Urden, Stacy, Lough: Critical Care Nursing, 6 Edition: Chapter 19: Cardiovascular Disorders Test Bank Multiple Choice

Urden, Stacy, Lough: Critical Care Nursing, 6th Edition
Chapter 19: Cardiovascular Disorders
Test Bank
MULTIPLE CHOICE
1. Data concerning coronary artery disease (CAD) and specific risk factors have demonstrated
a. a low correlation of modifiable risk factors to CAD.
b. the onset of CAD in middle age.
c. an association between development of specific risk factors and CAD.
d. no decisive correlation between risk factors and CAD.
ANS: C
Research and epidemiologic data collected during the past 50 years have demonstrated a strong
association between specific risk factors and the development of CAD.
DIF: Cognitive Level: Knowledge REF: {CAD, Description and Etiology}

OBJ: Nursing Process Step: Diagnosis TOP: Cardiovascular
MSC: NCLEX: Physiologic Integrity
2. Which of the following values, when elevated, places the patient at lowest risk for CAD?
a. Very low-density lipoproteins (VLDLs)
b. Triglycerides
c. Low-density lipoproteins (LDLs)
d. High-density lipoproteins (HDLs)
ANS: D
All the reasons are not completely understood, but one recognized physiologic effect is the
ability of HDL to promote the efflux of cholesterol from cells. This process may minimize the
accumulation of foam cells in the artery wall and thus decrease the risk of developing
atherosclerosis. High HDL levels confer both antiinflammatory and antioxidant benefits on the
arterial wall. In contrast, a low HDL level is an independent risk factor for the development of
CAD and other atherosclerotic conditions.
DIF: Cognitive Level: Comprehension REF: {HDL Cholesterol}

3. The major hemodynamic effect of CAD is

a. decreased left ventricular end-diastolic volume.
b. decreased left ventricular end-diastolic pressure.
c. disturbance in the balance between myocardial oxygen supply and demand.
Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank 19-2
d. increased coronary artery vessel lumen.
ANS: C
The major hemodynamic effect of CAD is the disturbance in the delicate balance between
myocardial oxygen supply and demand.
DIF: Cognitive Level: Comprehension REF: {Pathophysiology of CAD}

OBJ: Nursing Process Step: Assessment TOP: Cardiovascular
4. One differentiating factor between stable angina and unstable angina is that stable angina
a. responds predictably well to nitrates.
b. is not precipitated by activity.
c. has a low correlation to CAD.
d. is a result of coronary artery spasm.
ANS: A
Pain control is achieved by rest and by sublingual nitroglycerin within 5 minutes. Stable angina
is the result of fixed lesions (blockages) of more than 75% of the coronary artery lumen.
Ischemia and chest pain occur when myocardial demand from exertion exceeds the fixed blood
oxygen supply.
DIF: Cognitive Level: Application REF: {Stable Angina}

5. Nursing management of the patient with angina is directed toward

a. immediate administration of nitrates.
b. assessment of history of previous anginal episodes.
c. assessment and documentation of chest pain episodes.
d. administration of prophylactic lidocaine for ventricular ectopy.
ANS: C
Nursing interventions focus on early identification of myocardial ischemia, control of chest pain,
recognition of complications, maintenance of a calm environment, and patient and family
education. It is important to document the characteristics of the pain and the patient’s heart rate
and rhythm, blood pressure, respirations, temperature, skin color, peripheral pulses, urine output,
mentation, and overall tissue perfusion.
DIF: Cognitive Level: Synthesis REF: {Recognize Myocardial Ischemia}

OBJ: Nursing Process Step: Evaluation TOP: Cardiovascular
Test Bank 19-3
6. All of the following are mechanisms responsible for a myocardial infarction (MI) EXCEPT
a. coronary artery thrombosis
b. plaque rupture
c. coronary artery spasm near the ruptured plaque
d. preinfarction angina.
ANS: D
The three mechanisms that block the coronary artery and are responsible for the acute reduction
in oxygen delivery to the myocardium are the following: (1) plaque rupture, (2) new coronary
artery thrombosis, (3) coronary artery spasm close to the ruptured plaque.
DIF: Cognitive Level: Knowledge REF: {Description and Etiology}

