Myocardial Infarction and Heart Failure Practice Quiz 8.

Which of the following complications is indicated by a

third heart sound (S3)?
1. Which of the following actions is the first priority of care
for a client exhibiting signs and symptoms of coronary artery 1. Ventricular dilation
disease? 2. Systemic hypertension
3. Aortic valve malfunction
1. Decrease anxiety 4. Increased atrial contractions
2. Enhance myocardial oxygenation
3. Administer sublingual nitroglycerin 9. After an anterior wall myocardial infarction, which of the
4. Educate the client about his symptoms following problems is indicated by auscultation of crackles
in the lungs?
2. Medical treatment of coronary artery disease includes
which of the following procedures? 1. Left-sided heart failure
2. Pulmonic valve malfunction
1. Cardiac catheterization 3. Right-sided heart failure
2. Coronary artery bypass surgery 4. Tricupsid valve malfunction
3. Oral medication therapy
4. Percutaneous transluminal coronary angioplasty 10. What is the first intervention for a client experiencing
MI?
3. Which of the following is the most common symptom of
myocardial infarction (MI)? 1. Administer morphine
2. Administer oxygen
1. Chest pain 3. Administer sublingual nitroglycerin
2. Dyspnea 4. Obtain an ECG
3. Edema
4. Palpitations 11. Which of the following classes of medications protects
the ischemic myocardium by blocking catecholamines and
4. Which of the following symptoms is the most likely origin sympathetic nerve stimulation?
of pain the client described as knifelike chest pain that
increases in intensity with inspiration? 1. Beta-adrenergic blockers
2. Calcium channel blockers
1. Cardiac 3. Narcotics
2. Gastrointestinal 4. Nitrates
3. Musculoskeletal
4. Pulmonary 12. What is the most common complication of an MI?

5. Which of the following blood tests is most indicative of 1. Cardiogenic shock

cardiac damage? 2. Heart failure
3. arrhythmias
1. Lactate dehydrogenase 4. Pericarditis
2. Complete blood count (CBC)
3. Troponin I 13. With which of the following disorders is jugular vein
4. Creatine kinase (CK) distention most prominent?

6. What is the primary reason for administering morphine to 1. Abdominal aortic aneurysm
a client with an MI? 2. Heart failure
3. MI
1. To sedate the client 4. Pneumothorax
2. To decrease the client’s pain
3. To decrease the client’s anxiety 14. Toxicity from which of the following medications may
4. To decrease oxygen demand on the client’s heart cause a client to see a green-yellow halo around lights?

7. Which of the following conditions is most commonly 1. Digoxin

responsible for myocardial infarction? 2. Furosemide (Lasix)
3. Metoprolol (Lopressor)
1. Aneurysm 4. Enalapril (Vasotec)
2. Heart failure
3. Coronary artery thrombosis
4. Renal failure
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15. Which of the following symptoms is most commonly 22. Which of the following types of cardiomyopathy can be
associated with left-sided heart failure? associated with childbirth?

1. Crackles 1. Dilated
2. Arrhythmias 2. Hypertrophic
3. Hepatic engorgement 3. Myocarditis
4. Hypotension 4. Restrictive

16. In which of the following disorders would the nurse 23. Septal involvement occurs in which type of
expect to assess sacral edema in a bedridden client? cardiomyopathy?

1. Diabetes 1. Congestive
2. Pulmonary emboli 2. Dilated
3. Renal failure 3. Hypertrophic
4. Right-sided heart failure 4. Restrictive

17. Which of the following symptoms might a client with 24. Which of the following recurring conditions most
right-sided heart failure exhibit? commonly occurs in clients with cardiomyopathy?

1. Adequate urine output 1. Heart failure

2. Polyuria 2. Diabetes
3. Oliguria 3. MI
4. Polydipsia 4. Pericardial effusion

18. Which of the following classes of medications maximizes 25. Dyspnea, cough, expectoration, weakness, and edema
cardiac performance in clients with heart failure by are classic signs and symptoms of which of the following
increasing ventricular contractility? conditions?

1. Beta-adrenergic blockers 1. Pericarditis

2. Calcium channel blockers 2. Hypertension
3. Diuretics 3. MI
4. Inotropic agents 4. Heart failure

19. Stimulation of the sympathetic nervous system produces 26. In which of the following types of cardiomyopathy does
which of the following responses? cardiac output remain normal?

1. Bradycardia 1. Dilated
2. Tachycardia 2. Hypertrophic
3. Hypotension 3. Obliterative
4. Decreased myocardial contractility 4. Restrictive

20. Which of the following conditions is most closely 27. Which of the following cardiac conditions does a fourth
associated with weight gain, nausea, and a decrease in urine heart sound (S4) indicate?
output?
1. Dilated aorta
1. Angina pectoris 2. Normally functioning heart
2. Cardiomyopathy 3. Decreased myocardial contractility
3. Left-sided heart failure 4. Failure of the ventricle to eject all of the blood during
4. Right-sided heart failure systole

21. Which of the following heart muscle diseases is 28. Which of the following classes of drugs is most widely
unrelated to other cardiovascular disease? used in the treatment of cardiomyopathy?

