Question 1

A patient was planning to undergo Mitral valve replacement surgery. He was on warfarin therapy for Atrial Fibrillation. What modification should the nurse do with the anticoagulant medication?
A)Stop warfarin on the day of surgery
B)Stop warfarin 4-5 days before surgery
C)Stop warfarin 4-5 days prior to surgery; admit and start on IV heparin; stop IV heparin 2-3 hours pre-op
D)Continue warfarin therapy

Accepted Answer

For patients taking anticoagulants like warfarin, stop 4-5 days prior to surgery; admit and start on IV heparin if high risk of thrombosis (large left atrium, atrial fibrillation, mitral valve prosthesis). IV heparin should be stopped 2-3 hours pre-op (unless on intra-aortic balloon pump (IABP) support).

Question 2

A patient presents with acute Arterial Occlusion of one of his upper limbs. Which of the following drugs should the nurse prepare to administer to the patient?
A)Streptokinase
B)Heparin
C)Warfarin
D)Urokinase

Accepted Answer

Management of acute arterial occlusion is immediate heparinization with 5000iu bolus and continuous infusion to maintain PTT > 60.

Question 3

What are the contraindications of percutaneous transluminal angioplasty of the lower extremity?
A)Hypertensive patients of poor ventricular function
B)Patients having dyslipidemia
C)Medically unstable, diabetic patient, long arterial occlusion, poor distal run off
D)Patient who has undergone coronary angioplasty

Accepted Answer

Percutaneous transluminal angioplasty of the lower extremity is contraindicated in patients who are medically unstable, have long arterial occlusions, have poor distal run off, or who have diabetes.

Question 4

Which of the following signs and symptoms would the attending nurse expect to see in a patient of aneurysmal rupture?
A)Pain abdomen, hypertension, bradycardia
B)Hypotension, tachycardia, nausea, vomiting, shortness of breath, chest pain/lower back/abdominal pain
C)Headache, nausea, vomiting, vertigo
D)Hypertension, chest pain, syncope

Accepted Answer

Signs and symptoms of aneurysm rupture include hypotension, rapid heartbeat, lightheadedness, fainting, nausea, vomiting, sweating, shortness of breath, chest pain, lower back/abdominal pain, and dizziness.

Question 5

The nurse receives the blood test reports for a patient who was admitted to hospital with complaints of chest pain. The report shows an elevated level of CKMB. What does this report signify in this patient?
A)Damage to myocardium
B)Damage to intercostals muscles
C)Liver damage
D)None

Accepted Answer

Cardiac enzymes get elevated in conditions of damage to myocardium. CKMB is one of the important cardiac enzymes used to assess the damage to myocardium.

Question 6

Which systemic complications are associated with peripheral thromobolectomy?
A)Vessel vasospasm, hematoma formation, compartment syndrome
B)Renal failure, rhabdomyolysis, vessel vasospasm, hemorrhage
C)Edema, hyperkalemia, cardiac arrhythmia, renal failure, rhabdomyolysis
D)All of the above

Accepted Answer

Complications associated with peripheral thromboembolectomy include thrombus formation, vessel vasospasm, hematoma formation, artery dissection, compartment syndrome, venous thrombosis, edema, hyperkalemia, cardiac arrhythmia, renal failure, and rhabdomyolysis.

Question 7

A male smoker presents with pain in his extremities after exercise. He also complains of color changes in his digits when exposed to cold. Which of the following diseases need to be ruled out before considering a diagnosis of Buerger's disease?
A)Systemic lupus erythematosus, diabetes, hypercoagulable conditions, scleroderma
B)Bleeding disorders, dyslipidemia, systemic lupus erythematosus
C)Bleeding disorders, diabetes, hypertension, vasculitis
D)Hypercoagulable states, disorders of lipid metabolism, polyarteritis nodosa

Accepted Answer

Blood tests are used as screening tools to aid in diagnosis of Buerger's disease. Tests are done to rule out scleroderma, lupus, diabetes and other blood clotting conditions. Allen test is used to assess blood flow to the hands and feet. Angiography, ultrasound, and echocardiography can be used to assess vascular flow.

Question 8

A patient is being released from hospital after improving from familial congestive heart failure. His son was anxious to know if the disease can be prevented by lifestyle modification or prophylactic medications. What advice should the attending nurse give him?
A)Avoid alcohol and smoking, maintain proper blood pressure, reduce salt and fluid intake, and maintain an active lifestyle
B)Treatment of co-morbidities is sufficient to prevent progression of disease
C)Avoiding alcohol and smoking and diet containing low sodium and fat are enough
D)Nothing needs to be done except for maintaining an active lifestyle

Accepted Answer

The nurse should advise that the patient of familial congestive heart failure can reduce the extent and degree of disease through self-care and proper disease management, although they cannot prevent the onset. In order to decrease disease progression, individuals should avoid alcohol and drug consumption, avoid smoking, maintain proper blood pressure, eat a diet low in saturated fats and sodium, reduce fluid intake, treat other co-morbidities and maintain an active lifestyle.

