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Practice Quiz (50 Questions). You scored 2 out of 50. Your performance has been
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Question 1

CORRECT

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:

Cerebrovascular accident

Liver disease

Myocardial infarction

Pulmonary disease

Question 1 Explanation: 
Hypertension is referred to as the silent killer for adults, because until the adult has
significant damage to other systems, the hypertension may go undetected. CVA’s
can be related to long-term hypertension. Liver or pulmonary disease is generally
not associated with hypertension. Myocardial infarction is generally related to
coronary artery disease.

Question 2

CORRECT

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?

Creatine kinase (CK or CPK)

 Lactic dehydrogenase (LDH)

LDH-1

LDH-2

Question 2 Explanation: 
Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present.
When the myocardium is damaged, CPK leaks out of the cell membranes and into
the bloodstream. Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2
rises in 8-24 hours.

Question 3

WRONG

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 2 mg of morphine
given intravenously. The nurse should first:

Administer the morphine

Obtain a 12-lead ECG

Obtain the lab work

Order the chest x-ray

Question 3 Explanation: 
Although obtaining the ECG, chest x-ray, and blood work are all important, the
nurse’s priority action would be to relieve the crushing chest pain.

Question 4

WRONG

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:

The same as the client’s own baseline level

Lower than the needed therapeutic level

Within the therapeutic range

Higher than the therapeutic range

Question 4 Explanation: 
The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients
at risk for thrombus. Based on the client’s control value, the therapeutic range for
this individual would be 16.5 to 22 seconds. Therefore the result is within
therapeutic range.

Question 5
 WRONG

Which of the following diagnostic tools is most commonly used to determine the
location of myocardial damage?

Cardiac catheterization

Cardiac enzymes

Echocardiogram

Electrocardiogram (ECG)

Question 5 Explanation: 
The ECG is the quickest, most accurate, and most widely used tool to determine the
location of myocardial infarction. Cardiac enzymes are used to diagnose MI but
can’t determine the location. An echocardiogram is used most widely to view
myocardial wall function after an MI has been diagnosed. Cardiac catheterization is
an invasive study for determining coronary artery disease and may also indicate the
location of myocardial damage, but the study may not be performed immediately.

Question 6

WRONG

A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of

the following assessments is most critical before the procedure?

Intake and output

Baseline peripheral pulse rates

Height and weight

Allergy to iodine or shellfish

Question 6 Explanation: 
This procedure requires an informed consent because it involves injection of a
radiopaque dye into the blood vessel. The risk of allergic reaction and possible
anaphylaxis is serious and must be assessed before the procedure.

Question 7

WRONG

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:

“Cardiac rehabilitation is not a cure but can help restore you to many of your
former activities.”

“Here we teach you to gradually change your lifestyle to accommodate your

heart disease.”

“You are probably right but we can gradually increase your activities so that you
can live a more active life.”

“Do you feel that you will have to make some changes in your life now?”

Question 7 Explanation: 
Such a response does not have false hope to the client but is positive and realistic.
The answer tells the client what cardiac rehabilitation is and does not dwell upon
his negativity about it.

Question 8
 WRONG

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:

Check the client status and lead placement

Press the recorder button on the electrocardiogram console

Call the physician

Call a code blue

Question 8 Explanation: 
Sudden loss of electrocardiogram complexes indicates ventricular asystole or
possible electrode displacement. Accurate assessment of the client and equipment
is necessary to determine the cause and identify the appropriate intervention.

Question 9
 WRONG

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:

Open and dilate the blocked coronary arteries

Assess the extent of arterial blockage

Bypass obstructed vessels

Assess the functional adequacy of the valves and heart muscle

Question 9 Explanation: 
Cardiac catheterization is done in clients with angina primarily to assess the extent
and severity of the coronary artery blockage, A decision about medical
management, angioplasty, or coronary artery bypass surgery will be based on the
catheterization results.

Question 10

WRONG

A client is receiving spironolactone to treat hypertension. Which of the following

instructions should the nurse provide?

“Eat foods high in potassium.”

“Take daily potassium supplements.”

“Discontinue sodium restrictions.”

“Avoid salt substitutes.”

Question 10 Explanation: 
Because spironolactone is a potassium-sparing diuretic, the client should avoid salt
substitutes because of their high potassium content. The client should also avoid
potassium-rich foods and potassium supplements. To reduce fluid-volume
overload, sodium restrictions should continue.

Question 11

WRONG

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?

