N461 Exam 2 Practice Questions And Answer Latest Updated 2023, Exams of Cardiology

Download N461 Exam 2 Practice Questions And Answer Latest Updated 2023 and more Exams Cardiology in PDF only on Docsity! 1 N461 Exam 2 Practice Questions And answer latest updated 2023 with assured success% 1. The nurse, discussing coronary heart 2 disease risk factors with a group of factory employees, would include which option(s) as modifiable risk factors? Select all that apply. a. hypertension b. diabetes mellitus c. obesity d. age e. heredity 2. Which diagnostic test would the nurse anticipate as priority for a patient admitted with chest pain to determine coronary heart disease status? a. coronary angiography b. stress electrocardiography c. echocardiography d. radionuclide testing Aspirin has been prescribed for a patient following a myocardial infarction. What should the nurse include in teaching about this drug? e. Check with your healthcare provider before taking any herbal remedies. 5 6. During patient teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease? a. elevated homocysteine b. elevated creatinine c. elevated high density lipoprotein (HDL) d. elevated INR 7. The nurse, caring for a patient admitted with chest pain, realizes that which factor places the patient at the highest risk for heart disease? a. overweight and carries the weight around the waist b. mother died at age 70 of an acute myocardial infarction c. a single mother of four young children with a low income d. has a desk job and works long hours 8. The nurse, assessing a middle-aged patient experiencing chest pain, realizes that presence of which symptoms would be 6 most characteristic of an acute myocardial infarction? a. substernal pressure type pain, radiating down the left arm b. colic-like epigastric pain c. sharp, well-localized unilateral chest and left arm pain d. sharp, burning chest pain moving from place to place 9. The nurse, caring for a patient diagnosed with Prinzmetal’s or variant angina, realizes this is a serious type of chest pain. Why is this so? a. It indicates presence of coronary artery spasm. b. It indicates there is associated renal disease. c. It indicates there is associated pulmonary disease. d. It indicates the presence of a myocardial infarction. 10. A patient enters the emergency department complaining of chest pain that 7 is radiating down the left arm. The emergent treatment plan for this patient includes which nursing actions? Select all that apply. Select all that apply. a. morphine intravenously and oxygen b. aspirin 325 mg orally c. open heart surgery d. heparin drip at 100 units per hour e. Foley catheter insertion 11. Following a transmural myocardial infarction, which ECG change stays with the patient for life? a. Q wave deepening b. ST segment elevation c. ST segment depression d. P wave inversion 12. A patient reports chest pain, nausea, and vomiting off and on for the last 4 days, which the patient interpreted as the flu. Which laboratory tests will provide information about acute cardiac damage for this patient? a. Troponin I and T 10 c. patient’s gender d. development of heart block 16. Nursing care of the patient after thrombolytic therapy focuses on the assessment of which finding that is the most common complication? a. bleeding b. reperfusion chest pain c. lethargy d. heart block 17. Upon ascultating the chest of a 75-year- old patient who recently experienced a myocardial infarction (MI) the nurse hears an S3 and lung crackles. Because of these findings, the nurse would assess for which other condition? a. heart failure b. extension of the MI c. renal failure d. liver failure 18. The nurse is teaching a patient about coronary artery bypass surgery. Which statement, included in this teaching, is 11 essential for the patient to understand? a. “You must still reduce or modify cardiac risk factors.” b. “This surgery prolongs life on an average of two years.” c. “You have only a minimal chance of functional improvement, even with this surgery.” d. “This surgery will cure your atherosclerosis.” 19. A patient, recovering from coronary artery bypass graft (CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which of the following is the most appropriate response for the nurse to make? Select all that apply. a. “The surgery only relieves the symptoms; it does not cure the disease.” b. “You must continue to modify your cardiac risk factors.” c. “You are correct; your heart is now normal.” d. “You should not ever exercise again.” 12 e. “There no need to monitor your fat intake any longer.” 15 females unless they smoke.” c. “This problem affects only older adults over the age of 65.” d. “It can be avoided by taking vitamins daily and drinking 64 fluid ounces of water a day.” 25. What information does the nurse consider when administering medication to treat hyperlipidemia? a. Such medications include the statins, which act by lowering LDL levels. b. These medications act by increasing the LDL levels and decreasing the HDL levels. c. These medications do not include angiotensin-converting enzyme (ACE) inhibitors. d. Such medications include bile acid sequestrants as first-line drugs to lower cholesterol levels. 