The Client with Cardiac Health Problems 327

59. The nurse should teach the client that signs 66. When teaching a client with heart failure
of digoxin toxicity include which of the following? about preventing complications and future hospi-
■ 1. Rash over the chest and back. talizations, which problems stated by the client as
■ 2. Increased appetite. reasons to call the physician would indicate to the
■ 3. Visual disturbances such as seeing yellow nurse that the client has understood the teaching?
spots. Select all that apply.
■ 4. Elevated blood pressure. ■ 1. Becoming increasingly short of breath at rest.
■ 2. Weight gain of 2 lb or more in 1 day.
60. The nurse should be especially alert for signs ■ 3. High intake of sodium for breakfast.
and symptoms of digoxin toxicity if serum levels
■ 4. Having to sleep sitting up in a reclining chair.
indicate that the client has a:
■ 5. Weight loss of 2 lb in 1 day.
■ 1. Low sodium level.
■ 2. High glucose level.
■ 3. High calcium level.
■ 4. Low potassium level. The Client with Valvular
Heart Disease
61. Which of the following foods should the
nurse teach a client with heart failure to limit when
following a 2-g sodium diet?
67. A client has returned from the cardiac cath-
eterization laboratory after a balloon valvuloplasty
■ 1. Apples.
for mitral stenosis. Which of the following requires
■ 2. Tomato juice.
immediate nursing action?
■ 3. Whole wheat bread.
■ 1. A low, grade 1 intensity mitral regurgitation
■ 4. Beef tenderloin.
murmur.
62. A client receiving a loop diuretic should be ■ 2. SpO2 is 94% on 2 liters of oxygen via nasal
encouraged to eat which of the following foods? cannula.
Select all that apply. ■ 3. The client has become more somnolent.
■ 1. Angel food cake. ■ 4. Urine output has decreased from 60 mL/hour
■ 2. Banana. to 40 mL over the last hour.
■ 3. Dried fruit.
■ 4. Orange juice.
68. A client with aortic stenosis complains of
increasing dyspnea and dizziness. Identify the area
■ 5. Peppers.
where the nurse would place the stethoscope to
63. The nurse finds the apical impulse below the assess a murmur from aortic stenosis.
fifth intercostal space. The nurse suspects:
■ 1. Left atrial enlargement.
■ 2. Left ventricular enlargement.
■ 3. Right atrial enlargement.
■ 4. Right ventricular enlargement.
64. The nurse is admitting a 68-year-old male
to the medical floor. The echocardiogram report
revealed left ventricular enlargement. The nurse
1
notes 2+ pitting edema in the ankles when getting 2
the client into bed. Based on this finding, what 3
should the nurse do first?
■ 1. Assess respiratory status. 4
■ 2. Draw blood for laboratory studies. 5
■ 3. Insert a Foley catheter.
■ 4. Weigh the client.
65. The nurse’s discharge teaching plan for the
client with heart failure should stress the impor-
tance of which of the following?
■ 1. Maintaining a high-fiber diet.
■ 2. Walking 2 miles every day. Midsternum
■ 3. Obtaining daily weights at the same time each
Midclavicular line
day.
■ 4. Remaining sedentary for most of the day.

Billings_Part 2_Chap 3_Test 01.indd 327 8/7/2010 10:07:07 AM

 328 The Nursing Care of Adults with Medical and Surgical Health Problems
69. A client is scheduled for a cardiac catheter-
ization. The nurse should do which of the following
preprocedure tasks? Select all that apply.
■ 1. Administer all ordered oral medications.
■ 2. Check for iodine sensitivity.
■ 3. Verify that written consent has been obtained.
■ 4. Withhold food and oral fluids before the
procedure.
■ 5. Insert a urinary drainage catheter.
70. A client has returned to the medical-surgical
unit after a cardiac catheterization. Which is the
most important initial postprocedure nursing assess-
ment for this client?
■ 1. Monitor the laboratory values.
