Onco Midterm Reviewer

NCLEX coronary artery disease
1. A client is scheduled for a cardiac catheterization using a radiopaque

dye. Which of the following assessments is most critical before the
procedure?
1. Intake and output
2. Baseline peripheral pulse rates
3. Height and weight
4. Allergy to iodine or shellfish
2. A client with no history of cardiovascular disease comes into the
ambulatory clinic with flu-like symptoms. The client suddenly complains
of chest pain. Which of the following questions would best help a nurse
to discriminate pain caused by a non-cardiac problem?
1. Have you ever had this pain before?
2. Can you describe the pain to me?
3. Does the pain get worse when you breathe in?
4. Can you rate the pain on a scale of 1-10, with 10 being the worst?
3. A client with myocardial infarction has been transferred from a
coronary care unit to a general medical unit with cardiac monitoring via
telemetry. A nurse plans to allow for which of the following client
activities?
1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances under 200 feet
4. Ad lib activities because the client is monitored.
4. A nurse notes 2+ bilateral edema in the lower extremities of a client
with myocardial infarction who was admitted 2 days ago. The nurse
would plan to do which of the following next?
1. Review the intake and output records for the last 2 days
2. Change the time of diuretic administration from morning to evening
3. Request a sodium restriction of 1 g/day from the physician.
4. Order daily weights starting the following morning.
5. A client is wearing a continuous cardiac monitor, which begins to
sound its alarm. A nurse sees no electrocardiogram complexes on the
screen. The first action of the nurse is to:
1. Check the client status and lead placement
2. Press the recorder button on the electrocardiogram console.
3. Call the physician
4. Call a code blue
6. A nurse is assessing the blood pressure of a client diagnosed with
primary hypertension. The nurse ensures accurate measurement by
avoiding which of the following?
1. Seating the client with arm bared, supported, and at heart level.
2. Measuring the blood pressure after the client has been seated quietly for 5
minutes.
3. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
7. IV heparin therapy is ordered for a client. While implementing this
order, a nurse ensures that which of the following medications is
available on the nursing unit?
1. Vitamin K
2. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate
8. A client is at risk for pulmonary embolism and is on anticoagulant
therapy with warfarin (Coumadin). The clients prothrombin time is 20
seconds, with a control of 11 seconds. The nurse assesses that this result
is:
1. The same as the clients own baseline level
2. Lower than the needed therapeutic level
3. Within the therapeutic range
4. Higher than the therapeutic range
9. A client who has been receiving heparin therapy also is started on
warfarin. The client asks a nurse why both medications are being
administered. In formulating a response, the nurse incorporates the
understanding that warfarin:
1. Stimulates the breakdown of specific clotting factors by the liver, and it takes
2-3 days for this to exert an anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days
for this medication to exert an anticoagulant effect.
3. Stimulates production of the bodys own thrombolytic substances, but it takes
2-4 days for this to begin.
4. Has the same mechanism of action as Heparin, and the crossover time is
needed for the serum level of warfarin to be therapeutic.
10. A 60-year-old male client comes into the emergency department with
complaints of crushing chest pain that radiates to his shoulder and left
arm. The admitting diagnosis is acute myocardial infarction. Immediate
admission orders include oxygen by NC at 4L/minute, blood work, chest
x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse
should first:
1. Administer the morphine
2. Obtain a 12-lead ECG
3. Obtain the lab work
4. Order the chest x-ray
11. When administered a thrombolytic drug to the client experiencing an
MI, the nurse explains to him that the purpose of this drug is to:
1. Help keep him well hydrated
2. Dissolve clots he may have
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias.
12. When interpreting an ECG, the nurse would keep in mind which of the
following about the P wave? Select all that apply.
1. Reflects electrical impulse beginning at the SA node
2. Indicated electrical impulse beginning at the AV node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has duration of normally 0.11 seconds or less.
13. A client has driven himself to the ER. He is 50 years old, has a history
of hypertension, and informs the nurse that his father died of a heart
attack at 60 years of age. The client is presently complaining of
indigestion. The nurse connects him to an ECG monitor and begins
administering oxygen at 2 L/minute per NC. The nurses next action
would be to:
1. Call for the doctor
2. Start an intravenous line
3. Obtain a portable chest radiograph
4. Draw blood for laboratory studies
14. The nurse receives emergency laboratory results for a client with
chest pain and immediately informs the physician. An increased
myoglobin level suggests which of the following?
1. Cancer
2. Hypertension
3. Liver disease
4. Myocardial infarction
15. When teaching a client about propranolol hydrochloride, the nurse
should base the information on the knowledge that propranolol
hydrochloride:
1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate,
myocardial contractility, and conduction.
2. Increases norepinephrine secretion and thus decreases blood pressure and
heart rate.
3. Is a potent arterial and venous vasodilator that reduces peripheral vascular
resistance and lowers blood pressure.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by
blocking the conversion of angiotensin I to angiotensin II.
16. The most important long-term goal for a client with hypertension
would be to:
1. Learn how to avoid stress
2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
4. Control high blood pressure
17. Hypertension is known as the silent killer. This phrase is associated
with the fact that hypertension often goes undetected until symptoms of
other system failures occur. This may occur in the form of:
1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction
4. Pulmonary disease
18. During the previous few months, a 56-year-old woman felt brief
twinges of chest pain while working in her garden and has had frequent
episodes of indigestion. She comes to the hospital after experiencing
severe anterior chest pain while raking leaves. Her evaluation confirms a
diagnosis of stable angina pectoris. After stabilization and treatment, the
client is discharged from the hospital. At her follow-up appointment, she
is discouraged because she is experiencing pain with increasing
frequency. She states that she is visiting an invalid friend twice a week
and now cannot walk up the second flight of steps to the friends
apartment without pain. Which of the following measures that the nurse
could suggest would most likely help the client deal with this problem?
1. Visit her friend earlier in the day.
2. Rest for at least an hour before climbing the stairs.
3. Take a nitroglycerin tablet before climbing the stairs.
4. Lie down once she reaches the friends apartment.
19. Which of the following symptoms should the nurse teach the client
with unstable angina to report immediately to her physician?
1. A change in the pattern of her pain
2. Pain during sex
3. Pain during an argument with her husband
4. Pain during or after an activity such as lawn mowing
20. The physician refers the client with unstable angina for a cardiac
catheterization. The nurse explains to the client that this procedure is
being used in this specific case to:
1. Open and dilate the blocked coronary arteries
2. Assess the extent of arterial blockage
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and heart muscle.
21. As an initial step in treating a client with angina, the physician
prescribes nitroglycerin tablets, 0.3mg given sublingually. This drugs
principal effects are produced by:
1. Antispasmodic effect on the pericardium
2. Causing an increased myocardial oxygen demand
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium
22. The nurse teaches the client with angina about the common expected
side effects of nitroglycerin, including:
1. Headache
2. High blood pressure
3. Shortness of breath
4. Stomach cramps
23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes.

How should the nurse instruct the client to use the drug when chest pain
occurs?
1. Take one tablet every 2 to 5 minutes until the pain stops.
2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after
10 minutes.
3. Take one tablet, then an additional tablet every 5 minutes for a total of 3
tablets. Call the physician if pain persists after three tablets.
4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still
persists 5 minutes later, call the physician.
24. Which of the following arteries primarily feeds the anterior wall of
the heart?
1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery
25. When do coronary arteries primarily receive blood flow?
1. During inspiration
2. During diastolic
3. During expiration
4. During systole
26. Prolonged occlusion of the right coronary artery produces an
infarction in which of the following areas of the heart?
1. Anterior
2. Apical
3. Inferior
4. Lateral
27. A murmur is heard at the second left intercostal space along the left
sternal border. Which valve is this?
1. Aortic
2. Mitral
3. Pulmonic
4. Tricuspid
28. Which of the following blood tests is most indicative of cardiac
damage?
1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)
29. Which of the following diagnostic tools is most commonly used to
determine the location of myocardial damage?
1. Cardiac catheterization
2. Cardiac enzymes
3. Echocardiogram
4. Electrocardiogram (ECG)
30. Which of the following types of pain is most characteristic of angina?

1. Knifelike
2. Sharp
3. Shooting
4. Tightness
31. Which of the following parameters is the major determinant of
diastolic blood pressure?
1. Baroreceptors
2. Cardiac output
3. Renal function
4. Vascular resistance
32. Which of the following factors can cause blood pressure to drop to
normal levels?
1. Kidneys excretion of sodium only
2. Kidneys retention of sodium and water
3. Kidneys excretion of sodium and water
4. Kidneys retention of sodium and excretion of water
33. Baroreceptors in the carotid artery walls and aorta respond to which
of the following conditions?
1. Changes in blood pressure
2. Changes in arterial oxygen tension
3. Changes in arterial carbon dioxide tension
4. Changes in heart rate
34. Which of the following terms describes the force against which the
ventricle must expel blood?
1. Afterload
2. Cardiac output
3. Overload
4. Preload
35. Which of the following terms is used to describe the amount of
stretch on the myocardium at the end of diastole?
1. Afterload
2. Cardiac index
3. Cardiac output
4. Preload
36. A 57-year-old client with a history of asthma is
prescribed propranolol (Inderal) to control hypertension.
Before administered propranolol, which of the following actions should
the nurse take first?
1. Monitor the apical pulse rate
2. Instruct the client to take medication with food
3. Question the physician about the order
4. Caution the client to rise slowly when standing.
37. One hour after administering IV furosemide (Lasix) to a client with
heart failure, a short burst of ventricular tachycardia appears on the
cardiac monitor. Which of the following electrolyte imbalances should the

nurse suspect?
1. Hypocalcemia
2. Hypermagnesemia
3. Hypokalemia
4. Hypernatremia
38. A client is receiving spironolactone to treat hypertension. Which of
the following instructions should the nurse provide?
1. Eat foods high in potassium.
2. Take daily potassium supplements.
3. Discontinue sodium restrictions.
4. Avoid salt substitutes.
39. When assessing an ECG, the nurse knows that the P-R interval
represents the time it takes for the:
1. Impulse to begin atrial contraction
2. Impulse to transverse the atria to the AV node
3. SA node to discharge the impulse to begin atrial depolarization
4. Impulse to travel to the ventricles
40. Following a treadmill test and cardiac catheterization, the client is
found to have coronary artery disease, which is inoperative. He is
referred to the cardiac rehabilitation unit. During his first visit to the unit
he says that he doesnt understand why he needs to be there because
there is nothing that can be done to make him better. The best nursing
response is:
1. Cardiac rehabilitation is not a cure but can help restore you to many of your
former activities.
2. Here we teach you to gradually change your lifestyle to accommodate your
heart disease.
3. You are probably right but we can gradually increase your activities so that
you can live a more active life.
4. Do you feel that you will have to make some changes in your life now?
41. To evaluate a clients condition following cardiac catheterization, the
nurse will palpate the pulse:
1. In all extremities
2. At the insertion site
3. Distal to the catheter insertion
4. Above the catheter insertion
42. A clients physician orders nuclear cardiography and makes an
appointment for a thallium scan. The purpose of injecting radioisotope
into the bloodstream is to detect:
1. Normal vs. abnormal tissue
2. Damage in areas of the heart
3. Ventricular function
4. Myocardial scarring and perfusion
43. A client enters the ER complaining of severe chest pain. A myocardial

infarction is suspected. A 12 lead ECG appears normal, but the doctor
admits the client for further testing until cardiac enzyme studies are
returned. All of the following will be included in the nursing care plan.
Which activity has the highest priority?
1. Monitoring vital signs
2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site
44. A client is experiencing tachycardia. The nurses understanding of the
physiological basis for this symptom is explained by which of the
following statements?
1. The demand for oxygen is decreased because of pleural involvement
2. The inflammatory process causes the body to demand more oxygen to meet its
needs.
3. The heart has to pump faster to meet the demand for oxygen when there is
lowered arterial oxygen tension.
4. Respirations are labored.
45. A client enters the ER complaining of chest pressure and severe
epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor
orders cardiac enzymes. If the client were diagnosed with an MI, the
nurse would expect which cardiac enzyme to rise within the next 3 to 8
hours?
1. Creatine kinase (CK or CPK)
2. Lactic dehydrogenase (LDH)
3. LDH-1
4. LDH-2
46. A 45-year-old male 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:
1. Decreased arterial blood flow secondary to vasoconstriction
2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries
4. Trauma to the lower extremities
47. Which of the following instructions should be included in the
discharge teaching for a patient discharged with a transdermal
nitroglycerin patch?
1. Apply the patch to a non hairy, nonfatty area of the upper torso or arms.
2. Apply the patch to the same site each day to maintain consistent drug
absorption.
3. If you get a headache, remove the patch for 4 hours and then reapply.
4. If you get chest pain, apply a second patch right next to the first patch.
48. In order to prevent the development of tolerance, the nurse instructs
the patient to:
1. Apply the nitroglycerin patch every other day