Question 9

An adolescent boy presents with complaints of chest pain which increases on coughing and deep breathing. During auscultation, the nurse finds that heart sounds are muffled. What is the most likely cause of his condition?
A)Dressler syndrome
B)Aortic dissection
C)Myocardial infarction
D)Viral infection

Accepted Answer

The symptoms and signs of this patient are suggestive of pericarditis. In adolescents, pericarditis is most commonly caused by adenovirus or Coxsackie virus.

Question 10

Which of the following set of diseases is associated with valvular heart disease?
A)Systemic lupus erythematosus, syphilis, Marfan syndrome, carcinoid syndrome
B)Amyloidosis, Tuberculosis, Sjogren syndrome
C)Ankylosing spondylitis, Leprosy
D)Rheumatic fever, collagen vascular disease

Accepted Answer

The conditions that have been associated with valvular disease include systemic lupus erythematosus, cardiomyopathy, syphilis, hypertension, aneurysms, connective tissue disorders, carcinoid syndrome, metabolic disorders, medication and radiation therapy.

Question 11

Which of the following statements is not true regarding cardiac arrhythmias?
A)Arrhythmia can cause a slowing, speeding up, or irregular heartbeat
B)Supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias
C)Supraventricular arrhythmias originate in the atria
D)Sick sinus syndrome does not cause any arrhythmia

Accepted Answer

Arrhythmia is defined as a condition that involves dysregulation of cardiac electrical activity. Arrhythmia can cause a slowing, speeding up, or irregular heartbeat. Tachycardia is a condition that occurs when an arrhythmia is faster than normal, whereas bradycardia is a condition that occurs when an arrhythmia beats slower than normal.
There are many types of arrhythmias including premature beats, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias. Premature beats can originate in both atria and the ventricles. Supraventricular arrhythmias originate in the atria and include atrial fibrillation, atrial flutter, and Wolf-Parkinson-White syndrome. Bradycardias occur when the heart rate is below 60 beats per minute and can be categorized as sick sinus or conduction block.

Question 12

Choose the statement below which correctly defines intermittent claudication.
A)The condition is defined as muscle cramp during physical activity which resolves once activity is stopped
B)Intermittent claudication arises from occlusion of peripheral arteries
C)It consists of muscle cramps during night which is severe enough to awake the patient
D)It consists of joint pain which resolves when the patient starts walking

Accepted Answer

The condition is defined as muscle pain or cramping in appendages triggered by walking and physical activity. Individuals may also experience ischemic rest pain. The condition occurs after physical exertion and consists of pain during physical activity, which resolves once the activity is stopped. The pain most commonly occurs in the calves, thighs, and/or buttocks.

Question 13

A patient of peripheral arterial disease is being released from hospital. What advice should be given by the nurse about foot care?
A)Wash and moisturize feet daily; wear thick socks and comfortable shoes
B)Clean the foot by rubbing with pumice stone
C)Clean feet using soft scrubber and keep dry
D)Clean feet and regularly walk barefoot in morning

Accepted Answer

Patients with peripheral arterial disease and intermittent claudication should maintain their feet to prevent the onset of complications such as infections and gangrene. Patients should wash their feet daily and moisturize them, wear thick socks and comfortable shoes, promptly treat fungal infections, trim toe nails, avoid walking barefoot, and immediately have sores and open wounds treated.

Question 14

A patient presents with complaints of dizziness and lightheadedness and history of one episode of syncope. The nurse record his pulse rate as 40/minute and blood pressure as 90/70 mm Hg. His EKG findings are suggestive of second-degree type II AV block. What should be the goal of treatment in this patient?
A)Increase the heart rate
B)Restore sinus rhythm and maintain cardiac output
C)Increase blood pressure
D)Improve blood supply to vital organs

Accepted Answer

Treatment of second-degree atrioventricular block type II varies on the extent and degree of the condition and the presence of other comorbid cardiovascular conditions. The goal of treatment is to restore sinus rhythm and maintain cardiac output.

Question 15

Alpha-adrenergic antagonists are used in the treatment of which of the following conditions?
A)Cardiac arrhythmia, carcinoid syndrome
B)Cardiogenic shock, postprandial hypertension
C)Hypotension, cardiac arrhythmia
D)Hypertension, pheochromocytoma

Accepted Answer

Alpha-adrenergic antagonists decrease vascular tone, increase vasodilation and decrease blood pressure. Therapeutic uses of alpha-adrenergic antagonists include hypertension, pheochromocytoma, and extravasation of tissue-toxic agents.

Question 16

Which of the following investigations is useful in differentiating intermittent claudication due to arterial disease and neurogenic claudication?
A)Real-time Duplex scanning
B)Doppler flow studies
C)Digital subtraction angiography scan
D)All of above

Accepted Answer

Doppler flow studies is useful in differentiating intermittent claudication.

