CARDIOVASCULAR NCLEX QUESTIONS WITH ANSWERS AND RATIONALES 2024 UPDATED LATEST GRADED A+., Exams of Nursing

Download CARDIOVASCULAR NCLEX QUESTIONS WITH ANSWERS AND RATIONALES 2024 UPDATED LATEST GRADED A+. and more Exams Nursing in PDF only on Docsity! CARDIOVASCULAR NCLEX QUESTIONS WITH ANSWERS AND RATIONALES 2024 UPDATED LATEST GRADED A+. Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.) Mental status changes Agitation Frequent falls Sudden changes in GI function - Answer Mental status changes Agitation Frequent falls Rationale: Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem. A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of the heart receives blood from systemic circulation? Left atrium Right atrium Right ventricle Left ventricle - Answer Right atrium Rationale: The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus. It is important that the nurse be knowledgeable about cardiac output in order to: Evaluate blood flow to peripheral tissues. Determine the electrical activity of the myocardium. Provide information on the immediate need for oxygen. Implement nutritional changes. - Answer Evaluate blood flow to peripheral tissues. Rationale: Blood flow to the tissues is measured clinically as the cardiac output, and assists to predict tissue perfusion. Electrical activity is evaluated more effectively by EKG. While the cardiac output is important for perfusion and oxygenation of tissues, the oxygen saturation would provide more valuable information. Nutritional changes would be targeted to sodium and would depend on symptoms of disease. Integrated Process: Nursing Process; Planning Cognitive Level: Evaluation NCLEX-RN Test Plan: Health Promotion and Maintenance Nurses can best help older clients prevent hypertension by teaching: Low-fat, low-cholesterol diets. The importance of exercise. How to handle stressful situations. How to maintain a normal blood pressure. - Answer How to maintain a normal blood pressure. Rationale: Hypertension is a major risk factor for other cardiovascular conditions. In persons older than 50, systolic blood pressure greater than 140 mm Hg is a much more important cardiovascular disease risk factor than is diastolic blood pressure. The risk of cardiovascular disease, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg. Answers 1, 2, and 3 are important elements to include in education of a patient with blood pressure elevation, and are included in the Answer. Modification of lifestyle behaviors to help manage hypertension does not include which of the following? (Select all that apply.) Weight loss of even 10 pounds The DASH diet Fruits, vegetables, and whole grains Alcohol intake with meals - Answer Alcohol intake with meals \ of the question. Trisoralen is used to repigment skin for persons with vitiligo. Which of the following diagnostic tests is preferred for evaluating heart valve function? Chest x-ray Duplex Doppler Echocardiogram Electrocardiogram - Answer Echocardiogram Rationale: The echocardiogram is the preferred test to evaluate heart valves, because it allows the visualization of the valves as they open and close. A chest x-ray will determine the size of the heart, the duplex measures blood flow through major arteries, and an electrocardiogram identifies electrical activity. An elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient? Observe electrocardiogram readings and report deviations to the nurse. Assist the client with ambulation three times during the shift. Monitor vital signs every 15 minutes and report each reading to the nurse. Accurately weigh the patient, and report and record the readings. - Answer Accurately weigh the patient, and report and record the readings. Rationale: Due to fluid accumulation, an expanded blood volume can result when the heart fails. Body weight is a sensitive indicator of water and sodium retention, which will manifest itself with edema, dyspnea - especially nocturnal - and pedal edema. Patients also should be instructed about the need to perform daily weights upon discharge to monitor body water. It is not within the role of the CNA to monitor ECG readings, and ambulation is not an assessment. Vital signs every 15 minute are not necessary for this level of patient care. Which of the following drug classifications should the nurse question if prescribed for a person with congested heart failure (CHF)? Angiotensin-converting enzyme (ACE) inhibitor Beta-adrenergic blocker Alpha adrenergic antagonist Rosiglitazone (Avandia) - Answer Rosiglitazone (Avandia) Answer: Thiazolidinediones, like rosiglitazone (Avandia), are glucose- reducing drugs that are prescribed for persons with type 2 diabetes mellitus. ACE inhibitors, such as Lisinopril, are first-line drugs used to treat CHF. Propranolol (Inderal), a beta blocker, has remained one of the most widely used beta-blocking drugs. It blocks both beta1 and beta2 receptors in various organs, resulting in reduction of heart rate and the force of contraction, and suppresses impulse conduction through the AV node, all of which slows the progression of the disease process. Carvedilol (Coreg) is another beta-adrenergic blocker used to treat heart failure. A common arrhythmia found in some older clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered? Aspirin (acetylsalicylic acid) Warfarin sodium (Coumadin) Simvastatin (Zocor) Vinorelbine tartrate (Navelbine) - Answer Warfarin sodium (Coumadin) Rationale: Chronic atrial fibrillation places a patient at high risk for clot formation. Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent clots associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL. Navelbine is an anti-neoplastic. Which of the following assessments would be an important finding for a patient with arterial disease? Intermittent claudication with exercise Brownish discoloration around the ankles Non-pitting edema on the lower extremities Altered sensation to touch - Answer Intermittent claudication with exercise Rationale: Intermittent claudication is a common finding in persons with arterial disease, usually due to progression of atherosclerosis and alteration of tissue perfusion to the extremities. In venous disease, valves of the veins in the extremities become incompetent, resulting in higher pressures than normal in the veins. The pressure is transmitted to the capillaries of the lower extremities, resulting in thickening and non-pitting edema of tissues around the ankles. Prolonged thickening results in the red blood cells' being pressed outside the capillaries. The cells eventually break down, resulting in collection of hemosiderin deposits being collected in the area. Altered sensation to touch would be due to neuropathic changes commonly found with diabetes mellitus. 1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? Intake and output Baseline peripheral pulse rates Height and weight Allergy to iodine or shellfish - 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) 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? "Have you ever had this pain before?" "Can you describe the pain to me?" "Does the pain get worse when you breathe in?" "Can you rate the pain on a scale of 1-10, with 10 being the worst?" - 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) 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? Strict bed rest for 24 hours after transfer Bathroom privileges and self-care activities Unsupervised hallway ambulation with distances under 200 feet administered. In formulating a response, the nurse incorporates the understanding that warfarin: Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for this to begin. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic. - Answer 2. Warfarin works in the liver and inhibits synthesis of four vitamin K- dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited. 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: Administer the morphine Obtain a 12-lead ECG Obtain the lab work Order the chest x-ray - Answer 1. Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse's priority action would be to relieve the crushing chest pain. 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: Help keep him well hydrated Dissolve clots he may have Prevent kidney failure Treat potential cardiac arrhythmias. - 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) When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. Reflects electrical impulse beginning at the SA node Indicated electrical impulse beginning at the AV node Reflects atrial muscle depolarization Identifies ventricular muscle depolarization Has duration of normally 0.11 seconds or less. - 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) 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 nurse's next action would be to: Call for the doctor Start an intravenous line Obtain a portable chest radiograph Draw blood for laboratory studies - 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) 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? Cancer Hypertension Liver disease Myocardial infarction - 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) When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II. - 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) The most important long-term goal for a client with hypertension would be to: Learn how to avoid stress Explore a job change or early retirement Make a commitment to long-term therapy Control high blood pressure - 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) 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: Cerebrovascular accident Liver disease Myocardial infarction Pulmonary disease - Answer 1. Take one tablet every 2 to 5 minutes until the pain stops. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes. 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. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician. - 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 blood stream within 2 to 3 minutes and is metabolized within about 10 minutes. 24) Which of the following arteries primarily feeds the anterior wall of the heart? Circumflex artery Internal mammary artery Left anterior descending artery Right coronary artery - 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) When do coronary arteries primarily receive blood flow? During inspiration During diastolic During expiration During systole - 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) Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? Anterior Apical Inferior Lateral - 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 doesn't 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) A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this? Aortic Mitral Pulmonic Tricupsid - 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) Which of the following blood tests is most indicative of cardiac damage? Lactate dehydrogenase Complete blood count (CBC) Troponin I Creatine kinase (CK) - Answer 3. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren't detectable in people without cardiac injury. 29) Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? Cardiac catherization Cardiac enzymes Echocardiogram Electrocardiogram (ECG) - 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 can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catherization 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) Which of the following types of pain is most characteristic of angina? Knifelike Sharp Shooting Tightness - 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) Which of the following parameters is the major determinate of diastolic blood pressure? Baroreceptors Cardiac output Renal function Vascular resistance - 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) Which of the following factors can cause blood pressure to drop to normal levels? Kidneys' excretion of sodium only Kidneys' retention of sodium and water Kidneys' excretion of sodium and water Kidneys' retention of sodium and excretion of water - 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. should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue. 39) When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the: Impulse to begin atrial contraction Impulse to transverse the atria to the AV node SA node to discharge the impulse to begin atrial depolarization Impulse to travel to the ventricles - 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) 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 doesn't understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is: "Cardiac rehabilitation is not a cure but can help restore you to many of your former activities." "Here we teach you to gradually change your lifestyle to accommodate your heart disease." "You are probably right but we can gradually increase your activities so that you can live a more active life." "Do you feel that you will have to make some changes in your life now?" - 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) To evaluate a client's condition following cardiac catheterization, the nurse will palpate the pulse: In all extremities At the insertion site Distal to the catheter insertion Above the catheter insertion - 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) A client's physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect: Normal vs. abnormal tissue Damage in areas of the heart Ventricular function Myocardial scarring and perfusion - 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) 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? Monitoring vital signs Completing a physical assessment Maintaining cardiac monitoring Maintaining at least one IV access site - 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) A client is experiencing tachycardia. The nurse's understanding of the physiological basis for this symptom is explained by which of the following statements? The demand for oxygen is decreased because of pleural involvement The inflammatory process causes the body to demand more oxygen to meet its needs. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension. Respirations are labored. - Answer 3. The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart's having to beat faster to meet the body's needs for oxygen. . 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? Creatine kinase (CK or CPK) Lactic dehydrogenase (LDH) LDH-1 LDH-2 - 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 blood stream. Lactic dehydrogenase rises in 24- 48 hours, and LDH-1 and LDH-2 rises in 8-24 hours. 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: Decreased arterial blood flow secondary to vasoconstriction Decreased arterial blood flow leading to hyperemia Atherosclerotic obstruction of the arteries Trauma to the lower extremities - 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) Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch? "Apply the patch to a nonhairy, nonfatty area of the upper torso or arms." "Apply the patch to the same site each day to maintain consistent drug absorption." "If you get a headache, remove the patch for 4 hours and then reapply." When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of A. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation. B. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation. C. baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate. D. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate. - Answer C. baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate. When checking the capillary filling time of a patient, the color returns in 10 seconds. The nurse recognizes this finding as indicative of A. a normal response. B. thrombus formation in the veins. C. lymphatic obstruction of venous return. D. impaired arterial flow to the extremities. - Answer D. impaired arterial flow to the extremities. The auscultatory area in the left midclavicular line at the level of the fifth ICS is the A. aortic area. B. mitral area. C. tricuspid area. D. pulmonic area. - Answer B. mitral area. When assessing the patient, the nurse notes a palpable precordial thrill. This finding may be caused by A. heart murmurs. B. gallop rhythms. C. pulmonary edema. D. right ventricular hypertrophy. - Answer A. heart murmurs. When assessing the cardiovascular system of a 79-year-old patient, the nurse expects to find A. a narrowed pulse pressure. B. diminished carotid artery pulses. C. difficulty in isolating the apical pulse. D. an increased heart rate in response to stress. - Answer C. difficulty in isolating the apical pulse. An important nursing responsibility for a patient having an invasive cardiovascular diagnostic study is A. checking the peripheral pulses and percutaneous site. B. instructing the patient about radioactive isotope injection. C. informing the patient that general anesthesia will be given. D. assisting the patient to do a surgical scrub of the insertion site. - Answer A. checking the peripheral pulses and percutaneous site. A P wave on an ECG represents an impulse A. arising at the SA node and repolarizing the atria. B. arising at the SA node and depolarizing the atria. C. arising at the AV