■ 2. Observe neurologic function every 15 min-
utes.
■ 3. Observe the puncture site for swelling and
bleeding.
■ 4. Monitor skin warmth and turgor.
71. A 70-year-old female 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 symptoms
until 4 years ago. Recently, she noticed increased
symptoms, despite daily doses of digoxin and furo-
semide. During the initial interview with the client,
the nurse would most likely learn that the client’s
childhood health history included:
■ 1. Chickenpox.
■ 2. Poliomyelitis.
■ 3. Rheumatic fever.
■ 4. Meningitis.
72. A client experiences initial indications of
excitation after having an I.V. infusion of lidocaine
hydrochloride started. The nurse should further
assess the client when the client reports having:
■ 1. Palpitations.
■ 2. Tinnitus.
■ 3. Urinary frequency.
■ 4. Lethargy.
73. A pulmonary artery catheter is inserted in a
client with severe mitral stenosis and regurgitation.
The nurse administers furosemide (Lasix) to treat
pulmonary congestion and begins a Nitroprusside
(Nipride) drip for afterload reduction per physi-
cian orders. The nurse notices a sudden drop in the
pulmonary artery diastolic pressure and pulmonary
artery wedge pressure. Which of the following has
the highest priority?
■ 1. Assess the 12-lead EKG.
■ 2. Assess the blood pressure.
■ 3. Assess the lung sounds.
■ 4. Assess the urine output.
Billings_Part 2_Chap 3_Test 01.indd 328
74. A client has mitral stenosis and is a prospec-
tive valve recipient. The nurse is instructing the
client about health maintenance prior to surgery.
Inability to follow which of the following regimens
would pose the greatest health hazard to this client
at this time?
■ 1. Medication therapy.
■ 2. Diet modification.
■ 3. Activity restrictions.
■ 4. Dental care.
75. In preparing the client and the family for a
postoperative stay in the intensive care unit (ICU)
after open heart surgery, the nurse should explain
that:
■ 1. The client will remain in the ICU for 5 days.
■ 2. The client will sleep most of the time while
in the ICU.
■ 3. Noise and activity within the ICU are mini-
mal.
■ 4. The client will receive medication to relieve
pain.
76. A client who has undergone a mitral valve
replacement has persistent bleeding from the sternal
incision during the early postoperative period. The
nurse should do which of the following? Select all
that apply.
■ 1. Begin Warfarin (Coumadin).
■ 2. Check the postoperative CBC, INR, PTT, &
platelet levels.
■ 3. Confirm availability of blood products.
■ 4. Monitor the mediastinal chest tube drainage.
■ 5. Start a Dopamine (Intropin) drip for a systolic
BP < 100.
77. The most effective measure the nurse can use
to prevent wound infection when changing a client’s
dressing after coronary artery bypass surgery is to:
■ 1. Observe careful hand-washing procedures.
■ 2. Clean the incisional area with an antiseptic.
■ 3. Use prepackaged sterile dressings to cover the
incision.
■ 4. Place soiled dressings in a waterproof bag
before disposing of them.
78. 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 complica-
tions 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.
8/7/2010 10:07:07 AM

79. The nurse should teach the client who is
receiving warfarin sodium that:
■ 1. Partial thromboplastin time values determine
the dosage of warfarin sodium.
■ 2. Protamine sulfate is used to reverse the effects
of warfarin sodium.
■ 3. International Normalized Ratio (INR) is used
to assess effectiveness.
■ 4. Warfarin sodium will facilitate clotting of the
blood.
80. 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.
81. Before a client’s discharge after mitral valve
replacement surgery, the nurse should evaluate the
client’s understanding of postsurgery activity restric-
tions. Which of the following should the client not
engage in until after the 1-month postdischarge
appointment with the surgeon?
■ 1. Showering.
■ 2. Lifting anything heavier than 10 lb.
■ 3. A program of gradually progressive walking.
■ 4. Light housework.
