Deck 11: Cardiovascular Clinical Assessment and Diagnostic Procedures

Question 1

Abnormal heart sounds are labeled S₃ and S₄ and are referred to as __________ when auscultated during a tachycardic episode.

A) Korotk off sounds
B) pulse pressure
C) murmurs
D) gallops

Answer 1

gallops

Question 2

A sudden increase in left atrial pressure, acute pulmonary edema, and low cardiac output, caused by the ventricle contracting during systole, are all characteristics of

A) acute mitral regurgitation.
B) aortic insufficiency.
C) chronic mitral regurgitation.
D) pericardial friction rub.

Answer 2

acute mitral regurgitation.

Question 3

A 68-year-old patient is admitted to the critical care unit with reports of midchest pressure radiating into the jaw and shortness of breath when walking up stairs.The patient is admitted with a diagnosis of "rule out myocardial infarction." When inspecting the patient, the nurse notes that the patient needs to sit in a high Fowler position to breathe.This may indicate

A) pericarditis.
B) anxiety.
C) heart failure.
D) angina.

Answer 3

heart failure.

Question 4

An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis.Physical assessment findings reveal tachycardia with an S₃ and a 3/6 systolic murmur.The nurse knows that the presence of an S₃ heart sound is

A) normal for a person this age.
B) a ventricular gallop.
C) a systolic sound.
D) heard best with the diaphragm of the stethoscope.

Question 5

_____ are created by the turbulence of blood flow through a vessel caused by constriction of the blood pressure cuff.

A) Korotk off sounds
B) Pulse pressures
C) Murmurs
D) Gallops

Question 6

A 68-year-old patient is admitted to the critical care unit with reports of midchest pressure radiating into the jaw and shortness of breath when walking up stairs.The patient is admitted with a diagnosis of "rule out myocardial infarction." The history portion of the assessment should be guided by

A) medical history.
B) history of prior surgeries.
C) presenting symptoms.
D) a review of systems.

Question 7

A heart murmur is described as blowing, grating, or harsh.This description would fall under which criteria?

A) Intensity
B) Quality
C) Timing
D) Pitch

Question 8

A nurse palpates the descending aorta and feels a strong, bounding pulse.The nurse reports the findings to the physician because the results suggest

A) decreased cardiac output.
B) increased cardiac output.
C) an aneurysm.
D) aortic insufficiency.

Question 9

An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis.Physical assessment findings reveal tachycardia with an S₃ and a 3/6 systolic murmur.Which of the following descriptions best describes the murmur heard with mitral stenosis?

A) High-pitched systolic sound
B) Medium-pitched systolic sound
C) High-pitched diastolic sound
D) Low-pitched diastolic sound

Question 10

The purpose of the Allen test is to

A) assess adequate blood flow through the ulnar artery.
B) occlude the brachial artery and evaluate hypoxemia to the hand.
C) test the patency of an internal graft.
D) determine the size of needle to be used for puncture.

Question 11

A patient's blood pressure is 90/72 mm Hg.What is the patient's pulse pressure?

A) 40 mm Hg
B) 25 mm Hg
C) 18 mm Hg
D) 12 mm Hg

Question 12

A nurse from the ICU receives report from the ED nurse on a patient that includes a diagnosis of syncope unknown etiology.Orthostatic VS lying: 110/80 mm/Hg; sitting: 100/74 mm/Hg; standing: 92/40 mm/Hg.Based on this information, the nurse should monitor the patient's

A) breathing.
B) dietary intake.
C) peripheral pulses.
D) activity.

Question 13

An 82-year-old patient is admitted into the critical care unit with a diagnosis of left-sided heart failure related to mitral stenosis.Physical assessment findings reveal tachycardia with an S₃ and a 3/6 systolic murmur.The grading of a murmur as a 3/6 refers to which of the following characteristics of murmurs?

A) Intensity
B) Quality
C) Timing
D) Pitch

Question 14

When checking the patient's back, the nurse pushes her thumb into the patient's sacrum.An indentation remains.The nurse charts that the patient has

A) sacral compromise.
B) delayed skin turgor.
C) pitting edema.
D) dehydration.

Question 15

The presence of a carotid or femoral bruit may be evidence of

A) left-sided heart failure.
B) blood flow through a partially occluded vessel.
C) the early onset of pulmonary embolism.
D) myocardial rupture.

