall of
the heart?
1 Circumflex artery
2 Internal mammary artery
3 Left anterior descending artery
4 Right coronary artery
25) When do coronary arteries primarily receive blood flow?
1 During inspiration
2 During diastolic
3 During expiration
4 During systole
26) Prolonged occlusion of the right coronary artery produces an
infarction in which of the following areas of the heart?
1 Anterior
2 Apical
3 Inferior
4 Lateral
27) A murmur is heard at the second left intercostal space along the
left sternal border. Which valve is this?
1 Aortic
2 Mitral
3 Pulmonic
4 Tricupsid
28) Which of the following blood tests is most indicative of cardiac
damage?
1 Lactate dehydrogenase
2 Complete blood count (CBC)
3 Troponin I
4 Creatine kinase (CK)
29) Which of the following diagnostic tools is most commonly used to
determine the location of myocardial damage?
1 Cardiac catherization
2 Cardiac enzymes

3 Echocardiogram
4 Electrocardiogram (ECG)
30) Which of the following types of pain is most characteristic of
angina?
1 Knifelike
2 Sharp
3 Shooting
4 Tightness
31) Which of the following parameters is the major determinate of
diastolic blood pressure?
1 Baroreceptors
2 Cardiac output
3 Renal function
4 Vascular resistance
32) Which of the following factors can cause blood pressure to drop to
normal levels?
1 Kidneys excretion of sodium only
2 Kidneys retention of sodium and water
3 Kidneys excretion of sodium and water
4 Kidneys retention of sodium and excretion of water
33) Baroreceptors in the carotid artery walls and aorta respond to
which of the following conditions?
1 Changes in blood pressure
2 Changes in arterial oxygen tension
3 Changes in arterial carbon dioxide tension
4 Changes in heart rate
34) Which of the following terms describes the force against which
the ventricle must expel blood?
1 Afterload
2 Cardiac output
3 Overload
4 Preload
35) Which of the following terms is used to describe the amount of
stretch on the myocardium at the end of diastole?
1 Afterload
2 Cardiac index
3 Cardiac output
4 Preload
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?
1 Monitor the apical pulse rate
2 Instruct the client to take medication with food
3 Question the physician about the order
4 Caution the client to rise slowly when standing.

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?
1 Hypocalcemia
2 Hypermagnesemia
3 Hypokalemia
4 Hypernatremia
38) A client is receiving spironolactone to treat hypertension. Which
of the following instructions should the nurse provide?
1 Eat foods high in potassium.
2 Take daily potassium supplements.
3 Discontinue sodium restrictions.
4 Avoid salt substitutes.
39) When assessing an ECG, the nurse knows that the P-R interval
represents the time it takes for the:
1 Impulse to begin atrial contraction
2 Impulse to transverse the atria to the AV node
3 SA node to discharge the impulse to begin atrial depolarization
4 Impulse to travel to the ventricles
40) 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 doesnt understand why he needs to be there
because there is nothing that can be done to make him better. The
best nursing response is:
1 Cardiac rehabilitation is not a cure but can help restore you to
many of your former activities.
2 Here we teach you to gradually change your lifestyle to
accommodate your heart disease.
3 You are probably right but we can gradually increase your
activities so that you can live a more active life.
4 Do you feel that you will have to make some changes in your
life now?
41) To evaluate a clients condition following cardiac catheterization,
the nurse will palpate the pulse:
1 In all extremities
2 At the insertion site
3 Distal to the catheter insertion
4 Above the catheter insertion
42) A clients physician orders nuclear cardiography and makes an
appointment for a thallium scan. The purpose of injecting radioisotope
into the bloodstream is to detect:
1 Normal vs. abnormal tissue
2 Damage in areas of the heart
3 Ventricular function