82. Three days after mitral valve surgery, a
45-year-old female comments that she hears a
“clicking” noise coming from her chest and her
“rather large” chest incision. The nurse’s response
should reflect the understanding that the client may
be experiencing which of the following?
■ 1. Anxiety related to altered body image.
■ 2. Anxiety related to altered health status.
■ 3. Altered tissue perfusion.
■ 4. Lack of knowledge regarding the postopera-
tive course.
The Client with Hypertension
83. Metoprolol (Toprol XL) is added to the
pharmacologic therapy of a diabetic female diag-
nosed with stage 2 hypertension initially treated
with Furosemide (Lasix) and Ramipril (Altace).
An expected therapeutic effect is:
■ 1. Decrease in heart rate.
■ 2. Lessening of fatigue.
■ 3. Improvement in blood sugar levels.
■ 4. Increase in urine output.
Billings_Part 2_Chap 3_Test 01.indd 329
The Client with Cardiac Health Problems 329
84. A client is taking clonidine (Catapres) for
treatment of hypertension. The nurse should teach
the client about which of the following common
adverse effects of this drug? Select all that apply.
■ 1. Dry mouth.
■ 2. Hyperkalemia.
■ 3. Impotence.
■ 4. Pancreatitis.
■ 5. Sleep disturbance.
85. A client with hypertensive emergency is
being treated with sodium nitroprusside (Nipride).
In a dilution of 50 mg/250 mL, how many micro-
grams of Nipride are in each milliliter?
________________________ mcg.
86. In teaching the hypertensive client to avoid
orthostatic hypotension, the nurse should empha-
size which of the following instructions? Select all
that apply.
■ 1. Plan regular times for taking medications.
■ 2. Arise slowly from bed.
■ 3. Avoid standing still for long periods.
■ 4. Avoid excessive alcohol intake.
■ 5. Avoid hot baths.
87. An industrial health nurse at a large print-
ing plant finds a male employee’s blood pressure
to be elevated on two occasions 1 month apart and
refers him to his private physician. The employee
is about 25 lb overweight and has smoked a pack
of cigarettes daily for more than 20 years. The cli-
ent’s physician prescribes atenolol (Tenormin) for
the hypertension. The nurse should instruct the
client to:
■ 1. Avoid sudden discontinuation of the drug.
■ 2. Monitor the blood pressure annually.
■ 3. Follow a 2-g sodium diet.
■ 4. Discontinue the medication if severe head-
aches develop.
88. The nurse teaches a client, who has recently
been diagnosed with hypertension, about dietary
restrictions: a low-calorie, low-fat, low-sodium diet.
Which of the following menu selections would best
meet the client’s needs?
■ 1. Mixed green salad with blue cheese dressing,
crackers, and cold cuts.
■ 2. Ham sandwich on rye bread and an orange.
■ 3. Baked chicken, an apple, and a slice of white
bread.
■ 4. Hot dogs, baked beans, and celery and carrot
sticks.
8/7/2010 10:07:08 AM

read labels carefully. Apples and whole wheat breads
are not high in sodium. Beef tenderloin would have
less sodium than canned foods or tomato juice.
CN: Reduction of risk potential;
CL: Apply
62. 2, 3, 4. Hypokalemia is a side effect of loop
diuretics. Bananas, dried fruit, and oranges are
examples of food high in potassium. Angel food
cake, yellow cake, and peppers are listed by the
National Kidney Foundation as low in potassium.
CN: Pharmacological and parenteral
therapies; CL: Apply
63. 2. A normal apical impulse is found over
the apex of the heart and is typically located and
auscultated in the left fifth intercostal space in
the midclavicular line. An apical impulse located
or auscultated below the fifth intercostal space or
lateral to the midclavicular line may indicate left
ventricular enlargement.