1. Cardiomyopathy 1. Antihypertensives
2. Coronary artery disease 2. Beta-adrenergic blockers
3. Myocardial infarction 3. Calcium channel blockers
4. Pericardial effusion 4. Nitrates
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29. If medical treatments fail, which of the following 36. Myocardial oxygen consumption increases as which of
invasive procedures is necessary for the following parameters increase?
treating cardiomyopathy?
1. Preload, afterload, and cerebral blood flow
1. Cardiac catheterization 2. Preload, afterload, and renal blood flow
2. Coronary artery bypass graft (CABG) 3. Preload, afterload, contractility, and heart rate.
3. Heart transplantation 4. Preload, afterload, cerebral blood flow, and heart rate.
4. Intra-aortic balloon pump (IABP)
37. Which of the following positions would best aid
30. Which of the following conditions is associated with a breathing for a client with acute pulmonary edema?
predictable level of pain that occurs as a result of physical or
emotional stress? 1. Lying flat in bed
2. Left side-lying
1. Anxiety 3. In high Fowler’s position
2. Stable angina 4. In semi-Fowler’s position
3. Unstable angina
4. Variant angina 38. Which of the following blood gas abnormalities is
initially most suggestive of pulmonary edema?
31. Which of the following types of angina is most closely
related with an impending MI? 1. Anoxia
2. Hypercapnia
1. Angina decubitus 3. Hyperoxygenation
2. Chronic stable angina 4. Hypocapnia
3. Nocturnal angina
4. Unstable angina 39. Which of the following is a compensatory response
to decreased cardiac output?
32. Which of the following conditions is the predominant
cause of angina? 1. Decreased BP
2. Alteration in LOC
1. Increased preload 3. Decreased BP and diuresis
2. Decreased afterload 4. Increased BP and fluid retention
3. Coronary artery spasm
4. Inadequate oxygen supply to the myocardium 40. Which of the following actions is the appropriate initial
response to a client coughing up pink, frothy sputum?
33. Which of the following tests is used most often to
diagnose angina? 1. Call for help
2. Call the physician
1. Chest x-ray 3. Start an I.V. line
2. Echocardiogram 4. Suction the client
3. Cardiac catheterization
4. 12-lead electrocardiogram (ECG) 41. Which of the following terms describes the force against
which the ventricle must expel blood?
34. Which of the following results is the primary treatment
goal for angina? 1. Afterload
2. Cardiac output
1. Reversal of ischemia 3. Overload
2. Reversal of infarction 4. Preload
3. Reduction of stress and anxiety
4. Reduction of associated risk factors 42. Acute pulmonary edema caused by heart failure is
usually a result of damage to which of the following areas of
35. Which of the following interventions should be the first the heart?
priority when treating a client experiencing chest pain while
walking? 1. Left atrium
2. Right atrium
1. Sit the client down 3. Left ventricle
2. Get the client back to bed 4. Right ventricle
3. Obtain an ECG
4. Administer sublingual nitroglycerin

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43. An 18-year-old client who recently had an URI is 48. When developing a teaching plan for a client with
admitted with suspected rheumatic fever. Which endocarditis, which of the following points is most essential
assessment findings confirm this diagnosis? for the nurse to include?

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. “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. The 58-year-old client who was admitted 2 days ago with 1. Digoxin level
heart failure, BP of 126/76, and a respiratory rate of 21 2. Sodium level
breaths a minute. 3. Potassium level
2. The 88-year-old client with end-stage right-sided heart 4. Creatinine level
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).

4
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:
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. Thrombocytopenia and weight gain 1. Left ventricular atrophy

2. Anorexia, nausea, and visual disturbances 2. Irregular heartbeats
3. Diarrhea and hypotension 3. Peripheral vascular occlusion
4. Fatigue and muscle twitching 4. Pacemaker placement

5
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?
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
Coronary Artery Disease & Hypertension Practice Quiz
1. A client is scheduled for a cardiac catheterization 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 flu-like 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 ten (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.

1. Apples 4. A nurse notes 2+ bilateral edema in the lower extremities

2. Tomato juice of a client with myocardial infarction who was admitted two
3. Whole wheat bread (2) days ago. The nurse would plan to do which of the
4. Beef tenderloin following next?

69. The nurse finds the apical pulse below the 1. Review the intake and output records for the last two (2)
5th intercostal space. The nurse suspects: days
2. Change the time of diuretic administration from morning
1. Left atrial enlargement to evening
2. Left ventricular enlargement 3. Request a sodium restriction of one (1) g/day from the
3. Right atrial enlargement physician.
4. Right ventricular enlargement 4. Order daily weight starting the following morning.

6
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. Aminocaproic 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
client’s prothrombin time is 20 seconds, with a control of 11
seconds. The nurse assesses that this result is:
1. The same as the client’s 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 two (2)- three (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 body’s 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 two (2) mg 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 a 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 nurse’s 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
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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 friend’s apartment without
pain. Which of the following measures that the nurse could
suggest would most likely help the client deal with this
problem?
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 friend’s 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 lawn mowing
20. The physician refers the client with unstable angina for a
cardiac catheterization. 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 drug’s principal effects are produced by:
1. Antispasmodic effect on the pericardium
2. Causing an increased myocardial 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 (1) tablet every two (2) to five (5) minutes until
the pain stops.
2. Take one (1) tablet and rest for ten (10) minutes. Call the
physician if pain persists after ten (10) minutes.
3. Take one (1) tablet, then an additional tablet every 5
minutes for a total of three (3) tablets. Call the physician if
pain persists after three (3) tablets.
4. Take one (1) tablet. If pain persists after five (5) minutes,
take two (2) tablets. If pain persists five (5) minutes later, call
the physician.
8
24. Which of the following arteries primarily feeds the 31. Which of the following parameters is the
anterior wall of the heart? major determinant of diastolic blood pressure?