7. The most frequent dysrhythmia seen initially with sudden cardiac death is
a. premature ventricular contractions.
b. ventricular tachycardia.
c. ventricular fibrillation.
d. asystole.
ANS: B
When the onset of symptoms is rapid, the most likely mechanism of death is ventricular
tachycardia (VT), which degenerates into ventricular fibrillation (VF).
DIF: Cognitive Level: Knowledge REF: {Sudden Cardiac Death, Description}

8. Assessment of the patient with pericarditis may reveal which of the following signs and
symptoms?
a. Ventricular gallop and substernal chest pain
b. Narrowed pulse pressure and shortness of breath
c. Pericardial friction rub and pain
d. Pericardial tamponade and widened pulse pressure
ANS: C
Pain is the most common symptom of pericarditis, and a pericardial friction rub is the most
common initial sign. The friction rub is best auscultated with a stethoscope at the sternal border
and is described as a grating, scraping, or leathery scratching. Pericarditis frequently produces a
pericardial effusion.
DIF: Cognitive Level: Synthesis REF: {Pericarditis After MI}
Test Bank 19-4

9. Clinical manifestations of right-sided heart failure include

a. elevated central venous pressure and sacral edema.
b. pulmonary congestion and jugular venous distention.
c. hypertension and chest pain.
d. liver tenderness and pulmonary edema.
ANS: A
The common manifestations of right ventricular failure are the following: jugular venous
distention, elevated central venous pressure, weakness, peripheral or sacral edema, hepatomegaly
(enlarged liver), jaundice, and liver tenderness. Gastrointestinal symptoms include poor appetite,
anorexia, nausea, and an uncomfortable feeling of fullness.
DIF: Cognitive Level: Comprehension REF: {Right Ventricular Failure}

10. An essential aspect of teaching that may prevent recurrence of heart failure is
a. notifying the physician if a 2-lb weight gain occurs in 24 hours.
b. compliance with diuretic therapy.
c. taking nitroglycerin if chest pain occurs.
d. assessment of an apical pulse.
ANS: B
Reduction or cessation of diuretics usually results in sodium and water retention, which may
precipitate heart failure.
DIF: Cognitive Level: Application REF: {Patient Education}

OBJ: Nursing Process Step: Intervention TOP: Cardiovascular
MSC: NCLEX: Health Promotion and Maintenance
11. Compensatory mechanisms may be activated when heart failure occurs. In general, these
mechanisms
a. may worsen the degree of heart failure.
b. are effective in maintaining cardiac output for prolonged periods.
c. assist in decreasing preload and afterload.
d. minimize hypertrophic changes in the ventricles.
ANS: A
Test Bank 19-5
The compensatory mechanisms may sustain cardiac function, especially at rest, but over a period
of time may worsen the degree of failure as the retention of sodium and water leads to
overdistention of the ventricles and a consequent decrease in the force of ventricular contraction.
DIF: Cognitive Level: Synthesis

REF: {Neuro-hormonal Compensatory Mechanisms in Heart Failure}
OBJ: Nursing Process Step: N/A TOP: Cardiovascular
12. Which of the following assessment findings is most specific for acute onset of pulmonary
edema?
a. Pulmonary crackles
b. Peripheral edema
c. Pink, frothy sputum
d. Elevated central venous pressure
ANS: C
Heart failure patients in pulmonary edema are extremely breathless and anxious and have a
sensation of suffocation. They expectorate pink, frothy liquid and feel as if they are drowning.
The respiratory rate is elevated and accessory muscles of ventilation are used. Respirations are
characterized by loud inspiratory and expiratory gurgling sounds. Diaphoresis is profuse, and the
skin is cold, ashen, and sometimes cyanotic, reflecting low cardiac output, increased sympathetic
stimulation, peripheral vasoconstriction, and desaturation of arterial blood.
DIF: Cognitive Level: Application REF: {Pulmonary Edema in Heart Failure}