Vitamin K

Aminocaproic acid

Potassium chloride

Protamine sulfate

Question 11 Explanation: 
The antidote to heparin is protamine sulfate and should be readily available for use
if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for
warfarin.

Question 12

WRONG

Prolonged occlusion of the right coronary artery produces an infarction in which of

the following areas of the heart?

Anterior
 Apical

Inferior

Lateral

Question 12 Explanation: 
The right coronary artery supplies the right ventricle, or the inferior portion of the
heart. Therefore, prolonged occlusion could produce an infarction in that area. The
right coronary artery doesn’t supply the anterior portion (left ventricle), lateral
portion (some of the left ventricle and the left atrium), or the apical portion (left
ventricle) of the heart.

Question 13

WRONG

Which of the following blood tests is most indicative of cardiac damage?

Lactate dehydrogenase

Complete blood count (CBC)

 Troponin I

Creatine kinase (CK)

Question 13 Explanation: 
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury.
Troponin levels aren’t detectable in people without cardiac injury.

Question 14

WRONG

Which of the following terms is used to describe the amount of stretch on the
myocardium at the end of diastole?

Afterload

Cardiac index

Cardiac output

Preload

Question 14 Explanation: 
Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole.
The volume of blood in the ventricle at the end of diastole determines the preload.
Afterload is the force against which the ventricle must expel blood. Cardiac index is
the individualized measurement of cardiac output, based on the client’s body
surface area. Cardiac output is the amount of blood the heart is expelling per
minute.
Question 15

WRONG

A nurse notes 2+ bilateral edema in the lower extremities of a client with

myocardial infarction who was admitted 2 days ago. The nurse would plan to do
which of the following next?

Review the intake and output records for the last 2 days

Change the time of diuretic administration from morning to evening

Request a sodium restriction of 1 g/day from the physician

Order daily weights starting the following morning

Question 15 Explanation: 
Edema, the accumulation of excess fluid in the interstitial spaces, can be measured
by intake greater than output and by a sudden increase in weight. Diuretics should
be given in the morning whenever possible to avoid nocturia. Strict sodium
restrictions are reserved for clients with severe symptoms.

Question 16

WRONG

In order to prevent the development of tolerance, the nurse instructs the patient to:

Apply the nitroglycerin patch every other day

Switch to sublingual nitroglycerin when the patient’s systolic blood pressure

elevates to >140 mm Hg
 Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night

Use the nitroglycerin patch for acute episodes of angina only

Question 16 Explanation: 
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period
each day.

Question 17

WRONG

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?

Cancer

Hypertension

Liver disease

Myocardial infarction

Question 17 Explanation: 
Detection of myoglobin is one diagnostic tool to determine whether myocardial
damage has occurred. Myoglobin is generally detected about one hour after a heart
attack is experienced and peaks within 4 to 6 hours after infarction (Note: less than
90 mg/L is normal).

Question 18

WRONG

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?

Monitoring vital signs

Completing a physical assessment

Maintaining cardiac monitoring

Maintaining at least one IV access site

Question 18 Explanation: 
Even though initial tests seem to be within normal range, it takes at least 3 hours
for the cardiac enzyme studies to register. In the meantime, the client needs to be
watched for bradycardia, heart block, ventricular irritability, and other arrhythmias.
Other activities can be accomplished around the MI monitoring.

Question 19
 WRONG

When interpreting an ECG, the nurse would keep in mind which of the following
about the P wave? Select all that apply.

Reflects electrical impulse beginning at the SA node

Indicated electrical impulse beginning at the AV node

Reflects atrial muscle depolarization

Identifies ventricular muscle depolarization

Has duration of normally 0.11 seconds or less.

Question 19 Explanation: 
In a client who has had an ECG, the P wave represents the activation of the
electrical impulse in the SA node, which is then transmitted to the AV node. In
addition, the P wave represents atrial muscle depolarization, not ventricular
depolarization. The normal duration of the P wave is 0.11 seconds or less in
duration and 2.5 mm or more in height.

Question 20

WRONG

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are
prescribed together, the nurse bases teaching on the knowledge that:

Moderate doses of two different types of diuretics are more effective than a large
dose of one type

This combination promotes diuresis but decreases the risk of hypokalemia

This combination prevents dehydration and hypovolemia

Using two drugs increases osmolality of plasma and the glomerular filtration rate
Question 20 Explanation: 
Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing
diuretic. Giving these together minimizes electrolyte imbalance.

