Question 1

A patient is being discharged from hospital seven days post myocardial infarction. He is curious to know why he must wait six weeks before having sexual intercourse. What is the best response by the nurse to this question?

Accepted Answer

"When you are able to climb two flights of stairs comfortably, it is generally safe to have sex." After myocardial infarction, there is a risk of cardiac rupture for about six weeks. Scar tissue generally forms by that time. The usual advice given by health care providers is to wait until the patient can tolerate climbing stairs.

Question 2

A nurse is assisting a physician in treating a patient with ventricular tachycardia. Which of the following drugs should the nurse anticipate that the doctor would prescribe?

Accepted Answer

The nurse should anticipate that the doctor would prescribe amiodarone. Amiodarone is an antiarrhythmia agent used for various types of tachyarrhythmias, both ventricular and supraventricular (atrial) arrhythmias. Sodium bicarbonate is indicated for metabolic acidosis; dopamine is used for hypotension.

Question 3

A patient with cyanosis is admitted to the emergency room without a diagnosis. Which of the nursing action is a priority in relation to oxygen administration?

Accepted Answer

The priority nursing action in relation to oxygen administration would be to administer oxygen at 2 liters per minute. Oxygen should not be administered at higher rates because if the patient is emphysemic and receives high flow oxygen, he will develop CO2 narcosis and the respiratory system will cease to function.

Question 4

A patient arrives in the ER complaining of substernal chest pain, profuse sweating and shortness of breath. His vital signs are as follows: Temperature 37 C; HR 110; BP 160/100 mmHg; Respiration 30. Which of the following includes the immediate treatment of the patient?

Accepted Answer

The immediate treatment of the patient includes sublingual nitroglycerin, followed by morphine if the nitroglycerin fails to relieve the pain. The nurse must be able to provide oxygen, nitroglycerine followed by morphine if the nitroglycerine fails as the symptoms above is an indication of possible MI.

Question 5

A patient diagnosed with heart failure is receiving digoxin (Lanoxin) and furosemide (Lasix). During the morning rounds, the patient complains of nausea and yellow vision. Which of the following nursing actions is a priority?

Accepted Answer

The priority action by the nurse is to check the serum digoxin level. The nurse should be able to check the morning results of the digoxin level of the patient. The complaints of the patient are similar to digitalis toxicity. The digoxin must be withheld until the level is known.

Question 6

Which of the following statements does not abide by the nurses' code of ethics?

Accepted Answer

"The nurse is not supposed to collaborate with other healthcare professional while caring for patients" does not abide by nurses code of ethics.
Code of ethics for nurses includes 9 key points:
1.Nurses should practice medicine with compassion and respect for the patient and should not be biased in their treatment approach. They should not be restrictive in their care due to social or economic status, personal attributes, or the nature of the health issues.
2.The nurse's main commitment is to the patient.
3.The nurse is an advocate for the patient and aims to protect the health, safety, and rights of the patient.
4.The nurse delegates care of the patient and makes sure to provide optimum patient care.
5.The nurse is responsible for preserving the integrity and safety of the patient.
6.The nurse should aim to maintain and improve the healthcare environment to administer optimum care consistent with the profession.
7.The nurse participates in the advancement of the profession through contributions to practice and education to meet health needs.
8.The nurse should collaborate effectively with other healthcare professional to provide optimum care.
9.The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy.

Question 7

Which of the following models of team effectiveness views the team as components of a whole?

Accepted Answer

The traditional model of team effectiveness views the team as components of a whole. The components include team building processes and team effectiveness. The cognitive motivational model of team effectiveness views the team as a series of interdependent variables such as assumptions, team causes, team processes, team effectiveness, and team building.

Question 8

A patient is scheduled to undergo cardiac catheterization. He says to the nurse: "I am so afraid of the outcome of this surgery." What is the best response of the nurse?

Accepted Answer

The best response of the nurse is to ask the patient "tell me what concerns you have on this surgery". The nurse must assess the feelings of the patient regarding the impending surgery. Asking the concerns of patient about the surgery will generate a response that will assist the patient in exploring her feelings with the surgery.

Question 9

A nurse is caring for a patient on digoxin therapy. It is the responsibility of the nurse to know the signs and symptoms of digoxin toxicity. Which of the following is correct?

Accepted Answer

"Halo effect on vision, ventricular bigeminy, PVC, anorexia" are the correct signs and symptoms of digoxin toxicity. Signs and symptoms of digoxin toxicity include anorexia, bradycardia, halo effect on vision, nausea, vomiting, paroxysmal atrial tachycardia, premature ventricular contractions and ventricular bigeminy.

Question 10

Cardioversion is an electrical current administration used to convert certain dysrhythmias to normal rhythm. This procedure is most effective when the patient demonstrates:

Accepted Answer

Cardioversion is most effective when the patient is having ventricular tachycardia. Cardioversion is a procedure that involves administration of precordial shock, which is synchronized with the R wave to interrupt an abnormally fast heart rate or cardiac arrhythmia. It is used for atrial fibrillation, ventricular tachycardia and paroxysmal atrial tachycardia when all pharmaceutical interventions fail.