1. Circumflex artery 1. Baroreceptors

2. Internal mammary artery 2. Cardiac output
3. Left anterior descending artery 3. Renal function
4. Right coronary artery 4. Vascular resistance

25. When do coronary arteries primarily receive blood flow? 32. Which of the following factors can cause blood pressure
to drop to normal levels?
1. During inspiration
2. During diastolic 1. Kidneys’ excretion of sodium only
3. During expiration 2. Kidneys’ retention of sodium and water
4. During systole 3. Kidneys’ excretion of sodium and water
4. Kidneys’ retention of sodium and excretion of water
26. Prolonged occlusion of the right coronary artery
produces an infarction in which of the following areas of the 33. Baroreceptors in the carotid artery walls
heart? and aorta respond to which of the following conditions?

1. Anterior 1. Changes in blood pressure

2. Apical 2. Changes in arterial oxygen tension
3. Inferior 3. Changes in arterial carbon dioxide tension
4. Lateral 4. Changes in heart rate

27. A murmur is heard at the second left intercostal space 34. Which of the following terms describes the force against
along the left sternal border. Which valve is this? which the ventricle must expel blood?

1. Aortic 1. Afterload
2. Mitral 2. Cardiac output
3. Pulmonic 3. Overload
4. Tricuspid 4. Preload

28. Which of the following blood tests is most indicative of 35. Which of the following terms is used to describe the
cardiac damage? amount of stretch on the myocardium at the end of
diastole?
1. Lactate dehydrogenase
2. Complete blood count (CBC) 1. Afterload
3. Troponin I 2. Cardiac index
4. Creatine kinase (CK) 3. Cardiac output
4. Preload
29. Which of the following diagnostic tools is most
commonly used to determine the location of myocardial 36. A 57-year-old client with a history of asthma is
damage? prescribed propranolol (Inderal) to control hypertension.
Before administered propranolol, which of the following
1. Cardiac catheterization actions should the nurse take first?
2. Cardiac enzymes
3. Echocardiogram 1. Monitor the apical pulse rate
4. Electrocardiogram (ECG) 2. Instruct the client to take medication with food
3. Question the physician about the order
30. Which of the following types of pain is most 4. Caution the client to rise slowly when standing.
characteristic of angina?

1. Knifelike
2. Sharp
3. Shooting
4. Tightness

9
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 doesn’t
understand why he needs to be there because there is
nothing that can be done to make him better. The best
nursing response is:
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 client’s 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 client’s physician orders nuclear cardiography and
makes an appointment for a thallium scan. The purpose of
injecting radioisotope into the bloodstream is to detect:
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 nurse’s
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
10
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 non hairy, 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 patient’s
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
Peripheral Vascular Diseases Practice Quiz
1. The most important factor in regulating the caliber
of blood vessels, which determines resistance to flow, is:
1. Hormonal secretion
2. Independent arterial wall activity.
3. The influence of circulating chemicals
4. The sympathetic nervous system
2. With peripheral arterial insufficiency, leg pain during rest
can be reduced by:
1. Elevating the limb above heart level
2. Lowering the limb so it is dependent
3. Massaging the limb after application of cold compresses
4. Placing the limb in a plane horizontal to the body
3. Buerger’s disease is characterized by all of the following
except:
1. Arterial thrombosis formation and occlusion
2. Lipid deposits in the arteries
3. Redness or cyanosis in the limb when it is dependent
4. Venous inflammation and occlusion
4. A significant cause of venous thrombosis is:
1. Altered blood coagulation
2. Stasis of blood
3. Vessel wall injury
4. All of the above
5. When caring for a patient who has started anticoagulant
therapy with warfarin (Coumadin), the nurse knows not to
expect therapeutic benefits for:
1. At least 12 hours
2. The first 24 hours
3. 2-3 days
4. 1 week
6. Mike, a 43-year old construction worker, has a history
of hypertension. He smokes two packs of cigarettes a day, is
nervous about the possibility of being unemployed, and has
difficulty coping with stress. His current concern is calf pain
during minimal exercise that decreased with rest. The nurse
assesses Mike’s symptoms as being associated with
peripheral arterial occlusive disease. The nursing diagnosis is
probably:
1. Alteration in tissue perfusion related to compromised
circulation
2. Dysfunctional use of extremities related to muscle spasms
3. Impaired mobility related to stress associated with pain
4. Impairment in muscle use associated with pain on exertion.
7. A 24-year old man seeks medical attention for complaints
of claudication in the arch of the foot. A nurse also notes
superficial thrombophlebitis of the lower leg. The nurse
would next assess the client for:
1. Familial tendency toward peripheral vascular disease
2. Smoking history
3. Recent exposures to allergens
4. History of insect bites
11
8. Intravenous 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. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate
9. A client who has been receiving heparin therapy also is
started on warfarin sodium (coumadin). The client asks the
nurse why both medications are being administered. In
formulating a response, the nurse incorporates the
understanding that warfarin sodium:
1. Stimulates the breakdown of specific clotting factors by
the liver, and it takes 2-3 days for this is exhibit an
anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and
it takes 3 to 4 days for this medication to exert an
anticoagulation effect.
3. Stimulates production of the body’s own thrombolytic
substances, but it takes 2-4 days for it to begin.
4. Has the same mechanism action of heparin, and the
crossover time is needed for the serum level of warfarin
sodium to be therapeutic.
12. A client is admitted with a venous stasis leg ulcer. A
nurse assesses the ulcer, expecting to note that the ulcer:
1. Has a pale colored base
2. Is deep, with even edges
3. Has little granulation tissue
4. Has brown pigmentation around it.
13. In preparation for the discharge of a client with arterial
insufficiency and Raynaud’s disease, client teaching
instructions should include:
1. Walking several times each day as an exercise program.
2. Keeping the heat up so that the environment is warm
3. Wearing TED hose during the day
4. Using hydrotherapy for increasing oxygenation
14. A client comes to the outpatient clinic and tells the nurse
that he has had legs pains that began when he walks but
cease when he stops walking. Which of the following
conditions would the nurse assess for?
1. An acute obstruction in the vessels of the legs
2. Peripheral vascular problems in both legs
3. Diabetes
4. Calcium deficiency

