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1.

Which of the following actions is the first priority of care for a client
exhibiting signs and symptoms of coronary artery disease?

1. Decrease anxiety
2. Enhance myocardial oxygenation
3. Administer sublingual nitroglycerin
4. Educate the client about his symptoms

2. Medical treatment of coronary artery disease includes which of the following


procedures?

1. Cardiac catheterization
2. Coronary artery bypass surgery
3. Oral medication therapy
4. Percutaneous transluminal coronary angioplasty

3. Which of the following is the most common symptom of myocardial infarction (MI)?

1. Chest pain
2. Dyspnea
3. Edema
4. Palpitations

4. Which of the following symptoms is the most likely origin of pain the client
described as knifelike chest pain that increases in intensity with inspiration?

1. Cardiac
2. Gastrointestinal
3. Musculoskeletal
4. Pulmonary

5. 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)

6. What is the primary reason for administering morphine to a client with an MI?

1. To sedate the client


2. To decrease the client�s pain
3. To decrease the client�s anxiety
4. To decrease oxygen demand on the client�s heart

7. Which of the following conditions is most commonly responsible for myocardial


infarction?

1. Aneurysm
2. Heart failure
3. Coronary artery thrombosis
4. Renal failure

8. Which of the following complications is indicated by a third heart sound (S3)?

1. Ventricular dilation
2. Systemic hypertension
3. Aortic valve malfunction
4. Increased atrial contractions
9. After an anterior wall myocardial infarction, which of the following problems is
indicated by auscultation of crackles in the lungs?

1. Left-sided heart failure


2. Pulmonic valve malfunction
3. Right-sided heart failure
4. Tricupsid valve malfunction

10. What is the first intervention for a client experiencing MI?

1. Administer morphine
2. Administer oxygen
3. Administer sublingual nitroglycerin
4. Obtain an ECG

11. Which of the following classes of medications protects the ischemic myocardium
by blocking catecholamines and sympathetic nerve stimulation?

1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Narcotics
4. Nitrates

12. What is the most common complication of an MI?

1. Cardiogenic shock
2. Heart failure
3. arrhythmias
4. Pericarditis

13. With which of the following disorders is jugular vein distention most
prominent?

1. Abdominal aortic aneurysm


2. Heart failure
3. MI
4. Pneumothorax

14. Toxicity from which of the following medications may cause a client to see a
green-yellow halo around lights?

1. Digoxin
2. Furosemide (Lasix)
3. Metoprolol (Lopressor)
4. Enalapril (Vasotec)

15. Which of the following symptoms is most commonly associated with left-sided
heart failure?

1. Crackles
2. Arrhythmias
3. Hepatic engorgement
4. Hypotension

16. In which of the following disorders would the nurse expect to assess sacral
edema in a bedridden client?

1. Diabetes
2. Pulmonary emboli
3. Renal failure
4. Right-sided heart failure

17. Which of the following symptoms might a client with right-sided heart failure
exhibit?

1. Adequate urine output


2. Polyuria
3. Oliguria
4. Polydipsia

18. Which of the following classes of medications maximizes cardiac performance in


clients with heart failure by increasing ventricular contractility?

1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Diuretics
4. Inotropic agents

19. Stimulation of the sympathetic nervous system produces which of the following
responses?

1. Bradycardia
2. Tachycardia
3. Hypotension
4. Decreased myocardial contractility

20. Which of the following conditions is most closely associated with weight gain,
nausea, and a decrease in urine output?

1. Angina pectoris
2. Cardiomyopathy
3. Left-sided heart failure
4. Right-sided heart failure

21. Which of the following heart muscle diseases is unrelated to other


cardiovascular disease?

1. Cardiomyopathy
2. Coronary artery disease
3. Myocardial infarction
4. Pericardial effusion

22. Which of the following types of cardiomyopathy can be associated with


childbirth?

1. Dilated
2. Hypertrophic
3. Myocarditis
4. Restrictive

23. Septal involvement occurs in which type of cardiomyopathy?

1. Congestive
2. Dilated
3. Hypertrophic
4. Restrictive
24. Which of the following recurring conditions most commonly occurs in clients
with cardiomyopathy?

1. Heart failure
2. Diabetes
3. MI
4. Pericardial effusion

25. Dyspnea, cough, expectoration, weakness, and edema are classic signs and
symptoms of which of the following conditions?

1. Pericarditis
2. Hypertension
3. MI
4. Heart failure

26. In which of the following types of cardiomyopathy does cardiac output remain
normal?

1. Dilated
2. Hypertrophic
3. Obliterative
4. Restrictive

27. Which of the following cardiac conditions does a fourth heart sound (S4)
indicate?

1. Dilated aorta
2. Normally functioning heart
3. Decreased myocardial contractility
4. Failure of the ventricle to eject all of the blood during systole

28. Which of the following classes of drugs is most widely used in the treatment of
cardiomyopathy?

1. Antihypertensives
2. Beta-adrenergic blockers
3. Calcium channel blockers
4. Nitrates

29. If medical treatments fail, which of the following invasive procedures is


necessary for treating cardiomyopathy?