node and depolarizing the atria. D. arising at the AV node and spreading to the bundle of His. - Answer B. arising at the SA node and depolarizing the atria. If a patient has decreased cardiac output caused by fluid volume deficit and marked vasodilation, the regulatory mechanism that will increase the blood pressure by improving both of these is A. release of antidiuretic hormone (ADH). B. secretion of prostaglandins PGE C. stimulation of the sympathetic nervous system. D. activation of the renin-angiotensin-aldosterone system. - Answer D. activation of the renin-angiotensin-aldosterone system.Q While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is A. hyperlipidemia. B. excessive alcohol intake. C. a family history of hypertension. D. consumption of a high-carbohydrate, high-calcium diet - Answer B. excessive alcohol intake. Target organ damage that can occur from hypertension includes A. headache and dizziness. B. retinopathy and diabetes. C. hypercholesterolemia and renal dysfunction. D. renal dysfunction and left ventricular hypertrophy. - Answer D. renal dysfunction and left ventricular hypertrophy. A high-risk population that should be targeted in the primary prevention of hypertension is A. smokers. B. African Americans. C. business executives. D. middle-aged women. - Answer B. African Americans. In teaching a patient with hypertension about controlling the condition, the nurse recognizes that A. all patients with elevated BP require medication. B. it is not necessary to limit salt in the diet if taking a diuretic. C. obese persons must achieve a normal weight in order to lower BP. D. lifestyle modifications are indicated for all persons with elevated BP. - Answer D. lifestyle modifications are indicated for all persons with elevated BP. A major consideration in the management of the older adult with hypertension is to A. prevent pseudohypertension from converting to true hypertension. B. recognize that the older adult is less likely to comply with the drug therapy than a younger adult. C. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap. - Answer D. use careful The most common pathologic finding in individuals with sudden cardiac death is A. cardiomyopathies. B. mitral valve disease. C. atherosclerotic heart disease. D. left ventricular hypertrophy. - Answer C. atherosclerotic heart disease. A compensatory mechanism involved in congestive heart failure that leads to inappropriate fluid retention and additional workload of the heart is A. ventricular dilation. B. ventricular hypertrophy. C. neurohormonal response. D. sympathetic nervous system activation. - Answer C. neurohormonal response. The drug used in the management of a patient with acute pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is A. morphine. B. amrinone. C. dobutamine. D. aminophylline. - Answer A. morphine. A patient with chronic congestive heart failure and atrial fibrillation is treated with a digitalis preparation and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to A. monitor serum potassium levels. B. keep an accurate measure of intake and output. C. teach the patient about dietary restriction of potassium. D. withhold the digitalis and notify the health care provider if the heart rate is irregular. A. monitor serum potassium levels. - Answer A. monitor serum potassium levels. The nurse plans care for the patient with dilated cardiomyopathy based on the knowledge that A. family members may be at risk because of the infectious nature of the disease. B. medical management of the disorder focuses on treatment of the underlying cause. C. the prognosis of the patient is poor, and emotional support is a high priority of care. D. the condition may be successfully treated with surgical ventriculomyotomy and myectomy. - Answer C. the prognosis of the patient is poor, and emotional support is a high priority of care. The primary causes of death in patients with heart transplants in the first year include A. infection and rejection. B. rejection and arrhythmias. C. arrhythmias and infection. D. myocardial infarction and lymphoma. - Answer A. infection and rejection. A patient with a stable blood pressure and no symptoms has the following electrocardiogram characteristics: atrial rate—74 and regular; ventricular rate—62 and irregular; P wave—normal contour; PR interval—lengthens progressively until a P wave is not conducted; QRS—normal contour. The nurse would expect that treatment would involve A. epinephrine 1 mg IV push. B. isoproterenol IV continuous drip. C. immediate insertion of a temporary pacemaker. D. careful observation for symptoms of hypotension. - Answer D. careful observation for symptoms of hypotension. The cardiac monitor of a patient in the cardiac care unit following an acute MI indicates ventricular bigeminy. The nurse anticipates A. performing defibrillation. B. treatment with IV lidocaine. C. insertion of a temporary pacemaker. D. continuing monitoring without other treatment. - Answer B. treatment with IV lidocaine. The nurse prepares a patient for electrical cardioversion knowing that cardioversion differs from defibrillation in that A. defibrillation requires a greater dose of electrical current. B. defibrillation is synchronized to countershock during the QRS complex. C. cardioversion is indicated only for treatment of atrial tachyarrhythmias. D. cardioversion may be done on a nonemergency basis with sedation of the patient. - Answer D. cardioversion may be done on a nonemergency basis with sedation of the patient. When providing discharge instructions to a patient with a new permanent pacemaker, the nurse teaches the patient to A. take and record a daily pulse rate. B. request special hand scanning