Question 16

The abdominojugular reflux test determines the presence of

A) right ventricular failure.
B) hypoxemia.
C) liver failure.
D) pitting edema.

Question 17

An assessment finding of pulsus alternans may indicate evidence of

A) left-sided heart failure.
B) jugular venous distention.
C) pulmonary embolism.
D) myocardial ischemia.

Question 18

The nurse assesses the dorsalis pedis and posterior tibial pulses as weak and thready.Indicate the correct documentation for the pulse volume that the nurse would use.

A) 0
B) 1+
C) 2+
D) 3+

Question 19

Which of the following conditions is usually associated with clubbing?

A) Central cyanosis
B) Peripheral cyanosis
C) Carbon monoxide poisoning
D) Acute hypoxemia

Question 20

Evaluation of arterial circulation to an extremity is accomplished by assessing which of the following?

A) Homans sign
B) Skin turgor
C) Peripheral edema
D) Capillary refill

Question 21

Which of the following criteria are representative of the patient in normal sinus rhythm?

A) Heart rate, 64 beats/min; rhythm regular; PR interval, 0.10 second; QRS, 0.04 second
B) Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second
C) Heart rate, 54 beats/min; rhythm regular; PR interval, 0.16 second; QRS, 0.08 second
D) Heart rate, 92 beats/min; rhythm irregular; PR interval, 0.16 second; QRS, 0.04 second

Question 22

Which of the following interventions should be strictly followed to ensure accurate cardiac output readings?

A) Use 5 mL of iced injectate only.
B) Inject the fluid into the pulmonary artery port only.
C) Ensure a difference of at least 5° C between injectate temperature and the patient's body temperature.
D) Administer the injectate within 4 seconds.

Question 23

Which portion of the ECG is most valuable in diagnosing atrioventricular (AV)conduction disturbances?

A) P wave
B) PR interval
C) QRS complex
D) QT interval

Question 24

Which of the following diagnostic tests is most effective for measuring overall heart size?

A) Twelve-lead electrocardiography
B) Echocardiography
C) Chest radiography
D) Vectorcardiography

Question 25

The major key to the clinical significance of atrial flutter is the

A) atrial rate.
B) ventricular response rate.
C) PR interval.
D) QRS duration.

Question 26

During a history examination, a patient tells the nurse, "The cardiologist says I have a leaking valve." The nurse documents that the patient has a history of

A) acute mitral regurgitation.
B) aortic insufficiency.
C) chronic mitral regurgitation.
D) pericardial friction rub.

Question 27

The physiologic effect of left ventricular afterload reduction is

A) decreased left atrial tension.
B) decreased systemic vascular resistance.
C) increased filling pressures.
D) decreased cardiac output.

Question 28

A patient with heart failure may be at risk for hypomagnesemia as a result of

A) pump failure.
B) diuretic use.
C) fluid overload.
D) hemodilution.

Question 29

ST segment monitoring for ischemia has gained increasing importance with the advent of thrombolytic therapy.The most accurate method for monitoring the existence of true ischemic changes is

A) T-wave inversion in leads overlying the ischemia.
B) ST segment depression in leads overlying the ischemia.
C) adjusting the gain control on bedside monitoring for best visualization.
D) 12-lead ECG for confirmation.

Question 30

Contractility of the left side of the heart is measured by

A) pulmonary artery wedge pressure.
B) left atrial pressure.
C) systemic vascular resistance.
D) left ventricular stroke work index.

Question 31

Pulsus paradoxus may be seen on intra-arterial blood pressure monitoring when

A) there is a decrease of more than 10 mm Hg in the arterial waveform before inhalation.
B) there is a single, nonperfused beat.
C) the waveform demonstrates tall, tented T waves.
D) the pulse pressure is greater than 20 mm Hg on exhalation.

Question 32

A patient was admitted on the night shift with a diagnosis of acute myocardial infarction.Upon auscultation, the nurse hears a harsh, holosystolic murmur along the left sternal border.The nurse notifies the physician immediately because the symptoms are indicate the patient has developed

A) papillary muscle rupture.
B) tricuspid stenosis.
C) ventricular septal rupture.
D) pericardial friction rub.

Question 33

When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal because it appears

A) in various shapes in the same lead.
B) with increasing frequency.
C) to widen the QRS width.
D) in a specific pattern in the same lead.

Question 34

A patient with a serum potassium level of 6.8 mEq/L may exhibit electrocardiographic changes of

A) a prominent U wave.
B) tall, peaked T waves.
C) a narrowed QRS.
D) sudden ventricular dysrhythmias.