2. Switch to sublingual nitroglycerin when the patients systolic blood pressure
elevates to >140 mm Hg
3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at
night
4. Use the nitroglycerin patch for acute episodes of angina only
49. Direct-acting vasodilators have which of the following effects on the
heart rate?
1. Heart rate decreases
2. Heart rate remains significantly unchanged
3. Heart rate increases
4. Heart rate becomes irregular
50. When teaching a patient why spironolactone (Aldactone) and
furosemide (Lasix) are prescribed together, the nurse bases teaching on
the knowledge that:
1. Moderate doses of two different types of diuretics are more effective than a
large dose of one type
2. This combination promotes diuresis but decreases the risk of hypokalemia
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration
rate
Answers and Rationale
Gauge your performance by counter checking your answers to the answers below.
Learn more about the question by reading the rationale. If you have any disputes
or questions, please direct them to the comments section.
1. Answer: 4. This procedure requires an informed consent because it involves
injection of a radiopaque dye into the blood vessel. The risk of allergic reaction
and possible anaphylaxis is serious and must be assessed before the procedure.
2. Answer: 3. Chest pain is assessed by using the standard pain assessment
parameters. Options 1, 2, and 4 may or may not help discriminate the origin of
pain. Pain of pleuropulmonary origin usually worsens on inspiration.
3. Answer: 2. On transfer from the CCU, the client is allowed self-care activities
and bathroom privileges. Supervised ambulation for brief distances are
encouraged, with distances gradually increased (50, 100, 200 feet).
4. Answer: 1. Edema, the accumulation of excess fluid in the interstitial spaces,
can be measured by intake greater than output and by a sudden increase in
weight. Diuretics should be given in the morning whenever possible to avoid
nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
5. Answer: 1. Sudden loss of electrocardiogram complexes indicates ventricular
asystole or possible electrode displacement. Accurate assessment of the client
and equipment is necessary to determine the cause and identify the appropriate
intervention.
6. Answer: 4. BP should be taken with the client seated with the arm bared,
positioned with support and at heart level. The client should sit with the legs on
the floor, feet uncrossed, and not speak during the recording. The client should
not have smoked tobacco or taken in caffeine in the 30 minutes preceding the
measurement. The client should rest quietly for 5 minutes before the reading is
taken. The cuff bladder should encircle at least 80% of the limb being measured.
Gauges other than a mercury sphygmomanometer should be calibrated every 6
months to ensure accuracy.
7. Answer: 4. The antidote to heparin is protamine sulfate and should be readily
available for use if excessive bleeding or hemorrhage should occur. Vitamin K is
an antidote for warfarin.
8. Answer: 3. The therapeutic range for prothrombin time is 1.5 to 2 times the
control for clients at risk for thrombus. Based on the clients control value, the
therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the
result is within therapeutic range.
9. Answer: 2. Warfarin works in the liver and inhibits synthesis of four vitamin Kdependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the
therapeutic effect of warfarin is exhibited.
10. Answer: 1. Although obtaining the ECG, chest x-ray, and blood work are all
important, the nurses priority action would be to relieve the crushing chest pain.
11. Answer: 2. Thrombolytic drugs are administered within the first 6 hours after
onset of a MI to lyse clots and reduce the extent of myocardial damage.
12. Answer: 1, 3, 5. In a client who has had an ECG, the P wave represents the
activation of the electrical impulse in the SA node, which is then transmitted to
the AV node. In addition, the P wave represents atrial muscle depolarization, not
ventricular depolarization. The normal duration of the P wave is 0.11 seconds or
less in duration and 2.5 mm or more in height.
13. Answer: 2. Advanced cardiac life support recommends that at least one or
two intravenous lines be inserted in one or both of the antecubital spaces. Calling
the physician, obtaining a portable chest radiograph, and drawing blood are
important but secondary to starting the intravenous line.
14. Answer: 4. Detection of myoglobin is one diagnostic tool to determine
whether myocardial damage has occurred. Myoglobin is generally detected about
one hour after a heart attack is experienced and peaks within 4 to 6 hours after
infarction (Remember, less than 90 mg/L is normal).
15. Answer: 1. Propranolol hydrochloride is a beta-adrenergic blocking agent.
Actions of propranolol hydrochloride include reducing heart rate, decreasing
myocardial contractility, and slowing conduction.
16. Answer: 3. Compliance is the most critical element of hypertensive therapy.
In most cases, hypertensive clients require lifelong treatment and their
hypertension cannot be managed successfully without drug therapy. Stress
management and weight management are important components of hypertension
therapy, but the priority goal is related to compliance.
17. Answer: 1. Hypertension is referred to as the silent killer for adults, because
until the adult has significant damage to other systems, the hypertension may go
undetected. CVAs can be related to long-term hypertension. Liver or pulmonary

disease is generally not associated with hypertension. Myocardial infarction is
generally related to coronary artery disease.
18. Answer: 3. Nitroglycerin may be used prophylactically before stressful
physical activities such as stair climbing to help the client remain pain free.
Visiting her friend early in the day would have no impact on decreasing pain
episodes. Resting before or after an activity is not as likely to help prevent an
activity-related pain episode.
19. Answer: 1. The client should report a change in the pattern of chest pain. It
may indicate increasing severity of CAD.
20. Answer: 2. Cardiac catheterization is done in clients with angina primarily to
assess the extent and severity of the coronary artery blockage, A decision about
medical management, angioplasty, or coronary artery bypass surgery will be
based on the catheterization results.
21. Answer: 3. Nitroglycerin produces peripheral vasodilation, which reduces
myocardial oxygen consumption and demand. Vasodilation in coronary arteries
and collateral vessels may also increase blood flow to the ischemic areas of the
heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not
have an effect on pericardial spasticity or conductivity in the myocardium.
22. Answer: 1. Because of the widespread vasodilating effects, nitroglycerin often
produces such side effects as headache, hypotension, and dizziness. The client
should lie or sit down to avoid fainting. Nitro does not cause shortness of breath
or stomach cramps.
23. Answer: 3. The correct protocol for nitroglycerin used involves immediate
administration, with subsequent doses taken at 5-minute intervals as needed, for
a total dose of 3 tablets. Sublingual nitroglycerin appears in the bloodstream
within 2 to 3 minutes and is metabolized within about 10 minutes.
24. Answer: 3. The left anterior descending artery is the primary source of blood
flow for the anterior wall of the heart. The circumflex artery supplies the lateral
wall, the internal mammary supplies the mammary, and the right coronary artery
supplies the inferior wall of the heart.
25. Answer: 2. Although the coronary arteries may receive a minute portion of
blood during systole, most of the blood flow to coronary arteries is supplied
during diastole. Breathing patterns are irrelevant to blood flow.
26. Answer: 3. The right coronary artery supplies the right ventricle, or the
inferior portion of the heart. Therefore, prolonged occlusion could produce an
infarction in that area. The right coronary artery doesnt supply the anterior
portion (left ventricle), lateral portion (some of the left ventricle and the left
atrium), or the apical portion (left ventricle) of the heart.
27. Answer: 3. Abnormalities of the pulmonic valve are auscultated at the second
left intercostal space along the left sternal border. Aortic valve abnormalities are
heard at the second intercostal space, to the right of the sternum. Mitral valve
abnormalities are heard at the fifth intercostal space in the midclavicular line.
Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces
along the sternal border.
28. Answer: 3. Troponin I levels rise rapidly and are detectable within 1 hour of
myocardial injury. Troponin levels arent detectable in people without cardiac
injury.
29. Answer: 4. The ECG is the quickest, most accurate, and most widely used tool
to determine the location of myocardial infarction. Cardiac enzymes are used to
diagnose MI but cant determine the location. An echocardiogram is used most
widely to view myocardial wall function after an MI has been diagnosed. Cardiac
catheterization is an invasive study for determining coronary artery disease and
may also indicate the location of myocardial damage, but the study may not be
performed immediately.
30. Answer: 4. The pain of angina usually ranges from a vague feeling of
tightness to heavy, intense pain. Pain impulses originate in the most visceral
muscles and may move to such areas as the chest, neck, and arms.
31. Answer: 4. Vascular resistance is the impedance of blood flow by the
arterioles that most predominantly affects the diastolic pressure. Cardiac output
determines systolic blood pressure.
32. Answer: 3. The kidneys respond to a rise in blood pressure by excreting
sodium and excess water. This response ultimately affects systolic pressure by
regulating blood volume.
33. Answer: 1. Baroreceptors located in the carotid arteries and aorta sense
pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart
rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide.
Peripheral chemoreceptors in the aorta and carotid arteries are primarily
stimulated by oxygen.
34. Answer: 1. Afterload refers to the resistance normally maintained by the
aortic and pulmonic valves, the condition and tone of the aorta, and the
resistance offered by the systemic and pulmonary arterioles. Cardiac output is the
amount of blood expelled from the heart per minute. Overload refers to an
abundance of circulating volume. Preload is the volume of blood in the ventricle at
the end of diastole.
35. Answer: 4. Preload is the amount of stretch of the cardiac muscle fibers at
the end of diastole. The volume of blood in the ventricle at the end of diastole
determines the preload. Afterload is the force against which the ventricle must
expel blood. Cardiac index is the individualized measurement of cardiac output,
based on the clients body surface area. Cardiac output is the amount of blood the
heart is expelling per minute.
36. Answer: 3. Propranolol and other beta-adrenergic blockers are
contraindicated in a client with asthma, so the nurse should question the
physician before giving the dose. The other responses are appropriate actions for
a client receiving propranolol, but questioning the physician takes priority. The
clients apical pulse should always be checked before giving propranolol; if the
pulse rate is extremely low, the nurse should withhold the drug and notify the
physician.
37. Answer: 3. Furosemide is a potassium-depleting diuretic than can cause

hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to
ventricular tachycardia.
38. Answer: 4. Because spironolactone is a potassium-sparing diuretic, the client
should avoid salt substitutes because of their high potassium content. The client
should also avoid potassium-rich foods and potassium supplements. To reduce
fluid-volume overload, sodium restrictions should continue.
39. Answer: 4. The P-R interval is measured on the ECG strip from the beginning
of the P wave to the beginning of the QRS complex. It is the time it takes for the
impulse to travel to the ventricle.
40. Answer: 1. Such a response does not have false hope to the client but is
positive and realistic. The answer tells the client what cardiac rehabilitation is and
does not dwell upon his negativity about it.
41. Answer: 3. Palpating pulses distal to the insertion site is important to
evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and
strong.
42. Answer: 4. This scan detects myocardial damage and perfusion, an acute or
chronic MI. It is a more specific answer than (1) or (2). Specific ventricular
function is tested by a gated cardiac blood pool scan.
43. Answer: 3. Even though initial tests seem to be within normal range, it takes
at least 3 hours for the cardiac enzyme studies to register. In the meantime, the
client needs to be watched for bradycardia, heart block, ventricular irritability, and
other arrhythmias. Other activities can be accomplished around the MI
monitoring.
44. Answer: 3. The arterial oxygen supply is lowered and the demand for oxygen
is increased, which results in the hearts having to beat faster to meet the bodys
needs for oxygen.
45. Answer: 1. Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if
an MI is present. When the myocardium is damaged, CPK leaks out of the cell
membranes and into the bloodstream. Lactic dehydrogenase rises in 24-48 hours,
and LDH-1 and LDH-2 rises in 8-24 hours.
46. Answer: 1. Decreased arterial flow is a result of vasospasm. The etiology is
unknown. It is more problematic in colder climates or when the person is under
stress. Hyperemia occurs when the vasospasm is relieved.
47. Answer: 1. A nitroglycerin patch should be applied to a non hairy, nonfatty
area for the best and most consistent absorption rates. Sites should be rotated to
prevent skin irritation, and the drug should be continued if headache occurs
because tolerance will develop. Sublingual nitroglycerin should be used to treat
chest pain.
48. Answer: 3. Tolerance can be prevented by maintaining an 8- to 12-hour
nitrate-free period each day.
49. Answer: 3. Heart rate increases in response to decreased blood pressure
caused by vasodilation.
50. Answer: 2. Spironolactone is a potassium-sparing diuretic; furosemide is a
potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
1. A client is scheduled for a cardiac catherization using a radiopaque

dye. Which of the following assessments is most critical before the
procedure?
a. Intake and output
b. Baseline peripheral pulse rates
c. Height and weight
d. Allergy to iodine or shellfish
2. A client with no history of cardiovascular disease comes into the
ambulatory clinic with flulike symptoms. The client suddenly complains
of chest pain. Which of the following questions would best help a nurse
to discriminate pain caused by a non-cardiac problem?
a. Have you ever had this pain before?
b. Can you describe the pain to me?
c. Does the pain get worse when you breathe in?
d. Can you rate the pain on a scale of 1-10, with 10 being the worst?
3. A client with myocardial infarction has been transferred from a
coronary care unit to a general medical unit with cardiac monitoring via
telemetry. A nurse plans to allow for which of the following client
activities?
a. Strict bed rest for 24 hours after transfer
b. Bathroom privileges and self-care activities
c. Unsupervised hallway ambulation with distances under 200 feet
d. Ad lib activities because the client is monitored.
4. A nurse notes 2+ bilateral edema in the lower extremities of a client
with myocardial infarction who was admitted 2 days ago. The nurse
would plan to do which of the following next?
a. Review the intake and output records for the last 2 days
b. Change the time of diuretic administration from morning to evening
c. Request a sodium restriction of 1 g/day from the physician.
d. Order daily weights starting the following morning.
5. A client is wearing a continuous cardiac monitor, which begins to