4 Myocardial scarring and perfusion

43) 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?
1 Monitoring vital signs
2 Completing a physical assessment
3 Maintaining cardiac monitoring
4 Maintaining at least one IV access site
44) A client is experiencing tachycardia. The nurses understanding of
the physiological basis for this symptom is explained by which of the
following statements?
1 The demand for oxygen is decreased because of pleural
involvement
2 The inflammatory process causes the body to demand more
oxygen to meet its needs.
3 The heart has to pump faster to meet the demand for oxygen
when there is lowered arterial oxygen tension.
4 Respirations are labored.
45) A client enters the ER complaining of chest pressure and severe
epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor
orders cardiac enzymes. If the client were diagnosed with an MI, the
nurse would expect which cardiac enzyme to rise within the next 3 to 8
hours?
1 Creatine kinase (CK or CPK)
2 Lactic dehydrogenase (LDH)
3 LDH-1
4 LDH-2
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:
1 Decreased arterial blood flow secondary to vasoconstriction
2 Decreased arterial blood flow leading to hyperemia
3 Atherosclerotic obstruction of the arteries
4 Trauma to the lower extremities
47) Which of the following instructions should be included in the
discharge teaching for a patient discharged with a transdermal
nitroglycerin patch?
1 Apply the patch to a nonhairy, nonfatty area of the upper torso
or arms.
2 Apply the patch to the same site each day to maintain
consistent drug absorption.
3 If you get a headache, remove the patch for 4 hours and then
reapply.

4 If you get chest pain, apply a second patch right next to the first
patch.
48) In order to prevent the development of tolerance, the nurse
instructs the patient to:
1 Apply the nitroglycerin patch every other day
2 Switch to sublingual nitroglycerin when the patients systolic
blood pressure elevates to >140 mm Hg
3 Apply the nitroglycerin patch for 14 hours each and remove for
10 hours at night
4 Use the nitroglycerin patch for acute episodes of angina only
49) Direct-acting vasodilators have which of the following effects on
the heart rate?
1 Heart rate decreases
2 Heart rate remains significantly unchanged
3 Heart rate increases
4 Heart rate becomes irregular
50) When teaching a patient why spironolactone (Aldactone) and
furosemide (Lasix) are prescribed together, the nurse bases teaching
on the knowledge that:
1 Moderate doses of two different types of diuretics are more
effective than a large dose of one type
2 This combination promotes diuresis but decreases the risk of
hypokalemia
3 This combination prevents dehydration and hypovolemia
4 Using two drugs increases osmolality of plasma and the
glomerular filtration rate
ANSWERS
1 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.
2 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.
3 2. On transfer from the CCU, the client is allowed self-care
activities and bathroom privileges. Supervised ambulation for
brief distances are encouraged, with distances gradually
increased (50, 100, 200 feet).
4 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.
5 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.
6 4. BP should be taken with the client seated with the arm bared,
positioned with support and at heart level. The client should sit
with the legs on the floor, feet uncrossed, and not speak during
the recording. The client should not have smoked tobacco or
taken in caffeine in the 30 minutes preceding the measurement.
The client should rest quietly for 5 minutes before the reading is
taken. The cuff bladder should encircle at least 80% of the limb
being measured. Gauges other than a mercury
sphygmomanometer should be calibrated every 6 months to
ensure accuracy.
7 4. The antidote to heparin is protamine sulfate and should be
readily available for use if excessive bleeding or hemorrhage
should occur. Vitamin K is an antidote for warfarin.
8 3. The therapeutic range for prothrombin time is 1.5 to 2 times
the control for clients at risk for thrombus. Based on the clients
control value, the therapeutic range for this individual would be
16.5 to 22 seconds. Therefore the result is within therapeutic
range.
9 2. Warfarin works in the liver and inhibits synthesis of four
vitamin K-dependent clotting factors (X, IX, VII, and II), but it
takes 3 to 4 days before the therapeutic effect of warfarin is
exhibited.
10 1. Although obtaining the ECG, chest x-ray, and blood work are
all important, the nurses priority action would be to relieve the
crushing chest pain.
11 2. Thrombolytic drugs are administered within the first 6 hours
after onset of a MI to lyse clots and reduce the extent of
myocardial damage.
12 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.
13 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.
14 4. Detection of myoglobin is one diagnostic tool to determine
whether myocardial damage has occurred. Myoglobin is
generally detected about one hour after a heart attack is
experienced and peaks within 4 to 6 hours after infarction
(Remember, less than 90 mg/L is normal).