Question 21

WRONG

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?

“Have you ever had this pain before?”

“Can you describe the pain to me?”

“Does the pain get worse when you breathe in?”

“Can you rate the pain on a scale of 1-10, with 10 being the worst?”

Question 21 Explanation: 
Chest pain is assessed by using the standard pain assessment parameters. Options
1, 2, and 4 may or may not help discriminate the origin of pain. Pain of
pleuropulmonary origin usually worsens on inspiration.

Question 22

WRONG
A client is experiencing tachycardia. The nurse’s understanding of the physiological
basis for this symptom is explained by which of the following statements?

The demand for oxygen is decreased because of pleural involvement

The inflammatory process causes the body to demand more oxygen to meet its
needs

The heart has to pump faster to meet the demand for oxygen when there is
lowered arterial oxygen tension

Respirations are labored

Question 22 Explanation: 
The arterial oxygen supply is lowered and the demand for oxygen is increased,
which results in the heart’s having to beat faster to meet the body’s needs for
oxygen.

Question 23

WRONG

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:

Antispasmodic effect on the pericardium

Causing an increased myocardial oxygen demand

 Vasodilation of peripheral vasculature

Improved conductivity in the myocardium

Question 23 Explanation: 
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen
consumption and demand. Vasodilation in coronary arteries and collateral vessels
may also increase blood flow to the ischemic areas of the heart. Nitroglycerin
decreases myocardial oxygen demand. Nitroglycerin does not have an effect on
pericardial spasticity or conductivity in the myocardium.

Question 24

WRONG

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?

Take one tablet every 2 to 5 minutes until the pain stops.

Take one tablet and rest for 10 minutes. Call the physician if pain persists after
10 minutes.

Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets.
Call the physician if pain persists after three tablets.

Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still
persists 5 minutes later, call the physician.

Question 24 Explanation: 
The correct protocol for nitroglycerin used involves immediate administration, with
subsequent doses taken at 5-minute intervals as needed, for a total dose of 3
tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes
and is metabolized within about 10 minutes.
Question 25

WRONG

Baroreceptors in the carotid artery walls and aorta respond to which of the
following conditions?

Changes in blood pressure

Changes in arterial oxygen tension

Changes in arterial carbon dioxide tension

Changes in heart rate

Question 25 Explanation: 
Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure.
Decreases in pulsatile pressure cause a reflex increase in heart rate.
Chemoreceptors in the medulla are primarily stimulated by carbon dioxide.
Peripheral chemoreceptors in the aorta and carotid arteries are primarily
stimulated by oxygen.

Question 26

WRONG

When teaching a client about propranolol hydrochloride, the nurse should base the
information on the knowledge that propranolol hydrochloride:

Blocks beta-adrenergic stimulation and thus causes decreased heart rate,

myocardial contractility, and conduction.

Increases norepinephrine secretion and thus decreases blood pressure and heart
 rate.

Is a potent arterial and venous vasodilator that reduces peripheral vascular

resistance and lowers blood pressure.

Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by

blocking the conversion of angiotensin I to angiotensin II

Question 26 Explanation: 
Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of
propranolol hydrochloride include reducing heart rate, decreasing myocardial
contractility, and slowing conduction.

Question 27

WRONG

The most important long-term goal for a client with hypertension would be to:

Learn how to avoid stress

Explore a job change or early retirement

Make a commitment to long-term therapy

Control high blood pressure

Question 27 Explanation: 
Compliance is the most critical element of hypertensive therapy. In most cases,
hypertensive clients require lifelong treatment and their hypertension cannot be
managed successfully without drug therapy. Stress management and weight
management are important components of hypertension therapy, but the priority
goal is related to compliance.

Question 28

WRONG

Which of the following parameters is the major determinant of diastolic blood

pressure?

Baroreceptors

Cardiac output

Renal function

Vascular resistance

Question 28 Explanation: 
Vascular resistance is the impedance of blood flow by the arterioles that most
predominantly affects the diastolic pressure. Cardiac output determines systolic
blood pressure.

Question 29
 WRONG

A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to

control hypertension. Before administered propranolol, which of the following
actions should the nurse take first?

Monitor the apical pulse rate

Instruct the client to take medication with food

Question the physician about the order

Caution the client to rise slowly when standing

Question 29 Explanation: 
Propranolol and other beta-adrenergic blockers are contraindicated in a client with
asthma, so the nurse should question the physician before giving the dose. The
other responses are appropriate actions for a client receiving propranolol, but
questioning the physician takes priority. The client’s apical pulse should always be
checked before giving propranolol; if the pulse rate is extremely low, the nurse
should withhold the drug and notify the physician.

