Cardio 2

MULTIPLE CHOICE
5. A patient asks what a transesophageal echocardiogram (TEE) is and what it is expected to do?
What is the best explanation by the nurse?

a. Measures conductivity
b. Records the force of contraction
c. Evaluates the efficiency of the valves
d. Checks the volume of the preload
ANS: C
TEE evaluates the efficiency of the valves.

DIF: Cognitive Level: Application
REF: p. 689
OBJ: 6
TOP: TEE
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
6. A nurse records the finding of a normal sinus rhythm (NSR) when the P, Q, R, S, and T are all
present in the electrocardiographic complex. What additional information should the nurse
document?
a. Rate of 82 seconds
b. PR interval of 0.36 second
c. QRS complex of 0.16 second
d. Inverted T
ANS: A
NSR requires the presence of P, Q, R, S, and T waves, in that order, and all pointing in the
same direction, with a rate of 60 to 100 seconds. Normal intervals are a PR interval of 0.12 to
0.20 seconds and a QRS complex less than 0.10 second.
REF: p. 730-731
OBJ: 5
TOP: Normal Sinus Rhythm
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
7. A nurse should anticipate that a patient taking Vasotec, an angiotensin-converting enzyme
(ACE) inhibitor, should have which positive outcome to this drug?

Increased fluid retention
Decreased blood pressure
Decreased urine output
Increased appetite
a.
b.
c.
d.
ANS: B
ACE inhibitors suppress the excretion of angiotensin, which lowers the blood pressure,
reduces fluid retention, and leads to increased urine output.
REF: p. 696
OBJ: 6
TOP: ACE Inhibitors
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
8. A 29-year-old patient is to receive cardioversion for a dysrhythmia. What should the nurse
instruct the patient to expect?
a.
b.
c.
d.
Administration of a short-acting sedative

Digoxin dose to be taken as scheduled
Procedure to be completely safe
Pacemaker spikes to be carefully monitored
ANS: A
A cardioversion has risks, such as ventricular fibrillation. Emergency equipment should be

available. The digoxin dose is held before a cardioversion, and the patient is given a shortacting sedative such as Versed or Valium, which will require recovery. The electrocardiogram
R wave is synchronized via the computer, and no pacemaker is involved.
DIF: Cognitive Level: Comprehension
REF: p. 705
OBJ: 6 | 7
TOP: Cardioversion
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
9. A 68-year-old patient is scheduled for open heart surgery in the morning and is crying. What
is the most appropriate response by the nurse?

a. Everything will go great! Dr. C. is the best!
b. I know how you feel, so do not cry.
c. Tell me what concerns you the most.
d. I will call the physician for a sedative. You are too upset.
ANS: C
Therapeutic implementations identify and acknowledge feelings. Do not assume that you
know how the patient feels and do not give false assurances.
REF: p. 707
OBJ: 7 | 9
TOP: Open Heart Surgery
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
10. What do fibrous plaques of atherosclerosis serve as when they are laid down in the vessels?
a. Stent to keep the vessel open
b. Trap to which other substances adhere
c. Threat to the integrity of the vessel wall
d. Embolus
ANS: B
The plaque surface acts as a trap to which fibrous plaques can adhere, causing more narrowing
of the vessel. The enlarging plaque can become a thrombus but not an embolus because
emboli are usually considered to be traveling aggregations that lodge in a small arteriole.
REF: p. 709
OBJ: 7
TOP: Atherosclerosis
11. A patient with an irregular sinoatrial (SA) node conduction has a permanent pacemaker with
the code AAIOO and is now going home. The patient asks, What happens when my real SA
node fires on its own? How should the nurse respond regarding what the pacemaker should
do?
a. Not fire
b. Fire only the ventricles
c. Change the rate of firing
d. Fire both the atria and the ventricles.