sound its alarm. A nurse sees no electrocardiogram complexes on the
screen. The first action of the nurse is to:
a. Check the client status and lead placement
b. Press the recorder button on the electrocardiogram console.
c. Call the physician
d. Call a code blue
6. A nurse is assessing the blood pressure of a client diagnosed with
primary hypertension. The nurse ensures accurate measurement by
avoiding which of the following?
a. Seating the client with arm bared, supported, and at heart level.
b. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
c. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
7. IV heparin therapy is ordered for a client. While implementing this
order, a nurse ensures that which of the following medications is
available on the nursing unit?
a. Vitamin K
b. Aminocaporic acid
c. Potassium chloride
d. Protamine sulfate
8. A client is at risk for pulmonary embolism and is on anticoagulant
therapy with warfarin (Coumadin). The clients prothrombin time is 20
seconds, with a control of 11 seconds. The nurse assesses that this
result is:
a. The same as the clients own baseline level
b. Lower than the needed therapeutic level
c. Within the therapeutic range
d. Higher than the therapeutic range
9. A client who has been receiving heparin therapy also is started on
warfarin. The client asks a nurse why both medications are being
administered. In formulating a response, the nurse incorporates the
understanding that warfarin:
a. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for
this to exert an anticoagulant effect.
b. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this
medication to exert an anticoagulant effect.
c. Stimulates production of the bodys own thrombolytic substances, but it takes 2-4 days for
this to begin.
d. Has the same mechanism of action as Heparin, and the crossover time is needed for the
serum level of warfarin to be therapeutic.
10. A 60-year-old male client comes into the emergency department with
complaints of crushing chest pain that radiates to his shoulder and left
arm. The admitting diagnosis is acute myocardial infarction. Immediate
admission orders include oxygen by NC at 4L/minute, blood work, chest
x-ray, an ECG, and 2mg of morphine given intravenously. The nurse
should first:
a. Administer the morphine
b. Obtain a 12-lead ECG
c. Obtain the lab work
d. Order the chest x-ray
11. When administered a thrombolytic drug to the client experiencing an
MI, the nurse explains to him that the purpose of this drug is to:
a. Help keep him well hydrated
b. Dissolve clots he may have
c. Prevent kidney failure
d. Treat potential cardiac arrhythmias.
12. When interpreting an ECG, the nurse would keep in mind which of
the following about the P wave? Select all that apply.
a. Reflects electrical impulse beginning at the SA node
b. Indicated electrical impulse beginning at the AV node
c. Reflects atrial muscle depolarization
d. Identifies ventricular muscle depolarization
e. Has duration of normally 0.11 seconds or less.
13. A client has driven himself to the ER. He is 50 years old, has a
history of hypertension, and informs the nurse that his father died of a
heart attack at 60 years of age. The client is presently complaining of
indigestion. The nurse connects him to an ECG monitor and begins
administering oxygen at 2 L/minute per NC. The nurses next action

would be to:
a. Call for the doctor
b. Start an intravenous line
c. Obtain a portable chest radiograph
d. Draw blood for laboratory studies
14. The nurse receives emergency laboratory results for a client with
chest pain and immediately informs the physician. An increased
myoglobin level suggests which of the following?
a. Cancer
b. Hypertension
c. Liver disease
d. Myocardial infarction
15. When teaching a client about propranolol hydrochloride, the nurse
should base the information on the knowledge that propranolol
hydrochloride:
a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial
contractility, and conduction.
b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and
lowers blood pressure.
d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the
conversion of angiotensin I to angiotensin II.
16. The most important long-term goal for a client with hypertension
would be to:
a. Learn how to avoid stress
b. Explore a job change or early retirement
c. Make a commitment to long-term therapy
d. Control high blood pressure
17. Hypertension is known as the silent killer. This phrase is associated
with the fact that hypertension often goes undetected until symptoms of
other system failures occur. This may occur in the form of:
a. Cerebrovascular accident
b. Liver disease
c. Myocardial infarction
d. Pulmonary disease
18. During the previous few months, a 56-year-old woman felt brief
twinges of chest pain while working in her garden and has had frequent
episodes of indigestion. She comes to the hospital after experiencing
severe anterior chest pain while raking leaves. Her evaluation confirms a
diagnosis of stable angina pectoris. After stabilization and treatment,
the client is discharged from the hospital. At her follow-up appointment,
she is discouraged because she is experiencing pain with increasing
frequency. She states that she is visiting an invalid friend twice a week
and now cannot walk up the second flight of steps to the friends
apartment without pain. Which of the following measures that the nurse
could suggest would most likely help the client deal with this problem?
a. Visit her friend earlier in the day.
b. Rest for at least an hour before climbing the stairs.
c. Take a nitroglycerin tablet before climbing the stairs.
d. Lie down once she reaches the friends apartment.
19. Which of the following symptoms should the nurse teach the client
with unstable angina to report immediately to her physician?
a. A change in the pattern of her pain
b. Pain during sex
c. Pain during an argument with her husband
d. Pain during or after an activity such as lawnmowing
20. The physician refers the client with unstable angina for a cardiac
catherization. The nurse explains to the client that this procedure is
being used in this specific case to:
a. Open and dilate the blocked coronary arteries
b. Assess the extent of arterial blockage
c. Bypass obstructed vessels
d. Assess the functional adequacy of the valves and heart muscle.
View Answers and Rationale
1. ANSWER D. This procedure requires an informed consent because it involves injection

of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible
anaphylaxis is serious and must be assessed before the procedure.
2. ANSWER C. Chest pain is assessed by using the standard pain assessment
parameters. Options A, B, and D may or may not help discriminate the origin of pain. Pain of
pleuropulmonary origin usually worsens on inspiration.
3. ANSWER B. On transfer from the CCU, the client is allowed self-care activities and
bathroom privileges. Supervised ambulation for brief distances are encouraged, with
distances gradually increased (50, 100, 200 feet).
4. ANSWER A. Edema, the accumulation of excess fluid in the interstitial spaces, can be
measured by intake greater than output and by a sudden increase in weight. Diuretics should
be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are
reserved for clients with severe symptoms.
5. ANSWER A. Sudden loss of electrocardiogram complexes indicates ventricular asystole
or possible electrode displacement. Accurate assessment of the client and equipment is
necessary to determine the cause and identify the appropriate intervention.
6. ANSWER D. BP should be taken with the client seated with the arm bared, positioned
with support and at heart level. The client should sit with the legs on the floor, feet uncrossed,
and not speak during the recording. The client should not have smoked tobacco or taken in
caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5
minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb
being measured. Gauges other than a mercury sphygmomanometer should be calibrated
every 6 months to ensure accuracy.
7. ANSWER D. The antidote to heparin is protamine sulfate and should be readily available
for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for
warfarin.
8. ANSWER C. The therapeutic range for prothrombin time is 1.5 to 2 times the control for
clients at risk for thrombus. Based on the clients control value, the therapeutic range for this
individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.
9. ANSWER B. Warfarin works in the liver and inhibits synthesis of four vitamin Kdependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic
effect of warfarin is exhibited.
10. ANSWER A. Although obtaining the ECG, chest x-ray, and blood work are all
important, the nurses priority action would be to relieve the crushing chest pain.
11. ANSWER B. Thrombolytic drugs are administered within the first 6 hours after onset of
a MI to lyse clots and reduce the extent of myocardial damage.
12. ANSWERS A, C, E. In a client who has had an ECG, the P wave represents the
activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In
addition, the P wave represents atrial muscle depolarization, not ventricular depolarization.
The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in
height.
13. ANSWER B. Advanced cardiac life support recommends that at least one or two
intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician,
obtaining a portable chest radiograph, and drawing blood are important but secondary to
starting the intravenous line.
14. ANSWER D. Detection of myoglobin is one diagnostic tool to determine whether
myocardial damage has occurred. Myoglobin is generally detected about one hour after a
heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less
than 90 mg/L is normal).
15. ANSWER A. Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of
propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and
slowing conduction.
16. ANSWER C. Compliance is the most critical element of hypertensive therapy. In most
cases, hypertensive clients require lifelong treatment and their hypertension cannot be
managed successfully without drug therapy. Stress management and weight management
are important components of hypertension therapy, but the priority goal is related to
compliance.
17. ANSWER A. Hypertension is referred to as the silent killer for adults, because until the
adult has significant damage to other systems, the hypertension may go undetected. CVAs
can be related to long-term hypertension. Liver or pulmonary disease is generally not
associated with hypertension. Myocardial infarction is generally related to coronary artery
disease.
18. ANSWER C. Nitroglycerin may be used prophylactically before stressful physical
activities such as stair climbing to help the client remain pain free. Visiting her friend early in
the day would have no impact on decreasing pain episodes. Resting before or after an activity
is not as likely to help prevent an activity-related pain episode.
19. ANSWER A. The client should report a change in the pattern of chest pain. It may
indicate increasing severity of CAD.
20. ANSWER B. Cardiac catherization is done in clients with angina primarily to assess the
extent and severity of the coronary artery blockage, A decision about medical management,
angioplasty, or coronary artery bypass surgery will be based on the catherization results.
NCLEX myocardial infarction

1. Which of the following actions is the first priority of care for a client
exhibiting signs and symptoms of coronary artery disease?
1.
2.
3.
4.
Decrease anxiety
Enhance myocardial oxygenation
Administer sublingual nitroglycerin
Educate the client about his symptoms
2. Medical treatment of coronary artery disease includes which of the

following procedures?
1.
2.
3.
4.
Cardiac catheterization
Coronary artery bypass surgery
Oral medication therapy
Percutaneous transluminal coronary angioplasty
3. Which of the following is the most common symptom of myocardial

infarction (MI)?
1.
2.
3.
4.
Chest pain
Dyspnea
Edema
Palpitations
4. Which of the following symptoms is the most likely origin of pain the
client described as knifelike chest pain that increases in intensity with
inspiration?
1.
2.
3.
4.
Cardiac
Gastrointestinal
Musculoskeletal
Pulmonary

damage?
1.
2.
3.
4.
Lactate dehydrogenase
Complete blood count (CBC)
Troponin I
Creatine kinase (CK)
6. What is the primary reason for administering morphine to a client with

an MI?
1.
2.
3.
4.
To
To
To
To
sedate the client

decrease the clients pain
decrease the clients anxiety
decrease oxygen demand on the clients heart
7. Which of the following conditions is most commonly responsible for

myocardial infarction?
1.
2.
3.
4.
Aneurysm
Heart failure
Coronary artery thrombosis
Renal failure
8. Which of the following complications is indicated by a third heart

sound (S3)?
1.
2.
3.
4.
Ventricular dilation
Systemic hypertension
Aortic valve malfunction
Increased atrial contractions
9. After an anterior wall myocardial infarction, which of the following

problems is indicated by auscultation of crackles in the lungs?
1.
2.
3.
4.
Left-sided heart failure

Pulmonic valve malfunction
Right-sided heart failure
Tricupsid valve malfunction
10. What is the first intervention for a client experiencing MI?
1.
2.
3.
4.
Administer morphine
Administer oxygen
Obtain an ECG
11. Which of the following classes of medications protects the ischemic

myocardium by blocking catecholamines and sympathetic nerve
stimulation?
1.
2.
3.
4.
Beta-adrenergic blockers
Calcium channel blockers
Narcotics
Nitrates
12. What is the most common complication of an MI?

1.
2.
3.
4.
Cardiogenic shock
Heart failure
arrhythmias
Pericarditis
13. With which of the following disorders is jugular vein distention most
prominent?
1.
2.
3.
4.
Abdominal aortic aneurysm

Heart failure
MI
Pneumothorax
14. Toxicity from which of the following medications may cause a client
to see a green-yellow halo around lights?
1.
2.
3.
4.
Digoxin
Furosemide (Lasix)
Metoprolol (Lopressor)
Enalapril (Vasotec)
15. Which of the following symptoms is most commonly associated with

left-sided heart failure?
1. Crackles
2. Arrhythmias
3. Hepatic engorgement
4. Hypotension
16. In which of the following disorders would the nurse expect to assess
sacral edema in a bedridden client?
1.
2.
3.
4.
Diabetes
Pulmonary emboli
Renal failure
17. Which of the following symptoms might a client with right-sided

heart failure exhibit?
1.
2.
3.
4.
Adequate urine output

Polyuria
Oliguria
Polydipsia
18. Which of the following classes of medications maximizes cardiac

performance in clients with heart failure by increasing
ventricular contractility?
1.
2.
3.
4.
Diuretics
Inotropic agents
19. Stimulation of the sympathetic nervous system produces which of the

following responses?
1.
2.
3.
4.
Bradycardia
Tachycardia
Hypotension
Decreased myocardial contractility
20. Which of the following conditions is most closely associated with

weight gain, nausea, and a decrease in urine output?
1. Angina pectoris
2. Cardiomyopathy
3. Left-sided heart failure

4. Right-sided heart failure
21. Which of the following heart muscle diseases is unrelated to other
cardiovascular disease?
1.
2.
3.
4.
Cardiomyopathy
Coronary artery disease
Myocardial infarction
Pericardial effusion
22. Which of the following types of cardiomyopathy can be associated

with childbirth?
1.
2.
3.
4.
Dilated
Hypertrophic
Myocarditis
Restrictive
23. Septal involvement occurs in which type of cardiomyopathy?