Question 11

A patient arrives in the ER and was diagnosed with angina pectoris. After taking 2 sublingual nitroglycerin tablets for chest pain, the patient states that the chest pain is relieved but he is now complaining of headache. The nurse should inform the patient that:

Accepted Answer

The nurse should inform the patient that headache is an expected side effect of the medication. The nurse must realize that headache is a major side effect of nitroglycerin due to the vasodilating action of this drug. As the patient becomes accustomed to this medication, headaches are usually diminished.

Question 12

Graham Steell murmur is heard in which of the valvular diseases?

Accepted Answer

Graham Steell murmur is heard in pulmonary regurgitation. Graham Steell murmur is a high pitched early diastolic murmur heard best at the left sterna edge in the 2nd and 3rd left intercostals space in full inspiration.

Question 13

Which of the following criteria is not used to diagnose Buerger's disease?

Accepted Answer

Pain in muscles on walking is not a criterion for diagnosis of Buerger's disease. The most commonly used criteria used for the diagnosis of Buerger's disease: individuals younger than 45 years of age, past or present tobacco use, presence of distal extremity ischemia (ischemic ulcers and gangrene), exclusion of autoimmune disorders, and consistent angiographic findings in extremities.

Question 14

A 72-year old male patient has been diagnosed to have peripheral arterial disease. What are the contraindications of percutaneous transluminal angioplasty of the lower extremity in this patient?

Accepted Answer

Contraindications of percutaneous transluminal angioplasty of the lower extremity are:
•Medically unstable patients
•Patients having long arterial occlusions
•Patients having poor distal run off
•Diabetic patients

Question 15

Which of the following approaches are not used for reducing triglyceride levels?

Accepted Answer

Antiplatelets are not used for reducing triglyceride levels. The approaches demonstrated to be effective in lowering triglyceride levels includes fibrates, statins, nicotinic acid, and omega-3 fatty acids.

Question 16

A patient with atrial fibrillation is presents with acute pain in left lower limb which progressed to loss of sensation and feeling of cold and numbness over few hours. What is the first treatment the nurse should start?

Accepted Answer

The first treatment the nurse should start is immediate heparinization with 5000 IU bolus and continuous infusion to maintain PTT > 60. The symptoms of this patient are highly suggestive of acute arterial occlusion.
Management of acute arterial occlusion:
•Immediate heparinization at 5000 IU bolus and continuous infusion to maintain PTT > 60
•In the absence of power and sensation - need emergent re-vascularization: for embolus - embolectomy; (ii) for thrombus - bypass
•In the presence of power and sensation - need work-up - including angiogram: for embolus - embolectomy; (ii) for thrombus - bypass
•Embolectomy: Fogarty catheter tied to fish embolus out of artery
•Bypass: bypass occlusion allowing blood flow to resume to distal site
•Identify and treat underlying cause
•Continue heparin post-op, start warfarin post-op day 1 for 3 months
•Re-perfusion phenomenon
•Toxic metabolites from ischemic muscle --> renal failure and multi-organ system failure

Question 17

Pericardial fluid has been aspirated and examined from a patient presenting with pericardial effusion. The fluid examination report shows a transudative fluid. Which of the following is unlikely to be the cause of this pericardial effusion?

Accepted Answer

Aortic dissection is unlikely to be the cause of transudative pericardial fluid.
There are two types of effusions:
•Transudative (serous): CHF, hypoalbuminemia/hypoproteinemia, hypothyroidism
•Exudative (serosanguinous or bloody): Causes similar to the causes of acute pericarditis, may develop acute effusion secondary to hemopericardium (trauma, post MI myocardial rupture, aortic dissection)

Question 18

Holter monitoring of a 65-year old female patient having cervical carcinoma stage 3 shows ventricular tachycardia resulting in syncope. The condition is treatable by implantable cardio-defibrillator. Which of the following is a contraindication of use of ICD in this patient?

Accepted Answer

Cervical carcinoma stage 3 is a contraindication of use of ICD in this patient. Contraindications associated with implantable cardiac defibrillators include myocardial ischemia, electrolyte abnormalities, terminal illness with short life expectancy, and ventricular tachycardia or ventricular fibrillation due to dysrhythmia.

Question 19

Which of the following is a correctly matched correlation of jugular venous pulse?

Accepted Answer

The correct match is loss of "a" wave: atrial fibrillation.
Pathological waveforms of JVP:
•Loss of "a" wave: A fib, atrial standstill
•Absent venous pulse: RHF/CHF, SVC obstruction, cardiac tamponade
•Giant "a" waves: contraction of atrium against increased resistance (RVH, PS, TS, pulmonary HTN)
•Cannon "a" waves: contraction of atrium against closed TV as in AV dissociation (AV dissociation, PVC)
•Systolic venous pulsation (c-v waves): regurgitation of blood into venous system with ventricular contraction as in TR (rapid "y")
•Sharp "y" descent: increased venous pressure as in constrictive pericarditis ("y">"x" phenomenon)

Question 20

A 65-year hypertensive non-smoker male patient has an abnormal lipid profile. What lifestyle modification should the nurse advise to this patient?

Accepted Answer

The nurse should advise physical exercise, healthy diet, control of blood pressure as lifestyle modifications. Lifestyle modification for a patient of atherosclerotic disease include physical exercise, healthy diet, dietary supplementation, smoking cession and treatment of comorbid conditions like diabetes and hypertension.

Quiz 3: AACN Cardiac Vascular Nursing