10. A nurse has the order to begin administering warfarin 15. Which of the following characteristics is typical of the
sodium (Coumadin) to a client. While implementing this pain associated with DVT?
order, the nurse ensures that which of the following
1. Dull ache
medications is available on the nursing unit as the antidote
2. No pain
for Coumadin?
3. Sudden onset
1. Vitamin K 4. Tingling
2. Aminocaproic acid
16. Cancer can cause changes in what component of
3. Potassium chloride
Virchow’s triad?
4. Protamine sulfate
1. Blood coagulability
11. A nurse is assessing the neurovascular status of a client
2. Vessel walls
who returned to the surgical nursing unit 4 hours ago after
3. Blood flow
undergoing aortoiliac bypass graft. The affected leg is warm,
4. Blood viscosity
and the nurse notes redness and edema. The pedal pulse is
palpable and unchanged from admission. The nurse 17. Varicose veins can cause changes in what component of
interprets that the neurovascular status is: Virchow’s triad?
1. Normal because of the increased blood flow through the 1. Blood coagulability
leg 2. Vessel walls
2. Slightly deteriorating and should be monitored for another 3. Blood flow
hour 4. Blood viscosity
3. Moderately impaired, and the surgeon should be called.
4. Adequate from the arterial approach, but venous 18. Which technique is considered the gold standard for
complications are arising. diagnosing DVT?

1. Ultrasound imaging
2. Venography
3. MRI
4. Doppler flow study

12
19. A nurse is assessing a client with an abdominal aortic
aneurysm. Which of the following assessment findings by
the nurse is probably unrelated to an aneurysm?
1. Pulsatile abdominal mass
2. Hyperactive bowel sounds in that area
3. Systolic bruit over the area of the mass
4. Subjective sensation of “heart beating” in the abdomen.
20. A nurse is caring for a client who had a percutaneous
insertion of an inferior vena cava filter and was on heparin
therapy before surgery. The nurse would inspect the surgical
site most closely for signs of:
1. Thrombosis and infection
2. Bleeding and infection
3. Bleeding and wound dehiscence.
4. Wound dehiscence and evisceration.
Hematologic Disorders Practice Quiz
1. The nurse is preparing to teach a client with microcytic
hypochromic anemia about the diet to follow after
discharge. Which of the following foods should be included
in the diet?
A. Eggs
B. Lettuce
C. Citrus fruits
D. Cheese
2. The nurse would instruct the client to eat which of the
following foods to obtain the best supply of vitamin B12?
A. Whole grains
B. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts
3. The nurse has just admitted a 35-year-old female client
who has a serum B12 concentration of 800 pg/ml. Which of
the following laboratory findings would cue the nurse to
focus the client history on specific drug or alcohol abuse?
A. Total bilirubin, 0.3 mg/dL
B. Serum creatinine, 0.5 mg/dL
C. Hemoglobin, 16 g/dL
D. Folate, 1.5 ng/mL
4. The nurse understands that the client with pernicious
anemia will have which distinguishing laboratory findings?
A. Schilling’s test elevated
B. Intrinsic factor, absent.
C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million
5. The nurse devises a teaching plan for the patient with
aplastic anemia. Which of the following is the most
important concept to teach for health maintenance?
A. Eat animal protein and dark leafy vegetables each day
B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress
and anxiety
D. Get 8 hours of sleep at night and take naps during the day
6. A client comes into the health clinic 3 years after
undergoing a resection of the terminal ileum complaining of
weakness, shortness of breath, and a sore tongue. Which
client statement indicates a need for intervention and client
teaching?
A. “I have been drinking plenty of fluids.”
B. “I have been gargling with warm salt water for my sore
tongue.”
C. “I have 3 to 4 loose stools per day.”
D. “I take a vitamin B12 tablet every day.”
7. A vegetarian client was referred to a dietitian for
nutritional counseling for anemia. Which client outcome
indicates that the client does not understand nutritional
counseling? The client:
A. Adds dried fruit to cereal and baked goods
B. Cooks tomato-based foods in iron pots
C. Drinks coffee or tea with meals
D. Adds vitamin C to all meals
8. A client was admitted with iron deficiency
anemia and blood-streaked emesis. Which question is most
appropriate for the nurse to ask in determining the extent
of the client’s activity intolerance?
A. “What activities were you able to do 6 months ago
compared to the present?”
B. “How long have you had this problem?”
C. “Have you been able to keep up with all your usual
activities?”
D. “Are you more tired now than you used to be?”
9. The primary purpose of the Schilling test is to measure
the client’s ability to:
A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12
13
10. The nurse implements which of the following for the 15. A client states that she is afraid of receiving vitamin
client who is starting a Schilling test? B12 injections because of the potential toxic reactions.
What is the nurse’s best response to relieve these fears?
A. Administering methylcellulose (Citrucel)
B. Starting a 24- to 48 hour urine specimen collection A. “Vitamin B12 will cause ringing in the eats before a toxic
C. Maintaining NPO status level is reached.”
D. Starting a 72 hour stool specimen collection B. “Vitamin B12 may cause a very mild skin rash initially.”
C. “Vitamin B12 may cause mild nausea but nothing toxic.”
11. A client with pernicious anemia asks why she must take D. “Vitamin B12 is generally free of toxicity because it is water
vitamin B12 injections for the rest of her life. What is the soluble.”
nurse’s best response?
16. A client with microcytic anemia is having trouble
A. “The reason for your vitamin deficiency is an inability to selecting food items from the hospital menu. Which food is
absorb the vitamin because the stomach is not producing best for the nurse to suggest for satisfying the client’s
sufficient acid.” nutritional needs and personal preferences?
B. “The reason for your vitamin deficiency is an inability to
absorb the vitamin because the stomach is not producing A. Egg yolks
sufficient intrinsic factor.” B. Brown rice
C. “The reason for your vitamin deficiency is an excessive C. Vegetables
excretion of the vitamin because of kidney dysfunction.” D. Tea
D. “The reason for your vitamin deficiency is an increased
requirement for the vitamin because of rapid red blood cell 17. A client with macrocytic anemia has a burn on her foot
production.” and states that she had been watching television while lying
on a heating pad. What is the nurse’s first response?
12. The nurse is assessing a client’s activity intolerance by
having the client walk on a treadmill for 5 minutes. Which of A. Assess for potential abuse
the following indicates an abnormal response? B. Check for diminished sensations
C. Document the findings
A. Pulse rate increased by 20 bpm immediately after the D. Clean and dress the area
activity
B. Respiratory rate decreased by 5 breaths/minute 18. Which of the following nursing assessments is a late
C. Diastolic blood pressure increased by 7 mm Hg symptom of polycythemia vera?
D. Pulse rate within 6 bpm of resting phase after 3 minutes of
rest. A. Headache
B. Dizziness
13. When comparing the hematocrit levels of a post-op C. Pruritus
client, the nurse notes that the hematocrit decreased from D. Shortness of breath
36% to 34% on the third day even though the RBC and
hemoglobin values remained stable at 4.5 million and 11.9 19. The nurse is teaching a client with polycythemia vera
g/dL, respectively. Which nursing intervention is most about potential complications from this disease. Which
appropriate? manifestations would the nurse include in the client’s
teaching plan? Select all that apply.
A. Check the dressing and drains for frank bleeding
B. Call the physician A. Hearing loss
C. Continue to monitor vital signs B. Visual disturbance
D. Start oxygen at 2L/min per NC C. Headache
D. Orthopnea
14. A client is to receive epoetin (Epogen) injections. What E. Gout
laboratory value should the nurse assess before giving the F. Weight loss
injection?
20. When a client is diagnosed with aplastic anemia, the
A. Hematocrit nurse monitors for changes in which of the following
B. Partial thromboplastin time physiological functions?
C. Hemoglobin concentration
D. Prothrombin time A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function