CN: Physiological adaptation;
CL: Analyze
64. 1. The ankle edema suggests fluid volume
overload. The nurse should assess respiratory
rate, lung sounds, and SpO2 to identify any signs
of respiratory symptoms of heart failure requiring
immediate attention. The nurse can then draw blood
for laboratory studies, insert the Foley catheter, and
weigh the client.
CN: Physiological adaptation;
CL: Synthesize
65. 3. Heart failure is a complex and chronic
condition. Education should focus on health promo-
tion and preventive care in the home environment.
Signs and symptoms can be monitored by the client.
Instructing the client to obtain daily weights at the
same time each day is very important. The client
should be told to call the physician if there has been
a weight gain of 2 lb or more. This may indicate
fluid overload, and treatment can be prescribed
early and on an outpatient basis, rather than wait-
ing until the symptoms become life-threatening.
Following a high-fiber diet is beneficial, but it is
not relevant to the teaching needs of the client with
heart failure. Prescribing an exercise program for
the client, such as walking 2 miles every day, would
not be appropriate at discharge. The client’s exercise
program would need to be planned in consultation
with the physician and based on the history and
the physical condition of the client. The client may
require exercise tolerance testing before an exercise
plan is laid out. Although the nurse does not pre-
scribe an exercise program for the client, a sedentary
lifestyle should not be recommended.
CN: Reduction of risk potential;
CL: Create
Billings_Part 2_Chap 3_Test 01.indd 339
The Client with Cardiac Health Problems 339
66. 1, 2, 4. The client stating that he would call
the physician with increasing shortness of breath,
weight gain over 2 lb in 1 day, and having to sleep
sitting up, indicates that he has understood the
teaching because these signs and symptoms suggest
worsening of the client’s heart failure. Although the
client will most likely be placed on a sodium-re-
stricted diet, the client would not need to notify the
physician if he or she had consumed a high-sodium
breakfast. Instead the client would need to be alert
for possible signs and symptoms of worsening heart
failure and work to reduce sodium intake for the
rest of that day and in the future.
CN: Reduction of risk potential;
CL: Evaluate
The Client with Valvular
Heart Disease
67. 3. A complication of balloon valvuloplasty is
emboli resulting in a stroke. The client’s increased
drowsiness should be evaluated. Some degree of
mitral regurgitation is common after the procedure.
The oxygen status and urine output should be moni-
tored closely, but do not warrant concern.
CN: Reduction of risk potential;
CL: Synthesize
68. The stethoscope is placed at the second inter-
costal space right of sternum (1) to assess the aortic
area. (2) is the pulmonic valve area, (3) is Erb’s
point, (4) is the Tricuspid valve area, and (5) is the
Mitral valve area.
CN: Physiological adaptation; CL: Apply
1
2
3
4
5
Midsternum
Midclavicular line
8/7/2010 10:07:13 AM
 340 The Nursing Care of Adults with Medical and Surgical Health Problems
69. 2, 3, 4. For clients scheduled for a cardiac
catheterization it is important to assess for iodine
sensitivity, verify written consent, and instruct the
client to take nothing by mouth for 6 to 18 hours
before the procedure. Oral medications are with-
held unless specifically ordered. A urinary drainage
catheter is rarely required for this procedure.
CN: Reduction of risk potential;
CL: Apply
70. 3. Assessment of circulatory status, includ-
ing observation of the puncture site, is of primary
importance after a cardiac catheterization. Labora-
tory values and skin warmth and turgor are impor-
tant to monitor but are not the most important initial
nursing assessment. Neurologic assessment every 15
minutes is not required.
CN: Reduction of risk potential;
CL: Analyze
71. 3. Most clients with mitral stenosis have a
history of rheumatic fever or bacterial endocarditis.
Chickenpox, poliomyelitis, and meningitis are not
associated with mitral stenosis.
