Deck 1: Cardiovascular

Question 1

A client with acute pulmonary edema secondary to congestive heart failure has continuous monitoring of ventral venous pressure (CVP). Which of the following conditions indicates that the client's treatment regimen is effective?

A)Central venous pressure increases
B)Central venous pressure decreases
C)There is no change in the central venous pressure
D)Central venous pressure is not a useful indicator for this client

Answer 1

Central venous pressure decreases

Question 2

A patient has been prescribed sublingual nitroglycerine for the treatment of angina pectoris. What response from the client indicates that he understands a key trait of this medication?

A)"Will the physician give me a year's supply of nitroglycerine tablets?"
B)"I will carry my nitroglycerine tablets in the inside pocket of my jacket so they are always close."
C)"I usually take three of my nitroglycerine tablets at the same time. I find that they work better that way."
D)"I have a small labeled case for a few nitroglycerine tablets that I carry with me when I go out."
E)None of the above

Answer 2

"I have a small labeled case for a few nitroglycerine tablets that I carry with me when I go out."

Question 3

Snider, a 53-year-old Gulf veteran, underwent a percutaneous transluminal coronary angioplasty (PTCA). Four hours after the procedure, the nurse reviewed his chart and noticed no vital signs and no change in the catheter was initiated since his return. The nurse obtains a 12-lead ECG and notes that the client has ST depressions. Mr. Snider denies any chest pain. Which of the following is the next action that the nurse should take?

A)Notify the physician
B)Continue to assess the client for chest pain
C)Administer nitroglycerine
D)Apply pressure to the catheter site

Answer 3

Notify the physician

Question 4

A hospitalized client has continuous ECG monitoring and the monitor shows that the rhythm has changed to ventricular tachycardia. Which of the following is the first action that the nurse should take?

A)Administer intravenous lidocaine according to emergency protocol
B)Obtain the defibrillator and defibrillate the client
C)Quickly assess the client's level of consciousness, blood pressure, and pulse
D)Administer a precordial thump

Question 5

The physician has diagnosed a myocardial infarction on the basis of ECG changes for Mr. Montgomery, a 67-year-old retired College professor, who was rushed to the Emergency Department after collapsing in his front yard. The nurse is assessing Mr. Montgomery frequently and notes that he seems forgetful, making the nurse repeat the explanations about the ECG and non-invasive blood pressure monitors. The nurse concludes that Mr. Montgomery's response is most likely due to which of the following reasons?

A)Mr. Montgomery is showing signs of Alzheimer's disease
B)Mr. Montgomery is showing signs of fear and anxiety
C)Nurses in the Emergency Department are too busy to properly explain the purpose of the equipment
D)Memory lapses are common with clients experiencing myocardial infarction

Question 6

Jenkins, 38 years old, is admitted to the Cardiac Care Unit due to complications of congestive heart failure. To evaluate the client's cardiac status, the doctor orders cardiac catheterization. The nurse reviews Mrs. Jenkins' chart following the procedure and notes the ejection fraction is 0.3 or 30% of normal. The nurse would expect the plan of care to focus on:

A)Management of pain from angina episodes
B)Inability to perform self-care caused by fatigue
C)Impaired motor and sensory function in extremities
D)Reducing risk of stroke (brain attack) from hypertension

Question 7

Which client is at greatest risk for developing hypertension?

A)Mr. Lincoln, a 52-year-old Caucasian with a family history of hypertension and heart disease
B)Mrs. Franklin, a 50-year-old African-American who is 24 pounds overweight
C)Mr. Bush, a 52-year-old African-American who smokes cigarettes
D)Mr. Carter, a 67-year-old Caucasian with diabetes

Question 8

The nurse is developing a plan for Mrs. Ramos, a 38-year-old housewife, who is going home with a new diagnosis of heart failure. The nurse is teaching Mrs. Ramos to monitor fluid status. Which of the following is the best instruction?

A)Restrict fluid intake to 800ml per day
B)Increase the dose of diuretics if there is decreased urination
C)Record body weight every day before breakfast and report a weight gain of 3 or more pounds in a week
D)Keep track of daily output and call the doctor for if it is less than 1 liter on any day

Question 9

Ambrose, 41 years old, has a blood pressure of 170/96 after 6 months of intensive exercise and diet modifications, which his doctor prescribed for him. The nurse advises him:

A)To continue current treatment plan, as blood pressure is being adequately controlled.
B)To discontinue current treatment plan, as it has not been effective and medications will be required.
C)To increase his exercise by two-fold and continue dietary modifications to attempt to lower blood pressure further.
D)That medication therapy will likely need to be started along with exercise and diet program.

Question 10

Jon Stark has been diagnosed with coronary artery disease. His physician requires him to have a low-fat, low-cholesterol diet. The nurse knows that Mr. Stark understands the diet plan if which entrée is selected?

A)Fried cod
B)Grilled chicken breast
C)Pasta with cream sauce
D)Broiled T-bone steak

Question 11

Which intervention would be appropriate for the nurse to include when discussing foot care with a client with peripheral vascular disease? Select all that apply.

A)Dry the feet thoroughly after bathing
B)Cut off all corns and calluses
C)Educate the patient to break in new footwear to prevent tissue injury
D)Sit with the legs crossed to decrease swelling
E)Use constrictive clothing on the feet and ankles

Question 12

The nurse is providing discharge teaching for a client's family member on the administration of enoxaparin (Lovenox). Which action by the family member would indicate an understanding of the administration procedure for the drug?

A)An 18-gauge, 1½-inch needle is selected for injection
B)The family member administers the medication subcutaneously
C)The family member aspirates for blood return after the needle is inserted in the muscle
D)The same administration site is used for every injection

Question 13

A man came in to the Emergency Department and says that he's having a severe headache. A blood pressure of 230/150 mmHg is found when the nurse obtained his vital signs. The patient is given nitroprusside (Nipride). What is the desired action of this drug?

A)It relaxes the smooth muscles of the arterioles and veins.
B)It reduces blood volume.
C)It blocks the action of angiotensin II.
D)It blocks the action of aldosterone on the kidneys.

Question 14

Turner, 50-year-old journalist with acute heart failure, is receiving digoxin and furosemide. What is the best indicator that this regimen is effective in removing excess fluid?

A)Decreased weight
B)Therapeutic digoxin level
C)Decreased swelling in the ankles
D)Pulse rate decreases to 84

Question 15

The nurse notes that Shelly's ECG has a rate of 78 bpm, normal P waves that precede each QRS complex, PR intervals of 0.16 seconds, and a regular pattern of shortening and lengthening of P-P and R-R intervals. The nurse should:

A)Notify the physician STAT.
B)Call for a STAT 12-lead ECG.
C)Prepare the client for cardiac catheterization.
D)Document the client as having sinus arrhythmia.

Question 16

Eliot James, a 51-year-old truck driver, was admitted in the Cardiac Care Unit for an anterior Myocardial Infarction. On the third of hospitalization, Mr. James becomes increasingly restless. Pulse rate has increased to 126 beats per minute. The first nursing action is to:

A)Do a partial physical assessment, which includes vital signs, pulmonary auscultation, and cognitive functions.
B)Ask if the client is upset, because depression is common on the third day of hospitalization.
C)Re-administer oxygen per nasal catheter (prongs or tongs) at 6 liters, because restlessness is an early sign of cerebral hypoxia.
D)Decrease the rate of intravenous infusion to prevent fluid volume overload.

Question 17

Toby Hogan, 34-year-old editor, was recently diagnosed with subacute bacterial endocarditis (SBE). The nurse determines that the client understands the discharge teaching when he does which of the following?

A)Asks for a referral to a dietician for a low-sodium diet
B)Explains to his wife why he needs antibiotics before seeing the dentist
C)Asks when he can start to take his antibiotics in pill form
D)Explains his plans to quit smoking

Question 18

The nurse is monitoring a client who has recently undergone pericardiocentesis. The nurse suspects cardiac tamponade after observing which of the following?

A)A rapid increase in blood pressure and flushing
B)Jugular vein distention (JVD) and narrowing pulse pressure
C)Bradycardia and bilateral crackles
D)Louder and harsher heart sounds

Question 19

The nurse is conducting an assessment on Mr. See, a 50-year-old Chinese man, who is a cashier at a local store. Mr. See acknowledged that because of his work, he often stands 6 to 8 hours at a time. The nurse should inspect Mr. See for:

A)Capillary dysfunction
B)Buerger's disease
C)Varicosities
D)Aneurysms

Question 20

Atkins, 33 years old, arrived at the unit for her cardiac stress test. Ms. Atkins reports that no breakfast was delivered this morning and she is hungry. Which of the following is the nurse's best action?

