LA SALLE UNIVERSITY

Nursing Department
Ozamiz City

Subject: Competency Appraisal 2 Christian Joshua T. Lamban, MN, MAN

Date: Assistant Professor 1

MEDICAL-SURGICAL NURSING
(CARDIOLOGIC NURSING)

Instructions: Carefully read the statements and select the appropriate answers from the 4 choices. Write
your answer along with their rationales after each question.

Multiple Choice: (30 points)

1. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?

A. Plaques obstruct the vein

B. Plaques obstruct the artery
C. Blood clots form outside the vessel wall
D. 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?

A. Left-sided heart failure

B. Aortic regurgitation
C. Complete heart block
D. 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?

A. 46 mm Hg
B. 80 mm Hg
C. 95 mm Hg
D. 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:

A. Degree of coronary artery stenosis

B. Peripheral arterial pressure
C. Pressure from fluid within the left ventricle
D. 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?

A. Ensure a liberal fluid intake

B. Provide an alkaline ash diet
C. Prevent constipation
D. 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:

A. Normal because of increased blood flow through the leg

B. Slightly deteriorating and should be monitored for another hour
C. Moderately impaired, and the surgeon should be called
D. 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:

A. Increase the cardiac output

B. May indicate cerebral edema
C. May be a forerunner of hemorrhage
D. 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:

A. All contain less CO2 than does pulmonary vein blood

B. All contain more oxygen than does pulmonary vein blood
C. The samples of blood all contain about the same amount of oxygen
D. 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:

A. Stroke volume
B. Cardiac output
C. Venous pressure
D. 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:

A. No further drainage from the incisions after hospitalizations

B. A mild fever and extreme fatigue for several weeks after surgery
C. Little incisional pain and tenderness after 3 to 4 weeks after surgery
D. 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)?

A. Have the client bear down when measuring the PCWP

B. Deflate the balloon as soon as the PCWP is measured
C. Place the client in a supine position before measuring the PCWP
D. 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:

A. Incisional pain
B. Pedal pulse rate
C. Capillary refill time
D. Degree of hair growth

13. The following are signs that may cause the nurse to suspect cardiac tamponade after a client
has cardiac surgery, except:

1. Tachycardia
2. Hypertension
3. Increased CVP
4. 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:

A. Blood pressure rises

B. Blood pressure decreases
C. Cardiac index falls
D. 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?

A. Hypovolemic shock
B. Cardiac tamponade
C. Wound dehiscence
D. Atelectasis

16. 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:

A. Normal sinus rhythm

B. Sinus bradycardia
C. Sick sinus syndrome
D. First-degree heart block.

17. 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?

A. Frequent movement of the client

B. Tightly secured cable connections
C. Leads applied over hairy areas
D. Leads applied to the limbs
18. 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:

A. Premature ventricular contractions

B. Ventricular tachycardia
C. Ventricular fibrillation
D. Sinus tachycardia

19. 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?

A. Immediately defibrillate
B. Prepare for pacemaker insertion
C. Administer amiodarone (Cordarone) intravenously
D. Administer epinephrine (Adrenaline) intravenously

20. 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?

A. Breathe deeply, regularly, and easily.

B. Inhale deeply and cough forcefully every 1 to 3 seconds.
C. Lie down flat in bed
D. Remove any metal jewelry

21. A client is having frequent premature ventricular contractions. A nurse would place priority
on assessment of which of the following items?

A. Blood pressure and peripheral perfusion

B. Sensation of palpitations
C. Causative factors such as caffeine
D. Precipitating factors such as infection

22.  A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A
nurse assesses the client for:

A. Hypotension and dizziness

B. Nausea and vomiting
C. Hypertension and headache
D. Flat neck veins

23. 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:

A. Sinus tachycardia
B. Atrial fibrillation
C. Ventricular tachycardia
D. Ventricular fibrillation
24. 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:

A. Vagus nerve to slow the heart rate

B. Vagus nerve to increase the heart rate; overdriving the rhythm.
C. Diaphragmatic nerve to slow the heart rate
D. Diaphragmatic nerve to overdrive the rhythm

25. 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:

A. Ventricular tachycardia
B. Ventricular fibrillation
C. Atrial fibrillation
D. Asystole

26.  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:

A. Increase the IV infusion rate

B. Notify the physician promptly
C. Increase the oxygen concentration
D. Administer a prescribed analgesic

27. The adaptations of a client with complete heart block would most likely include:

A. Nausea and vertigo

B. Flushing and slurred speech
C. Cephalalgia and blurred vision
D. Syncope and slow ventricular rate

28. A client with a bundle branch block is on a cardiac monitor. The nurse should expect to
observe:

A. Sagging ST segments
B. Absence of P wave configurations
C. Inverted T waves following each QRS complex
D. Widening of QRS complexes to 0.12 second or greater.

29. When ventricular fibrillation occurs in a CCU, the first person reaching the client should:

A. Administer oxygen
B. Defibrillate the client
C. Initiate CPR
D. Administer sodium bicarbonate intravenously

30. When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would
expect to hear a rhythm that is characterized by:

A. The presence of occasional coupled beats

B. Long pauses in an otherwise regular rhythm
C. A continuous and totally unpredictable irregularity
D. Slow but strong and regular beat