13. Medical management of hypertrophic cardiomyopathy includes

a. beta-blockers.
b. positive inotropes.
c. intensive exercise regimen.
d. aortic valve replacement.
ANS: A
Pharmacologic management includes beta-blockers to decrease left ventricular workload,
medications to control and prevent atrial and ventricular dysrhythmias, anticoagulation if atrial
fibrillation or left ventricular thrombi are present, and finally drugs to manage heart failure.
DIF: Cognitive Level: Comprehension REF: {Hypertrophic Obstructive Cardiomyopathy}

14. Patient teaching regarding valvular heart disease should include which of the following?
Test Bank 19-6
a. Increase fluid intake to increase cardiac output.

b. Monitor and increase sodium intake to replace sodium lost with diuretics.
c. Increase daily activity until shortness of breath occurs.
d. Take prophylactic antibiotics before undergoing any invasive procedure.
ANS: D
Education for the patient with acute or chronic heart failure secondary to valvular dysfunction
includes: (1) information related to diet, (2) fluid restrictions, (3) the actions and side effects of
heart failure medications, (4) the need for prophylactic antibiotics before undergoing any
invasive procedures such as dental work, and (5) when to call the health care provider to report a
negative change in cardiac symptoms.
DIF: Cognitive Level: Application REF: {p. 480}

15. Which medication may be administered to the patient with hypertensive crisis?
a. Digitalis
b. Vasopressin
c. Verapamil
d. Sodium nitroprusside
ANS: D
Frequently used medications for hypertensive crisis include furosemide, sodium nitroprusside,
nitroglycerine, phentolamine, labetalol, and clonidine.
DIF: Cognitive Level: Knowledge REF: {p. 495}

16. The classic description of pain associated with aortic dissection is

a. substernal pressure.
b. tearing in the chest, abdomen, or back.
c. numbness and tingling in the left arm.
d. patient is asymptomatic.
ANS: B
The classic clinical presentation is the sudden onset of intense, severe, tearing pain, which may
be localized initially in the chest, abdomen, or back. As the aortic tear (dissection) extends, pain
radiates to the back or distally toward the lower extremities. Many patients have hypertension
upon initial presentation and the focus is upon control of blood pressure and early operation.
DIF: Cognitive Level: Comprehension REF: {Aortic Dissection}
Test Bank 19-7

17. Which of the following clinical manifestations is usually the first symptom of arterial peripheral
vascular disease?
a. Cramping when walking
b. Thrombophlebitis
c. Pulmonary embolism
d. Cordlike veins
ANS: A
Arterial occlusion obstructs blood flow to the distal extremity. The lack of blood flow produces
ischemic muscle pain known as intermittent claudication. This cramping, aching pain while
walking is often the first symptom of peripheral arterial occlusive disease. The pain is relieved
by rest and may remain stable in occurrence and intensity for many years.
DIF: Cognitive Level: Knowledge REF: {Intermittent Claudication}

18. You are teaching a patient with endocarditis about his diagnosis. Which statement below is
correct?
a. Endocarditis is a viral infection that is easily treated with antibiotics.
b. The risk of this diagnosis is occlusion of the coronary arteries.
c. A long course of antibiotics is needed to treat this disorder.
d. Complications are rare once antibiotics have been started.
ANS: C
Treatment requires prolonged IV therapy with adequate doses of antimicrobial agents tailored to
the specific infective endocarditis (IE) microbe and patient circumstances.
DIF: Cognitive Level: Application REF: {Endocarditis, Medical Management}

Mr. M is a 66-year-old patient admitted to the critical care unit with a diagnosis of acute inferior
MI. A 12-lead electrocardiogram (ECG) is done to validate the area of infarction.
19. Which finding on the ECG is most conclusive for infarction?