1. Cardiac catheterization
2. Coronary artery bypass graft (CABG)
3. Heart transplantation
4. Intra-aortic balloon pump (IABP)

30. Which of the following conditions is associated with a predictable level of


pain that occurs as a result of physical or emotional stress?

1. Anxiety
2. Stable angina
3. Unstable angina
4. Variant angina

31. Which of the following types of angina is most closely related with an
impending MI?
1. Angina decubitus
2. Chronic stable angina
3. Nocturnal angina
4. Unstable angina

32. Which of the following conditions is the predominant cause of angina?

1. Increased preload
2. Decreased afterload
3. Coronary artery spasm
4. Inadequate oxygen supply to the myocardium

33. Which of the following tests is used most often to diagnose angina?

1. Chest x-ray
2. Echocardiogram
3. Cardiac catheterization
4. 12-lead electrocardiogram (ECG)

34. Which of the following results is the primary treatment goal for angina?

1. Reversal of ischemia
2. Reversal of infarction
3. Reduction of stress and anxiety
4. Reduction of associated risk factors

35. Which of the following interventions should be the first priority when treating
a client experiencing chest pain while walking?

1. Sit the client down


2. Get the client back to bed
3. Obtain an ECG
4. Administer sublingual nitroglycerin

36. Myocardial oxygen consumption increases as which of the following parameters


increase?

1. Preload, afterload, and cerebral blood flow


2. Preload, afterload, and renal blood flow
3. Preload, afterload, contractility, and heart rate.
4. Preload, afterload, cerebral blood flow, and heart rate.

37. Which of the following positions would best aid breathing for a client with
acute pulmonary edema?

1. Lying flat in bed


2. Left side-lying
3. In high Fowler�s position
4. In semi-Fowler�s position

38. Which of the following blood gas abnormalities is initially most suggestive of
pulmonary edema?

1. Anoxia
2. Hypercapnia
3. Hyperoxygenation
4. Hypocapnia

39. Which of the following is a compensatory response to decreased cardiac output?


1. Decreased BP
2. Alteration in LOC
3. Decreased BP and diuresis
4. Increased BP and fluid retention

40. Which of the following actions is the appropriate initial response to a client
coughing up pink, frothy sputum?

1. Call for help


2. Call the physician
3. Start an I.V. line
4. Suction the client

41. Which of the following terms describes the force against which the ventricle
must expel blood?

1. Afterload
2. Cardiac output
3. Overload
4. Preload

42. Acute pulmonary edema caused by heart failure is usually a result of damage to
which of the following areas of the heart?

1. Left atrium
2. Right atrium
3. Left ventricle
4. Right ventricle

43. An 18-year-old client who recently had an URI is admitted with suspected
rheumatic fever. Which assessment findings confirm this diagnosis?

1. Erythema marginatum, subcutaneous nodules, and fever


2. Tachycardia, finger clubbing, and a load S3
3. Dyspnea, cough, and palpitations
4. Dyspnea, fatigue, and syncope

44. A client admitted with angina complains of severe chest pain and suddenly
becomes unresponsive. After establishing unresponsiveness, which of the following
actions should the nurse take first?

1. Activate the resuscitation team


2. Open the client�s airway
3. Check for breathing
4. Check for signs of circulation

45. A 55-year-old client is admitted with an acute inferior-wall myocardial


infarction. During the admission interview, he says he stopped taking his
metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the
following nursing diagnoses takes priority for this client?

1. Anxiety
2. Ineffective tissue perfusion; cardiopulmonary
3. Acute pain
4. Ineffective therapeutic regimen management

46. A client comes into the E.R. with acute shortness of breath and a cough that
produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a
BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The
client�s medical history included DM, HTN, and heart failure. Which of the
following disorders should the nurse suspect?

1. Pulmonary edema
2. Pneumothorax
3. Cardiac tamponade
4. Pulmonary embolus

47. The nurse coming on duty receives the report from the nurse going off duty.
Which of the following clients should the on-duty nurse assess first?

1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of
126/76, and a respiratory rate of 21 breaths a minute.
2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50,
and a DNR order.
3. The 62-year-old client who was admitted one day ago with thrombophlebitis and
receiving IV heparin.
4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial
fibrillation and is receiving IV diltiazem (Cardizem).

48. When developing a teaching plan for a client with endocarditis, which of the
following points is most essential for the nurse to include?

1. �Report fever, anorexia, and night sweats to the physician.�


2. �Take prophylactic antibiotics after dental work and invasive procedures.�
3. �Include potassium rich foods in your diet.�
4. �Monitor your pulse regularly.�

49. A nurse is conducting a health history with a client with a primary diagnosis
of heart failure. Which of the following disorders reported by the client is
unlikely to play a role in exacerbating the heart failure?

1. Recent URI
2. Nutritional anemia
3. Peptic ulcer disease
4. A-Fib

50. A nurse is preparing for the admission of a client with heart failure who is
being sent directly to the hospital from the physician�s office. The nurse would
plan on having which of the following medications readily available for use?