Question 30

WRONG

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

Afterload

Cardiac output

Overload

Preload
Question 30 Explanation: 
Afterload refers to the resistance normally maintained by the aortic and pulmonic
valves, the condition and tone of the aorta, and the resistance offered by the
systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled
from the heart per minute. Overload refers to an abundance of circulating volume.
Preload is the volume of blood in the ventricle at the end of diastole.

Question 31

WRONG

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?

Visit her friend earlier in the day

Rest for at least an hour before climbing the stairs

Take a nitroglycerin tablet before climbing the stairs

Lie down once she reaches the friend’s apartment

Question 31 Explanation: 
Nitroglycerin may be used prophylactically before stressful physical activities such
as stair climbing to help the client remain pain free. Visiting her friend early in the
day would have no impact on decreasing pain episodes. Resting before or after an
activity is not as likely to help prevent an activity-related pain episode.

Question 32

WRONG

Which of the following factors can cause blood pressure to drop to normal levels?

Kidneys’ excretion of sodium only

Kidneys’ retention of sodium and water

Kidneys’ excretion of sodium and water

Kidneys’ retention of sodium and excretion of water

Question 32 Explanation: 
The kidneys respond to a rise in blood pressure by excreting sodium and excess
water. This response ultimately affects systolic pressure by regulating blood
volume.

Question 33

WRONG

When do coronary arteries primarily receive blood flow?

During inspiration

During diastolic
 During expiration

During systole

Question 33 Explanation: 
Although the coronary arteries may receive a minute portion of blood during
systole, most of the blood flow to coronary arteries is supplied during diastole.
Breathing patterns are irrelevant to blood flow.

Question 34

WRONG

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:

Call for the doctor

Start an intravenous line

Obtain a portable chest radiograph

Draw blood for laboratory studies

Question 34 Explanation: 
Advanced cardiac life support recommends that at least one or two intravenous
lines be inserted in one or both of the antecubital spaces. Calling the physician,
obtaining a portable chest radiograph, and drawing blood are important but
secondary to starting the intravenous line.
Question 35

WRONG

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?

Strict bed rest for 24 hours after transfer

Bathroom privileges and self-care activities

Unsupervised hallway ambulation with distances under 200 feet

Ad lib activities because the client is monitored

Question 35 Explanation: 
On transfer from the CCU, the client is allowed self-care activities and bathroom
privileges. Supervised ambulation for brief distances are encouraged, with
distances gradually increased (50, 100, 200 feet).

Question 36

WRONG

When administered a thrombolytic drug to the client experiencing an MI, the nurse
explains to him that the purpose of this drug is to:

Help keep him well hydrated

Dissolve clots he may have

Prevent kidney failure

 Treat potential cardiac arrhythmias

Question 36 Explanation: 
Thrombolytic drugs are administered within the first 6 hours after onset of a MI to
lyse clots and reduce the extent of myocardial damage.

Question 37

WRONG

The nurse teaches the client with angina about the common expected side effects
of nitroglycerin, including:

Headache

High blood pressure

Shortness of breath

Stomach cramps

Question 37 Explanation: 
Because of the widespread vasodilating effects, nitroglycerin often produces such
side effects as headache, hypotension, and dizziness. The client should lie or sit
down to avoid fainting. Nitro does not cause shortness of breath or stomach
cramps.

Question 38

WRONG

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:

Normal vs. abnormal tissue

Damage in areas of the heart

Ventricular function

Myocardial scarring and perfusion

Question 38 Explanation: 
This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a
more specific answer than (1) or (2). Specific ventricular function is tested by a
gated cardiac blood pool scan.

Question 39

WRONG
Which of the following symptoms should the nurse teach the client with unstable
angina to report immediately to her physician?

A change in the pattern of her pain

Pain during sex

Pain during an argument with her husband

Pain during or after an activity such as lawn mowing

Question 39 Explanation: 
The client should report a change in the pattern of chest pain. It may indicate
increasing severity of CAD.

Question 40

WRONG

To evaluate a client’s condition following cardiac catheterization, the nurse will

palpate the pulse:

In all extremities

At the insertion site

Distal to the catheter insertion

Above the catheter insertion

Question 40 Explanation: 
Palpating pulses distal to the insertion site is important to evaluate for
thrombophlebitis and vessel occlusion. They should be bilateral and strong.
Question 41

WRONG

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:

Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3
days for this to exert an anticoagulant effect.

Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for
this medication to exert an anticoagulant effect.

Stimulates production of the body’s own thrombolytic substances, but it takes 2-

4 days for this to begin.

Has the same mechanism of action as Heparin, and the crossover time is needed
for the serum level of warfarin to be therapeutic.

Question 41 Explanation: 
Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent
clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic
effect of warfarin is exhibited

Question 42

WRONG
Direct-acting vasodilators have which of the following effects on the heart rate?

Heart rate decreases

Heart rate remains significantly unchanged

Heart rate increases

Heart rate becomes irregular

Question 42 Explanation: 
Heart rate increases in response to decreased blood pressure caused by
vasodilation.

Question 43

WRONG

Which of the following instructions should be included in the discharge teaching for
a patient discharged with a transdermal nitroglycerin patch?

“Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”

“Apply the patch to the same site each day to maintain consistent drug
absorption.”

“If you get a headache, remove the patch for 4 hours and then reapply.”
 “If you get chest pain, apply a second patch right next to the first patch.”

Question 43 Explanation: 
A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best
and most consistent absorption rates. Sites should be rotated to prevent skin
irritation, and the drug should be continued if headache occurs because tolerance
will develop. Sublingual nitroglycerin should be used to treat chest pain.

Question 44

WRONG

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?

Seating the client with arm bared, supported, and at heart level.

Measuring the blood pressure after the client has been seated quietly for 5
minutes.

Using a cuff with a rubber bladder that encircles at least 80% of the limb.

Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

Question 44 Explanation: 
BP should be taken with the client seated with the arm bared, positioned with
support and at heart level. The client should sit with the legs on the floor, feet
uncrossed, and not speak during the recording. The client should not have smoked
tobacco or taken in caffeine in the 30 minutes preceding the measurement. The
client should rest quietly for 5 minutes before the reading is taken. The cuff bladder
should encircle at least 80% of the limb being measured. Gauges other than a
mercury sphygmomanometer should be calibrated every 6 months to ensure
accuracy.
Question 45

WRONG

When assessing an ECG, the nurse knows that the P-R interval represents the time
it takes for the:

Impulse to begin atrial contraction

Impulse to transverse the atria to the AV node

SA node to discharge the impulse to begin atrial depolarization

Impulse to travel to the ventricles

Question 45 Explanation: 
The P-R interval is measured on the ECG strip from the beginning of the P wave to
the beginning of the QRS complex. It is the time it takes for the impulse to travel to
the ventricle.

Question 46

WRONG

A murmur is heard at the second left intercostal space along the left sternal border.
Which valve is this?

Aortic

Mitral

Pulmonic

Tricuspid

Question 46 Explanation: 
Abnormalities of the pulmonic valve are auscultated at the second left intercostal
space along the left sternal border. Aortic valve abnormalities are heard at the
second intercostal space, to the right of the sternum. Mitral valve abnormalities are
heard at the fifth intercostal space in the midclavicular line. Tricupsid valve
abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal
border.

Question 47

WRONG

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?

Hypocalcemia

Hypermagnesemia

Hypokalemia

Hypernatremia

Question 47 Explanation: 
Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn,
hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

Question 48
 WRONG

Which of the following types of pain is most characteristic of angina?

Knifelike

Sharp

Shooting

Tightness

Question 48 Explanation: 
The pain of angina usually ranges from a vague feeling of tightness to heavy,
intense pain. Pain impulses originate in the most visceral muscles and may move to
such areas as the chest, neck, and arms.

Question 49

WRONG

Which of the following arteries primarily feeds the anterior wall of the heart?

Circumflex artery

Internal mammary artery

 Left anterior descending artery

Right coronary artery

Question 49 Explanation: 
The left anterior descending artery is the primary source of blood flow for the
anterior wall of the heart. The circumflex artery supplies the lateral wall, the
internal mammary supplies the mammary, and the right coronary artery supplies
the inferior wall of the heart.

Question 50

WRONG

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:

Decreased arterial blood flow secondary to vasoconstriction

Decreased arterial blood flow leading to hyperemia

Atherosclerotic obstruction of the arteries

Trauma to the lower extremities

Question 50 Explanation: 
Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more
problematic in colder climates or when the person is under stress. Hyperemia
occurs when the vasospasm is relieved.