a. Inverted T waves
b. Tall, peaked T waves
c. ST-segment depression
d. Q waves
Test Bank 19-8
ANS: D
On the ECG, evidence of infarction is seen by the presence of pathologic Q waves.
DIF: Cognitive Level: Knowledge REF: {MI Location}

20. Which leads on Mr. M’s ECG correlate with an inferior wall MI?
a. II, III, aVF
b. I, aVL
c. V2 to V4
d. V5 to V6
ANS: A
Inferior infarctions are manifested by ECG changes in leads II, III, and aVF.
DIF: Cognitive Level: Application REF: {Inferior Wall Infarction}

21. Complications after MI are common. The nurse should anticipate which of the following as the
most common complication?
a. Pulmonary edema
b. Cardiogenic shock
c. Dysrhythmias
d. Sudden cardiac death
ANS: C
Many patients experience complications occurring either early or late in the postinfarction
course. These complications may result from electrical dysfunction or from a cardiac
contractility problem.
DIF: Cognitive Level: Application REF: {Complications with Acute MI}

22. Which classification of dysrhythmia is most common after an inferior wall MI?
a. Sinus tachycardia
b. Premature atrial contractions
c. Atrial fibrillation
d. Atrioventricular heart block
Test Bank 19-9
ANS: D
Atrioventricular heart block most frequently follows an inferior wall MI.
DIF: Cognitive Level: Application REF: {AV Heart Block During MI}
23. Which of the following cholesterol values indicates a heightened risk for the development of
CAD?
a. Total cholesterol level of 170 mg/dL
b. HDL cholesterol level of 30 mg/dL
c. Triglyceride level of 120 mg/dL
d. LDL cholesterol level of 90 mg/dL
ANS: B
The higher the HDL (good) cholesterol level, the lower the risk of CAD.
DIF: Cognitive Level: Comprehension REF: {HDL Cholesterol}

24. A patient with known CAD in the critical care unit with chest pain is suddenly awakened with
severe chest pain. Three nitroglycerine sublingual tablets are administered 5 minutes apart
without relief. A 12-lead ECG reveals nonspecific ST- segment elevation. This patient probably
has
a. silent ischemia.
b. stable angina.
c. unstable angina.
d. Prinzmetal’s angina.
ANS: C
These are hallmark signs and symptoms of unstable angina.
DIF: Cognitive Level: Comprehension REF: {Unstable Angina}

25. A patient has been newly diagnosed with stable angina. He tells the nurse he knows a lot about
his diagnosis already because his father had the same diagnosis 15 years ago. The nurse asks him
to state what he already knows about angina. Which of the following responses by the patient
have a sound scientific basis?
a. He cannot drink ice-cold beverages.
b. He can no longer drink colas or coffee.
c. He can no longer get a strong back massage.
Test Bank 19-10
d. He should not strain when going to the bathroom.
ANS: C
The Valsalva maneuver is contraindicated in cardiac patients.

26. A patient presents with severe substernal chest pain. The patient exclaims, “This is the most
severe pain I have ever felt!” The patient reports that the pain came on suddenly about 2 hours
ago and that three sublingual nitroglycerin tablets have not relieved the pain. The 12-lead ECG
reveals only the following abnormalities:
T-wave inversion in leads I, aVL, V4, and V5

Pathologic Q waves in leads II, III, and aVF
ST-segment elevation in leads V1, V2, V3, and V4
Which of the following is probably accurate about this patient?

a. This patient has an old lateral wall infarction.
b. This patient is having an inferior wall infarction.
c. This patient is having an acute anterior wall infarction.
d. This patient is having a posterior wall infarction.
ANS: C
The Q waves indicate an old inferior wall MI, and the T-wave inversions and ST-segment
elevations indicate an acute anterior wall MI.
DIF: Cognitive Level: Analysis REF: 441-443