1.
2.
3.
4.
Congestive
Dilated
Hypertrophic
Restrictive
24. Which of the following recurring conditions most commonly occurs in

clients with cardiomyopathy?
1.
2.
3.
4.
Heart failure
Diabetes
MI
25. Dyspnea, cough, expectoration, weakness, and edema are classic

signs and symptoms of which of the following conditions?
1.
2.
3.
4.
Pericarditis
Hypertension
MI
Heart failure
26. In which of the following types of cardiomyopathy does cardiac

output remain normal?
1.
2.
3.
4.
Dilated
Hypertrophic
Obliterative
Restrictive
27. Which of the following cardiac conditions does a fourth heart sound
(S4) indicate?
1.
2.
3.
4.
Dilated aorta
Normally functioning heart
Failure of the ventricle to eject all of the blood during systole
28. Which of the following classes of drugs is most widely used in the
treatment of cardiomyopathy?
1.
2.
3.
4.
Antihypertensives
Nitrates
29. If medical treatments fail, which of the following invasive procedures

is necessary for treating cardiomyopathy?
1.
2.
3.
4.
Coronary artery bypass graft (CABG)
Heart transplantation
Intra-aortic balloon pump (IABP)
30. Which of the following conditions is associated with a predictable

level of pain that occurs as a result of physical or emotional stress?
1.
2.
3.
4.
Anxiety
Stable angina
Unstable angina
Variant angina
31. Which of the following types of angina is most closely related with an
impending MI?
1.
2.
3.
4.
Angina decubitus
Chronic stable angina
Nocturnal angina
Unstable angina
32. Which of the following conditions is the predominant cause of

angina?
1.
2.
3.
4.
Increased preload
Decreased afterload
Coronary artery spasm
Inadequate oxygen supply to the myocardium
33. Which of the following tests is used most often to diagnose angina?
1.
2.
3.
4.
Chest x-ray
Echocardiogram
12-lead electrocardiogram (ECG)
34. Which of the following results is the primary treatment goal for
angina?
1.
2.
3.
4.
Reversal of ischemia
Reversal of infarction
Reduction of stress and anxiety
Reduction of associated risk factors
35. Which of the following interventions should be the first priority when
treating a client experiencing chest pain while walking?
1.
2.
3.
4.
Sit the client down

Get the client back to bed
Obtain an ECG
36. Myocardial oxygen consumption increases as which of the following

parameters increase?
1. Preload, afterload, and cerebral blood flow
2. Preload, afterload, and renal blood flow
3. Preload, afterload, contractility, and heart rate.

4. Preload, afterload, cerebral blood flow, and heart rate.
37. Which of the following positions would best aid breathing for a client
with acute pulmonary edema?
1.
2.
3.
4.
Lying flat in bed

Left side-lying
In high Fowlers position
In semi-Fowlers position
38. Which of the following blood gas abnormalities is initially most

suggestive of pulmonary edema?
1.
2.
3.
4.
Anoxia
Hypercapnia
Hyperoxygenation
Hypocapnia
39. Which of the following is a compensatory response to decreased

cardiac output?
1.
2.
3.
4.
Decreased BP
Alteration in LOC
Decreased BP and diuresis
Increased BP and fluid retention
40. Which of the following actions is the appropriate initial response to a

client coughing up pink, frothy sputum?
1.
2.
3.
4.
Call for help

Call the physician
Start an I.V. line
Suction the client
1.
2.
3.
4.
Afterload
Cardiac output
Overload
Preload
42. Acute pulmonary edema caused by heart failure is usually a result of

damage to which of the following areas of the heart?
1.
2.
3.
4.
Left atrium
Right atrium
Left ventricle
Right ventricle
43. An 18-year-old client who recently had an URI is admitted with

suspected rheumatic fever. Which assessment findings confirm this
diagnosis?
1.
2.
3.
4.
Erythema marginatum, subcutaneous nodules, and fever

Tachycardia, finger clubbing, and a load S3
Dyspnea, cough, and palpitations
Dyspnea, fatigue, and syncope
44. A client admitted with angina complains of severe chest pain and
suddenly becomes unresponsive. After establishing unresponsiveness,
which of the following actions should the nurse take first?
1.
2.
3.
4.
Activate the resuscitation team

Open the clients airway
Check for breathing
Check for signs of circulation
45. A 55-year-old client is admitted with an acute inferior-wall

myocardial infarction. During the admission interview, he says he
stopped taking his metoprolol (Lopressor) 5 days ago because he was
feeling better. Which of the following nursing diagnoses takes priority for
this client?
1.
2.
3.
4.
Anxiety
Ineffective tissue perfusion; cardiopulmonary
Acute pain
Ineffective therapeutic regimen management
46. A client comes into the E.R. with acute shortness of breath and a
cough that produces pink, frothy sputum. Admission assessment reveals
crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory
rate of 38 breaths/minute. The clients medical history included DM, HTN,
and heart failure. Which of the following disorders should the nurse
suspect?
1.
2.
3.
4.
Pulmonary edema
Pneumothorax
Cardiac tamponade
Pulmonary embolus
47. The nurse coming on duty receives the report from the nurse going
off duty. Which of the following clients should the on-duty nurse assess
first?
1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of
126/76, and a respiratory rate of 21 breaths a minute.
2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50,
and a DNR order.
3. The 62-year-old client who was admitted one day ago with thrombophlebitis
and receiving IV heparin.
4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial
fibrillation and is receiving IV diltiazem (Cardizem).
48. When developing a teaching plan for a client with endocarditis, which
of the following points is most essential for the nurse to include?
1.
2.
3.
4.
Report fever, anorexia, and night sweats to the physician.

Take prophylactic antibiotics after dental work and invasive procedures.
Include potassium rich foods in your diet.
Monitor your pulse regularly.
49. A nurse is conducting a health history with a client with a primary

diagnosis of heart failure. Which of the following disorders reported by
the client is unlikely to play a role in exacerbating the heart failure?
1.
2.
3.
4.
Recent URI
Nutritional anemia
Peptic ulcer disease
A-Fib
50. A nurse is preparing for the admission of a client with heart failure
who is being sent directly to the hospital from the physicians office. The
nurse would plan on having which of the following medications readily

available for use?
1.
2.
3.
4.
Diltiazem (Cardizem)
Digoxin (Lanoxin)
Propranolol (Inderal)
51. A nurse caring for a client in one room is told by another nurse that a
second client has developed severe pulmonary edema. On entering the
2nd clients room, the nurse would expect the client to be:
1.
2.
3.
4.
Slightly anxious
Mildly anxious
Moderately anxious
Extremely anxious
52. A client with pulmonary edema has been on diuretic therapy. The
client has an order for additional furosemide (Lasix) in the amount of 40
mg IV push. Knowing that the client also will be started on Digoxin
(Lanoxin), a nurse checks the clients most recent:
1.
2.
3.
4.
Digoxin level
Sodium level
Potassium level
Creatinine level
53. A client who had cardiac surgery 24 hours ago has a urine output
averaging 19 ml/hr for 2 hours. The client received a single bolus of 500
ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily
laboratory results indicate the blood urea nitrogen is 45 mg/dL and the
serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for:
1.
2.
3.
4.
Hypovolemia
UTI
Glomerulonephritis
Acute renal failure
54. A nurse is preparing to ambulate a client on the 3rd day after cardiac
surgery. The nurse would plan to do which of the following to enable the
client to best tolerate the ambulation?
1.
2.
3.
4.
Encourage the client to cough and deep breathe

Premedicate the client with an analgesic
Provide the client with a walker
Remove telemetry equipment because it weighs down the hospital gown.
55. A clients electrocardiogram strip shows atrial and ventricular rates

of 80 complexes per minute. The PR interval is 0.14 second, and the QRS
complex measures 0.08 second. The nurse interprets this rhythm is:
1.
2.
3.
4.
Normal sinus rhythm

Sinus bradycardia
Sinus tachycardia
Sinus dysrhythmia
56. A client has frequent bursts of ventricular tachycardia on the cardiac

monitor. A nurse is most concerned with this dysrhythmia because:
1. It is uncomfortable for the client, giving a sense of impending doom.
2. It produces a high cardiac output that quickly leads to cerebral and myocardial
ischemia.
3. It is almost impossible to convert to a normal sinus rhythm.
4. It can develop into ventricular fibrillation at any time.
57. A home care nurse is making a routine visit to a client receiving
digoxin (Lanoxin) in the treatment of heart failure. The nurse would
particularly assess the client for:
1.
2.
3.
4.
Thrombocytopenia and weight gain

Anorexia, nausea, and visual disturbances
Diarrhea and hypotension
Fatigue and muscle twitching
58. A client with angina complains that the angina pain is prolonged and
severe and occurs at the same time each day, most often in the morning,
On further assessment a nurse notes that the pain occurs in the absence
of precipitating factors. This type of anginal pain is best described as:
1.
2.
3.
4.
Stable angina
Unstable angina
Variant angina
Nonanginal pain
59. The physician orders continuous intravenous nitroglycerin infusion

for the client with MI. Essential nursing actions include which of the
following?
1.
2.
3.
4.
Obtaining an infusion pump for the medication

Monitoring BP q4h
Monitoring urine output hourly
Obtaining serum potassium levels daily
60. Aspirin is administered to the client experiencing an MI because of

its:
1.
2.
3.
4.
Antipyretic action
Antithrombotic action
Antiplatelet action
Analgesic action
61. Which of the following is an expected outcome for a client on the

second day of hospitalization after an MI?
1.
2.
3.
4.
Has severe chest pain

Can identify risks factors for MI
Agrees to participate in a cardiac rehabilitation walking program
Can perform personal self-care activities without pain
62. Which of the following reflects the principle on which a clients diet
will most likely be based during the acute phase of MI?
1.
2.
3.
4.
Liquids as ordered
Small, easily digested meals
Three regular meals per day
NPO
63. An older, sedentary adult may not respond to emotional or physical

stress as well as a younger individual because of:
1.
2.
3.
4.
Left ventricular atrophy

Irregular heartbeats
Peripheral vascular occlusion
Pacemaker placement
64. Which of the following nursing diagnoses would be appropriate for a

client with heart failure? Select all that apply.
1. Ineffective tissue perfusion related to decreased peripheral blood flow
secondary to decreased cardiac output.
2. Activity intolerance related to increased cardiac output.
3. Decreased cardiac output related to structural and functional changes.
4. Impaired gas exchange related to decreased sympathetic nervous system
activity.
65. Which of the following would be a priority nursing diagnosis for the
client with heart failure and pulmonary edema?
1.
2.
3.
4.
Risk for infection related to stasis of alveolar secretions

Impaired skin integrity related to pressure
Activity intolerance related to pump failure
Constipation related to immobility
66. Captopril may be administered to a client with HF because it acts as

a:
1.
2.
3.
4.
Vasopressor
Volume expander
Vasodilator
Potassium-sparing diuretic
67. Furosemide is administered intravenously to a client with HF. How

soon after administration should the nurse begin to see evidence of the
drugs desired effect?
1.
2.
3.
4.
5 to 10 minutes
30 to 60 minutes
2 to 4 hours
6 to 8 hours
68. Which of the following foods should the nurse teach a client with
heart failure to avoid or limit when following a 2-gram sodium diet?
1. Apples
2. Tomato juice
3. Whole wheat bread

4. Beef tenderloin
69. The nurse finds the apical pulse below the 5th intercostal space. The
nurse suspects:
1.
2.
3.
4.
Left atrial enlargement

Left ventricular enlargement
Right atrial enlargement
Right ventricular enlargement
the heart?
1.
2.
3.
4.
Circumflex artery
Internal mammary artery
Left anterior descending artery
Right coronary artery

1. Answer: 2. Enhancing myocardial oxygenation is always the first priority when
a client exhibits signs or symptoms of cardiac compromise. Without adequate
oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is
administered to treat acute angina, but administration isnt the first priority.
Although educating the client and decreasing anxiety are important in care
delivery, neither are priorities when a client is compromised.
2. Answer: 3. Oral medication administration is a noninvasive, medical treatment
for coronary artery disease. Cardiac catherization isnt a treatment, but a
diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal
coronary angioplasty are invasive, surgical treatments.
3. Answer: 1. The most common symptom of an MI is chest pain, resulting from
deprivation of oxygen to the heart. Dyspnea is the second most common
symptom, related to an increase in the metabolic needs of the body during an MI.
Edema is a later sign of heart failure, often seen after an MI. Palpitations may
result from reduced cardiac output, producing arrhythmias.
4. Answer: 4. Pulmonary pain is generally described by these symptoms.
Musculoskeletal pain only increases with movement. Cardiac and GI pains dont
change with respiration.
myocardial injury. Troponin I levels arent detectable in people without cardiac
injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not
specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury.
CBC is obtained to review blood counts, and a complete chemistry is obtained to
review electrolytes. Because CK levels may rise with skeletal muscle injury, CK
isoenzymes are required to detect cardiac injury.
6. Answer: 4. Morphine is administered because it decreases myocardial oxygen
demand. Morphine will also decrease pain and anxiety while causing sedation, but
it isnt primarily given for those reasons.
7. Answer: 3. Coronary artery thrombosis causes an inclusion of the artery,
leading to myocardial death. An aneurysm is an outpouching of a vessel and
doesnt cause an MI. Renal failure can be associated with MI but isnt a direct
cause. Heart failure is usually a result from an MI.
8. Answer: 1. Rapid filling of the ventricle causes vasodilation that is auscultated
as S3. Increased atrial contraction or systemic hypertension can result in a fourth
heart sound. Aortic valve malfunction is heard as a murmur.
9. Answer: 1. The left ventricle is responsible for most of the cardiac output. An
anterior wall MI may result in a decrease in left ventricular function. When the left
ventricle doesnt function properly, resulting in left-sided heart failure, fluid
accumulates in the interstitial and alveolar spaces in the lungs and causes
crackles. Pulmonic and tricuspid valve malfunction causes right sided heart
failure.
10. Answer: 2. Administering supplemental oxygen to the client is the first
priority of care. The myocardium is deprived of oxygen during an infarction, so
additional oxygen is administered to assist in oxygenation and prevent further
damage. Morphine and nitro are also used to treat MI, but theyre more
commonly administered after the oxygen. An ECG is the most common diagnostic
tool used to evaluate MI.
11. Answer: 1. Beta-adrenergic blockers work by blocking beta receptors in the