ANS: A
The code is A (chamber-paced) atria, A (sense impulse) atria only, I (inhibit) inhibit firing
from the pacemaker, O (rate modification) no rate modification, and O (multichamber) no
other chambers to be stimulated by the pacemaker. If the SA fires on its own, the pacemaker
does nothing until it fails to sense an impulse.
REF: p. 615
OBJ: 7 | 9
TOP: Permanent Pacemaker Care
12. A patient with angina pectoris complains of chest pain at rest and needs to take three
nitroglycerin (NTG) pills to relieve the pain. Of what should the nurse assess this as a major
symptom?
a. Stable angina
b. Unstable angina
c. Full-blown acute myocardial infarction (MI)
d. Pulmonary embolus
ANS: B
A patient with angina who has pain at rest that is not relieved with one NTG pill is considered
to have unstable angina, a precursor to an acute MI.
REF: p. 688
OBJ: 7
TOP: Unstable Angina
13. A nurse explains that cardiac rehabilitation lasts from the end of acute care to the return to
home and beyond. What does this service include?

One-on-one individualized care
Focus on the patient rather than the family
Telemetry-monitored exercise
Rejection from the program for noncompliance
a.
b.
c.
d.
ANS: C
Cardiac rehabilitation programs are supervised by a team of experts who arrange for
telemetry-supervised exercise and other modalities, such as diet and medical protocol
management. The focus is on the family, as well as the patient. Although some patients reject
the program, they are rarely rejected by the rehabilitation center.
REF: p. 727
OBJ: 7
TOP: Cardiac Rehabilitation
14. On auscultation, a nurse detects a heart murmur. What should the nurse know that a heart
murmur indicates?
Valves that do not close correctly
Pericardium that is inflamed
Decrease in pacemaker cells
Loud ventricular gallop
a.
b.
c.
d.
ANS: A
Heart murmurs indicate turbulent blood flow and can be caused by valves that are stiff and do
not shut correctly; consequently, blood flows back into the chamber.
REF: p. 688
OBJ: 7
TOP: Heart Murmur
15. What is an important teaching point for a patient with mitral stenosis?
a. Obtain a place on the heart transplant list.
b. Balance activity with oxygen supply.
c. Increase daily fluid intake to over 2000 mL.
d. Have an annual electrocardiogram.
ANS: B
Patients with mitral stenosis need to balance their activity with their oxygen supply and avoid
overhydration.
REF: p. 727
OBJ: 7
TOP: Mitral Stenosis
16. A physician has ordered continuous pulse oximetry. What should the nurse explain to the
patient about this procedure?

Involves a single prick
Measures the amount of oxygen in the blood
Is applied to the wrist
Identifies damaged cells in the myocardium
a.
b.
c.
d.
ANS: B
Pulse oximetry measures arterial oxygen saturation noninvasively by attaching a clip to a

digit, an ear, or a nose.
REF: p. 694
OBJ: 6
TOP: Pulse Oximetry
17. A stress test is scheduled for a 41-year-old patient. What action should the nurse implement to
prepare the patient for the examination?

a. Have the patient sign a consent form.
b. Give the patient a special heart diet.
c. Prepare the patient for sedation.
d. Remove all metal objects.
ANS: A
A stress test is a noninvasive test that consists of a patient walking on a treadmill while an
electrocardiogram records the activity. A consent form is required.
REF: p. 692
OBJ: 6
TOP: Stress Test
18. What action should a nurse expect to implement when a patient returns from a cardiac
catheterization?
Ambulate the patient in the hall.
Check the puncture site.
Monitor the gag reflex.
Remove the gel from all sites on the skin.
a.
b.
c.
d.
ANS: B
Cardiac catheterizations are invasive procedures during which a catheter is threaded through
an artery. Postprocedure care requires bedrest and monitoring the puncture site.
REF: p. 690
OBJ: 6
TOP: Cardiac Catheterization
19. A nurse assesses an inverted T wave on the ECG of a patient who had an acute MI two days
earlier. How should the nurse interpret this finding?

a. Normal recovery
b. New MI
c. Abnormal wave form
d. Congestive heart failure
ANS: C
The abnormal wave form of the inverted T wave is an indicator that tissue death has occurred
in part of the cardiac wall. The cardiac wall now has no ability to conduct or to contract and
sends that message to the ECG via the inverted T. The tissue will take 6 weeks to regenerate.
DIF: Cognitive Level: Analysis
REF: p. 711
OBJ: 8
TOP: Significance of Inverted T Wave
KEY: Nursing Process Step: Evaluation
20. Laboratory tests are performed to identify damage to the heart muscle. Which test is elevated
the earliest with heart damage?