27. Three days after an anterior wall MI, a patient is in the critical care unit. She is receiving oxygen
at 4 L/min by nasal cannula; nitroglycerin paste, 1-inch q6h; and Lopressor 25 mg PO q12h. The
monitor shows that she is beginning to have preventricular contractions (PVCs). Over the course
of the next several hours, the PVCs increase in frequency to more than 15 per minute, with
occasional runs of multifocal bigeminal PVCs. The patient's vital signs follow: heart rate, 84
beats/min, sinus rhythm with described PVCs; blood pressure, 124/68 mm Hg; respirations, 20
breaths/min; SpO2, 92%. Laboratory values are blood pH, 7.44; potassium, 4.4 mEq/L;
magnesium, 1.0 mEq/L. Which of the following, if ordered, would be inappropriate for this
patient?
a. Lidocaine 100 mg IV push
b. Increase oxygen to 6 L/min by nasal cannula
c. Potassium chloride 40 mEq in 250 mL 0.9% saline IV piggyback over a 4-hour
Test Bank 19-11
period
d. Magnesium sulfate 2 g IV piggyback over a 2-hour period
ANS: C
The potassium level is within normal limits and replacement is not warranted. All other
interventions listed are appropriate for this patient.
DIF: Cognitive Level: Analysis REF: {p. 451}

28. A 45-year-old patient is admitted to the critical care unit with a diagnosis of acute MI.
Nitroglycerin is infusing at 10 mcg/min and heparin at 1000 U/hr. Which of the following
statements would be appropriate at this time?
a. The patient will be able to resume normal sexual activity when discharged.
b. The patient will need to decrease fat intake to reduce the risk of another heart
attack.
c. The patient has been admitted to the critical care unit because damage to the heart
muscle has occurred.
d. Angina is usually relieved by rest, but a myocardial infarction is not.
ANS: C
Because the window of time has passed when the myocardium could be saved, the patient should
receive education to clarify the reasons for admission to the critical care unit.

COMPLETION
1. __________ angina is caused by spasm of coronary arteries with or without atherosclerotic

lesions.
ANS:
Variant
Variant angina is also known as Prinzmetal's angina and is the result of coronary artery
vasospasm as opposed to occlusion by plaque.
DIF: Cognitive Level: Comprehension REF: {Variant Angina}

OBJ: Nursing Process Step: Diagnosis TOP: Cardiovascular Disorders
2. The cramping, aching pain in the calves while walking is called _____ _____.
Test Bank 19-12
ANS:
intermittent claudication.
Intermittent claudication is caused by arterial occlusion and ischemia in the peripheral
vasculature.
DIF: Cognitive Level: Application REF: {Intermittent Claudication}

OBJ: Nursing Process Step: Diagnosis TOP: Cardiovascular Disorders
MATCHING
Match the following ECG changes with the pathophysiology it represents.

a. T-wave inversion
b. ST-segment elevation
c. Q waves
1. Infarction
2. Ischemia
3. Injury
1. ANS: C DIF: Cognitive Level: Application REF: {pp. 439-440}

OBJ: Nursing Process Step: Assessment TOP: Cardiovascular Disorders
2. ANS: A DIF: Cognitive Level: Application REF: {pp. 439-440}

3. ANS: B DIF: Cognitive Level: Application REF: {pp. 439-440}

MULTIPLE RESPONSE
1. Which of the following effects can be associated with physical exercise? Select all that apply.
a. Decreased LDL cholesterol
b. Increased HDL cholesterol
c. Increased incidence of osteoporosis
d. Decreased triglycerides
e. Increased insulin resistance
f. Decreased incidence of depression
Test Bank 19-13
ANS: A, B, D, F
Rationale: The benefits of regular exercise have been well documented.
DIF: Cognitive Level: Comprehension REF: {Physical Inactivity}

2. Which of the following clinical manifestations are indicative of left ventricular failure? Select all
that apply.
a. Cool, pale extremities
b. Jugular venous distention
c. Liver tenderness
d. Edema
e. Rales
f. Weak peripheral pulses
ANS: A, D, E, F
Rationale: Jugular venous distention, liver tenderness, hepatomegaly, and peripheral edema are
signs of right ventricular failure.
DIF: Cognitive Level: Analysis REF: {Left Ventricular Failure}


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Urden, Stacy, Lough: Critical Care Nursing, 6th Edition

Chapter 19: Cardiovascular Disorders

DIF: Cognitive Level: Knowledge REF: {CAD, Description and Etiology}

DIF: Cognitive Level: Comprehension REF: {HDL Cholesterol}

3. The major hemodynamic effect of CAD is

d. increased coronary artery vessel lumen.

DIF: Cognitive Level: Comprehension REF: {Pathophysiology of CAD}

DIF: Cognitive Level: Application REF: {Stable Angina}

5. Nursing management of the patient with angina is directed toward

DIF: Cognitive Level: Synthesis REF: {Recognize Myocardial Ischemia}

DIF: Cognitive Level: Knowledge REF: {Description and Etiology}

DIF: Cognitive Level: Knowledge REF: {Sudden Cardiac Death, Description}

DIF: Cognitive Level: Synthesis REF: {Pericarditis After MI}

OBJ: Nursing Process Step: Assessment TOP: Cardiovascular

9. Clinical manifestations of right-sided heart failure include

DIF: Cognitive Level: Comprehension REF: {Right Ventricular Failure}

DIF: Cognitive Level: Application REF: {Patient Education}

DIF: Cognitive Level: Synthesis

DIF: Cognitive Level: Application REF: {Pulmonary Edema in Heart Failure}

13. Medical management of hypertrophic cardiomyopathy includes

DIF: Cognitive Level: Comprehension REF: {Hypertrophic Obstructive Cardiomyopathy}

a. Increase fluid intake to increase cardiac output.

DIF: Cognitive Level: Application REF: {p. 480}

DIF: Cognitive Level: Knowledge REF: {p. 495}

16. The classic description of pain associated with aortic dissection is

DIF: Cognitive Level: Comprehension REF: {Aortic Dissection}

OBJ: Nursing Process Step: Assessment TOP: Cardiovascular

DIF: Cognitive Level: Knowledge REF: {Intermittent Claudication}

DIF: Cognitive Level: Application REF: {Endocarditis, Medical Management}

19. Which finding on the ECG is most conclusive for infarction?

DIF: Cognitive Level: Knowledge REF: {MI Location}

DIF: Cognitive Level: Application REF: {Inferior Wall Infarction}

DIF: Cognitive Level: Application REF: {Complications with Acute MI}

DIF: Cognitive Level: Comprehension REF: {HDL Cholesterol}

DIF: Cognitive Level: Comprehension REF: {Unstable Angina}

d. He should not strain when going to the bathroom.

DIF: Cognitive Level: Application REF: {p. 439}

T-wave inversion in leads I, aVL, V4, and V5

Which of the following is probably accurate about this patient?

DIF: Cognitive Level: Analysis REF: 441-443

DIF: Cognitive Level: Analysis REF: {p. 451}

DIF: Cognitive Level: Application REF: {p. 455}

1. __________ angina is caused by spasm of coronary arteries with or without atherosclerotic

DIF: Cognitive Level: Comprehension REF: {Variant Angina}

DIF: Cognitive Level: Application REF: {Intermittent Claudication}

Match the following ECG changes with the pathophysiology it represents.

1. ANS: C DIF: Cognitive Level: Application REF: {pp. 439-440}

2. ANS: A DIF: Cognitive Level: Application REF: {pp. 439-440}

3. ANS: B DIF: Cognitive Level: Application REF: {pp. 439-440}

DIF: Cognitive Level: Comprehension REF: {Physical Inactivity}

DIF: Cognitive Level: Analysis REF: {Left Ventricular Failure}

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