CN: Physiological adaptation;
CL: Analyze
72. 2. Common adverse effects of lidocaine
hydrochloride include dizziness, tinnitus, blurred
vision, tremors, numbness and tingling of extremi-
ties, excessive perspiration, hypotension, seizures,
and finally coma. Cardiac effects include slowed
conduction and cardiac arrest. Palpitations, urinary
frequency, and lethargy are not considered typical
adverse reactions to lidocaine.
CN: Pharmacological and parenteral
therapies; CL: Analyze
73. 2. The nurse should immediately assess the
blood pressure since Nipride and Lasix can cause
severe hypotension from a decrease in preload and
afterload. If the client is hypotensive, the Nipride
dose should be reduced or discontinued. Urine
output should then be monitored to make sure there
is adequate renal perfusion. A 12-lead EKG is per-
formed if the client experiences chest pain. A reduc-
tion in pulmonary artery pressures should improve
the pulmonary congestion and lung sounds.
CN: Physiological adaptation;
CL: Synthesize
74. 1. Preoperatively, anticoagulants may be
prescribed for the client with advanced valvular
heart disease to prevent emboli. Postoperatively,
all clients with mechanical valves and some clients
with bioprostheses are maintained indefinitely on
anticoagulant therapy. Adhering strictly to a dos-
age schedule and observing specific precautions are
Billings_Part 2_Chap 3_Test 01.indd 340
necessary to prevent hemorrhage or thromboembo-
lism. Some clients are maintained on lifelong antibi-
otic prophylaxis to prevent recurrence of rheumatic
fever. Episodic prophylaxis is required to prevent
infective endocarditis after dental procedures or
upper respiratory, gastrointestinal, or genitourinary
tract surgery. Diet modification, activity restrictions,
and dental care are important; however, they do not
have as much significance postoperatively as medi-
cation therapy does.
CN: Reduction of risk potential;
CL: Evaluate
75. 4. Management of postoperative pain is a
priority for the client after surgery, including valve
replacement surgery, according to the Agency
for Health Care Policy and Research. The client
and family should be informed that pain will be
assessed by the nurse and medications will be given
to relieve the pain. The client will stay in the ICU as
long as monitoring and intensive care are needed.
Sensory deprivation and overload, high noise levels,
and disrupted sleep and rest patterns are some envi-
ronmental factors that affect recovery from valve
replaceent surgery.
CN: Reduction of risk potential;
CL: Synthesize
76. 2, 3, 4. The hemoglobin and hematocrit
should be assessed to evaluate blood loss. An
elevated INR & PTT and decreased platelet count
increase the risk for bleeding. The client may require
blood products depending on lab values and sever-
ity of bleeding, therefore availability of blood prod-
ucts should be confirmed by calling the blood bank.
Close monitoring of blood loss from the mediastinal
chest tubes should be done. Coumadin is an antico-
agulant that will increase bleeding. Anticoagulation
should be held at this time. Information is needed
on the type of valve replacement. For a mechani-
cal heart valve, the INR is kept at 2 to 3.5. Tissue
valves do not require anticoagulation. Dopamine
should NOT be initiated if the client is hypotensive
from hypovolemia. Fluid volume assessment should
always be done first. Volume replacement should be
initiated in a hypovolemic client prior to starting an
inotrope such as dopamine.
CN: Physiological adaptation;
CL: Synthesize
77. 1. Many factors help prevent wound infec-
tions, including washing hands carefully, using
sterile prepackaged supplies and equipment, clean-
ing the incisional area well, and disposing of soiled
dressings properly. However, most authorities say
that the single most effective measure in prevent-
ing wound infections is to wash the hands care-
fully before and after changing dressings. Careful
hand washing is also important in reducing other
8/7/2010 10:07:14 AM

infections often acquired in hospitals, such as
urinary tract and respiratory tract infections.
CN: Reduction of risk potential;
CL: Synthesize
78. 1. In an immobilized client, calcium leaves
the bone and concentrates in the extracellular fluid.
When a large amount of calcium passes through the
kidneys, calcium can precipitate and form calculi.