A)Bring the client coffee and toast
B)Explain that a client should have no food the morning of a cardiac stress test
C)Call the nutrition department and get the client's regular full breakfast
D)Have the nursing assistant get the client cereal with milk and orange juice

Question 21

J. Andrews is admitted with angina pectoris and was ruled out for a myocardial infarction. The nurse reviews her laboratory results and plans to include dietary teaching after noting that Ms. Andrews's lipid profile shows which of the following sets of values?

A)Cholesterol: 180, HDL: 40, triglycerides: 220
B)Cholesterol: 190, HDL: 40, triglycerides: 160
C)Cholesterol: 120, HDL: 25, triglycerides: 220
D)Cholesterol: 220, HDL: 40, triglycerides: 190

Question 22

Rodrick Simpson a.k.a. "Crook", a 35-year-old gangster, was knifed in a street fight. He was admitted through the Emergency Department and is now in the ICU. An assessment of his condition reveals the following: respirations shallow and rapid, paradoxical pulse, CVP 15 cm H2O, BP 90mmHg systolic, skin cold and pale, and urinary output 60-100mL.hr for the last 2 hours. Analyzing these findings, the nurse will base a nursing diagnosis on the conclusion that the client has which one of the following conditions?

A)Hypovolemic shock
B)Cardiac tamponade
C)Wound dehiscence
D)Atelectasis

Question 23

A 45-year-old client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:

A)Decreased arterial blood flow secondary to vasoconstriction
B)Decreased arterial blood flow leading to hyperemia
C)Atherosclerotic obstruction of arteries
D)Trauma to the lower extremities

Question 24

GB is diagnosed with thromboangiitis obliterans (Buerger's disease). As a nurse caring for her, it is essential for you to teach modifications to which risk factor of the disease?

A)Familial tendency
B)Cigarette smoking
C)Excessive stress
D)Diet low in vitamin C and iron

Question 25

Arnold Swanson, a 54-year-old janitor of Middletown High School, suddenly felt a crushing chest pain while doing his early chores one morning. He called for his neighbor to drive him to the nearest hospital. Upon arrival in the Emergency Department, the doctor ordered for a 12-lead ECG to determine a possible myocardial infarction. The nurse would know that an early finding in the ECG of a client with an infarcted myocardium would be:

A)Disappearance of QRS complex
B)Elevated ST segments
C)Absence of P wave
D)Flattened T waves

Question 26

Arnold Swanson, who had a myocardial infarction 2 days ago, has been complaining to the nurse about issues related to his hospital stay. The best initial nursing response would be to:

A)Allow him to release his feelings and then leave him alone to allow him to regain his composure.
B)Refocus the conversation on his fears, frustrations, and anger about his condition.
C)Explain how his being upset dangerously disturbs his need for rest.
D)Attempt to explain the purpose of different hospital routines.

Question 27

Thrombus formation is a danger for all postoperative clients. The nurse should act independently to prevent this complication by:

A)Encouraging adequate fluids
B)Applying elastic stockings
C)Gently massaging the legs with lotion
D)Performing active-assistive leg exercises

Question 28

Josef Braga was ordered Digoxin 0.25 mg. OD. The nurse should include in her teaching plan how this drug affects Mr. Braga's condition. Which statement is poor knowledge regarding this drug?

A)It has positive inotropic and negative chronotropic effects.
B)The positive inotropic effect will decrease urine output.
C)Toxicity can occur more easily in the presence of hypokalemia, liver, and renal problems.
D)Do not give the drug if the apical rate is less than 60 beats per minute.

Question 29

The nurse is teaching the client regarding his permanent artificial pacemaker. The nurse needs to enhance the client's understanding regarding the artificial pacemaker if he/she states:

A)"I will take my pulse rate once a day, in the morning upon awakening."
B)"I may be allowed to use electrical appliances."
C)"I have to observe regular follow up care."
D)"I may engage in contact sports."
E)Any of the above

Question 30

A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the nurse include in the explanation to the client?

A)It dissolves existing thrombi.
B)It prevents the conversion of factors that are needed in the formation of clots.
C)It inactivates thrombin that forms and dissolves existing thrombi.
D)It interferes with vitamin K absorption.

Question 31

A female patient undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives at the recovery room, she is still in shock. The nurse's priority should be:

A)Placing her in Trendelenburg position
B)Putting several warm blankets on her
C)Monitoring her hourly urine output
D)Assessing her VS, especially her RR

Question 32

The nurse is teaching a group of call center agents about deep vein thrombosis. She includes in her teaching plan the factors that usually cause deep vein thrombosis (DVT) which includes:

A)Aerobic exercise
B)Inactivity
C)Pregnancy
D)Tight clothing