14
21. Which of the following blood components is decreased 28. The nurse explains to the parents of a 1-year-old child
in anemia? admitted to the hospital in a sickle cell crisis that the local
tissue damage the child has on admission is caused by which
A. Erythrocytes of the following?
B. Granulocytes
C. Leukocytes A. Autoimmune reaction complicated by hypoxia
D. Platelets B. Lack of oxygen in the red blood cells
C. Obstruction to circulation
22. A client with anemia may be tired due to a tissue D. Elevated serum bilirubin concentration.
deficiency of which of the following substances?
29. The mothers asks the nurse why her child’s hemoglobin
A. Carbon dioxide was normal at birth but now the child has S hemoglobin.
B. Factor VIII Which of the following responses by the nurse is most
C. Oxygen appropriate?
D. T-cell antibodies
A. “The placenta bars passage of the hemoglobin S from the
23. Which of the following cells is the precursor to the red mother to the fetus.”
blood cell (RBC)? B. “The red bone marrow does not begin to produce
hemoglobin S until several months after birth.”
A. B cell C. “Antibodies transmitted from you to the fetus provide
B. Macrophage the newborn with temporary immunity.”
C. Stem cell D. “The newborn has a high concentration of fetal
D. T cell hemoglobin in the blood for some time after birth.”
24. Which of the following symptoms is expected with 30. Which of the following would the nurse identify as the
hemoglobin of 10 g/dl? priority nursing diagnosis during a toddler’s vaso-occlusive
sickle cell crisis?
A. None
B. Pallor A. Ineffective coping related to the presence of a life-
C. Palpitations threatening disease
D. Shortness of breath B. Decreased cardiac output related to abnormal hemoglobin
formation
25. Which of the following diagnostic findings are most
C. Pain related to tissue anoxia
likely for a client with aplastic anemia?
D. Excess fluid volume related to infection
A. Decreased production of T-helper cells
31. A mother asks the nurse if her child’s iron deficiency
B. Decreased levels of white blood cells, red blood cells, and
anemia is related to the child’s frequent infections. The
platelets
nurse responds based on the understanding of which of the
C. Increased levels of WBCs, RBCs, and platelets
following?
D. Reed-Sternberg cells and lymph node enlargement
A. Little is known about iron-deficiency anemia and its
26. A client with iron deficiency anemia is scheduled for
relationship to infection in children.
discharge. Which instruction about prescribed ferrous
B. Children with iron deficiency anemia are more susceptible
gluconate therapy should the nurse include in the teaching
to infection than are other children.
plan?
C. Children with iron-deficiency anemia are less susceptible to
A. “Take the medication with an antacid.” infection than are other children.
B. “Take the medication with a glass of milk.” D. Children with iron-deficient anemia are equally as
C. “Take the medication with cereal.” susceptible to infection as are other children.
D. “Take the medication on an empty stomach.”
32. Which statements by the mother of a toddler would
27. Which of the following disorders results from a lead the nurse to suspect that the child has iron-deficiency
deficiency of factor VIII? anemia? Select all that apply.