Nursing interventions that help prevent calculi
include ensuring a liberal fluid intake (unless con-
traindicated). A diet rich in acid should be provided
to keep the urine acidic, which increases the solu-
bility of calcium. Preventing constipation is not
associated with excessive calcium excretion. Limit-
ing foods rich in calcium, such as dairy products,
will help in preventing renal calculi.
CN: Physiological adaptation;
CL: Synthesize
79. 3. INR is the value used to assess effective-
ness of the warfarin sodium therapy. INR is the
prothrombin time ratio that would be obtained if
the thromboplastin reagent from the World Health
Organization was used for the plasma test. It is now
the recommended method to monitor effectiveness
of warfarin sodium. Generally, the INR for clients
administered warfarin sodium should range from 2
to 3. In the past, prothrombin time was used to assess
effectiveness of warfarin sodium and was maintained
at 1.5 to 2.5 times the control value. Partial throm-
boplastin time is used to assess the effectiveness of
heparin therapy. Fresh frozen plasma or vitamin K is
used to reverse warfarin sodium’s anticoagulant effect,
whereas protamine sulfate reverses the effects of hepa-
rin. Warfarin sodium will help to prevent blood clots.
CN: Pharmacological and parenteral
therapies; CL: Apply
80. 1. Daily dental care and frequent checkups
by a dentist who is informed about the client’s
condition are required to maintain good oral health.
Use of an electric toothbrush, an irrigation device,
or dental floss may cause gums to bleed and allow
bacteria to enter mucous membranes and the blood-
stream, increasing the risk of endocarditis.
CN: Reduction of risk potential;
CL: Create
81. 2. Most cardiac surgical clients have median
sternotomy incisions, which take about 3 months to
heal. Measures that promote healing include avoid-
ing heavy lifting, performing muscle reconditioning
exercises, and using caution when driving. Shower-
ing or bathing is allowed as long as the incision is
well approximated with no open areas or drainage.
Activities should be gradually resumed on discharge.
CN: Safety and infection control;
CL: Evaluate
Billings_Part 2_Chap 3_Test 01.indd 341
The Client with Cardiac Health Problems 341
82. 1. Verbalized concerns from this client
may stem from her anxiety over the changes her
body has gone through after open heart surgery.
Although the client may experience anxiety
related to her altered health status or may have
a lack of knowledge regarding her postoperative
course, she is pointing out the changes in her body
image. The client is not concerned about altered
tissue perfusion.
CN: Psychosocial adaptation;
CL: Analyze
The Client with Hypertension
83. 1. The effect of a beta blocker is a decrease
in heart rate, contractility, and afterload, which
leads to a decrease in blood pressure. The client at
first may have an increase in fatigue when starting
the beta blocker. The mechanism of action does not
improve blood sugar or urine output.
CN: Pharmacologicl and parenteral
therapies; CL: Evaluate
84. 1, 3, 5. Clonidine (Catapres) is a central-
acting adrenergic antagonist. It reduces sympa-
thetic outflow from the central nervous system. Dry
mouth, impotence, and sleep disturbances are pos-
sible adverse effects. Hyperkalemia and pancreatitis
are not anticipated with use of this drug.
CN: Pharmacological and parenteral
therapies; CL: Apply
85. 200 mcg
First, calculate the number of milligrams per
milliliter:
50 mg 1 mg 0.2 mg
= =
250 mL 5 mL 1 mL
Next, calculate the number of micrograms in each
milligram:
0.2 mg × 1,000 mcg = 200 mcg.
CN: Pharmacological and parenteral
therapies; CL: Apply
86. 2, 3. Changing positions slowly and avoiding
long periods of standing may limit the occurrence
of orthostatic hypotension. Scheduling regular
medication times is important for blood pressure
management but this aspect is not related to the
development of orthostatic hypotension. Excessive
alcohol intake and hot baths are associated with
vasodilation.
CN: Reduction of risk potential;
CL: Create
8/7/2010 10:07:15 AM