myocardium, reducing the response to catecholamines and sympathetic nerve
stimulation. They protect the myocardium, helping to reduce the risk of another
infarction by decreasing myocardial oxygen demand. Calcium channel blockers
reduce the workload of the heart by decreasing the heart rate. Narcotics reduce
myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates
reduce myocardial oxygen consumption by decreasing left ventricular enddiastolic pressure (preload) and systemic vascular resistance (afterload).
12. Answer: 3. Arrhythmias, caused by oxygen deprivation to the myocardium,
are the most common complication of an MI. Cardiogenic shock, another
complication of an MI, is defined as the end stage of left ventricular dysfunction.
This condition occurs in approximately 15% of clients with MI. Because the
pumping function of the heart is compromised by an MI, heart failure is the
second most common complication. Pericarditis most commonly results from a
bacterial or viral infection but may occur after the MI.
13. Answer: 2. Elevated venous pressure, exhibited as jugular vein distention,
indicates a failure of the heart to pump. JVD isnt a symptom of abdominal aortic
aneurysm or pneumothorax. An MI, if severe enough, can progress to heart
failure, however, in and of itself, an MI doesnt cause JVD.
14. Answer: 1. One of the most common signs of digoxin toxicity is the visual
disturbance known as the green-yellow halo sign. The other medications arent
associated with such an effect.
15. Answer: 1. Crackles in the lungs are a classic sign of left-sided heart failure.
These sounds are caused by fluid backing up into the pulmonary system.
Arrhythmias can be associated with both right- and left-sided heart failure. Leftsided heart failure causes hypertension secondary to an increased workload on
the system.
16. Answer: 4. The most accurate area on the body to assess dependent edema
in a bed-ridden client is the sacral area. Sacral, or dependent, edema is
secondary to right-sided heart failure.
17. Answer: 3. Inadequate deactivation of aldosterone by the liver after rightsided heart failure leads to fluid retention, which causes oliguria.
18. Answer: 4. Inotropic agents are administered to increase the force of the
hearts contractions, thereby increasing ventricular contractility and ultimately
increasing cardiac output.
19. Answer: 2. Stimulation of the sympathetic nervous system causes tachycardia
and increased contractility. The other symptoms listed are related to the
parasympathetic nervous system, which is responsible for slowing the heart rate.
20. Answer: 4. Weight gain, nausea, and a decrease in urine output are
secondary effects of right-sided heart failure. Cardiomyopathy is usually identified
as a symptom of left-sided heart failure. Left-sided heart failure causes primarily
pulmonary symptoms rather than systemic ones. Angina pectoris doesnt cause
weight gain, nausea, or a decrease in urine output.
21. Answer: 1. Cardiomyopathy isnt usually related to an underlying heart
disease such as atherosclerosis. The etiology in most cases is unknown. CAD and
MI are directly related to atherosclerosis. Pericardial effusion is the escape of fluid
into the pericardial sac, a condition associated with Pericarditis and advanced
heart failure.
22. Answer: 1. Although the cause isnt entirely known, cardiac dilation and heart
failure may develop during the last month of pregnancy or the first few months
after birth. The condition may result from a preexisting cardiomyopathy not
apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal
symmetry of the ventricles that has an unknown etiology but a strong familial
tendency. Myocarditis isnt specifically associated with childbirth. Restrictive
cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually
myocardial.
23. Answer: 3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular
septumnot the ventricle chambersis apparent. This abnormality isnt seen in
other types of cardiomyopathy.
24. Answer: 1. Because the structure and function of the heart muscle is affected,
heart failure most commonly occurs in clients with cardiomyopathy. MI results
from prolonged myocardial ischemia due to reduced blood flow through one of the
coronary arteries. Pericardial effusion is most predominant in clients with
pericarditis.
25. Answer: 4. These are the classic signs of failure. Pericarditis is exhibited by a
feeling of fullness in the chest and auscultation of a pericardial friction rub.
Hypertension is usually exhibited by headaches, visual disturbances, and a

flushed face. MI causes heart failure but isnt related to these symptoms.
26. Answer: 2. Cardiac output isnt affected by hypertrophic cardiomyopathy
because the size of the ventricle remains relatively unchanged. All of the rest
decrease cardiac output.
27. Answer: 4. An S4 occurs as a result of increased resistance to ventricular
filling after atrial contraction. The increased resistance is related to decreased
compliance of the ventricle. A dilated aorta doesnt cause an extra heart sound,
though it does cause a murmur. Decreased myocardial contractility is heard as a
third heart sound. An S4 isnt heard in a normally functioning heart.
28. Answer: 2. By decreasing the heart rate and contractility, beta-blockers
improve myocardial filling and cardiac output, which are primary goals in the
treatment of cardiomyopathy. Antihypertensives arent usually indicated because
they would decrease cardiac output in clients who are already hypotensive.
Calcium channel blockers are sometimes used for the same reasons as betablockers; however, they arent as effective as beta-blockers and cause increased
hypotension. Nitrates arent used because of their dilating effects, which would
further compromise the myocardium.
29. Answer: 3. The only definitive treatment for cardiomyopathy that cant be
controlled medically is a heart transplant because the damage to the heart
muscle is irreversible.
30. Answer: 2. The pain of stable angina is predictable in nature, builds gradually,
and quickly reaches maximum intensity. Unstable angina doesnt always need a
trigger, is more intense, and lasts longer than stable angina. Variant angina
usually occurs at restnot as a result of exercise or stress.
31. Answer: 4. Unstable angina progressively increases in frequency, intensity,
and duration and is related to an increased risk of MI within 3 to 18 months.
32. Answer: 4. Inadequate oxygen supply to the myocardium is responsible for
the pain accompanying angina. Increased preload would be responsible for rightsided heart failure. Decreased afterload causes increased cardiac output.
Coronary artery spasm is responsible for variant angina.
33. Answer: 4. The 12-lead ECG will indicate ischemia, showing T-wave inversion.
In addition, with variant angina, the ECG shows ST-segment elevation. A chest x-
ray will show heart enlargement or signs of heart failure, but isnt used to
diagnose angina.
34. Answer: 1. Reversal of the ischemia is the primary goal, achieved by reducing
oxygen consumption and increasing oxygen supply. An infarction is permanent
and cant be reversed.
35. Answer: 1. The initial priority is to decrease the oxygen consumption; this
would be achieved by sitting the client down. An ECG can be obtained after the
client is sitting down. After the ECGm sublingual nitro would be administered.
When the clients condition is stabilized, he can be returned to bed.
36. Answer: 3. Myocardial oxygen consumption increases as preload, afterload,
renal contractility, and heart rate increase. Cerebral blood flow doesnt directly
affect myocardial oxygen consumption.
37. Answer: 3. A high Fowlers position promotes ventilation and facilitates
breathing by reducing venous return. Lying flat and side-lying positions worsen
the breathing and increase workload of the heart. Semi-Fowlers position wont
reduce the workload of the heart as well as the Fowlers position will.
38. Answer: 4. In an attempt to compensate for increased work of breathing due
to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the
condition persists, CO2 retention occurs and hypercapnia results.
39. Answer: 4. The body compensates for a decrease in cardiac output with a rise
in BP, due to the stimulation of the sympathetic NS and an increase in blood
volume as the kidneys retain sodium and water. Blood pressure doesnt initially
drop in response to the compensatory mechanism of the body. Alteration in LOC
will occur only if the decreased cardiac output persists.
40. Answer: 1. Production of pink, frothy sputum is a classic sign of acute
pulmonary edema. Because the client is at high risk for decompensation, the
nurse should call for help but not leave the room. The other three interventions
would immediately follow.
amount of blood expelled by the heart per minute. Overload refers to an

42. Answer: 3. The left ventricle is responsible for the majority of force for the
cardiac output. If the left ventricle is damaged, the output decreases and fluid
accumulates in the interstitial and alveolar spaces, causing pulmonary edema.
Damage to the left atrium would contribute to heart failure but wouldnt affect
cardiac output or, therefore, the onset of pulmonary edema. If the right atrium
and right ventricle were damaged, right-sided heart failure would result.
43. Answer: 1. Diagnosis of rheumatic fever requires that the client have either
two major Jones criteria or one minor criterion plus evidence of a previous
streptococcal infection. Major criteria include carditis, polyarthritis, Sydenhams
chorea, subcutaneous nodules, and erythema marginatum (transient, non pruritic
macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria
include fever, arthralgia, elevated levels of acute phase reactants, and a
prolonged PR-interval on ECG.
44. Answer: 1. Immediately after establishing unresponsiveness, the nurse
should activate the resuscitation team. The next step is to open the airway using
the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and
feeling for no more than 10-seconds). If the client isnt breathing, give two slow
breaths using a bag mask or pocket mask. Next, check for signs of circulation by
palpating the carotid pulse.
45. Answer: 2. MI results from prolonged myocardial ischemia caused by reduced
blood flow through the coronary arteries. Therefore, the priority nursing diagnosis
for this client is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute
pain, and ineffective therapeutic regimen management are appropriate but dont
take priority.
46. Answer: 1. SOB, tachypnea, low BP, tachycardia, crackles, and a cough
producing pink, frothy sputum are late signs of pulmonary edema.
47. Answer: 4. The client with A-fib has the greatest potential to become unstable
and is on IV medication that requires close monitoring. After assessing this client,
the nurse should assess the client with thrombophlebitis who is receiving a
heparin infusion, and then go to the 58-year-old client admitted 2-days ago with
heart failure (her s/s are resolving and dont require immediate attention). The
lowest priority is the 89-year-old with end stage right-sided heart failure, who
requires time consuming supportive measures.
48. Answer: 1. The most essential teaching point is to report signs of relapse,
such as fever, anorexia, and night sweats, to the physician. To prevent further
endocarditis episodes, prophylactic antibiotics are taken before and sometimes
after dental work, childbirth, or GU, GI, or gynecologic procedures. A potassiumrich diet and daily pulse monitoring arent necessary for a client with endocarditis.
49. Answer: 3. Heart failure is precipitated or exacerbated by physical or
emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy,
Pagets disease, nutritional deficiencies (thiamine, alcoholism), pulmonary
disease, and hypervolemia.
50. Answer: 2. Digoxin exerts a positive inotropic effect on the heart while
slowing the overall rate through a variety of mechanisms. Digoxin is the
medication of choice to treat heart failure. Diltiazem (calcium channel blocker)
and propranolol and metoprolol (beta blockers) have a negative inotropic effect
and would worsen the failing heart.
51. Answer: 4. Pulmonary edema causes the client to be extremely agitated and
anxious. The client may complain of a sense of drowning, suffocation, or
smothering.
52. Answer: 3. The serum potassium level is measured in the client receiving
digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can
occur in the client with hypokalemia. Hypokalemia also predisposes the client to
ventricular dysrhythmias.
53. Answer: 4. The client who undergoes cardiac surgery is at risk for renal injury
from poor perfusion, hemolysis, low cardiac output, or vasopressor medication
therapy. Renal insult is signaled by decreased urine output, and increased BUN
and creatinine levels. The client may need medications such as dopamine
(Intropin) to increase renal perfusion and possibly could need peritoneal dialysis
or hemodialysis.
54. Answer: 2. The nurse should encourage regular use of pain medication for the
first 48 to 72 hours after cardiac surgery because analgesia will promote rest,
decrease myocardial oxygen consumption resulting from pain, and allow better
participation in activities such as coughing, deep breathing, and ambulation.
Options 1 and 3 will not help in tolerating ambulation. Removal of telemetry
equipment is contraindicated unless prescribed.
55. Answer: 1
56. Answer: 4. Ventricular tachycardia is a life-threatening dysrhythmia that