A. Sickle cell disease A. “He drinks over 3 cups of milk per day.”
B. Christmas disease B. “I can’t keep enough apple juice in the house; he must
C. Hemophilia A drink over 10 ounces per day.”
D. Hemophilia B C. “He refuses to eat more than 2 different kinds of
vegetables.”
15
D. “He doesn’t like meat, but he will eat small amounts of it.”
5. “He sleeps 12 hours every night and take a 2-hour nap.”
33. Which of the following foods would the nurse
encourage the mother to offer to her child with iron
deficiency anemia?
A. Rice cereal, whole milk, and yellow vegetables
B. Potato, peas, and chicken
C. Macaroni, cheese, and ham
D. Pudding, green vegetables, and rice
34. The physician has ordered several laboratory tests to
help diagnose an infant’s bleeding disorder. Which of the
following tests, if abnormal, would the nurse interpret as
most likely to indicate hemophilia?
A. Bleeding time
B. Tourniquet test
C. Clot retraction test
D. Partial thromboplastin time (PTT)
35. Which of the following assessments in a child with
hemophilia would lead the nurse to suspect early
hemarthrosis?
A. Child’s reluctance to move a body part
B. Cool, pale, clammy extremity
C. Ecchymosis formation around a joint
D. Instability of a long bone in passive movement
36. Because of the risks associated with administration of
factor VIII concentrate, the nurse would teach the client’s
family to recognize and report which of the following?
A. Yellowing of the skin
B. Constipation
C. Abdominal distention
D. Puffiness around the eyes
37. A child suspected of having sickle cell disease is seen in
a clinic, and laboratory studies are performed. A nurse
checks the lab results, knowing that which of the following
would be increased in this disease?
A. Platelet count
B. Hematocrit level
C. Reticulocyte count
D. Hemoglobin level
38. A clinic nurse instructs the mother of a child with sickle
cell disease about the precipitating factors related to pain
crisis. Which of the following, if identified by the mother as
a precipitating factor, indicates the need for further
instructions?
A. Infection
B. Trauma
C. Fluid overload
D. Stress
39. Laboratory studies are performed for a child suspected
of having iron deficiency anemia. The nurse reviews the
laboratory results, knowing that which of the following
results would indicate this type of anemia?
A. An elevated hemoglobin level
B. A decreased reticulocyte count
C. An elevated RBC count
D. Red blood cells that are microcytic and hypochromic
40. A pediatric nurse health educator provides a teaching
session to the nursing staff regarding hemophilia. Which of
the following information regarding this disorder would the
nurse plan to include in the discussion?
A. Hemophilia is a Y linked hereditary disorder
B. Males inherit hemophilia from their fathers
C. Females inherit hemophilia from their mothers
D. Hemophilia A results from a deficiency of factor VIII
Valvular Diseases Practice Quiz
1. A 68-year-old woman is scheduled to undergo mitral
valve replacement for severe mitral stenosis and mitral
regurgitation. Although the diagnosis was made during
childhood, she did not have any symptoms until 4 years ago.
Recently, she noticed increased symptoms, despite daily
doses of digoxin and furosemide. During the initial interview
with the nice lady, the nurse would most likely learn that
the client’s childhood health history included:
1. Chicken pox
2. Poliomyelitis
3. Rheumatic fever
4. Meningitis
2. Which of the following signs and symptoms would most
likely be found in a client with mitral regurgitation?
1. Exertional dyspnea
2. Confusion
3. Elevated creatine phosphokinase concentration
4. Chest pain
16
3. The nurse expects that a client with mitral stenosis would
demonstrate symptoms associated with congestion in the:
1. Aorta
2. Right atrium
3. Superior vena cava
4. Pulmonary circulation
4. Because a client has mitral stenosis and is a prospective
valve recipient, the nurse preoperatively assesses the
client’s past compliance with medical regimens. Lack of
compliance with which of the following regimens would
pose the greatest health hazard to this client?
1. Medication therapy
2. Diet modification
3. Activity restrictions
4. Dental care
5. Good dental care is an important measure in reducing the
risk of endocarditis. A teaching plan to promote good dental
care in a client with mitral stenosis should include
demonstration of the proper use of:
1. A manual toothbrush
2. An electric toothbrush
3. An irrigation device
4. Dental floss
6. A client has been admitted to the hospital with a
diagnosis of suspected bacterial endocarditis. The
complication the nurse will constantly observe for is:
1. Presence of heart murmur
2. Systemic emboli
3. Fever
4. Congestive heart failure
7. Cholesterol, frequently discussed in relation to
atherosclerosis, is a substance that:
1. May be controlled by eliminating food sources
2. Is found in many foods, both plant and animal sources
3. All persons would be better off without because it causes
the disease process
4. Circulates in the blood, the level of which usually decreases
when unsaturated fats are substituted for saturated fats.
8. When teaching a client with a cardiac problem, who is on
a high-unsaturated fatty-acid diet, the nurse should stress
the importance of increasing the intake of:
1. Enriched whole milk
2. Red meats, such as beef
3. Vegetables and whole grains
4. Liver and other glandular organ meats
9. A 2-gram sodium diet is prescribed for a client with
severe hypertension. The client does not like the diet, and
the nurse hears the client request that the spouse “Bring in
some good home-cooked food.” It would be most effective
for the nurse to plan to:
1. Call in the dietician for client teaching
2. Wait for the client’s family and discuss the diet with the
client and family
3. Tell the client that the use of salt is forbidden, because it
will raise BP
4. Catch the family members before they go into the client’s
room and tell them about the diet.
10. What criteria should the nurse use to determine normal
sinus rhythm for a client on a cardiac monitor? Check all
that apply.
1. The RR intervals are relatively consistent
2. One P wave precedes each QRS complex
3. Four to eight complexes occur in a 6-second strip
4. The ST segment is higher than the PR interval
5. The QRS complex ranges from 0.12 to 0.2 seconds
Cardiac Arrhythmias Practice Quiz
1. A nurse is assessing an electrocardiogram rhythm strip.
The P waves and QRS complexes are regular. The PR interval
is 0.16 second, and QRS complexes measure 0.06 second.
The overall heart rate is 64 beats per minute. The nurse
assesses the cardiac rhythm as:
1. Normal sinus rhythm
2. Sinus bradycardia
3. Sick sinus syndrome
4. First-degree heart block.
2. A nurse notices frequent artifact on the ECG monitor for a
client whose leads are connected by cable to a console at
the bedside. The nurse examines the client to determine the
cause. Which of the following items is unlikely to be
responsible for the artifact?
1. Frequent movement of the client
2. Tightly secured cable connections
3. Leads applied over hairy areas
4. Leads applied to the limbs
3. A nurse is watching the cardiac monitor and notices that
the rhythm suddenly changes. There are no P waves, the
QRS complexes are wide, and the ventricular rate is regular
but over 100. The nurse determines that the client is
experiencing:
1. Premature ventricular contractions
2. Ventricular tachycardia
3. Ventricular fibrillation
4. Sinus tachycardia
17
4. A nurse is viewing the cardiac monitor in a client’s room
and notes that the client has just gone into ventricular
tachycardia. The client is awake and alert and has good skin
