ADULT HEALTH: CARDIOVASCULAR

1. A nurse is eating in a restaurant when a woman who is 8 months pregnant at the

next table begins to choke. Which hand placement should the nurse use to
perform the Heimlich maneuver?
A. Midsternum
Midway between the umbilicus and the xiphoid process is the abdomen,
which is contraindicated in the pregnant client.
B. Lower sternum
C. Midway between umbilicus and xiphoid process
D. Midway between umbilicus and symphysis pubis
2. The nurse is caring for a client on the third postoperative day after coronary
artery bypass (CAB) surgery. Because an important nursing diagnosis for postCABG clients is Ineffective Breathing Pattern, what is the best plan by the nurse?
A. Ensure that the client performs deep breathing and vigorous coughing every
hour
B. Ensure that the client uses the incentive spirometer every hour
Vigorous coughing is discouraged for post-CABG clients because it can
increase intrathoracic pressure and cause instability in the sternal area.
Incentive spirometry and deep breathing are the preferred techniques for
lung expansion with these clients. Premedication before ambulation will
facilitate activity tolerance; auscultating the lungs will detect adventitious
lung sounds resulting from the ineffective breathing pattern, but it is not an
action to encourage effective breathing patterns.
C. Premedicate the client before ambulation
D. Auscultate the lungs once a shift
3. The nurse explains that an older adult client with decreased total body water
may react differently to antihypertensive drugs for which reason?
A. Drug distribution is changed by plasma volume, extracellular fluid
volume, and serum protein levels.
Drug distribution is determined by the adequacy of the plasma volume, the
extracellular fluid volume, and the serum protein levels.
B. Liver and renal functions have little to no influence on the drugs distribution.
C. Decreased peripheral resistance occurs when body fluid decreases.
D. Intestinal absorption of the antihypertensive drug is accelerated.
4. The nurse is teaching a newly diagnosed client with hypertension about her
medications. The client has a history of chronic obstructive pulmonary disease
(COPD). The nurse informs the client that she should avoid which
antihypertensive medication?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Calcium channel blockers
C. Diuretics
D. Beta blockers
Calcium channel blockers pose no specific concern for a client with COPD.
5. When teaching a client with an aneurysm about signs and symptoms that may
indicate impending rupture, the nurse first considers which of the following?

A.
B.
C.
D.

Medication therapy the client is receiving

Clients usual blood pressure
Age and gender of the client
Size and location of the aneurysm
Aneurysms vary by size and location. Signs of rupture depend on the location
of the aneurysm. Dissection can occur anywhere but most often occurs in the
ascending aorta were pressure is the highest.

6. A client is taking lovastatin (Mevacor) for treatment of high cholesterol levels. In

conducting medication teaching, the nurse explains that this medication works
because it is what type of drug?
A. A bile-acid resin
B. A hormone
C. Fibric acid derivative
D. Lipid-lowering
Mevacor belongs to a group of drugs classified as statins. They work by
inhibiting cholesterol synthesis in the liver. Bile-acid resins and fibric acid
derivatives also work to decrease cholesterol levels, but they work at
different sites (options A and C). Bile-acid resins work in the gastrointestinal
tract, and bind bile salts in the intestine. Fibric acid derivatives work on
lipoproteins and triglycerides to reduce cholesterol. Mevacor is not a hormone
(option B).
7. Effective teaching for a client with Raynauds disease is evident when the client
says he will do which of the following?
A. Decrease my smoking to six cigarettes per day.
B. Try to learn to relax, but I cant promise anything.
C. Wear gloves and socks to bed at night.
Diet is not associated with Raynauds disease.
D. Try to eat a healthier diet.
8. Evidence that the outcome of increased arterial blood supply to the extremity
has been met in a client with peripheral arterial disease includes which of the
following?
A. Reduced muscle pain
Pain of arterial occlusive disease is related to interrupted blood flow, which
causes tissue hypoxia. An increase in blood supply, then, should reduce the
clients ischemic pain. The other options list additional manifestations of
peripheral arterial disease.
B. Reduced sensation to touch
C. Increased rubor
D. Decreased hair on the extremity
9. In congestive heart failure (CHF), the goal is to decrease workload, increase
contractility, and decrease afterload. Which of the following is the best definition
of afterload?
A. The volume of blood remaining in the left ventricle after systole
B. The impedance to ejection of blood from the left ventricle

Afterload is the force or resistance that the left ventricle must pump against
the impedance to the flow of the blood. By decreasing afterload in CHF, a
pump that is already inefficient has to work less to be effective.
C. The amount of force of ventricular contraction
D. The measurement of left ventricular end-diastolic pressure
10.The client has S-T segment depression on his 12-lead electrocardiogram (ECG).
The nurse determines that this would be indicative of which of the following?
A. Necrosis
B. Injury
C. Ischemia
Depressed S-T segments and inverted T waves represent myocardial
ischemia. Injury usually has an S-T segment elevation.
D. Nothing significant
11.A client with hypertension has a blood pressure of 170/96 after six months of
intensive exercise and diet modifications. The nurse advises the client to do
which of the following?
A. To continue the current treatment plan, as his blood pressure is being
adequately controlled.
B. To discontinue the current treatment plan, as it has not been effective, and
medications will be required.
C. To increase his exercise twofold and continue dietary modifications to attempt
to lower blood pressure further.
D. That medication therapy likely will need to be started along with the
exercise and diet program.
Blood pressure should be consistently below 140/90. Lifestyle modification
must be used in all hypertensive clients, with or without medication therapy.
12.An adult client arrives at the emergency department reporting chest pain and
shortness of breath. The nurse concludes that which item, if present in the
clients history, could indicate the pain may be related to cardiac disease? Select
all that apply.
A. History of diabetes and smoking
B. Recent travel out of the country
C. The pain increases with activity
D. The pain is reproducible when taking a deep breath
E. The client is experiencing sweating and nauseas when the pain is
severe
Knowledge of the cardiovascular disease risk factors and associated
symptoms can assist in determining the origin of chest pain and direct the
nurse to prioritize and implement appropriate care. Diabetes, smoking, and
hypertension are known modifiable risk factors to cardiac disease.
Travel out of the country is an unrelated factor.
Chest pain that occurs during activity may indicate cardiac ischemia due to
the increased oxygen demand.
Chest pain that increases with breathing, especially taking a deep breathe, is
most likely pleuritic pain.
Associated symptoms of nausea and diaphoresis are known warning signs of
cardiac ischemia.

13.The community health nurse visits a client at home. Amiodarone (Cordarone) has
been prescribed for the client. The nurse teaches the client about the
medication. Which of the following statements by the client indicates that further
teaching is necessary?
A. I will notify my doctor if I dont feel better in a couple of days.
Amiodarone (Cordarone) is a class III antiarrhythmic medication, and will
probably not demonstrate therapeutic effects for 1-3 weeks. This medication
can cause fatigue, cough, and pleuritic pain. The client must wear dark
glasses and avoid exposure to the sunlight. The medication is given with food
to avoid gastroenteritis distress.
B. Ill report any tiredness, coughing, or chest pain to my doctor.
C. Ill be careful to use dark glasses, and to avoid skin exposure to the sun.
D. Ill take this medication with food.
14.A 54-year-old male client recently was 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.
Once a client is diagnosed with SBE, he is at risk for repeated episodes.
Taking prophylactic antibiotics prior to dental care is an important activity to
prevent further infections.
C. Asks when he can start to take his antibiotics in pill form.
D. Explains his plans to quit smoking.
15.