results from an irritable ectopic focus that takes over as the pacemaker for the
heart. The low cardiac output that results can lead quickly to cerebral and
myocardial ischemia. Clients frequently experience a feeling of impending death.
Ventricular tachycardia is treated with antiarrhythmic medications or magnesium
sulfate, cardioversion (client awake), or defibrillation (loss of consciousness),
Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.
57. Answer: 2. The first signs and symptoms of digoxin toxicity in adults include
abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos
around lights), bradycardia, and other dysrhythmias.
58. Answer: 3. Stable angina is induced by exercise and is relieved by rest or
nitroglycerin tablets. Unstable angina occurs at lower and lower levels of activity
and rest, is less predictable, and is often a precursor of myocardial infarction.
Variant angina, or Prinzmetals angina, is prolonged and severe and occurs at the
same time each day, most often in the morning.
59. Answer: 1. IV nitro infusion requires an infusion pump for precise control of
the medication. BP monitoring would be done with a continuous system, and
more frequently than every 4 hours. Hourly urine outputs are not always
required. Obtaining serum potassium levels is not associated with nitroglycerin
infusion.
60. Answer: 2. Aspirin does have antipyretic, antiplatelet, and analgesic actions,
but the primary reason ASA is administered to the client experiencing an MI is its
antithrombotic action.
61. Answer: 4. By day 2 of hospitalization after an MI, clients are expected to be
able to perform personal care without chest pain. Day 2 hospitalization may be
too soon for clients to be able to identify risk factors for MI or begin a walking
program; however, the client may be sitting up in a chair as part of the cardiac
rehabilitation program. Severe chest pain should not be present.
62. Answer: 2. Recommended dietary principles in the acute phase of MI include
avoiding large meals because small, easily digested foods are better digested
foods are better tolerated. Fluids are given according to the clients needs, and
sodium restrictions may be prescribed, especially for clients with manifestations
of heart failure. Cholesterol restrictions may be ordered as well. Clients are not
prescribed a diet of liquids only or NPO unless their condition is very unstable.
63. Answer: 1. In older adults who are less active and do not exercise the heart
muscle, atrophy can result. Disuse or deconditioning can lead to abnormal
changes in the myocardium of the older adult. As a result, under sudden
emotional or physical stress, the left ventricle is less able to respond to the
increased demands on the myocardial muscle.
64. Answer: 1 and 3. HF is a result of structural and functional abnormalities of
the heart tissue muscle. The heart muscle becomes weak and does not
adequately pump the blood out of the chambers. As a result, blood pools in the
left ventricle and backs up into the left atrium, and eventually into the lungs.
Therefore, greater amounts of blood remain in the ventricle after contraction
thereby decreasing cardiac output. In addition, this pooling leads to thrombus
formation and ineffective tissue perfusion because of the decrease in blood flow
to the other organs and tissues of the body. Typically, these clients have an
ejection fraction of less than 50% and poorly tolerate activity. Activity intolerance
is related to a decrease, not increase, in cardiac output. Gas exchange is
impaired. However, the decrease in cardiac output triggers compensatory
mechanisms, such as an increase in sympathetic nervous system activity.
65. Answer: 3. Activity intolerance is a primary problem for clients with heart
failure and pulmonary edema. The decreased cardiac output associated with heart
failure leads to reduced oxygen and fatigue. Clients frequently complain of
dyspnea and fatigue. The client could be at risk for infection related to stasis of
secretions or impaired skin integrity related to pressure. However, these are not
the priority nursing diagnoses for the client with HF and pulmonary edema, nor is
constipation related to immobility.
66. Answer: 3. ACE inhibitors have become the vasodilators of choice in the client
with mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown
to improve survival in overt heart failure.
67. Answer: 1. After IV injection of furosemide, diuresis normally begins in about
5 minutes and reaches its peak within about 30 minutes. Medication effects last 2
to 4 hours.
68. Answer: 2. Canned foods and juices, such as tomato juice, are typically high
in sodium and should be avoided in a sodium-restricted diet.
69. Answer: 2. A normal apical impulse is found under over the apex of the heart
and is typically located and auscultated in the left fifth intercostal space in the
midclavicular line. An apical impulse located or auscultated below the fifth
intercostal space or lateral to the midclavicular line may indicate left ventricular
enlargement.
70. Answer: 3. Left anterior descending artery
The left anterior descending artery is the primary source of blood for the anterior
wall of the heart. The circumflex artery supplies the lateral wall, the internal
mammary artery supplies the mammary, and the right coronary artery supplies
the inferior wall of the heart.
1. Which of the following actions is the first priority of care for a client
exhibiting signs and symptoms of coronary artery disease?
1.
2.
3.
4.
Decrease anxiety
Enhance myocardial oxygenation
Educate the client about his symptoms
2. Medical treatment of coronary artery disease includes which of the

following procedures?
1.
2.
3.
4.
Coronary artery bypass surgery
Oral medication therapy
Percutaneous transluminal coronary angioplasty
3. Which of the following is the most common symptom of myocardial

infarction (MI)?
1.
2.
3.
4.
Chest pain
Dyspnea
Edema
Palpitations
4. Which of the following symptoms is the most likely origin of pain the
client described as knifelike chest pain that increases in intensity with
inspiration?
1.
2.
3.
4.
Cardiac
Gastrointestinal
Musculoskeletal
Pulmonary

damage?
1.
2.
3.
4.
Lactate dehydrogenase
Complete blood count (CBC)
Troponin I
Creatine kinase (CK)
6. What is the primary reason for administering morphine to a client with

an MI?
1.
2.
3.
4.
To
To
To
To
sedate the client

decrease the clients pain
decrease the clients anxiety
decrease oxygen demand on the clients heart
7. Which of the following conditions is most commonly responsible for

myocardial infarction?
1.
2.
3.
4.
Aneurysm
Heart failure
Coronary artery thrombosis
Renal failure
8. Which of the following complications is indicated by a third heart

sound (S3)?
1.
2.
3.
4.
Ventricular dilation
Systemic hypertension
Aortic valve malfunction
Increased atrial contractions
9. After an anterior wall myocardial infarction, which of the following

problems is indicated by auscultation of crackles in the lungs?
1.
2.
3.
4.

Pulmonic valve malfunction
Tricupsid valve malfunction
10. What is the first intervention for a client experiencing MI?

1.
2.
3.
4.
Administer morphine
Administer oxygen
Obtain an ECG
11. Which of the following classes of medications protects the ischemic

myocardium by blocking catecholamines and sympathetic nerve
stimulation?
1.
2.
3.
4.
Narcotics
Nitrates
12. What is the most common complication of an MI?

1.
2.
3.
4.
Cardiogenic shock
Heart failure
arrhythmias
Pericarditis
13. With which of the following disorders is jugular vein distention most
prominent?
1.
2.
3.
4.
Abdominal aortic aneurysm

Heart failure
MI
Pneumothorax
14. Toxicity from which of the following medications may cause a client
to see a green-yellow halo around lights?
1.
2.
3.
4.
Digoxin
Furosemide (Lasix)
Enalapril (Vasotec)
15. Which of the following symptoms is most commonly associated with

left-sided heart failure?
1.
2.
3.
4.
Crackles
Arrhythmias
Hepatic engorgement
Hypotension
16. In which of the following disorders would the nurse expect to assess
sacral edema in a bedridden client?
1.
2.
3.
4.
Diabetes
Pulmonary emboli
Renal failure
17. Which of the following symptoms might a client with right-sided

heart failure exhibit?
1.
2.
3.
4.
Adequate urine output

Polyuria
Oliguria
Polydipsia
18. Which of the following classes of medications maximizes cardiac

performance in clients with heart failure by increasing
ventricular contractility?
1.
2.
3.
4.
Diuretics
Inotropic agents
19. Stimulation of the sympathetic nervous system produces which of the

following responses?
1.
2.
3.
4.
Bradycardia
Tachycardia
Hypotension
20. Which of the following conditions is most closely associated with

weight gain, nausea, and a decrease in urine output?
1.
2.
3.
4.
Angina pectoris
Cardiomyopathy
21. Which of the following heart muscle diseases is unrelated to other

cardiovascular disease?
1.
2.
3.
4.
Cardiomyopathy
Coronary artery disease
Myocardial infarction
22. Which of the following types of cardiomyopathy can be associated

with childbirth?
1.
2.
3.
4.
Dilated
Hypertrophic
Myocarditis
Restrictive
23. Septal involvement occurs in which type of cardiomyopathy?

1.
2.
3.
4.
Congestive
Dilated
Hypertrophic
Restrictive
24. Which of the following recurring conditions most commonly occurs in

clients with cardiomyopathy?
1.
2.
3.
4.
Heart failure
Diabetes
MI
25. Dyspnea, cough, expectoration, weakness, and edema are classic

signs and symptoms of which of the following conditions?
1.
2.
3.
4.
Pericarditis
Hypertension
MI
Heart failure
26. In which of the following types of cardiomyopathy does cardiac

output remain normal?
1.
2.
3.
4.
Dilated
Hypertrophic
Obliterative
Restrictive
27. Which of the following cardiac conditions does a fourth heart sound
(S4) indicate?
1.
2.
3.
4.
Dilated aorta
Normally functioning heart
Failure of the ventricle to eject all of the blood during systole
28. Which of the following classes of drugs is most widely used in the
treatment of cardiomyopathy?
1.
2.
3.
4.
Antihypertensives
Nitrates
29. If medical treatments fail, which of the following invasive procedures

is necessary for treating cardiomyopathy?
1.
2.
3.
4.
Coronary artery bypass graft (CABG)
Heart transplantation
Intra-aortic balloon pump (IABP)
30. Which of the following conditions is associated with a predictable

level of pain that occurs as a result of physical or emotional stress?
1.
2.
3.
4.
Anxiety
Stable angina
Unstable angina
Variant angina
31. Which of the following types of angina is most closely related with an
impending MI?
1.
2.
3.
4.
Angina decubitus
Chronic stable angina
Nocturnal angina
Unstable angina
32. Which of the following conditions is the predominant cause of

angina?
1.
2.
3.
4.
Increased preload
Decreased afterload
Coronary artery spasm
Inadequate oxygen supply to the myocardium
33. Which of the following tests is used most often to diagnose angina?
1.
2.
3.
4.
Chest x-ray
Echocardiogram
12-lead electrocardiogram (ECG)
34. Which of the following results is the primary treatment goal for
angina?
1.
2.
3.
4.
Reversal of ischemia
Reversal of infarction
Reduction of stress and anxiety
Reduction of associated risk factors
35. Which of the following interventions should be the first priority when
treating a client experiencing chest pain while walking?
1.
2.
3.
4.
Sit the client down

Get the client back to bed
Obtain an ECG
36. Myocardial oxygen consumption increases as which of the following

parameters increase?
1.
2.
3.
4.
Preload,
Preload,
Preload,
Preload,
afterload,
afterload,
afterload,
afterload,
and cerebral blood flow

and renal blood flow
contractility, and heart rate.
cerebral blood flow, and heart rate.
37. Which of the following positions would best aid breathing for a client
with acute pulmonary edema?
1.
2.
3.
4.
Lying flat in bed

Left side-lying
In high Fowlers position
In semi-Fowlers position
38. Which of the following blood gas abnormalities is initially most

suggestive of pulmonary edema?
1.
2.
3.
4.
Anoxia
Hypercapnia
Hyperoxygenation
Hypocapnia
39. Which of the following is a compensatory response to decreased

cardiac output?
1.
2.
3.
4.
Decreased BP
Alteration in LOC
Decreased BP and diuresis
Increased BP and fluid retention
40. Which of the following actions is the appropriate initial response to a

client coughing up pink, frothy sputum?
1.
2.
3.
4.
Call for help

Call the physician
Start an I.V. line
Suction the client
1.
2.
3.
4.
Afterload
Cardiac output
Overload
Preload
42. Acute pulmonary edema caused by heart failure is usually a result of

damage to which of the following areas of the heart?
1.
2.
3.
4.
Left atrium
Right atrium
Left ventricle
Right ventricle
43. An 18-year-old client who recently had an URI is admitted with

suspected rheumatic fever. Which assessment findings confirm this
diagnosis?
1.
2.
3.
4.
Erythema marginatum, subcutaneous nodules, and fever

Tachycardia, finger clubbing, and a load S3
Dyspnea, cough, and palpitations
Dyspnea, fatigue, and syncope
44. A client admitted with angina complains of severe chest pain and
suddenly becomes unresponsive. After establishing unresponsiveness,
which of the following actions should the nurse take first?
1. Activate the resuscitation team
2. Open the clients airway
3. Check for breathing

4. Check for signs of circulation
45. A 55-year-old client is admitted with an acute inferior-wall
myocardial infarction. During the admission interview, he says he
stopped taking his metoprolol (Lopressor) 5 days ago because he was
feeling better. Which of the following nursing diagnoses takes priority for
this client?
1.
2.
3.
4.
Anxiety
Ineffective tissue perfusion; cardiopulmonary
Acute pain
Ineffective therapeutic regimen management
46. A client comes into the E.R. with acute shortness of breath and a
cough that produces pink, frothy sputum. Admission assessment reveals
crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory
rate of 38 breaths/minute. The clients medical history included DM, HTN,
and heart failure. Which of the following disorders should the nurse
suspect?
1.
2.
3.
4.
Pulmonary edema
Pneumothorax
Cardiac tamponade
Pulmonary embolus
47. The nurse coming on duty receives the report from the nurse going
off duty. Which of the following clients should the on-duty nurse assess
first?
1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of
126/76, and a respiratory rate of 21 breaths a minute.
2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50,
and a DNR order.
3. The 62-year-old client who was admitted one day ago with thrombophlebitis
and receiving IV heparin.
4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial
fibrillation and is receiving IV diltiazem (Cardizem).
48. When developing a teaching plan for a client with endocarditis, which
of the following points is most essential for the nurse to include?
1.
2.
3.
4.
Report fever, anorexia, and night sweats to the physician.