color. The nurse would prepare to do which of the
following?
1. Immediately defibrillate
2. Prepare for pacemaker insertion
3. Administer amiodarone (Cordarone) intravenously
4. Administer epinephrine (Adrenaline) intravenously
5. A nurse is caring for a client with unstable ventricular
tachycardia. The nurse instructs the client to do which of the
following, if prescribed, during an episode of ventricular
tachycardia?
1. Breathe deeply, regularly, and easily.
2. Inhale deeply and cough forcefully every 1 to 3 seconds.
3. Lie down flat in bed
4. Remove any metal jewelry
6. A client is having frequent premature ventricular
contractions. A nurse would place priority on assessment of
which of the following items?
1. Blood pressure and peripheral perfusion
2. Sensation of palpitations
3. Causative factors such as caffeine
4. Precipitating factors such as infection
7. A client has developed atrial fibrillation, which a
ventricular rate of 150 beats per minute. A nurse assesses
the client for:
1. Hypotension and dizziness
2. Nausea and vomiting
3. Hypertension and headache
4. Flat neck veins
8. A nurse is watching the cardiac monitor, and a client’s
rhythm suddenly changes. There are no P waves; instead,
there are wavy lines. The QRS complexes measure 0.08
second, but they are irregular, with a rate of 120 beats a
minute. The nurse interprets this rhythm as:
1. Sinus tachycardia
2. Atrial fibrillation
3. Ventricular tachycardia
4. Ventricular fibrillation
9. A client with rapid rate atrial fibrillation asks a nurse why
the physician is going to perform carotid massage. The nurse
responds that this procedure may stimulate the:
1. Vagus nerve to slow the heart rate
2. Vagus nerve to increase the heart rate; overdriving the
rhythm.
3. Diaphragmatic nerve to slow the heart rate
4. Diaphragmatic nerve to overdrive the rhythm
10. A nurse notes that a client with sinus rhythm has a
premature ventricular contraction that falls on the T wave
of the preceding beat. The client’s rhythm suddenly changes
to one with no P waves or definable QRS complexes.
Instead, there are coarse wavy lines of varying amplitude.
The nurse assesses this rhythm to be:
1. Ventricular tachycardia
2. Ventricular fibrillation
3. Atrial fibrillation
4. Asystole
11. While caring for a client who has sustained an MI, the
nurse notes eight PVCs in one minute on the cardiac
monitor. The client is receiving an IV infusion of D5W and
oxygen at 2 L/minute. The nurse’s first course of action
should be to:
1. Increase the IV infusion rate
2. Notify the physician promptly
3. Increase the oxygen concentration
4. Administer a prescribed analgesic
12. The adaptations of a client with complete heart block
would most likely include:
1. Nausea and vertigo
2. Flushing and slurred speech
3. Cephalalgia and blurred vision
4. Syncope and slow ventricular rate
13. A client with a bundle branch block is on a cardiac
monitor. The nurse should expect to observe:
1. Sagging ST segments
2. Absence of P wave configurations
3. Inverted T waves following each QRS complex
4. Widening of QRS complexes to 0.12 second or greater.
14. When ventricular fibrillation occurs in a CCU, the first
person reaching the client should:
1. Administer oxygen
2. Defibrillate the client
3. Initiate CPR
4. Administer sodium bicarbonate intravenously
15. What criteria should the nurse use to determine normal
sinus rhythm for a client on a cardiac monitor? Check all
that apply.
1. The RR intervals are relatively consistent
2. One P wave precedes each QRS complex
3. Four to eight complexes occur in a 6-second strip
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4. The ST segment is higher than the PR interval
5. The QRS complex ranges from 0.12 to 0.20 second.
16. When auscultating the apical pulse of a client who has
atrial fibrillation, the nurse would expect to hear a rhythm
that is characterized by:
1. The presence of occasional coupled beats
2. Long pauses in an otherwise regular rhythm
3. A continuous and totally unpredictable irregularity
4. Slow but strong and regular beats
Cardiovascular Surgery Care Practice Quiz
1. Atherosclerosis impedes coronary blood flow by which of
the following mechanisms?
1. Plaques obstruct the vein
2. Plaques obstruct the artery
3. Blood clots form outside the vessel wall
4. Hardened vessels dilate to allow blood to flow through
2. A paradoxical pulse occurs in a client who had a coronary
artery bypass graft (CABG) surgery two (2) days ago. Which
of the following surgical complications should the nurse
suspect?
1. Left-sided heart failure
2. Aortic regurgitation
3. Complete heart block
4. Pericardial tamponade
3. After cardiac surgery, a client’s blood pressure measures
126/80. The nurse determines that the mean arterial
pressure (MAP) is which of the following?
1. 46 mm Hg
2. 80 mm Hg
3. 95 mm Hg
4. 90 mm Hg
4. A woman with severe mitral stenosis and mitral
regurgitation has a pulmonary artery catheter inserted. The
physician orders pulmonary artery pressure monitoring,
including pulmonary capillary wedge pressures. The purpose
of this is to help assess the:
1. Degree of coronary artery stenosis
2. Peripheral arterial pressure
3. Pressure from fluid within the left ventricle
4. Oxygen and carbon dioxide concentration is the blood
5. For a client who excretes excessive amounts
of calcium during the postoperative period after open heart
surgery, which of the following measures should the nurse
institute to help prevent complications associated with
excessive calcium excretion?
1. Ensure a liberal fluid intake
2. Provide an alkaline ash diet
3. Prevent constipation
4. Enrich the client’s diet with dairy products
6. A nurse is assessing the neurovascular of a client who has
returned to the surgical nursing unit 4 hours ago after
undergoing aortoiliac bypass graft. The affected leg is warm,
and the nurse notes redness and edema. The pedal pulse is
palpable and unchanged from admission. The nurse
interprets that the neurovascular status is:
1. Normal because of increased blood flow through the leg
2. Slightly deteriorating and should be monitored for another
hour
3. Moderately impaired, and the surgeon should be called
4. Adequate from an arterial approach, but venous
complications are arising.
7. After open-heart surgery, a client develops a temperature
of 102*F. The nurse notifies the physician because elevated
temperatures:
1. Increase the cardiac output
2. May indicate cerebral edema
3. May be a forerunner of hemorrhage
4. Are related to diaphoresis and possible chilling
8. During a cardiac catheterization blood samples from the
right atrium, right ventricle, and pulmonary artery are
analyzed for their oxygen content. Normally:
1. All contain less CO2 than does pulmonary vein blood
2. All contain more oxygen than does pulmonary vein blood
3. The samples of blood all contain about the same amount of
oxygen
4. Pulmonary artery blood contains more oxygen than the
other samples
9. The nurse prepares the client for insertion of a pulmonary
artery catheter (Swan-Ganz catheter). The nurse teaches the
client that the catheter will be inserted to provide
information about:
1. Stroke volume
2. Cardiac output
3. Venous pressure
4. Left ventricular functioning
10. When preparing a client for discharge after surgery for a
CABG, the nurse should teach the client that there will be:
1. No further drainage from the incisions after
hospitalizations
2. A mild fever and extreme fatigue for several weeks after
surgery
3. Little incisional pain and tenderness after 3 to 4 weeks
after surgery
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4. Some increase in edema in the leg used for the donor graft
when activity increases