1. Diltiazem (Cardizem)
2. Digoxin (Lanoxin)
3. Propranolol (Inderal)
4. Metoprolol (Lopressor)

51. A nurse caring for a client in one room is told by another nurse that a second
client has developed severe pulmonary edema. On entering the 2nd client�s room, the
nurse would expect the client to be:

1. Slightly anxious
2. Mildly anxious
3. Moderately anxious
4. Extremely anxious

52. A client with pulmonary edema has been on diuretic therapy. The client has an
order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing
that the client also will be started on Digoxin (Lanoxin), a nurse checks the
client�s most recent:

1. Digoxin level
2. Sodium level
3. Potassium level
4. Creatinine level

53. A client who had cardiac surgery 24 hours ago has a urine output averaging 19
ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine
output for the subsequent hour was 25 ml. Daily laboratory results indicate the
blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse
interprets the client is at risk for:

1. Hypovolemia
2. UTI
3. Glomerulonephritis
4. Acute renal failure

54. A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery.
The nurse would plan to do which of the following to enable the client to best
tolerate the ambulation?

1. Encourage the client to cough and deep breathe


2. Premedicate the client with an analgesic
3. Provide the client with a walker
4. Remove telemetry equipment because it weighs down the hospital gown.

55. A client�s electrocardiogram strip shows atrial and ventricular rates of 80


complexes per minute. The PR interval is 0.14 second, and the QRS complex measures
0.08 second. The nurse interprets this rhythm is:

1. Normal sinus rhythm


2. Sinus bradycardia
3. Sinus tachycardia
4. Sinus dysrhythmia

56. A client has frequent bursts of ventricular tachycardia on the cardiac monitor.
A nurse is most concerned with this dysrhythmia because:

1. It is uncomfortable for the client, giving a sense of impending doom.


2. It produces a high cardiac output that quickly leads to cerebral and myocardial
ischemia.
3. It is almost impossible to convert to a normal sinus rhythm.
4. It can develop into ventricular fibrillation at any time.

57. A home care nurse is making a routine visit to a client receiving digoxin
(Lanoxin) in the treatment of heart failure. The nurse would particularly assess
the client for:

1. Thrombocytopenia and weight gain


2. Anorexia, nausea, and visual disturbances
3. Diarrhea and hypotension
4. Fatigue and muscle twitching

58. A client with angina complains that the angina pain is prolonged and severe and
occurs at the same time each day, most often in the morning, On further assessment
a nurse notes that the pain occurs in the absence of precipitating factors. This
type of anginal pain is best described as:
1. Stable angina
2. Unstable angina
3. Variant angina
4. Nonanginal pain

59. The physician orders continuous intravenous nitroglycerin infusion for the
client with MI. Essential nursing actions include which of the following?

1. Obtaining an infusion pump for the medication


2. Monitoring BP q4h
3. Monitoring urine output hourly
4. Obtaining serum potassium levels daily

60. Aspirin is administered to the client experiencing an MI because of its:

1. Antipyretic action
2. Antithrombotic action
3. Antiplatelet action
4. Analgesic action

61. Which of the following is an expected outcome for a client on the second day of
hospitalization after an MI?

1. Has severe chest pain


2. Can identify risks factors for MI
3. Agrees to participate in a cardiac rehabilitation walking program
4. Can perform personal self-care activities without pain

62. Which of the following reflects the principle on which a client�s diet will
most likely be based during the acute phase of MI?

1. Liquids as ordered
2. Small, easily digested meals
3. Three regular meals per day
4. NPO

63. An older, sedentary adult may not respond to emotional or physical stress as
well as a younger individual because of:

1. Left ventricular atrophy


2. Irregular heartbeats
3. Peripheral vascular occlusion
4. Pacemaker placement

64. Which of the following nursing diagnoses would be appropriate for a client with
heart failure? Select all that apply.

1. Ineffective tissue perfusion related to decreased peripheral blood flow


secondary to decreased cardiac output.
2. Activity intolerance related to increased cardiac output.
3. Decreased cardiac output related to structural and functional changes.
4. Impaired gas exchange related to decreased sympathetic nervous system activity.

65. Which of the following would be a priority nursing diagnosis for the client
with heart failure and pulmonary edema?

1. Risk for infection related to stasis of alveolar secretions


2. Impaired skin integrity related to pressure
3. Activity intolerance related to pump failure
4. Constipation related to immobility

66. Captopril may be administered to a client with HF because it acts as a:

1. Vasopressor
2. Volume expander
3. Vasodilator
4. Potassium-sparing diuretic

67. Furosemide is administered intravenously to a client with HF. How soon after
administration should the nurse begin to see evidence of the drugs desired effect?

1. 5 to 10 minutes
2. 30 to 60 minutes
3. 2 to 4 hours
4. 6 to 8 hours

68. Which of the following foods should the nurse teach a client with heart failure
to avoid or limit when following a 2-gram sodium diet?

1. Apples
2. Tomato juice
3. Whole wheat bread
4. Beef tenderloin

69. The nurse finds the apical pulse below the 5th intercostal space. The nurse
suspects:

1. Left atrial enlargement


2. Left ventricular enlargement
3. Right atrial enlargement
4. Right ventricular enlargement

70. 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