26. A patient who is prescribed atorvastatin (Lipitor) should be monitored for which occurrence? 16 a. liver enzyme alteration b. blood glucose and uric acid level alteration c. renal function alteration d. sudden back pain and constipation 27. The nurse completed teaching related to dietary management of coronary heart disease (CHD). Effective teaching would be indicated by which patient statement? 17 a. “I can lower my trans fatty acids by switching to the soft margarines and vegetable spreads.” b. “I will watch my fiber intake so I don’t get too much.” c. “Well, I’ll just have to go buy some of that coconut oil to cook with.” d. “Drinking a couple of glasses of milk each day will give me better protein.” 28. The nurse is assessing a patient who is currently experiencing chest pain. The patient has a previous diagnosis of chest pain but now reports an increase in the frequency and duration. Appropriate nursing care for this type of chest pain includes which nursing intervention? a. aspirin 325 mg PO per day per physician prescription b. bed rest with bathroom privileges c. aluminum hydroxide (Maalox) 5 mL PO PRN per physician prescription d. atropine (Atropair) 0.4 mg IVP PRN per physician prescription 20 33. The nurse is caring for a patient who develops atrial fibrillation with a heart rate above 100 beats per minute. Place the following nursing actions in sequence from the highest priority to the lowest priority. a. Assess the patient for comfort level and vital signs. b. Check the patency of an intermittent IV. c. Check the patient’s chart for lab results from today’s tests. d. Call the physician to report the dysrhythmia. 21 34. The nurse is instructing a patient on nitroglycerin tablets prescribed to treat angina. Which statement(s) should be included in the nurse’s instructions? Select all that apply. Select all that apply. a. “Take a second dose if the angina is not relieved within five minutes.” b. “The drug should remain in this brown bottle since it is sensitive to light.” c. “Store this medication in your bathroom medicine cabinet so it is readily available to you.” d. “Eating or drinking will not interfere when taking the medication.” e. “Call your doctor immediately if you develop a headache when taking this drug.” 35. Identify the following ECG rhythm. a. ventricular fibrillation 22 b. atrial flutter c. sinus tachycardia d. ventricular tachycardia 36. Sinus bradycardia (rate 56 beats per minute) is identified in a sleeping patient on telemetry. Which is the priority nursing action? a. Awaken the patient and see how the heart rate responds. b. Call the physician and report this dysrhythmia. c. Check the medication administration record and see if there is a PRN medication that will improve this rhythm. d. Call for an immediate 12-lead electrocardiogram (ECG). 37. A patient is in sinus tachycardia. Which nursing interventions are appropriate? Select all that apply. a. Observe the patient for effects on cardiac function. b. Administer two tablets of acetaminophen (Tylenol) per physician 25 39. The patient has a pacemaker with one pacing spike seen on the ECG before every QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes that this means that this which type of pacemaker? a. asynchronous pacing b. demand pacing c. dual-chamber pacing d. atrial single-chamber pacing 40. The nurse is notified by the cardiac monitoring technician that a patient on continuous cardiac monitoring is having frequent alarms. When the nurse enters the patient’s room, the patient is in no apparent distress, is sitting in the chair and eating. Which are appropriate nursing interventions? Select all that apply. a. Confirm that lead wires are properly connected. b. Assess placement of electrodes. c. Remove and reapply new electrodes if nonadherent. 26 d. Assess skin sites and move an electrode if the skin appears irritated. e. Call for assistance. 41. A patient reports the following symptoms to the nurse: nausea, loss of appetite, blurred and double vision, green yellow halos, vomiting and “feeling uneasy.”.” What situation should the nurse suspect? a. digoxin toxicity b. lidocaine toxicity c. amiodarone toxicity d. procainamide toxicity 42. A patient is having elective synchronized cardioversion. Place the following steps of the procedure in the correct order. a. Verify patency of IV access. b. Administer sedative per physician prescription. c. Set cardioverter to “synchronize” mode. d. Place conductive pads on the patient’s chest. e. Charge the cardioverter to the selected 27 energy level. Remove oxygen. f. Personnel step away from the bed prior to delivery of the electrical shock. 43. Premature ventricular contractions (PVCs) are best characterized by which statement? a. They are insignificant in people with no history of heart disease. b. PVCs typically have no pattern. c. The frequency of PVCs is not associated with specific events. d. Their incidence and significance has no relevance to the patient having had a myocardial infarction. 44. A nurse is performing cardiopulmonary resuscitation (CPR) on a patient who is in cardiac arrest. An automatic external defibrillator (AED) is available. Which activity will allow the nurse to assess the patient’s cardiac rhythm? a. Apply adhesive patch electrodes to the chest and move away from the patient. b. Apply standard electrocardiographic monitoring leads to the patient and 30 attributed to heartburn. b. Common symptoms of myocardial infarction (MI) include shortness of breath and fatigue. c. Women are more likely to have an unrecognized myocardial infarction. d. Weakness of the legs and back often precede a heart attack. e. The mortality rate of young women having an MI is 50 % lower than that of men. 47. The nurse is reviewing a new prescription for propranolol (Inderal) for a patient with coronary heart disease (CHD). The nurse would call the physician and question this prescription if the patient has which history? a. has a history of asthma and chronic obstructive pulmonary disease (COPD) b. is also taking antioxidants c. is also taking simvastatin (Zocor) d. has a history of bleeding disorders 48. Angina that is characterized as 31 atypical, occurs unpredictably and often at night and is associated with coronary artery spasm would be labeled as which type of angina? a. Prinzmetal’s (variant) angina b. stable angina c. unstable angina d. ischemic angina 49. During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient’s bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. elevated right atrial pressure. d. incompetent jugular vein valves. 50. The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best 32 indicator that the treatment has been effective is a. weight loss of 2 pounds overnight. b. hourly urine output greater than 60 mL. c. reduction in patient complaints of chest pain. d. decreased dyspnea with the head of bed at 30 degrees. 51. Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%? a. Need to participate in an aerobic exercise program several times weekly 35 feeling short of breath at night. b. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime. c. calls the clinic when the weight increases from 124 to 130 pounds in a week. d. says that the nitroglycerin patch will be used for any chest pain that develops. 56. When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. milk, yogurt, and other milk products. d. eggs and other high-cholesterol foods. 57. The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. avoid dietary sources of potassium. b. take the hydrochlorothiazide before 36 bedtime. c. notify the health care provider about any nausea. d. never take digoxin if the pulse is below 60 beats/minute. 58. While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the “water pill” with the “heart pill.” When planning for the patient’s discharge the nurse will facilitate 37 a. transfer to a dementia care service. b. referral to a home health care agency. c. placement in a long-term care facility. d. arrangements for around-the-clock care. 59. Following an acute myocardial infarction, a previously healthy 67-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. angiotensin-converting enzyme (ACE) inhibitors. b. digitalis preparations. c. -adrenergic agonists. d. calcium channel blockers. 60. A 55-year-old with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is appropriate? a. “Since you are diabetic, you would not be a candidate for a heart transplant.” b. “The choice of a patient for a heart transplant depends on many different 40 c. digoxin (Lanoxin) 0.125 mg d. carvedilol (Coreg) 3.125 mg 65. A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? a. Palpate the abdomen. b. Assess the orientation. 41 c. Check the capillary refill. d. Auscultate the lung sounds. 66. A patient with chronic heart failure who has prescriptions for a diuretic, an ACE- inhibitor, and a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurse’s first action will be to a. ask the patient to recall the dietary intake for the last 3 days. b. question the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of dietary sodium restrictions. 67. A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to 42 a. give IV diazepam (Valium) 2.5 mg. b. administer IV morphine sulfate 2 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min. 68. After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first? a. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure (BP) of 100/56 b. A patient who is cool and clammy, with new-onset confusion and restlessness c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who has crackles in both posterior lung bases and is receiving oxygen 69. Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most rapid 45 a. Evaluate the IV insertion site for extravasation. b. Monitor the patient’s BP and heart rate every hour. c. Adjust the rate to keep the systolic BP >90 mm Hg. d. Teach the patient the reasons for remaining on bed rest. 73. The nurse would assess that the individual most at risk for death from coronary heart disease (CHD) is a a. 30-year-old Hispanic woman. b. 42-year-old Caucasian woman. c. 55-year-old Asian man. d. 62-year-old African American woman. 74. The nurse would explain to a client who smokes that the nicotine in cigarette smoke increases the prevalence of CHD by a. causing proliferation of smooth muscle cells. b. decreasing the oxygen-carrying capacity of the blood. 46 c. increasing fat deposits along the intima of blood vessels. d. increasing the heart rate and the risk of dysrhythmia. 75. In advising a client with higher levels of high-density lipoproteins (HDLs) in proportion to low-density lipoproteins (LDLs), the nurse would suggest that the client a. consult the physician for an anticholesterol prescription. b. initiate a moderate exercise program. c. is less likely to develop CHD. d. should consider a reduced-fat diet. 76. The nurse would clarify for a client that the lipoproteins representing the “good” cholesterol are the a. HDLs. b. LDLs. c. VDRLs. d. VLDLs. 77. The nurse would advise a group of diabetic clients that primary prevention for 47 CHD can be achieved by keeping their fasting blood sugar levels below a. 56 mg/dl. b. 72 mg/dl. c. 105 mg/dl. d. 126 mg/dl. 78. To prevent a post-procedure complication, nursing care of a client after a percutaneous transluminal coronary angioplasty (PTCA) generally would include a. administering heparin. b. assessing for clinical manifestations of shock. c. forcing fluids. d. maintaining the client flat in bed for 24 hours. 79. The nurse would explain the etiology of heart failure after myocardial infarction (MI) as a. impairment of the contractile function of the ventricle. b. inability of the heart chambers to fill 50 b. breathlessness. c. leg swelling. d. nausea. 83. When auscultating the respirations of a client in left ventricular heart failure, the nurse would most likely detect a. crackling sounds. b. diminished sounds. c. grunting. d. wheezing. 84. A client is admitted to the intensive care unit with severe dyspnea, fear, noisy respirations, sweating, and tachypnea. The nurse would recognize that the client is exhibiting manifestations of a. acute pulmonary edema. b. acute myocardial infarction. c. chronic congestive heart failure. d. right ventricular failure. 85. When the a client with left ventricular heart failure complains that she has to get up several times during the night to urinate, the nurse would explain that this 51 bothersome event is a. a late clinical manifestation of heart failure. b. an indication that the right ventricle is being affected. c. caused by an increase in blood flow to the kidneys when lying down. d. the result of increased secretion of aldosterone at night. 86. When the client who had a myocardial infarction develops dependent edema, the nurse would assess that this could be an early manifestation of a. fluid deficit. b. left ventricular failure. c. renal failure. d. right ventricular failure. 87. A client with heart failure has been prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse would explain that this drug alleviates manifestations of heart failure by a. decreasing circulating volume. 52 b. increasing myocardial contractility. c. increasing vasodilation. d. slowing atrioventricular conduction time. 88. When a client with heart failure is receiving loop diuretics, the nurse would be sure to monitor serum a. calcium levels. b. enzyme levels. c. potassium levels. d. sodium levels. 89. The nurse would clarify to a client considering a MIDCABG that this procedure is less invasive and does not utilize a. anticoagulants. b. cardiopulmonary bypass. c. long-term anesthesia. d. mammary arteries. 90. A nurse is speaking to a group of high school girls about not smoking. The nurse would caution them that the risk of CHD in women who smoke is greater than that for nonsmoking women by 55 95. A client who is grossly overweight tells the nurse “I just can’t lose a bunch of weight to prevent a disease I might not get.” The best response by the nurse takes into consideration that a. even a small weight loss is beneficial. b. even overweight, women do not get coronary heart disease at high rates. c. obesity is not one of the major risk factors for coronary heart disease. d. the client really does need to lose substantial weight. 96. A nurse is conducting worksite health education classes. The nurse informs the participants that in order to prevent heart disease, the American Heart Association recommends which amount of exercise? a. 10-20 minutes every day. b. 20-30 minutes three to five times a week. c. 30-60 minutes every day. d. 30-60 minutes on most days of the week. 97. A client is scheduled to have CABG surgery next week. To best meet the 56 client’s need for psychosocial support, which intervention by the nurse would be best? a. Ask the client and family to relay fears and questions. b. Discuss the possible need for blood products during or after the operation. c. Provide written and oral instructions along with contact phone numbers. d. Refer the client to the preoperative educational classes at the hospital. 98. A client is being discharge after successful CABG surgery. Despite the positive prognosis, the nurse cautions the client and family that a. a heart attack could happen at any time. b. heart disease can always return. c. postoperative depression is common. d. the real results of the operation are not yet known. 99. A client had a PTCA with stent placement. Nursing care that can be delegated to the unlicensed assistive 57 personnel (UAP) after the procedure includes (Select all that apply) a. assessing the distal pulses every 15-30 minutes. b. calling for an ECG immediately if the client has angina. c. monitoring vital signs every 15-30 minutes. d. providing the client with plenty of fluids to drink. e. reminding the client to remain flat in bed. 100. A client is scheduled to have a PTCA. The nurse brings the consent forms and the client questions why he/she has to sign a consent form for possible coronary artery bypass grafting too. The nurse’s response should be based on understanding that (Select all that apply) a. a separate consent must be signed for each procedure. b. education will only have to be done one time if the client signs both now. c. in case of a complication, there may not 60 d. S4 and flat neck veins 4. When obtaining the health history of a patient who is being assessed for possible congestive heart failure, it is significant when the patient says which of the following? a. “I break out in a cold sweat when I eat a large meal.” b. “I am sleepy after I eat lunch each day.” c. “I have to prop myself up on three pillows to sleep at night, otherwise I can’t breathe.” d. “I feel better with my legs down when I sit in my favorite chair.” 5. A patient is admitted with acute heart failure. The nurse realizes that acute heart failure is associated with an abrupt onset of which of the following? Select all that apply. a. cardiomyopathy b. heart valve disease c. coronary heart disease (CHD) d. massive infarction (MI)) 61 e. myocardial injury 6. Blood tests are ordered for a patient who is diagnosed with possible congestive heart failure (CHF). The nurse understands which of the following lab tests indicates heart failure? The most specific test(s) to accurately indicate CHF would be which of the following? a. liver function b. urinalysis and blood urea nitrogen (BUN) c. brain natriuretic peptide (BNF). d. serum electrolytes 7. The nurse is caring for a patient who has invasive hemodynamic monitoring. The highest priority of care for this patient is which of the following? a. Prevent infection at the catheter site by changing the dressing as prescribed. b. Set alarm limits and turn monitor alarms on. c. Explain to family members why the monitoring is in use. d. Coil IV tubing on the bed. 62 8. The nurse is caring for a patient in the critical care area whose fluid volume status needs to be assessed closely. The most likely type of monitoring that will be used is which of the following? a. arterial pressure monitoring b. pulmonary artery pressure monitoring c. central venous pressure monitoring 65 output and tissue perfusion in a patient with heart failure? a. decreased mental alertness b. increased urine output c. abdominal distention d. strong peripheral pulses 13. The nurse is assessing a patient who is demonstrating dyspnea, orthopnea, cyanosis, clammy skin, a productive cough with pink, frothy sputum, and crackles. The nurse realizes that the patient likely has which of the following conditions? a. chronic heart failure b. pulmonary edema c. endocarditis d. angina 14. The priority nursing action the nurse would implement for the patient who is admitted with pulmonary edema would be to do which of the following? a. Insert a peripheral intravenous catheter. b. Seek a prescription to medicate the patient for comfort. 66 c. Monitor the blood glucose level. d. Place a pulse oximeter and administer oxygen. 15. Which of the following is important to consider when caring for patients with possible endocarditis? a. Endocarditis does not pose a high risk for damage to affected heart valves. b. Patients with this disorder can be treated by open heart surgery to clean the heart valves. 67 c. The condition is unrelated to fever so medicate patients with the prescribed antipyretic and observe. d. Endocarditis can be prevented in patients at risk by administering antibiotics prior to procedures. 16. The nurse would assess which of the following as clinical signs and symptoms of pericarditis? Select all that apply. a. pericardial friction rub b. abdominal discomfort and nausea c. chest pain d. bradycardia e. distended neck veins 17. The nurse, caring for a patient diagnosed with cardiac tamponade, realizes treatment would be with which of the following? a. antidysrhythmic drugs and oxygen b. oxygen and rest c. pericardiocentesis d. antibiotics 18. A nurse caring for a patient with coronary 70 22. The nurse, caring for an elderly patient, realizes that aging adults are at higher risk for development of heart failure due to which of the following? Select all that apply. a. impaired diastolic filling b. increased cardiac reserve c. increased maximal heart rate d. decreased ventricular compliance e. high responsiveness to sympathetic nervous system stimulation 23. An elderly patient arrives at the clinic complaining of dyspnea, weight gain, chest pain, and increasing edema of the lower extremities. The patient’s blood pressure is elevated. The nurse discovers the patient has a history of heart failure. Which of the following questions by the nurse may best help with determining why the patient is currently having health problems? a. “Are you married?” b. “Have you been out of the country lately?” 71 c. “Do you have grandchildren that you babysit?” d. “Have you attended any recent family or social gatherings?” 24. Which of the following patients should the nurse assess first? a. the patient with occasional chest pain who has recently been diagnosed with gallbladder disease b. the elderly patient with heart failure who was admitted with increasing edema of the lower extremities c. the newly admitted patient complaining of substernal chest pain. Patient has recently had a father die from heart disease d. the patient complaining of chest pain and is hyperventilating after a family member leaves the room following an argument 25. The nurse caring for patients on a cardiac unit should plan to see which of the following assigned patients first? a. a patient with hypertrophic 72 cardiomyopathy who is reporting dyspnea b. a patient who had a cardiac catheterization and will be ambulating for the first time c. a patient receiving antibiotics for bacterial endocarditis who is reporting anxiety and chest pain d. a patient who is recovering from coronary artery bypass grafting (CABG) surgery with a temperature of 101° F. 26. A patient with endocarditis develops sudden leg pain with pallor, tingling, and a loss of peripheral pulses. The initial nursing intervention should be to do which of the following? a. Notify the physician about these findings. b. Elevate the leg above the level of the heart. c. Wrap the extremity in a loose, warm blanket. Apply a foot cradle. d. Perform passive range of motion (PROM) exercises to stimulate circulation. 27. A patient, newly diagnosed with heart 75 b. “That will depend upon your surgeon. Ask him when you go to your office visit.” c. “You will be on it for the rest of your life because you have a biologic tissue valve.” d. “You will be told when to stop, which means your mechanical prosthetic valve is probably healed and there is minimal risk of clots.” 30. The nurse measures a patient’s blood pressure as 144/88 mmHg. Which of the following interventions would be most appropriate for this patient? a. Provide stress-reduction techniques. b. Inform the physician so antihypertensive medication can be prescribed. c. Offer the patient a glass of water. d. Remeasure the blood pressure in a few minutes. 31. A patient with diabetes is beginning treatment for hypertension. The nurse shares with the patient that a desirable blood pressure would be which of the 76 following? a. 140/90 mmHg b. 135/85 mmHg c. 130/80 mmHg d. 120/80 mmHg 32. The nurse is instructing a patient with hypertension about lifestyle modifications. Which of the following would be appropriate to include in the teaching for this patient? Select all that apply. a. Review the DASH diet. b. Begin a walking program, and progress to 30 minutes 5 to 6 days each week. c. Plan a weight lifting regimen. d. Eliminate dairy products from the diet. e. Restrict fluid intake. 33. A patient is being started on enalapril (Vasotec). The most common complaint from patients who routinely take this medication is which of the following? a. increased thirst b. reduced urine output c. persistent cough 77 d. sore throat 34. A patient’s blood pressure continues to be elevated despite being prescribed an ACE inhibitor for several weeks. Which of the following would be most appropriate for the nurse to do at this time? a. Ask if the patient is taking the prescribed medication. b. Suggest to the physician that another medication be added. 80 a. Encourage patient to reduce level of exercise. b. Discuss smoking cessation techniques. c. Keep extremities cool. d. Assist with pillow placement under knees. 40. A patient is diagnosed with thromboangiitis obliterans. Appropriate teaching for this patient includes which of the following? a. Medications are the only cure. b. Surgical procedures can be performed to cure this disorder. c. Management depends upon the patient’s willingness to stop smoking. d. Management strategies have no effect on disorder. 41. A patient is being discharged on long- term oral anticoagulant therapy for arterial thrombus formation in the lower extremity. Which of the following should be included in this patient’s discharge instructions? a. Slight bleeding from the nose is expected. 81 b. Contact the physician’s office for follow- up laboratory studies. c. Pain in the limb is a sign of healing. 82 d. Take two doses of the prescribed anticoagulant if a dose is missed one day. 42. .A patient is demonstrating signs of thrombophlebitis. With this disorder, the nurse realizes that which three mechanisms occur to cause this condition? Select all that apply. a. pooling of blood in the vessel b. blood hypercoagulation c. sluggish blood flow d. elevated systemic blood pressure e. vessel damage 43. A patient is seen for increasing edema in his left lower extremity, erythema, and pain in the limb with ambulation. Which of the following disorders do these symptoms suggest? a. arterial occlusion b. deep vein thrombosis c. superficial vein thrombosis (SVT) d. varicose veins 44. A patient with a deep vein thrombosis (DVT) is going to be weaned from 85 48. An elderly patient is prescribed elastic graduated compression stockings. The nurse should instruct this patient to do which of the following? a. Wear the stockings continuously, except when showering. b. Expect areas of skin breakdown under the stockings. c. Wear the stockings primarily while sleeping. d. Remove the stockings once per day and while sleeping. 86 49. The nurse is preparing to assess a patient’s hematologic, peripheral vascular, and lymphatic systems. Which of the following assessment techniques is not typically utilized for this assessment? a. inspection. b. palpation c. percussion d. auscultation 50. During the assessment, a patient’s pedal pulses are increased. The nurse should document this finding as which of the following? a. +1 b. +2 c. +3 d. +4 51. To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patient’s a. P wave. b. PR interval. 87 c. QT interval. d. QRS complex. 52. The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. b. Count the number of large squares in the R-R interval and divide by 300. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500. 53. A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of how many beats/minute? a. 15 to 20 b. 20 to 40 c. 40 to 60 90 (Xylocaine). d. Document the rhythm and monitor the patient. 58. After the nurse administers IV atropine to a patient with symptomatic type 1, second- degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patient’s heart rate b. Decrease in premature contractions c. Increase in peripheral pulse volume d. Decrease in ventricular ectopic beats 59. A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about a. electrical cardioversion. b. IV adenosine (Adenocard). c. anticoagulant therapy with warfarin (Coumadin). d. insertion of an implantable cardioverter- defibrillator (ICD). 91 60. Which information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response? a. The pacemaker prevents or minimizes ventricular irritability. b. The pacemaker paces the atria at rates up to 500 impulses/minute. c. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur. d. The pacemaker stimulates a heart beat if the patient’s heart rate drops too low. 61. A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse, a. “It will be 6 weeks before I can take a bath or return to my usual activities.” b. “I will notify the airlines when I make a reservation that I have a pacemaker.” 92 c. “I won’t lift the arm on the pacemaker side up very high until I see the doctor.” d. “I must avoid cooking with a microwave oven or being near a microwave in use.” 62. Which action by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? a. The nurse assists the patient to do active range of motion exercises for all extremities. 95 66. A patient has ST segment changes that indicate an acute inferior wall myocardial infarction. Which lead will be best for monitoring the patient? a. I b. II c. V6 d. MCL1 67. Which laboratory result for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose 228 mg/dL b. Serum chloride 90 mEq/L c. Serum sodium 133 mEq/L d. Serum potassium 2.8 mEq/L 68. A patient’s cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? a. Defibrillate at 360 joules. 96 b. Give O2 per bag-valve-mask. c. Give epinephrine (Adrenalin) IV. d. Prepare for endotracheal intubation. 97 69. A patient’s cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time? a. Prepare for possible temporary pacemaker insertion. b. Administer atropine sulfate 1 mg IV per agency protocol. c. Document the patient’s rhythm and assess the patient’s response to the rhythm. d. Call the health care provider before giving the prescribed metoprolol (Lopressor). 70. A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? a. Continue to monitor the rhythm and BP. b. Apply the transcutaneous pacemaker (TCP). c. Have the patient perform the Valsalva