Question 35

The rationale for giving the patient additional fluids after a cardiac catheterization is that

A) fluids help keep the femoral vein from clotting at the puncture site.
B) the patient had a nothing-by-mouth order before the procedure.
C) the radiopaque contrast acts as an osmotic diuretic.
D) fluids increase cardiac output.

Question 36

A patient with ventricular fibrillation (VF)is

A) hypertensive.
B) bradypneic.
C) diaphoretic.
D) pulseless.

Question 37

When assessing the pulmonary arterial waveform, the nurse notices dampening.After tightening the stopcocks and flushing the line, the nurse decides to calibrate the transducer.What are two essential components included in calibration?

A) Obtaining a baseline blood pressure and closing the transducer to air
B) Leveling the air-fluid interface to the phlebostatic axis and opening the transducer to air
C) Having the patient lay flat and closing the transducer to air
D) Obtaining blood return on line and closing all stopcocks

Question 38

A characteristic event in junctional dysrhythmias is

A) irregular rhythm.
B) rapid depolarization to the ventricles.
C) the spread of the impulse in two directions at once.
D) a widened QRS.

Question 39

A patient was admitted to the ICU 3 days ago with a diagnosis of myocardial infarction.The patient is complaining of increased chest pain when coughing, swallowing, and changing positions.The nurse hears a systolic scratching sound upon auscultation of the apical pulse.The nurse notifies the physician.Based on the symptoms, the physician suspects a(n)

A) acute mitral regurgitation.
B) aortic insufficiency.
C) chronic mitral regurgitation.
D) pericardial friction rub.

Question 40

The mean arterial pressure (MAP)is calculated by

A) averaging three of the patient's blood pressure readings over a 6-hour period.
B) dividing the systolic pressure by the diastolic pressure.
C) adding the systolic pressure and two diastolic pressures and then dividing by 3.
D) dividing the diastolic pressure by the pulse pressure.

Question 41

The patient's admitting 12-lead ECG shows peaked P waves.Which of the following admitting diagnoses could be responsible for this finding?

A) Mitral stenosis
B) Pulmonary edema
C) Ischemia
D) Pericarditis

Question 42

The most common complication of a central venous catheter (CVC)is

A) air embolus.
B) infection.
C) thrombus formation.
D) pneumothorax.

Question 43

Why is the measurement of the QT interval important?

A) It represents ventricular depolarization.
B) It represents ventricular contraction.
C) An increasing QT interval increases the risk of torsades de pointes.
D) A decreasing QT interval increases the risk of torsades de pointes.

Question 44

A physician orders removal of the central venous catheter (CVC)line.The patient has a diagnosis of heart failure with chronic obstructive pulmonary disease.The nurse would place the patient in what position for this procedure?

A) Supine in bed
B) Supine in a chair
C) Flat in bed
D) Reverse Trendelenburg position

Question 45

To accurately measure the heart rate of a patient in normal sinus rhythm, which technique would be the most accurate?

A) The number of R waves in a 6-second strip
B) The number of large boxes in a 6-second strip
C) The number of small boxes between QRS complexes divided into 1500
D) The number of large boxes between consecutive R waves divided into 300

Question 46

A new-onset MI can be recognized by which of the following ECG changes?

A) Q waves
B) Smaller R waves
C) Widened QRS
D) ST segment elevation

Question 47

A nurse is obtaining the history of a patient who reveals that he had an MI 5 years ago.When the admission 12-lead ECG is reviewed, Q waves are noted in leads V₃ and V₄ only.Which of the following conclusions is most consistent with this situation?

A) The patient may have had a posterior wall MI.
B) The patient must have had a right ventricular MI.
C) The admission 12-lead ECG was done incorrectly.
D) The patient may have had an anterior MI.

Question 48

What is the initial intervention in a patient with sinus tachycardia with the following vital signs: HR, 136 beats/min; BP, 102/60 mm Hg; RR, 24 breaths/min; T, 99.2° F; SpO₂, 94% on oxygen 2 L/min by nasal cannula?

A) Stat adenosine to decrease heart rate
B) Identification and correction of the cause of the increased heart rate
C) Sublingual nitroglycerine 0.4 mg
D) Lidocaine 75 mg IV push

Question 49

The P wave represents which of the following?