15 1. Propranolol hydrochloride is a beta-adrenergic blocking agent.

Actions of propranolol hydrochloride include reducing heart rate,
decreasing myocardial contractility, and slowing conduction.
16 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.
17 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. CVAs 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.
18 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.
19 1. The client should report a change in the pattern of chest pain.
It may indicate increasing severity of CAD.
20 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.
21 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.
22 1. Because of the widespread vasodilating effects, nitroglycerin
often produces such side effects as headache, hypotension, and
dizziness. The client should lie or shit down to avoid fainting.
Nitro does not cause shortness of breath or stomach cramps.
23 3. The correct protocol for nitroglycerin used involves immediate
administration, with subsequent doses taken at 5-minute
intervals as needed, for a total dose of 3 tablets. Sublingual
nitroglycerin appears in the blood stream within 2 to 3 minutes
and is metabolized within about 10 minutes.
24 3. The left anterior descending artery is the primary source of
blood flow for the anterior wall of the heart. The circumflex artery
supplies the lateral wall, the internal mammary supplies the

mammary, and the right coronary artery supplies the inferior wall
of the heart.
25 2. Although the coronary arteries may receive a minute portion
of blood during systole, most of the blood flow to coronary
arteries is supplied during diastole. Breathing patterns are
irrelevant to blood flow.
26 3. The right coronary artery supplies the right ventricle, or the
inferior portion of the heart. Therefore, prolonged occlusion could
produce an infarction in that area. The right coronary artery
doesnt supply the anterior portion (left ventricle), lateral portion
(some of the left ventricle and the left atrium), or the apical
portion (left ventricle) of the heart.
27 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.
28 3. Troponin I levels rise rapidly and are detectable within 1 hour
of myocardial injury. Troponin levels arent detectable in people
without cardiac injury.
29 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 cant 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.
30 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.
31 4. Vascular resistance is the impedance of blood flow by the
arterioles that most predominantly affects the diastolic pressure.
Cardiac output determines systolic blood pressure.
32 3. The kidneys respond to a rise in blood pressure by excreting
sodium and excess water. This response ultimately affects
systolic pressure by regulating blood volume.
33 1. Baroreceptors located in the carotid arteries and aorta sense
pulsatile pressure. Decreases in pulsatile pressure cause a reflex
increase in heart rate. Chemoreceptors in the medulla are
primarily stimulated by carbon dioxide. Peripheral
chemoreceptors in the aorta and carotid arteries are primarily
stimulated by oxygen.

34 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.
35 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
clients body surface area. Cardiac output is the amount of blood
the heart is expelling per minute.
36 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
clients 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.
37 3. Furosemide is a potassium-depleting diuretic than can cause
hypokalemia. In turn, hypokalemia increases myocardial
excitability, leading to ventricular tachycardia.
38 4. Because spironolactone is a potassium-sparing diuretic, the
client should avoid salt substitutes because of their high
potassium content. The client should also avoid potassium-rich
foods and potassium supplements. To reduce fluid-volume
overload, sodium restrictions should continue.
39 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.
40 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.
41 3. Palpating pulses distal to the insertion site is important to
evaluate for thrombophlebitis and vessel occlusion. They should
be bilateral and strong.
42 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.
43 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.
44 3. The arterial oxygen supply is lowered and the demand for
oxygen is increased, which results in the hearts having to beat
faster to meet the bodys needs for oxygen.
45 1. Creatine kinase (CK, formally known as CPK) rises in 3-8 hours
if an MI is present. When the myocardium is damaged, CPK leaks
out of the cell membranes and into the blood stream. Lactic
dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises
in 8-24 hours.
46 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.
47 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.
48 3. Tolerance can be prevented by maintaining an 8- to 12-hour
nitrate-free period each day.
49 3. Heart rate increases in response to decreased blood pressure
caused by vasodilation.
50. 2. Spironolactone is a potassium-sparing diuretic; furosemide is a
potassium-loosing diuretic. Giving these together minimizes electrolyte
imbalance.