Take prophylactic antibiotics after dental work and invasive procedures.
Include potassium rich foods in your diet.
Monitor your pulse regularly.
49. A nurse is conducting a health history with a client with a primary

diagnosis of heart failure. Which of the following disorders reported by
the client is unlikely to play a role in exacerbating the heart failure?
1.
2.
3.
4.
Recent URI
Nutritional anemia
Peptic ulcer disease
A-Fib
50. A nurse is preparing for the admission of a client with heart failure
who is being sent directly to the hospital from the physicians office. The
nurse would plan on having which of the following medications readily
available for use?
1.
2.
3.
4.
Diltiazem (Cardizem)
Digoxin (Lanoxin)
Propranolol (Inderal)
51. A nurse caring for a client in one room is told by another nurse that a
second client has developed severe pulmonary edema. On entering the
2nd clients room, the nurse would expect the client to be:
1.
2.
3.
4.
Slightly anxious
Mildly anxious
Moderately anxious
Extremely anxious
52. A client with pulmonary edema has been on diuretic therapy. The
client has an order for additional furosemide (Lasix) in the amount of 40
mg IV push. Knowing that the client also will be started on Digoxin
(Lanoxin), a nurse checks the clients most recent:
1. Digoxin level
2. Sodium level
3. Potassium level
4. Creatinine level
53. A client who had cardiac surgery 24 hours ago has a urine output
averaging 19 ml/hr for 2 hours. The client received a single bolus of 500
ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily
laboratory results indicate the blood urea nitrogen is 45 mg/dL and the
serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for:
1.
2.
3.
4.
Hypovolemia
UTI
Glomerulonephritis
Acute renal failure
54. A nurse is preparing to ambulate a client on the 3rd day after cardiac
surgery. The nurse would plan to do which of the following to enable the
client to best tolerate the ambulation?
1.
2.
3.
4.
Encourage the client to cough and deep breathe

Premedicate the client with an analgesic
Provide the client with a walker
Remove telemetry equipment because it weighs down the hospital gown.
55. A clients electrocardiogram strip shows atrial and ventricular rates

of 80 complexes per minute. The PR interval is 0.14 second, and the QRS
complex measures 0.08 second. The nurse interprets this rhythm is:
1.
2.
3.
4.
Normal sinus rhythm

Sinus bradycardia
Sinus tachycardia
Sinus dysrhythmia
56. A client has frequent bursts of ventricular tachycardia on the cardiac

monitor. A nurse is most concerned with this dysrhythmia because:
1. It is uncomfortable for the client, giving a sense of impending doom.
2. It produces a high cardiac output that quickly leads to cerebral and myocardial
ischemia.
3. It is almost impossible to convert to a normal sinus rhythm.
4. It can develop into ventricular fibrillation at any time.
57. A home care nurse is making a routine visit to a client receiving

digoxin (Lanoxin) in the treatment of heart failure. The nurse would
particularly assess the client for:
1.
2.
3.
4.
Thrombocytopenia and weight gain

Anorexia, nausea, and visual disturbances
Diarrhea and hypotension
Fatigue and muscle twitching
58. A client with angina complains that the angina pain is prolonged and
severe and occurs at the same time each day, most often in the morning,
On further assessment a nurse notes that the pain occurs in the absence
of precipitating factors. This type of anginal pain is best described as:
1.
2.
3.
4.
Stable angina
Unstable angina
Variant angina
Nonanginal pain
59. The physician orders continuous intravenous nitroglycerin infusion

for the client with MI. Essential nursing actions include which of the
following?
1.
2.
3.
4.
Obtaining an infusion pump for the medication

Monitoring BP q4h
Monitoring urine output hourly
Obtaining serum potassium levels daily
60. Aspirin is administered to the client experiencing an MI because of

its:
1.
2.
3.
4.
Antipyretic action
Antithrombotic action
Antiplatelet action
Analgesic action
61. Which of the following is an expected outcome for a client on the

second day of hospitalization after an MI?
1.
2.
3.
4.
Has severe chest pain

Can identify risks factors for MI
Agrees to participate in a cardiac rehabilitation walking program
Can perform personal self-care activities without pain
62. Which of the following reflects the principle on which a clients diet
will most likely be based during the acute phase of MI?
1.
2.
3.
4.
Liquids as ordered
Small, easily digested meals
Three regular meals per day
NPO
63. An older, sedentary adult may not respond to emotional or physical

stress as well as a younger individual because of:
1.
2.
3.
4.
Left ventricular atrophy

Irregular heartbeats
Peripheral vascular occlusion
Pacemaker placement
64. Which of the following nursing diagnoses would be appropriate for a

client with heart failure? Select all that apply.
1. Ineffective tissue perfusion related to decreased peripheral blood flow
secondary to decreased cardiac output.
2. Activity intolerance related to increased cardiac output.
3. Decreased cardiac output related to structural and functional changes.
4. Impaired gas exchange related to decreased sympathetic nervous system
activity.
65. Which of the following would be a priority nursing diagnosis for the
client with heart failure and pulmonary edema?
1.
2.
3.
4.
Risk for infection related to stasis of alveolar secretions

Impaired skin integrity related to pressure
Activity intolerance related to pump failure
Constipation related to immobility
66. Captopril may be administered to a client with HF because it acts as

a:
1.
2.
3.
4.
Vasopressor
Volume expander
Vasodilator
Potassium-sparing diuretic
67. Furosemide is administered intravenously to a client with HF. How

soon after administration should the nurse begin to see evidence of the
drugs desired effect?
1.
2.
3.
4.
5 to 10 minutes
30 to 60 minutes
2 to 4 hours
6 to 8 hours
68. Which of the following foods should the nurse teach a client with
heart failure to avoid or limit when following a 2-gram sodium diet?
1.
2.
3.
4.
Apples
Tomato juice
Whole wheat bread
Beef tenderloin
69. The nurse finds the apical pulse below the 5th intercostal space. The
nurse suspects:
1.
2.
3.
4.
Left atrial enlargement

Left ventricular enlargement
Right atrial enlargement
Right ventricular enlargement
the heart?
1.
2.
3.
4.
Circumflex artery
Internal mammary artery
Left anterior descending artery
Right coronary artery

1. Answer: 2. Enhancing myocardial oxygenation is always the first priority when
a client exhibits signs or symptoms of cardiac compromise. Without adequate
oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is
administered to treat acute angina, but administration isnt the first priority.
Although educating the client and decreasing anxiety are important in care
delivery, neither are priorities when a client is compromised.
2. Answer: 3. Oral medication administration is a noninvasive, medical treatment
for coronary artery disease. Cardiac catherization isnt a treatment, but a
diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal
coronary angioplasty are invasive, surgical treatments.
3. Answer: 1. The most common symptom of an MI is chest pain, resulting from
deprivation of oxygen to the heart. Dyspnea is the second most common
symptom, related to an increase in the metabolic needs of the body during an MI.
Edema is a later sign of heart failure, often seen after an MI. Palpitations may
result from reduced cardiac output, producing arrhythmias.
4. Answer: 4. Pulmonary pain is generally described by these symptoms.
Musculoskeletal pain only increases with movement. Cardiac and GI pains dont
change with respiration.
myocardial injury. Troponin I levels arent detectable in people without cardiac
injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not
specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury.
CBC is obtained to review blood counts, and a complete chemistry is obtained to
review electrolytes. Because CK levels may rise with skeletal muscle injury, CK
isoenzymes are required to detect cardiac injury.
6. Answer: 4. Morphine is administered because it decreases myocardial oxygen
demand. Morphine will also decrease pain and anxiety while causing sedation, but
it isnt primarily given for those reasons.
7. Answer: 3. Coronary artery thrombosis causes an inclusion of the artery,

leading to myocardial death. An aneurysm is an outpouching of a vessel and
doesnt cause an MI. Renal failure can be associated with MI but isnt a direct
cause. Heart failure is usually a result from an MI.
8. Answer: 1. Rapid filling of the ventricle causes vasodilation that is auscultated
as S3. Increased atrial contraction or systemic hypertension can result in a fourth
heart sound. Aortic valve malfunction is heard as a murmur.
9. Answer: 1. The left ventricle is responsible for most of the cardiac output. An
anterior wall MI may result in a decrease in left ventricular function. When the left
ventricle doesnt function properly, resulting in left-sided heart failure, fluid
accumulates in the interstitial and alveolar spaces in the lungs and causes
crackles. Pulmonic and tricuspid valve malfunction causes right sided heart
failure.
10. Answer: 2. Administering supplemental oxygen to the client is the first
priority of care. The myocardium is deprived of oxygen during an infarction, so
additional oxygen is administered to assist in oxygenation and prevent further
damage. Morphine and nitro are also used to treat MI, but theyre more
commonly administered after the oxygen. An ECG is the most common diagnostic
tool used to evaluate MI.
11. Answer: 1. Beta-adrenergic blockers work by blocking beta receptors in the
myocardium, reducing the response to catecholamines and sympathetic nerve
stimulation. They protect the myocardium, helping to reduce the risk of another
infarction by decreasing myocardial oxygen demand. Calcium channel blockers
reduce the workload of the heart by decreasing the heart rate. Narcotics reduce
myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates
reduce myocardial oxygen consumption by decreasing left ventricular enddiastolic pressure (preload) and systemic vascular resistance (afterload).
12. Answer: 3. Arrhythmias, caused by oxygen deprivation to the myocardium,
are the most common complication of an MI. Cardiogenic shock, another
complication of an MI, is defined as the end stage of left ventricular dysfunction.
This condition occurs in approximately 15% of clients with MI. Because the
pumping function of the heart is compromised by an MI, heart failure is the
second most common complication. Pericarditis most commonly results from a
bacterial or viral infection but may occur after the MI.
13. Answer: 2. Elevated venous pressure, exhibited as jugular vein distention,
indicates a failure of the heart to pump. JVD isnt a symptom of abdominal aortic
aneurysm or pneumothorax. An MI, if severe enough, can progress to heart

failure, however, in and of itself, an MI doesnt cause JVD.
14. Answer: 1. One of the most common signs of digoxin toxicity is the visual
disturbance known as the green-yellow halo sign. The other medications arent
associated with such an effect.
15. Answer: 1. Crackles in the lungs are a classic sign of left-sided heart failure.
These sounds are caused by fluid backing up into the pulmonary system.
Arrhythmias can be associated with both right- and left-sided heart failure. Leftsided heart failure causes hypertension secondary to an increased workload on
the system.
16. Answer: 4. The most accurate area on the body to assess dependent edema
in a bed-ridden client is the sacral area. Sacral, or dependent, edema is
secondary to right-sided heart failure.
17. Answer: 3. Inadequate deactivation of aldosterone by the liver after rightsided heart failure leads to fluid retention, which causes oliguria.
18. Answer: 4. Inotropic agents are administered to increase the force of the
hearts contractions, thereby increasing ventricular contractility and ultimately
increasing cardiac output.
19. Answer: 2. Stimulation of the sympathetic nervous system causes tachycardia
and increased contractility. The other symptoms listed are related to the
parasympathetic nervous system, which is responsible for slowing the heart rate.
20. Answer: 4. Weight gain, nausea, and a decrease in urine output are
secondary effects of right-sided heart failure. Cardiomyopathy is usually identified
as a symptom of left-sided heart failure. Left-sided heart failure causes primarily
pulmonary symptoms rather than systemic ones. Angina pectoris doesnt cause
weight gain, nausea, or a decrease in urine output.
21. Answer: 1. Cardiomyopathy isnt usually related to an underlying heart
disease such as atherosclerosis. The etiology in most cases is unknown. CAD and
MI are directly related to atherosclerosis. Pericardial effusion is the escape of fluid
into the pericardial sac, a condition associated with Pericarditis and advanced
heart failure.
22. Answer: 1. Although the cause isnt entirely known, cardiac dilation and heart
failure may develop during the last month of pregnancy or the first few months
after birth. The condition may result from a preexisting cardiomyopathy not
apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal
symmetry of the ventricles that has an unknown etiology but a strong familial
tendency. Myocarditis isnt specifically associated with childbirth. Restrictive
cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually
myocardial.
23. Answer: 3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular
septumnot the ventricle chambersis apparent. This abnormality isnt seen in
other types of cardiomyopathy.
24. Answer: 1. Because the structure and function of the heart muscle is affected,
heart failure most commonly occurs in clients with cardiomyopathy. MI results
from prolonged myocardial ischemia due to reduced blood flow through one of the
coronary arteries. Pericardial effusion is most predominant in clients with
pericarditis.
25. Answer: 4. These are the classic signs of failure. Pericarditis is exhibited by a
feeling of fullness in the chest and auscultation of a pericardial friction rub.
Hypertension is usually exhibited by headaches, visual disturbances, and a
flushed face. MI causes heart failure but isnt related to these symptoms.
26. Answer: 2. Cardiac output isnt affected by hypertrophic cardiomyopathy
because the size of the ventricle remains relatively unchanged. All of the rest
decrease cardiac output.
27. Answer: 4. An S4 occurs as a result of increased resistance to ventricular
filling after atrial contraction. The increased resistance is related to decreased
compliance of the ventricle. A dilated aorta doesnt cause an extra heart sound,
though it does cause a murmur. Decreased myocardial contractility is heard as a
third heart sound. An S4 isnt heard in a normally functioning heart.
28. Answer: 2. By decreasing the heart rate and contractility, beta-blockers
improve myocardial filling and cardiac output, which are primary goals in the
treatment of cardiomyopathy. Antihypertensives arent usually indicated because
they would decrease cardiac output in clients who are already hypotensive.
Calcium channel blockers are sometimes used for the same reasons as betablockers; however, they arent as effective as beta-blockers and cause increased
hypotension. Nitrates arent used because of their dilating effects, which would
further compromise the myocardium.
29. Answer: 3. The only definitive treatment for cardiomyopathy that cant be
controlled medically is a heart transplant because the damage to the heart
muscle is irreversible.
30. Answer: 2. The pain of stable angina is predictable in nature, builds gradually,
and quickly reaches maximum intensity. Unstable angina doesnt always need a
trigger, is more intense, and lasts longer than stable angina. Variant angina
usually occurs at restnot as a result of exercise or stress.
31. Answer: 4. Unstable angina progressively increases in frequency, intensity,
and duration and is related to an increased risk of MI within 3 to 18 months.
32. Answer: 4. Inadequate oxygen supply to the myocardium is responsible for
the pain accompanying angina. Increased preload would be responsible for rightsided heart failure. Decreased afterload causes increased cardiac output.
Coronary artery spasm is responsible for variant angina.
33. Answer: 4. The 12-lead ECG will indicate ischemia, showing T-wave inversion.
In addition, with variant angina, the ECG shows ST-segment elevation. A chest xray will show heart enlargement or signs of heart failure, but isnt used to
diagnose angina.
34. Answer: 1. Reversal of the ischemia is the primary goal, achieved by reducing
oxygen consumption and increasing oxygen supply. An infarction is permanent
and cant be reversed.
35. Answer: 1. The initial priority is to decrease the oxygen consumption; this
would be achieved by sitting the client down. An ECG can be obtained after the
client is sitting down. After the ECGm sublingual nitro would be administered.
When the clients condition is stabilized, he can be returned to bed.
36. Answer: 3. Myocardial oxygen consumption increases as preload, afterload,
renal contractility, and heart rate increase. Cerebral blood flow doesnt directly
affect myocardial oxygen consumption.
37. Answer: 3. A high Fowlers position promotes ventilation and facilitates
breathing by reducing venous return. Lying flat and side-lying positions worsen
the breathing and increase workload of the heart. Semi-Fowlers position wont
reduce the workload of the heart as well as the Fowlers position will.
38. Answer: 4. In an attempt to compensate for increased work of breathing due