A) Atrial contraction
B) Atrial depolarization
C) Sinus node discharge
D) Ventricular contraction

Question 50

Which of the following cardiac enzymes is a highly specific biomarker for myocardial damage?

A) CK-MB
B) Troponin I
C) Troponin T
D) LDH

Question 51

A patient's bedside ECG strips show the following changes: increased PR interval; increased QRS width; and tall, peaked T waves.Vital signs are T 98.2° F; HR 118 beats/min; BP 146/90 mm Hg; and RR 18 breaths/min.The patient is receiving the following medications: digoxin 0.125 mg PO every day; D?1/2 normal saline with 40 mEq potassium chloride at 125 mL/hr; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h.The physician is notified of the ECG changes.What orders should the nurse expect to receive?

A) Change IV fluid to D51/2 normal saline and draw blood chemistry.
B) Give normal saline with 40 mEq of potassium chloride over a 6-hour period.
C) Hold digoxin and draw serum digoxin level.
D) Hold Cardizem and give 500 mL normal saline fluid challenge over a 2-hour period.

Question 52

The value of SVO₂ monitoring is to determine

A) oxygen saturation at the capillary level.
B) an imbalance between oxygen supply and metabolic tissue demand.
C) the diffusion of gases at the alveolar capillary membrane.
D) the predicted cardiac output for acute pulmonary edema.

Question 53

A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period, and a repeat potassium level is obtained after the bolus.The current potassium level is 2.9 mEq/L.Which of the following should now be considered?

A) Stopping the patient's Aldactone
B) Drawing a serum magnesium level
C) Rechecking the potassium level
D) Monitoring the patient's urinary output

Question 54

The physician anticipates the CVC dwelling time to be 10 to 20 days.The nurse anticipates that the CVC will be placed in the

A) SC vein.
B) IJ vein.
C) EJ vein.
D) femoral vein.

Question 55

Which of the ECG findings would be positive for an inferior wall MI?

A) ST segment depression in leads I, aVL, and V2 to V4
B) Q waves in leads V1 to V2
C) Q waves in leads II, III, and aVF
D) T-wave inversion in leads V4 to V6, I, and aVL

Question 56

A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement (ECG changes had indicated an inferior wall myocardial infarction in progress).Which lead would best monitor this patient?

A) Varies based on the patient's clinical condition and recent clinical history
B) Lead MCL1
C) Lead V1
D) Lead II

Question 57

Which serum lipid value is a significant predictor of future acute MI in persons with established coronary artery atherosclerosis?

A) High-density lipoprotein (HDL)
B) Low-density lipoprotein (LDL)
C) Triglycerides
D) Very-low-density lipoprotein

Question 58

When performing a 12-lead ECG, how many wires are connected to the patient?

A) 3
B) 5
C) 10
D) 12

Question 59

A 52-year-old patient presents to the emergency department with reports of substernal chest pain.A history is taken; serum creatine kinase (CK)and lactate dehydrogenase (LDH)isoenzymes and serum lipid studies are ordered, as is a 12-lead ECG.Which of the following results is most significant in diagnosing an MI during the first 12 hours of chest pain?

A) ECG-inverted T waves
B) Serum enzymes-elevated LDH4
C) Serum enzymes-elevated CK-MB
D) Patient history-substernal chest pain

Question 60

Which lead is best to monitor a patient?

A) Varies based on the patient's clinical condition and recent clinical history
B) Lead MCL1
C) Lead V1
D) Lead II

Question 61

Which of the following expresses the correct order when working with an invasive pressure monitor?

A) Level the transducer, locate the phlebostatic axis, zero the transducer, and take the reading.
B) Locate the phlebostatic axis, level the transducer, zero the transducer, and take the reading.
C) Take the reading, level the transducer, locate the phlebostatic axis, and zero the transducer.
D) Locate the phlebostatic axis, zero the transducer, level the transducer, and take the reading.

Question 62

The Allen test is used before radial arterial line placement to assess

A) collateral circulation to the hand.
B) patency of the radial artery.
C) neurologic function of the hand.
D) pain sensation at the insertion point.

Question 63

Which of the following conditions can cause an artificial increase in the PAOP/PCWP?

A) Aortic regurgitation
B) Aortic stenosis
C) Mitral stenosis
D) Mitral regurgitation

Question 64

A patient becomes unresponsive.The patient's heart rate is 32 beats/min, idioventricular rhythm; blood pressure is 60/32 mm Hg; SpO₂ is 90%; and respiratory rate is 14 breaths/min.Which of the following interventions would the nurse do first?