Question 17

Which of the following descriptions is correct according to the 5-position code of pacemakers?
A)Position one (I) - chambers being sensed, Position two (II) - chambers being paced, Position three (III) - device's response to sensing, Position four (IV) - programmability and rate of modulation function, Position five (V) - only for tachycardia funct
B)Position one (I) - chambers being paced, Position two (II) - chambers being sensed, Position three (III) - device's response to sensing, Position four (IV) - programmability and rate of modulation function, Position five (V) - only for tachycardia funct
C)Position one (I) - chambers being paced, Position two (II) - chambers being sensed, Position three (III) - device's response to sensing, Position four (IV) - for defibrillation function, Position five (V) - only for rate modulation
D)Position one (I) - chambers being paced, Position two (II) - chambers being sensed, Position three (III) - device's response to sensing, Position four (IV) - programmability and rate of modulation function, Position five (V) - for defibrillation functio

Accepted Answer

Pacemakers are classified using a 5-position code, which describes the different types of pacemakers and their functions. Position one (I) indicates the chamber or chambers being paced. Position two (II) indicates the chamber or chambers being sensed. Position three (III) indicates the device's response to sensing. Position four (IV) indicates the programmability and rate of modulation function. Position five (V) is only used for tachycardia functions.

Question 18

Which of the following classes of drugs constitute the vasodilator group of drugs?
A)Beta-blockers, nitrates, calcium channel blockers
B)Beta-blockers, sympthomimetic drugs, diuretics
C)Beta-agonist, cardiac glycoside, steroids
D)Beta agonist, adrenaline, isoproterenol

Accepted Answer

Classes of agents include in the vasodilator group include beta-blockers such as acebutolol, atenolol, betaxolol, bisoprolol, carteolol, carvedilol, esmolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, propranolol, sotalol, and timolol; nitrates/nitrites, also known as anti-anginal vasodilators, such as amyl nitrate, isosorbide dinitrate, isosorbide mononitrate, and nitroglycerin; anti-hypertensive vasodilators such as diazoxide, minoxidil, fenoldopam, nitroprusside, hydralazine, and tolazoline; and calcium channel blockers such as amlodipine, bepridil, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine, and verapamil.

Question 19

Which of the following non-pharmacologic techniques is not used for treatment of maladaptive responses to coping?
A)Cognitive restructuring
B)Cognitive behavioral therapy
C)Electroconvulsive therapy and/or light therapy
D)Psychotherapy

Accepted Answer

Treatment of maladaptive responses to coping includes pharmacologic and non-pharmacologic approaches. Non-pharmacologic strategies include cognitive behavioral therapy, psychotherapy, electroconvulsive therapy and/or light therapy.

Question 20

A patient is wearing Holter monitor. What instructions should the nurse give to follow during monitoring?
A)Stop all his regular medications
B)Maintain an activity diary of his physical activities
C)Restrict physical activity
D)Do strenuous exercise

Accepted Answer

While wearing a Holter monitor, patients should maintain an activity diary so that any abnormality can be linked to this activity. Conversely, the diary may demonstrate that no abnormality occurs with certain activities. Patients should continue with prescribed medications and carry out normal activities since the primary purpose of a Holter monitor is to assist in diagnosis and to determine triggers for abnormal electrocardiogram readings. The monitor should be used during the night as some cardiac abnormalities may occur during sleep.

Quiz 1: Free CSC

A patient was planning to undergo Mitral valve replacement surgery. He was on warfarin therapy for Atrial Fibrillation. What modification should the nurse do with the anticoagulant medication?

A patient presents with acute Arterial Occlusion of one of his upper limbs. Which of the following drugs should the nurse prepare to administer to the patient?

What are the contraindications of percutaneous transluminal angioplasty of the lower extremity?

Which of the following signs and symptoms would the attending nurse expect to see in a patient of aneurysmal rupture?

The nurse receives the blood test reports for a patient who was admitted to hospital with complaints of chest pain. The report shows an elevated level of CKMB. What does this report signify in this patient?

Which systemic complications are associated with peripheral thromobolectomy?

A male smoker presents with pain in his extremities after exercise. He also complains of color changes in his digits when exposed to cold. Which of the following diseases need to be ruled out before considering a diagnosis of Buerger's disease?

A patient is being released from hospital after improving from familial congestive heart failure. His son was anxious to know if the disease can be prevented by lifestyle modification or prophylactic medications. What advice should the attending nurse give him?

An adolescent boy presents with complaints of chest pain which increases on coughing and deep breathing. During auscultation, the nurse finds that heart sounds are muffled. What is the most likely cause of his condition?

Which of the following set of diseases is associated with valvular heart disease?

Which of the following statements is not true regarding cardiac arrhythmias?

Choose the statement below which correctly defines intermittent claudication.

A patient of peripheral arterial disease is being released from hospital. What advice should be given by the nurse about foot care?

Alpha-adrenergic antagonists are used in the treatment of which of the following conditions?

Which of the following investigations is useful in differentiating intermittent claudication due to arterial disease and neurogenic claudication?

Which of the following descriptions is correct according to the 5-position code of pacemakers?

Which of the following classes of drugs constitute the vasodilator group of drugs?

Which of the following non-pharmacologic techniques is not used for treatment of maladaptive responses to coping?

A patient is wearing Holter monitor. What instructions should the nurse give to follow during monitoring?