Deck 21: Cardiovascular System Function, Assessment, and Therapeutic Measures

Question 1

The nurse is caring for a group of patients. Which patient is at highest risk of death related to cardiovascular disease?

A)An African American male who smokes
B)A Caucasian female who works a high-stress job
C)A Hispanic female who exercises daily
D)An Asian male who is vegetarian

Answer 1

An African American male who smokes

Question 2

The nurse takes the BP of a patient with a result of 120/80 mm Hg. Which action should the nurse take?

A)Document the finding as normal.
B)Notify the HCP.
C)Instruct the patient to follow a salt-free diet.
D)Prepare to administer a bolus of normal saline IV.

Answer 2

Document the finding as normal.

Question 3

The nurse is caring for a patient admitted with chest pain and suspected myocardial infarction (MI). Which laboratory value should the nurse expect to see an elevation?

A)Ammonia
B)Glucose
C)Amylase
D)Troponin

Answer 3

Troponin

Question 4

The nurse is assessing a patient and notes that the nailbed angle exceeds 180 degrees and feels spongy when squeezed. Which intervention should the nurse implement?

A)Tell the patient he has a congenital heart defect.
B)Document the normal finding in the chart.
C)Encourage the patient to elevate his extremities.
D)Notify the HCP.

Question 5

The nurse is reinforcing teaching to a patient about to undergo angiography. Which statement made by the patient indicates a need for further teaching?

A)"I cannot have anything to eat or drink for 4 hours before the test."
B)"I will stay at the hospital after my test so the nurse can monitor the injection site."
C)"This test will assess the electrical system of my heart."
D)"I may feel a hot, burning feeling when I am injected with dye."

Question 6

The nurse is caring for a patient who had a cardiac catheterization using the left femoral site for entry. Which data is most important for the nurse to monitor?

A)Pupil reaction
B)Left pedal pulse
C)Orientation status
D)Right foot sensation

Question 7

The nurse is auscultating heart sounds and notes an S₄ heart sound. The nurse knows an S₄ sound may be heard in a patient with which condition?

A)Hypertension
B)Crohn disease
C)Liver failure
D)Asthma

Question 8

The nurse is explaining the regulation of blood pressure (BP) to a patient newly diagnosed with hypertension. What tissues within the artery wall that helps maintain diastolic BP should the nurse identify for the patient?

A)Smooth muscle and elastic connective tissue
B)Smooth muscle and simple squamous epithelium
C)Elastic connective tissue and fibrous connective tissue
D)Fibrous connective tissue and simple squamous epithelium

Question 9

The nurse instructs a patient on beverages to avoid when taking the prescribed medication warfarin (Coumadin). Which beverage should the patient state that indicates teaching has been effective?

A)Beer
B)Orange juice
C)Grapefruit juice
D)Cranberry juice

Question 10

The nurse is caring for a patient recovering from a cardiac catheterization with a right femoral artery entry site. Which action should the nurse take?

A)Ambulate every 2 hours.
B)Position knees with 40-degree bend.
C)Avoid movement of right leg as ordered.
D)Perform passive range of motion of right leg hourly.

Question 11

The nurse is caring for a patient recovering from a cardiac catheterization. Which actions for site care should the nurse take?

A)Keep the site uncovered.
B)Apply an adhesive bandage to the site.
C)Maintain pressure dressing on the site.
D)Apply a gauze bandage to the puncture site.

Question 12

The nurse is caring for a patient recovering from a cardiac catheterization. Which action should the nurse take?

A)Force 1,000 mL of fluid per hour.
B)Keep patient NPO until gag reflex is present.
C)Encourage the patient to drink plenty of liquids.
D)Hold fluid intake for 2 hours after the procedure.

Question 13

The nurse is reviewing laboratory values for a patient and notes a potassium level of 6.4 mEq/L. Which clinical manifestation can the nurse expect the patient to report?

A)Constipation
B)Fast heart rate
C)Muscle cramps
D)High blood pressure

Question 14

A patient asks the nurse what the action of the arteries is. Which response by the nurse is most appropriate?

A)"The arteries act as valves of the heart."
B)"The arteries carry blood from capillaries to the heart."
C)"The arteries are the natural pacemaker of the heart."
D)"The arteries carry blood from the heart to capillaries."

Question 15

A patient will be wearing a Holter monitor for 2 days. What should the nurse instruct the patient about bathing while wearing the monitor?

A)"Take a sponge bath."
B)"You may take a tub bath."
C)"Take a shower with the monitor on."
D)"Remove the monitor before showering."

Question 16

The nurse is assessing the heart rate for a person who plays basketball and runs track. Which heart rate can the nurse expect to document?

A)50 beats/min
B)70 beats/min
C)90 beats/min
D)110 beats/min

Question 17

The nurse is assessing a patient and notices the radial pulse has fewer beats than the apical pulse. Which action should the nurse take?

A)Document the finding as normal.
B)Encourage the patient to ambulate and recheck.
C)Notify the health care provider (HCP).
D)Encourage the patient to increase fluid intake.

Question 18

A patient is being instructed about a Holter monitor. Which statement indicates that the patient knows what to do when a symptom occurs while wearing a Holter monitor?

A)"Call an ambulance."
B)"Notify the physician."
C)"Take an apical pulse."
D)"Push the event button."

Question 19

A patient has sustained damage to the sinoatrial (SA) node. Which heart rates indicate that the patient's atrioventricular (AV) node has taken over as the pacemaker for the heart? 1.10 to 20

A)20 to 35
B)40 to 60
C)80 to 100

Question 20

The nurse is observing a patient apply antiembolism stockings. Which action by the patient requires correction by the nurse?

A)The patient pulls the stockings up to 1 to 2 inches below the bottom of the kneecap.
B)The patient uses an assistive device in applying the stockings.
C)The patient rolls the stockings down.
D)The patient wears the stockings all day as instructed.

Question 21

A patient has a stroke volume of 75 mL and a heart rate of 88 beats/min. What should the nurse calculate this patient's cardiac output to be?

Question 22

While collecting data, a patient expectorates pink, frothy sputum. Which health problem should the nurse consider is occurring in this patient?

A)Gastritis
B)Pneumonia
C)Heart failure
D)Hepatic failure

Question 23

The nurse is caring for a patient with peripheral vascular disease. Which signs or symptoms should the nurse expect to observe in this patient? (Select all that apply.)

A)Pain
B)Pruritus
C)Purpura
D)Paralysis
E)Paresthesia
F)Pulselessness

Question 24

The nurse is assessing a patient and notes a prolonged, very loud swishing sound. The nurse knows this describes which of the following?

A)Pericardial friction rub
B)Murmur
C)Ventricular gallop
D)Atrial gallop

Question 25

The nurse is caring for a patient with decreased arterial blood flow. Which clinical manifestations can the nurse expect to document? (Select all that apply.)

A)Decreased hair distribution
B)Varicose veins
C)Thick, brittle nails
D)Shiny skin
E)Moist skin

Question 26

The nurse is caring for a patient with a potassium level of 7.6 mEq/L. For which HCP-ordered test should the nurse prepare the patient?

A)Angiography
B)Electrocardiogram
C)Nuclear radioisotope imaging
D)Cardiac catheterization

Question 27

The nurse is caring for a patient who is having an exercise treadmill test. What interventions would be appropriate for the test? (Select all that apply.)

A)Remove all metal objects.
B)Monitor vital signs throughout the test.
C)Administer antianxiety medication as ordered.
D)Monitor electrocardiogram before, during, and after the test.
E)Ask the patient about allergies to dyes used in diagnostic procedures.

Question 28

A patient being treated for a severe blood loss has a BP of 90/56 mm Hg and urine output of 10 mL over the last hour. Which physiological mechanism should the nurse recall is occurring in this patient?

A)Starling's law
B)Medulla-brainstem
C)Sodium-potassium pump
D)Renin-angiotensin-aldosterone

Question 29

The nurse notes that a patient's lower legs are brown and the feet are blue when they are in the dependent position. For which health problem should the nurse collect additional data?

A)Anemia
B)Insufficient oxygenation
C)Decreased arterial blood flow
D)Venous blood flow problems

Question 30

The nurse is reviewing the medication history for a patient about to undergo cardiac surgery. Which medication should the nurse report to the surgeon?

A)Furosemide (Lasix)
B)Warfarin (Coumadin)
C)Metformin (Glucophage)
D)Lisinopril (Prinivil)

Question 31

The nurse is reinforcing teaching for a patient who is to wear a Holter monitor. Which of the following should the nurse include? (Select all that apply.)

A)Avoid strenuous activity.
B)Transmit data over the phone.
C)Push the event button when symptoms occur.
D)Keep an accurate diary of symptoms and activities.
E)Avoid showers or baths while wearing the monitor. 6.Take nothing by mouth for 6 hours before applying the monitor.