A) Notify the physician and hang normal saline wide open.
B) Notify the physician and obtain the defibrillator.
C) Notify the physician and obtain a temporary pacemaker.
D) Notify the physician and obtain a 12-lead ECG.

Question 65

New-onset atrial fibrillation can be serious for which of the following reasons?

A) It increases the risk of stroke and pulmonary embolism from atrial clots.
B) It increases the patient's risk of deep venous thrombosis.
C) It may increase cardiac output to dangerous levels.
D) It indicates that the patient is about to have an MI.

Question 66

A patient's arterial line waveform has become damped.The nurse should

A) check for kinks, blood, and air bubbles in the tubing.
B) prepare for a normal saline fluid challenge for hypotension.
C) discontinue the arterial line.
D) check the patient's lung sounds.

Question 67

The patient has an HR of 84 beats/min and an SV of 65 mL.Calculate the CO.

A) 149 mL
B) 500 mL
C) 4650 mL
D) 5460 mL

Question 68

The blood test used to standardize PT results among clinical laboratories worldwide is known as

A) aPTT.
B) ACT.
C) HDL.
D) INR.

Question 69

On returning from the cardiac catheterization laboratory, the patient asks if he can get up in the chair.The most appropriate response would be

A) "You cannot get up because you may pass out."
B) "You cannot get up because you may start bleeding."
C) "You cannot get up because you may fall."
D) "You cannot get up until you urinate."

Question 70

After an MI, a patient presents with an increasing frequency of PVCs.The patient's heart rate is 110 beats/min, and ECG indicates a sinus rhythm with up to five unifocal PVCs per minute.Which of the following should be done? The patient is alert and responsive and denies any chest pain or dyspnea.

A) Administer lidocaine 100 mg bolus IV push stat.
B) Administer Cardizem 20 mg IV push stat.
C) Notify the physician and monitor the patient closely.
D) Nothing; PVCs are expected in this patient.

Question 71

Which of the following AV blocks can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct?

A) First-degree AV block
B) Second-degree AV block, type I
C) Second-degree AV block, type II
D) Third-degree AV block

Question 72

Which of the following has become the first-line hemodynamic assessment tool in the critical care unit?

A) Echocardiogram
B) ECG
C) Exercise stress test
D) 24-hour Holter monitor

Question 73

A patient's CVP reading suddenly increased from 10 to 48 mm Hg.His lungs are clear except for fine rales at the bases.Immediate response should be which of the following?

A) Nothing; this reading is still within normal limits.
B) Place a stat call into the physician.
C) Administered ordered prn Lasix.
D) Check the transducer level.

Question 74

Which of the following is most often found in ventricular dysrhythmias?

A) Retrograde P waves
B) Wide QRS complexes
C) No P waves
D) An inverted T wave

Question 75

Zeroing the pressure transducer on hemodynamic monitoring equipment occurs when the displays reads

A) 0.
B) 250.
C) 600.
D) 760.

Question 76

Ventricular tachycardia has which of the following hemodynamic effects?

A) Decreased cardiac output from increased ventricular filling time
B) Decreased cardiac output from decreased stroke volume
C) Decreased cardiac output from increased preload
D) Decreased cardiac output from decreased afterload

Question 77

The target INR range is

A) 1.0 to 2.0.
B) 1.5 to 3.0.
C) 1.5 to 2.5.
D) 2.0 to 3.0.

Question 78

Which of the following is most indicative of decreased left ventricular preload?

A) Increased PAOP/PAWP
B) Decreased PAOP/PAWP
C) Increased CVP
D) Decreased CVP

Question 79

A patient presents with atrial flutter with an atrial rate of 280 beats/min and a ventricular rate of 70 beats/min.Which of the following best explains this discrepancy in rates?

A) The ventricles are too tired to respond to all the atrial signals.
B) The AV node does not conduct all the atrial signals to the ventricles.
C) Some of the atrial beats are blocked before reaching the AV node.
D) The ventricles are responding to a ventricular ectopic pacemaker.

Question 80

Which of the following statements made by a patient would indicate the need for further education before an electrophysiology procedure?

A) "I need to take all my heart medications the morning of the procedure."
B) "The doctor is going to make my heart beat wrong on purpose."
C) "I will be awake but relaxed during the procedure."
D) "I will be x-rayed during the procedure."