at airport and other security gates. C. immobilize the arm and shoulder on the side of the pacemaker insertion for 6 weeks. D. avoid microwave ovens because they emit radio waves that alter pacemaker function. - Answer A. take and record a daily pulse rate. The nurse plans care for the patient with an implantable cardioverter- defibrillator based on the knowledge that A. antiarrhythmia drugs can be discontinued. B. all members of the patient's family should learn CPR. C. the patient should not drive until 1 month after the ICD has been implanted. D. the patient is usually relieved to have the device implanted to prevent arrhythmias. - Answer B. all members of the patient's family should learn CPR. A 62-year-old woman weighs 92 kg and has a history of daily alcohol intake, smoking, high blood pressure, high sodium intake, and sedentary lifestyle. The nurse identifies the risk factors most highly related to peripheral arterial disease in this patient as A. sex and age. B. weight and alcohol intake. C. cigarette smoking and hypertension. A. Has an increased risk for alcoholism B. Has an increased risk for obesity and diabetes C. Has an increased risk for stress-related illnesses D. Has an increased risk for cardiopulmonary disease and lung cancer - Answer D. Has an increased risk for cardiopulmonary disease and lung cancer The risk of lung cancer is 10 times greater for a person who smokes than for a nonsmoker. Cigarette smoking worsens peripheral vascular and coronary artery disease. Inhaled nicotine causes vasoconstriction of peripheral and coronary blood vessels, increasing blood pressure and decreasing blood flow to peripheral vessels. Conditions such as shock and severe dehydration resulting from extracellular fluid loss cause: A. Hypoxia B. Hypovolemia C. Hypervolemia D. Uncontrolled bleeding - Answer B. Hypovolemia Conditions such as shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume (hypovolemia). Left-sided heart failure is characterized by: A. Increased cardiac output B. Lowered cardiac pressures C. Decreased functioning of the left atrium D. Decreased functioning of the left ventricle - Answer D. Decreased functioning of the left ventricle Left-sided heart failure is an abnormal condition characterized by decreased functioning of the left ventricle. If left ventricular failure is significant, the amount of blood ejected from the left ventricle drops greatly, which results in decreased cardiac output. Progress The nurse is concerned when a client's heart rate, which is normally 95 beats per minute, rises to 220 beats per minute, because a rate this high will: A. Exhaust the client B. Decrease metabolic rate C. Reduce coronary artery perfusion D. Provide too much blood flow to major organs - Answer C. Reduce coronary artery perfusion Coronary arteries fill and perfuse the myocardium (heart muscle) during diastole. When the heart rate is elevated, more time is spent in systole and less in diastole; hence, the myocardium may not be perfused adequately. The client may be exhausted, but the primary concern is myocardial perfusion. Major organs will adjust to increased blood flow. This is usually not a problem. With a heart rate this high, metabolic rate will be increased, not decreased. The nurse is caring for a client who has undergone cardiac catheterization. The client says to the nurse, "The doctor said my cardiac output was 5.5 L/min. What is normal cardiac output?" Which of the following is the nurse's best response? A. "It is best to ask your doctor." B. "Did the test make you feel upset?" C. "The normal cardiac output for an adult is 4 to 6 L/min." D. "Are you able to explain why are you asking this question?" - Answer C. "The normal cardiac output for an adult is 4 to 6 L/min." A client asks why smoking is a major risk factor for heart disease. In formulating a response, the nurse incorporates the understanding that nicotine: A. Causes vasodilation B. Causes vasoconstriction C. Increases the level of high-density lipoproteins D. Increases the oxygen-carrying capacity of hemoglobin - Answer B. Causes vasoconstriction The nurse suspects left-sided heart failure in a newly admitted client when the nurse notes which of the following symptoms? (Select all that apply.) A. Distended neck veins B. Bilateral crackles in the lungs C. Weight gain of 2 lb in past 2 days D. Shortness of breath, especially at night . - Answer B. Bilateral crackles in the lungs D. Shortness of breath, especially at night Left-sided heart failure results in ineffective ejection of blood from the left ventricle. This causes a backup of blood into the lungs. Thus, symptoms of left-sided heart failure are usually related to the lungs A thoracic aortic aneurysm is found when a patient has a routine chest x- ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include: a. CT scan B. angiography c. echocardiography d. ultrasound - Answer a. CT scan A patient with a small abdominal aneurysm is not a good surgical candidate. The nurse teaches the patient that one of the best ways to prevent expansion of the lesion is to: - Answer control hypertension with prescribed therapy. During preoperative prep of patient scheduled for an abdominal aortic aneurysm the nurse establishes basline data for the patient knowing that a. postop all pphysiologic processes will be altered b. The cause of the aneurysm is a systemic vasuclar disease c. surgery will be canceled if any function is not normal d. blood pressure and HR will be maintained below normal levels during surgery - Answer b. The cause of the aneurysm is a systemic vascular disease During the patient's acute postop period following repair of an aneurysm, the nurse should ensure that: