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

Accepted Answer

Decreased central venous pressure indicates decreased fluid in the vascular space, one of the goals of treatment for this client. Choice A is incorrect because increased central venous pressure indicates increased fluid in the vascular space, which is not a desired goal. Choice C is incorrect because no change in central venous pressure indicates no change in the vascular fluid volume. Choice D is incorrect because central venous pressure is an accepted indicator of vascular fluid status.

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

Accepted Answer

"I have a small labeled case for a few nitroglycerine tablets that I carry with me when I go out." Nitroglycerine loses potency over time when exposed to light and heat. The tablets should be kept cool, dry, and in a dark container. Clients should get a new bottle every 6 months and store it in a cool place; tablets should be taken 5 minutes apart, taking more than one tablet at a time can actually decrease the effectiveness of the drug and may cause severe hypotension.

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

Accepted Answer

The physician should be notified immediately because ST depressions are a sign of ischemia. This is the best first action, after which the nurse should continue to assess the client for chest pain (Choice B). Choice C is not an appropriate nursing action. There is no sign of bleeding at the site; therefore, there is no indication to apply pressure (Choice D).

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

Accepted Answer

The best first action is to assess the client's level of consciousness and assess if the ventricular tachycardia is perfusing the body (BP, pulse). With pulseless ventricular tachycardia, immediate defibrillation (Choice B) is performed by an ACLS certified nurse. If the client has good BP and pulse, is awake, and is alert, the nurse may administer lidocaine as prescribed (Choice A) or in some cases, administer a precordial thump (Choice D).

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

Accepted Answer

Anxiety and fear are common responses to a diagnosis of myocardial infarction because of the possibility of death. This prevents the client and family from absorbing detailed explanations about the care being provided. Memory lapses are not a common symptom of myocardial infarction (Choice D) and there is not adequate information to determine that this memory lapse is associated with Alzheimer's disease (Choice A). Nurses in the Emergency Department are able to explain procedures well to their clients (Choice C).

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

Accepted Answer

The cardiac output is significantly reduced and perfusion will be impaired, leading to almost overwhelming fatigue. Choice A is incorrect because the ejection fraction is measuring cardiac output, not coronary artery disease. Systemic perfusion will be compromised and the client will experience extreme fatigue. Choice C is incorrect because the problem is not neurological. Choice D is incorrect because the client's blood pressure will be low, not high.

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

Accepted Answer

African-American men are at greatest risk of developing hypertension; and this client is a smoker, which is a considered a major risk factor. While all the other clients have contributing factors to hypertension, smoking is still considered the major risk factor for hypertension.

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

Accepted Answer

Daily weight is the most sensitive indicator of changes in fluid status. It is more accurate for a client at home than urine output. Fluid restriction may be recommended for a client with advanced heart failure, but it is not a method of monitoring fluid status. The client should never adjust the dose of his or her medications.

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.

Accepted Answer

Blood pressure should be consistently below 140/90. Lifestyle modification should be used in all hypertensive clients with or without medication therapy.

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

Accepted Answer

A reduction in intake of fat and cholesterol can reduce a person's risk of cardiovascular disease. The client should consider both the type of food consumed and the method of preparation. Grilled chicken would be the best selection for a patient on a low-fat, low-cholesterol diet.

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

Accepted Answer

The goal of foot care in a patient with peripheral vascular disease is to maintain and promote tissue integrity. Prevention of tissue damage acts to prevent potential complications such as ulceration, infection, and gangrene. Interventions that will facilitate maintenance of tissue integrity include washing the feet with mild soap and warm water thoroughly after bathing and breaking in new footwear.

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

Accepted Answer

Lovenox is an anticoagulant medication that is administered via the subcutaneous route. The medication is injected at the anterior lateral abdominal wall (ALAW), usually once or twice a day, or as directed by the physician. The administration site is changed for every injection, between right and left ALAW, to prevent bruising and bleeding.

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.

Accepted Answer

Nitroprusside is often the first-line medication used to manage hypertensive emergencies. This drug is administered by continuous intravenous infusion and is rapid acting. By relaxing the smooth muscles of the arterioles and veins, nitroprusside promotes vasodilation and reduces blood pressure.

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

Accepted Answer

Daily weight more rapidly reflects changes in fluid status. Choice B is incorrect because effectiveness of any therapy requires that the client be clinically assessed, in addition to reviewing lab values. Choice C is incorrect because swelling may take some time to dissipate even after the client's vascular volume is stabilized. Choice D is incorrect because decreased pulse rate may occur for several reasons, not necessarily because the heart failure is being managed effectively.

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.

Accepted Answer

The characteristics described are consistent with sinus arrhythmia, a common and non-life-threatening arrhythmia. There is no emergency in this situation (Choices A and B). The characteristics described are consistent with a sinus arrhythmia. In addition, the characteristics described do not warrant cardiac catheterization (Choice C).

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.

Accepted Answer

An early indication of cardiac decompression is tachycardia. Therefore, the client's vital signs, mentation, and pulmonary status should be assessed to rule out this complication of myocardial infarction. Other causes of tachycardia are hypovolemia, anxiety, and pain. Assessment of pain and emotional status can be determined during cognitive assessment. Choices B, C, and D are incorrect because actions such as encouraging verbalization of feelings, administering oxygen, and decreasing the rate of intravenous infusion will be determined by the nurse's assessment of vital signs.

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

Accepted Answer

Once a client is diagnosed with SBE, he or she is at risk for repeated episodes. Taking prophylactic antibiotics prior to dental care is an important activity to prevent further infections. There is no routine sodium restriction with SBE (Choice A). Antibiotic treatment for SBE is given by the IV route for the entire course (Choice C). Although stopping smoking will decrease his risk factor for coronary artery disease, it does not affect the SBE (Choice D).

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

Accepted Answer

When cardiac tamponade occurs, the restriction reduces stroke volume, cardiac output, and blood pressure. The right atrium is restricted, causing JVD and increasing pressure during diastole. While the decreased stroke volume decreases the volume during systole, the client compensates for decreased stroke volume and cardiac output by increasing heart rate. Because of decreased filling pressure, cardiac output drops and blood pumped from the right heart is reduced. Lung sounds are usually clear; heart sounds become more distant and muffled because they are heard through the fluid collection in the pericardium.

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

Accepted Answer

50 percent of people over the age of 50 develop varicose veins and a major risk factor is standing for long periods of time at work. The other responses do not address this concern.

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

Accepted Answer

The client should have a light meal with no caffeine before a cardiac stress test. Choices A, B, and C are incorrect because they do not follow the guideline.

Quiz 1: Cardiovascular

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 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 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?

Which client is at greatest risk for developing hypertension?

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?

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:

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?

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.

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 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?

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?

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:

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:

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?

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

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:

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?