a. Creatine phosphokinase-MB (CPK-MB)
b. Lactate dehydrogenase (LDH)
c. Lipid profile
d. Troponin
ANS: D
Troponin is elevated within 3 to 6 hours and is often measured in the emergency department.
CPK-MB is elevated in 12 to 24 hours. Three serial samples are drawn. The LDH increases
with heart damage within 3 to 6 days. The lipid profile is not elevated with heart damage.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Knowledge

REF: p. 690 | p. 712
8
TOP: Cardiac Enzymes
Nursing Process Step: Implementation
NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
21. A patient is scheduled for a heart catheterization. What action should the nurse implement in
preparation for this examination?

a. Ask the patient about allergies to seafood or iodine.
b. Remove all metal objects.
c. Give the patient a special heart diet.

d. Test arterial blood gases (ABGs).
ANS: A
The dye injected during the cardiac catheterization is iodine based. An allergy to seafood is
correlated with a reaction to this dye as well.
REF: p. 693
OBJ: 5
TOP: Cardiac Catheterization
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
22. A patient has had atropine sulfate that has been administered intravenously to treat a
dysrhythmia. What should the nurse assess this patient for after administration?
Weight gain
Tachycardia
Muscle twitching
Incontinence of urine
a.
b.
c.
d.
ANS: B
Atropine increases the heart rate. The nurse should watch for tachycardia, which increases the
workload of the heart. This medication causes urinary retention.
REF: p. 701
OBJ: 7
TOP: Drugs for Dysrhythmias
23. A dopamine infusion is being administered to a patient with shock. For what should the nurse
be alert?
Sharp spike in blood pressure
Tremor of the hands
Increasing urinary output
Hyperirritability of the patient
a.
b.
c.
d.
ANS: A
Dopamine has a direct effect by elevating the blood pressure. The criterion is to titrate to the
target blood pressure. Urinary output should also be monitored for a decreased amount
because a heightened blood pressure may slow urine filtration and reduce urine output.
REF: p. 701
OBJ: 7
TOP: Dopamine
24. A patient with atrial fibrillation is prescribed amiodarone for the dysrhythmia. Which potential
adverse reaction should the nurse report?

Ataxia
Decreasing pulse rate
Decreasing blood pressure
Increase in cardiac output
a.
b.
c.
d.
ANS: A
The drug amiodarone is meant to quiet atrial activity and modify rapid pulse rate, high blood
pressure, and decreased cardiac output caused by the dysrhythmia. The drug interferes with
the thyroid and causes an ataxic gait and trembling of hands as adverse effects.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Application

REF: p. 699
OBJ: 7
Atrial Fibrillation with Amiodarone
Nursing Process Step: Assessment
NCLEX: Physiological Integrity: Pharmacological Therapies
25. A medication, simvastatin (Zocor), is administered to lower a patients cholesterol level.
Follow-up lipid levels are reviewed by the nurse. Which level indicates the desired therapeutic
range?
a. High-density lipoprotein (HDL), 29 mg/dL; low-density lipoprotein (LDL), 160
mg/dL
b. HDL, 38 mg/dL; LDL, 120 mg/dL
c. HDL, 56 mg/dL; LDL, 106 mg/dL
d. HDL, 42 mg/dL; LDL, 98 mg/dL
ANS: D
The reading that has both an HDL level above 40 mg/dL and an LDL level below 100 mg/dL
is in the therapeutic target range.
DIF: Cognitive Level: Knowledge
REF: p. 695
OBJ: 7
TOP: Drug Therapy
26. What information should a nurse include in a patients discharge instruction after an acute
myocardial infarction (MI)?

Cautions about the use of morphine
Detailed symptoms that indicate impending MI
Written instructions on diet and follow-up appointments
High-energy exercise program directions
a.
b.
c.
d.
ANS: C
The patient needs written instructions for diet, follow-up appointments, and exercise
protocols. Giving detailed information about symptoms is not necessary other than to remind
the patient about reporting chest pain and shortness of breath. A high-energy exercise program
is not appropriate. Morphine is not part of the home care after an MI.
REF: p. 716
OBJ: 7
TOP: Myocardial Infarction
27. A patient with acute congestive heart failure has jugular vein distention, crackles bilaterally,
and dyspnea. Which nursing diagnosis should have the highest priority?
Activity intolerance
Excess fluid volume
Anxiety
Ineffective coping
a.
b.
c.
d.
ANS: B
Fluid volume excess increases the workload of the heart and interferes with breathing.
DIF:
OBJ:
KEY:
MSC:

REF: p. 687 | p. 720
7
TOP: Congestive Heart Failure
Nursing Process Step: Nursing Diagnosis
NCLEX: Physiological Integrity: Basic Care and Comfort
28.
A nurse is assessing the cardiac complex above. What pattern should the nurse recognize in
this rhythm strip?
a. NSR
b. Premature ventricular contractions (PVCs)
c. Ventricular tachycardia (VT)
d. AF
ANS: A
This pattern is NSR because it has one P wave for every QRS and one T wave.
REF: p. 731
OBJ: 7
TOP: Recognition of NSR
29. A diuretic medication, furosemide (Lasix), is being administered for congestive heart failure.
Which assessment is not an anticipated consequence of the therapy?

Increased urinary output
Weight loss
Thirst
Muscle weakness
a.
b.
c.
d.
ANS: D
Increased urinary output, weight loss, and thirst are all anticipated consequences of the
therapy. Muscle weakness is a sign of hypokalemia.
REF: p. 696
OBJ: 7
TOP: Diuretic Therapy
30. A patient is receiving digoxin 0.25 mg/day. What should the nurse do prior to administering
this medication?
Count an apical pulse for 15 seconds.
Hold the dose if the apical rate is 57 beats/min.
Give the dose if the apical rate is 59 beats/min.
Double the dose if the rate is 62 beats/min.
a.
b.
c.
d.
ANS: B
The dose should be held if the apical rate is less than 60 beats/min for 1 minute.

REF: p. 679
OBJ: 7
TOP: Drug Therapy
31. A 46-year-old patient is receiving propranolol (Inderal), a nonselective beta-adrenergic
blocker, for a heart condition. What patient teaching is most appropriate?

a. Sit or lie down when taking the drug.
b. Limit caffeine intake.
c. Double the dose if symptoms occur.
d. Never stop taking the drug abruptly.
ANS: D
Beta-blockers should never be stopped abruptly because they can cause angina or MI. Patients
are gradually weaned off these medications.
REF: p. 698
OBJ: 7
TOP: Drug Therapy
32. Which assessment should be immediately addressed in a patient on lidocaine?
a. Slowed ventricular rate
b. Occasional PVCs
c. Increase in temperature to 102 F
d. Nausea and vomiting
ANS: C
A temperature that goes up drastically indicates an adverse reaction to lidocaine, malignant

hyperthermia. The slowed ventricular rate, even with occasional PVCs, is an expected
outcome of lidocaine infusion. Nausea and vomiting are adverse effects.
REF: p. 699
OBJ: 7
TOP: Drug Therapy
33.
How should a nurse interpret the arrhythmia in the above strip?

NSR
PVC
VT
AF
a.
b.
c.
d.
ANS: B
This is an arrhythmia of a PVC with an extra premature QRS complex (inverted) before the P
wave.

REF: p. 732
OBJ: 7
TOP: Recognition of PVC
34. A nurse records a 1 for the pulse quality of the pedal pulse. What interpretation is correct
regarding the pulse?

Absent
Normal
Thready
Forceful
a.
b.
c.
d.
ANS: C
A 1 in a pulse evaluation indicates a thready pulse that is easily obliterated by pressure.

REF: p. 687
OBJ: 8
TOP: Pulse Quality
MULTIPLE RESPONSE
35. Which factors affect stroke volume? (Select all that apply.)
a. Contractility
b. Climate
c. Age
d. Preload
e. Afterload
ANS: A, D, E
Stroke volume is dependent on contractility, preload, and afterload. Age may affect all three,
but the stroke volume, regardless of age, is dependent on these three factors.
REF: p. 685
OBJ: 2
TOP: Stroke Volume
KEY:
Nursing Process Step: Implementation
36. Which age-related changes in the heart should a nurse take into consideration? (Select all that
apply.)
Decrease in contractility
Thickened valves
Stiffened valves
Decreased SA node cells
Increased nerve fibers in ventricles
a.
b.
c.
d.
e.
ANS: A, B, C, D
Aging thickens and stiffens the valves and reduces the cells in the SA node. Age decreases the
nerve fibers in the ventricles.
REF: p. 686
OBJ: 9
TOP: Age-Related Cardiac Changes
KEY: Nursing Process Step: Planning
37. What actions should a nurse implement to decrease the workload of the heart in a patient with
acute congestive failure? (Select all that apply.)

Eliminate unnecessary activities.
Direct the patient in active range-of-motion exercises.
Help the patient change positions every 2 hours.
Assist the patient to ambulate to the bathroom.
Give a partial bed bath rather than full bed bath.
a.
b.
c.
d.
e.
ANS: A, C, E
To minimize the workload of the heart, the nurse would adjust nursing care to eliminate all
unnecessary activities, assist in position changes, and give a minimal bath. Ambulation and
active range-of-motion exercises are unnecessary activities at this time.
DIF:
TOP:
KEY:
MSC:

REF: p. 720
OBJ: 7
Nursing Care of Congestive Failure
Nursing Process Step: Planning
NCLEX: Physiological Integrity: Basic Care and Comfort
38. A nurse urges a 50-year-old overweight executive who had a myocardial infarction (MI) 3
months earlier to take up some conditioning exercises for 30 minutes a day. What rationale
supports this suggestion? (Select all that apply.)
a. Lose weight.
b. Improve function of the left ventricle.
c. Decrease arterial stiffening.
d. Decrease cholesterol levels.
e. Improve cardiac dysrhythmia.
ANS: A, B, C, D
Conditioning exercises performed daily for 30 minutes can reduce weight, improve the
cardiac output of the left ventricle, decrease arterial stiffening, and decrease LDLs. Exercise
does not affect dysrhythmias.
REF: p. 715-716
OBJ: 7
TOP: Effects of Conditioning Exercises KEY: Nursing Process Step: Implementation
COMPLETION
39. At rest, the cardiac cells in the myocardium are electrically polarized, with the inside of the
cell being more _____ than the outside of the cell.

ANS:
negative
When the heart is at rest, the inside of the cell is negatively charged.
REF: p. 685
OBJ: 3
TOP: Polarization of Myocardium
OTHER
40. A nurse uses a picture to demonstrate the conduction pathway through the chambers of the
heart. (Arrange the following options in the correct sequence. Separate letters by a comma
and space as follows: A, B, C, D.)
A. The atria contract.
B. Conduction occurs through the bundle branches.
C. The AV node fires.
D. The Purkinje fibers conduct.
E. The SA node fires.
F. The ventricles contract.
ANS:
E, A, C, B, D, F
The conduction pathway begins in the SA node, travels down the atrial wall, depolarizing the
atria, to the AV node, bundle branches, and Purkinje fibers, contracting the ventricles.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Comprehension

REF: p. 684-685
OBJ: 4
Conduction Pathway for Cardiac Contraction
Nursing Process Step: Assessment
NCLEX: Physiological Integrity: Physiological Adaptation

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MULTIPLE CHOICE

What is the best explanation by the nurse?

TEE evaluates the efficiency of the valves.

(ACE) inhibitor, should have which positive outcome to this drug?

instruct the patient to expect?

Administration of a short-acting sedative

A cardioversion has risks, such as ventricular fibrillation. Emergency equipment should be

is the most appropriate response by the nurse?

d. Fire both the atria and the ventricles.

home and beyond. What does this service include?

patient about this procedure?

Pulse oximetry measures arterial oxygen saturation noninvasively by attaching a clip to a

prepare the patient for the examination?

earlier. How should the nurse interpret this finding?

the earliest with heart damage?

Cognitive Level: Knowledge

preparation for this examination?

c. Give the patient a special heart diet.

adverse reaction should the nurse report?

Cognitive Level: Application

25. A medication, simvastatin (Zocor), is administered to lower a patients cholesterol level.

myocardial infarction (MI)?

Cognitive Level: Application

Which assessment is not an anticipated consequence of the therapy?

DIF: Cognitive Level: Application

blocker, for a heart condition. What patient teaching is most appropriate?

A temperature that goes up drastically indicates an adverse reaction to lidocaine, malignant

How should a nurse interpret the arrhythmia in the above strip?

DIF: Cognitive Level: Analysis

regarding the pulse?

A 1 in a pulse evaluation indicates a thready pulse that is easily obliterated by pressure.

acute congestive failure? (Select all that apply.)

Cognitive Level: Application

cell being more _____ than the outside of the cell.

Cognitive Level: Comprehension

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