11. What is the most important nursing action when

measuring a pulmonary capillary wedge pressure (PCWP)?

1. Have the client bear down when measuring the PCWP

2. Deflate the balloon as soon as the PCWP is measured
3. Place the client in a supine position before measuring the
PCWP
4. Flush the catheter with heparin solution after the PCWP is
determined.

12. The most important assessment for the nurse to make

after a client has had a femoropopliteal bypass for
peripheral vascular disease would be:

1. Incisional pain
2. Pedal pulse rate
3. Capillary refill time
4. Degree of hair growth

13. Which signs cause the nurse to suspect cardiac

tamponade after a client has cardiac surgery? Check all that
apply.

1. Tachycardia
2. Hypertension
3. Increased CVP
4. Increased urine output
5. Jugular vein distention

14. A client has the diagnosis of left ventricular failure and a

high pulmonary capillary wedge pressure (PCWP). The
physician orders dopamine to improve ventricular function.
The nurse will know the medication is working if the client’s:

1. Blood pressure rises

2. Blood pressure decreases
3. Cardiac index falls
4. PCWP rises

15. A 35-year-old male was knifed in the street fight,

admitted through the ER, and is now in the ICU. An
assessment of his condition reveals the following symptoms:
respirations shallow and rapid, CVP 15 cm H2O, BP 90 mm
Hg systolic, skin cold and pale, urinary output 60-100 mL/hr
for the last 2 hours. Analyzing these symptoms, the nurse
will base a nursing diagnosis on the conclusion that the
client has which of the following conditions?

1. Hypovolemic shock
2. Cardiac tamponade
3. Wound dehiscence
4. Atelectasis

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