to hyperventilation, carbon dioxide decreases, causing hypocapnea. If the
condition persists, CO2 retention occurs and hypercapnia results.
39. Answer: 4. The body compensates for a decrease in cardiac output with a rise
in BP, due to the stimulation of the sympathetic NS and an increase in blood
volume as the kidneys retain sodium and water. Blood pressure doesnt initially
drop in response to the compensatory mechanism of the body. Alteration in LOC
will occur only if the decreased cardiac output persists.
40. Answer: 1. Production of pink, frothy sputum is a classic sign of acute
pulmonary edema. Because the client is at high risk for decompensation, the
nurse should call for help but not leave the room. The other three interventions
would immediately follow.
amount of blood expelled by the heart per minute. Overload refers to an
42. Answer: 3. The left ventricle is responsible for the majority of force for the
cardiac output. If the left ventricle is damaged, the output decreases and fluid
accumulates in the interstitial and alveolar spaces, causing pulmonary edema.
Damage to the left atrium would contribute to heart failure but wouldnt affect
cardiac output or, therefore, the onset of pulmonary edema. If the right atrium
and right ventricle were damaged, right-sided heart failure would result.
43. Answer: 1. Diagnosis of rheumatic fever requires that the client have either
two major Jones criteria or one minor criterion plus evidence of a previous
streptococcal infection. Major criteria include carditis, polyarthritis, Sydenhams
chorea, subcutaneous nodules, and erythema marginatum (transient, non pruritic
macules on the trunk or inner aspects of the upper arms or thighs). Minor criteria
include fever, arthralgia, elevated levels of acute phase reactants, and a
prolonged PR-interval on ECG.
44. Answer: 1. Immediately after establishing unresponsiveness, the nurse
should activate the resuscitation team. The next step is to open the airway using
the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and
feeling for no more than 10-seconds). If the client isnt breathing, give two slow
breaths using a bag mask or pocket mask. Next, check for signs of circulation by
palpating the carotid pulse.
45. Answer: 2. MI results from prolonged myocardial ischemia caused by reduced
blood flow through the coronary arteries. Therefore, the priority nursing diagnosis
for this client is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute
pain, and ineffective therapeutic regimen management are appropriate but dont
take priority.
46. Answer: 1. SOB, tachypnea, low BP, tachycardia, crackles, and a cough
producing pink, frothy sputum are late signs of pulmonary edema.
47. Answer: 4. The client with A-fib has the greatest potential to become unstable
and is on IV medication that requires close monitoring. After assessing this client,
the nurse should assess the client with thrombophlebitis who is receiving a
heparin infusion, and then go to the 58-year-old client admitted 2-days ago with
heart failure (her s/s are resolving and dont require immediate attention). The
lowest priority is the 89-year-old with end stage right-sided heart failure, who
requires time consuming supportive measures.
48. Answer: 1. The most essential teaching point is to report signs of relapse,
such as fever, anorexia, and night sweats, to the physician. To prevent further
endocarditis episodes, prophylactic antibiotics are taken before and sometimes
after dental work, childbirth, or GU, GI, or gynecologic procedures. A potassiumrich diet and daily pulse monitoring arent necessary for a client with endocarditis.
49. Answer: 3. Heart failure is precipitated or exacerbated by physical or
emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy,
Pagets disease, nutritional deficiencies (thiamine, alcoholism), pulmonary
disease, and hypervolemia.
50. Answer: 2. Digoxin exerts a positive inotropic effect on the heart while
slowing the overall rate through a variety of mechanisms. Digoxin is the
medication of choice to treat heart failure. Diltiazem (calcium channel blocker)
and propranolol and metoprolol (beta blockers) have a negative inotropic effect
and would worsen the failing heart.
51. Answer: 4. Pulmonary edema causes the client to be extremely agitated and
anxious. The client may complain of a sense of drowning, suffocation, or
smothering.
52. Answer: 3. The serum potassium level is measured in the client receiving
digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can
occur in the client with hypokalemia. Hypokalemia also predisposes the client to
ventricular dysrhythmias.
53. Answer: 4. The client who undergoes cardiac surgery is at risk for renal injury
from poor perfusion, hemolysis, low cardiac output, or vasopressor medication
therapy. Renal insult is signaled by decreased urine output, and increased BUN
and creatinine levels. The client may need medications such as dopamine
(Intropin) to increase renal perfusion and possibly could need peritoneal dialysis
or hemodialysis.
54. Answer: 2. The nurse should encourage regular use of pain medication for the
first 48 to 72 hours after cardiac surgery because analgesia will promote rest,
decrease myocardial oxygen consumption resulting from pain, and allow better
participation in activities such as coughing, deep breathing, and ambulation.
Options 1 and 3 will not help in tolerating ambulation. Removal of telemetry
equipment is contraindicated unless prescribed.
55. Answer: 1
56. Answer: 4. Ventricular tachycardia is a life-threatening dysrhythmia that
results from an irritable ectopic focus that takes over as the pacemaker for the
heart. The low cardiac output that results can lead quickly to cerebral and
myocardial ischemia. Clients frequently experience a feeling of impending death.
Ventricular tachycardia is treated with antiarrhythmic medications or magnesium
sulfate, cardioversion (client awake), or defibrillation (loss of consciousness),
Ventricular tachycardia can deteriorate into ventricular fibrillation at any time.
57. Answer: 2. The first signs and symptoms of digoxin toxicity in adults include
abdominal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos
around lights), bradycardia, and other dysrhythmias.
58. Answer: 3. Stable angina is induced by exercise and is relieved by rest or
nitroglycerin tablets. Unstable angina occurs at lower and lower levels of activity
and rest, is less predictable, and is often a precursor of myocardial infarction.
Variant angina, or Prinzmetals angina, is prolonged and severe and occurs at the
same time each day, most often in the morning.
59. Answer: 1. IV nitro infusion requires an infusion pump for precise control of
the medication. BP monitoring would be done with a continuous system, and
more frequently than every 4 hours. Hourly urine outputs are not always
required. Obtaining serum potassium levels is not associated with nitroglycerin
infusion.
60. Answer: 2. Aspirin does have antipyretic, antiplatelet, and analgesic actions,
but the primary reason ASA is administered to the client experiencing an MI is its
antithrombotic action.
61. Answer: 4. By day 2 of hospitalization after an MI, clients are expected to be
able to perform personal care without chest pain. Day 2 hospitalization may be
too soon for clients to be able to identify risk factors for MI or begin a walking
program; however, the client may be sitting up in a chair as part of the cardiac
rehabilitation program. Severe chest pain should not be present.
62. Answer: 2. Recommended dietary principles in the acute phase of MI include
avoiding large meals because small, easily digested foods are better digested
foods are better tolerated. Fluids are given according to the clients needs, and
sodium restrictions may be prescribed, especially for clients with manifestations
of heart failure. Cholesterol restrictions may be ordered as well. Clients are not
prescribed a diet of liquids only or NPO unless their condition is very unstable.
63. Answer: 1. In older adults who are less active and do not exercise the heart
muscle, atrophy can result. Disuse or deconditioning can lead to abnormal
changes in the myocardium of the older adult. As a result, under sudden
emotional or physical stress, the left ventricle is less able to respond to the
increased demands on the myocardial muscle.
64. Answer: 1 and 3. HF is a result of structural and functional abnormalities of
the heart tissue muscle. The heart muscle becomes weak and does not
adequately pump the blood out of the chambers. As a result, blood pools in the
left ventricle and backs up into the left atrium, and eventually into the lungs.
Therefore, greater amounts of blood remain in the ventricle after contraction
thereby decreasing cardiac output. In addition, this pooling leads to thrombus
formation and ineffective tissue perfusion because of the decrease in blood flow
to the other organs and tissues of the body. Typically, these clients have an
ejection fraction of less than 50% and poorly tolerate activity. Activity intolerance
is related to a decrease, not increase, in cardiac output. Gas exchange is
impaired. However, the decrease in cardiac output triggers compensatory
mechanisms, such as an increase in sympathetic nervous system activity.
65. Answer: 3. Activity intolerance is a primary problem for clients with heart
failure and pulmonary edema. The decreased cardiac output associated with heart
failure leads to reduced oxygen and fatigue. Clients frequently complain of

dyspnea and fatigue. The client could be at risk for infection related to stasis of
secretions or impaired skin integrity related to pressure. However, these are not
the priority nursing diagnoses for the client with HF and pulmonary edema, nor is
constipation related to immobility.
66. Answer: 3. ACE inhibitors have become the vasodilators of choice in the client
with mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown
to improve survival in overt heart failure.
67. Answer: 1. After IV injection of furosemide, diuresis normally begins in about
5 minutes and reaches its peak within about 30 minutes. Medication effects last 2
to 4 hours.
68. Answer: 2. Canned foods and juices, such as tomato juice, are typically high
in sodium and should be avoided in a sodium-restricted diet.
69. Answer: 2. A normal apical impulse is found under over the apex of the heart
and is typically located and auscultated in the left fifth intercostal space in the
midclavicular line. An apical impulse located or auscultated below the fifth
intercostal space or lateral to the midclavicular line may indicate left ventricular
enlargement.
70. Answer: 3. Left anterior descending artery
The left anterior descending artery is the primary source of blood for the anterior
wall of the heart. The circumflex artery supplies the lateral wall, the internal
mammary artery supplies the mammary, and the right coronary artery supplies
the inferior wall of the heart.

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NCLEX coronary artery disease

1. A client is scheduled for a cardiac catheterization using a radiopaque

23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes.

30. Which of the following types of pain is most characteristic of angina?

cardiac monitor. Which of the following electrolyte imbalances should the

43. A client enters the ER complaining of severe chest pain. A myocardial

1. Apply the nitroglycerin patch every other day

undetected. CVAs can be related to long-term hypertension. Liver or pulmonary

37. Answer: 3. Furosemide is a potassium-depleting diuretic than can cause

1. A client is scheduled for a cardiac catherization using a radiopaque

5. A client is wearing a continuous cardiac monitor, which begins to

administering oxygen at 2 L/minute per NC. The nurses next action

1. ANSWER D. This procedure requires an informed consent because it involves injection

NCLEX myocardial infarction

2. Medical treatment of coronary artery disease includes which of the

3. Which of the following is the most common symptom of myocardial

5. Which of the following blood tests is most indicative of cardiac

6. What is the primary reason for administering morphine to a client with

sedate the client

7. Which of the following conditions is most commonly responsible for

8. Which of the following complications is indicated by a third heart

9. After an anterior wall myocardial infarction, which of the following

Left-sided heart failure

10. What is the first intervention for a client experiencing MI?

11. Which of the following classes of medications protects the ischemic

12. What is the most common complication of an MI?

Abdominal aortic aneurysm

15. Which of the following symptoms is most commonly associated with

17. Which of the following symptoms might a client with right-sided

Adequate urine output

18. Which of the following classes of medications maximizes cardiac

19. Stimulation of the sympathetic nervous system produces which of the

20. Which of the following conditions is most closely associated with

3. Left-sided heart failure

22. Which of the following types of cardiomyopathy can be associated

23. Septal involvement occurs in which type of cardiomyopathy?

24. Which of the following recurring conditions most commonly occurs in

25. Dyspnea, cough, expectoration, weakness, and edema are classic

26. In which of the following types of cardiomyopathy does cardiac

29. If medical treatments fail, which of the following invasive procedures

30. Which of the following conditions is associated with a predictable

32. Which of the following conditions is the predominant cause of

Sit the client down

36. Myocardial oxygen consumption increases as which of the following

3. Preload, afterload, contractility, and heart rate.

Lying flat in bed

38. Which of the following blood gas abnormalities is initially most

39. Which of the following is a compensatory response to decreased

40. Which of the following actions is the appropriate initial response to a

Call for help

42. Acute pulmonary edema caused by heart failure is usually a result of

43. An 18-year-old client who recently had an URI is admitted with

Erythema marginatum, subcutaneous nodules, and fever

Activate the resuscitation team

45. A 55-year-old client is admitted with an acute inferior-wall

Report fever, anorexia, and night sweats to the physician.

49. A nurse is conducting a health history with a client with a primary

nurse would plan on having which of the following medications readily

Encourage the client to cough and deep breathe

55. A clients electrocardiogram strip shows atrial and ventricular rates

Normal sinus rhythm

56. A client has frequent bursts of ventricular tachycardia on the cardiac

Thrombocytopenia and weight gain

59. The physician orders continuous intravenous nitroglycerin infusion