QUESTIONS

1. The nurse on the cardiac unit has received the shift

report from the outgoing nurse.Which client should
the nurse assess first?
1. The client who has just been brought to the unit
from the emergency department (ED) with no report
of complaints.
2. The client who received pain medication 30
minutes ago for chest pain that was a level 3 on a 1-
to-10 pain scale.
3. The client who had a cardiac catheterization in the
morning and has palpable pedal pulses bilaterally.
4. The client who has been turning on the call light
frequently and stating her care has been neglected.

2. The nurse on the cardiac unit is preparing to

administer medications after receiving the morning
change-of-shift report. Which medication should the
nurse administer first?
1. The cardiac glycoside to the client who has an
apical pulse of 58.
2. The loop diuretic to a client with a serum K+ level
of 3.2 mEq/L.
3. The antidysrhythmic to the client in ventricular
fibrillation.
4. The calcium-channel blocker who has a blood
pressure of 110/68.

3. Which client should the telemetry nurse assess first

after receiving the a.m. shift report?
1. The client diagnosed with deep vein thrombosis
who has an edematous right calf.
2. The client diagnosed with mitral valve stenosis
who has heart palpitations.
3. The client diagnosed with arterial occlusive
disease who has intermittent
claudication.
4. The client diagnosed with congestive heart failure
who has pink frothy sputum.

4. The charge nurse is making assignments for clients

on a cardiac unit. Which client should the charge
nurse assign to a new graduate nurse?
1. The 44-year-old client diagnosed with a
myocardial infarction.
2. The 65-year-old client admitted with unstable
angina.
3. The 75-year-old client scheduled for a cardiac
catheterization.
4. The 50-year-old client complaining of chest pain

5. The charge nurse in the cardiac critical care unit is

making rounds. Which client should the nurse see
first?
1. The client with coronary artery disease who is
complaining that the nurses are being rude and won’t
answer the call lights.
2. The client diagnosed with an acute myocardial
infarction who has an elevated creatinine
phosphokinase-cardiac muscle (CPK-MB) level.
3. The client diagnosed with atrial fibrillation on an
oral anticoagulant who has an International
Normalized Ratio (INR) of 2.8.
4. The client 2 days’ postoperative coronary artery
bypass who is being transferred to the cardiac unit.

6. The nurse is preparing to administer digoxin 0.25

mg IVP to a client in severe congestive heart failure
who is receiving D5W/0.9 NaCL at 25 mL/hr. Rank
in order of importance.
1. Administer the medication over 5 minutes.
2. Dilute the medication with normal saline.
3. Draw up the medication in a tuberculin syringe.
4. Check the client’s identification band.
5. Clamp the primary tubing distal to the port.

7. The client is in the cardiac intensive care unit on

dopamine, a vasoconstrictor, and B/P increases to
210/130. Which intervention should the intensive
care nurse implement first?
1. Discontinue the client’s vasoconstrictor, dopamine.
2. Notify the client’s healthcare provider.
3. Administer the vasopressor hydralazine.
4. Assess the client’s neurological status.

8.The nurse is administering medications to clients in

the cardiac critical care area.
Which client should the nurse question administering
the medication?
1. The client receiving a calcium channel blocker
(CCB) who is drinking a glass of grapefruit juice.
2. The client receiving a beta-adrenergic blocker who
has an apical heart rate of
62 beats/min.
3. The client receiving nonsteroidal anti-
inflammatory drugs (NSAIDs) who has just finished
eating breakfast.
4. The client receiving an oral anticoagulant who has
an International Normalized Ratio (INR) of 2.8.

9. Which client warrants immediate intervention by

the nurse?
1. The client diagnosed with pericarditis who has
chest pain with inspiration.
2. The client diagnosed with mitral valve
regurgitation who has thready peripheral
pulse.
3. The client diagnosed with Marfan syndrome who
has pectus excavatum.
4. The client diagnosed with atherosclerosis who has
slurred speech and drooling.

10. The charge nurse on the cardiac unit is making

shift assignments. Which client should
be assigned to the most experienced nurse?
1. The client diagnosed with mitral valve stenosis.
2. The client diagnosed with asymptomatic sinus
bradycardia.
3. The client diagnosed with fulminant pulmonary
edema.
4. The client diagnosed with acute atrial fibrillation.

11. The client diagnosed with arterial hypertension

and has been taking a calcium channel
blocker, a loop diuretic, and an ACE inhibitor for 3
years. Which statement by the
client would warrant intervention by the nurse?
1. “I have to go to the bathroom a lot during the
morning.”
2. “I get up very slowly when I have been sitting for a
while.”
3. “I do not salt my food when I am cooking it but I
add it at the table.”
4. “I drink grapefruit juice every morning with my
breakfast.”

12. The nurse is teaching a client with

diabetes mellitus how to mix regular
insulin and NPH insulin in the same syringe.
Which action, if performed by
the client, indicates the need for further
teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the
desired dose of insulin into each vial

13. The home care nurse visits a client

recently diagnosed with diabetes mellitus
who is taking Humulin NPH insulin daily.
The client asks the nurse how to store the
unopened vials of insulin. The nurse should
tell the client to take
which action?
1. Freeze the insulin.
2. Refrigerate the insulin.
3. Store the insulin in a dark, dry place.
4. Keep the insulin at room temperature.
14. Glimepiride is prescribed for a client
with diabetes mellitus. The nurse
instructs the client that which food items
are most acceptable to consume
while taking this medication? Select all that
apply.
1. Alcohol
2. Red meats
3. Whole-grain cereals
4. Low-calorie desserts
5. Carbonated beverages
15. The nurse is providing discharge
teaching for a client newly diagnosed with
type 2 diabetes mellitus who has been
prescribed metformin. Which client
statement indicates the need for further
teaching?
1. “It is okay if I skip meals once in a while.”
2. “I need to let my doctor know if I get
unusually tired.”
3. “I need to constantly watch for signs of
low blood sugar.”
4. “I will be sure to not drink alcohol
excessively while on this medication.”
16. The primary health care provider (PHCP)
prescribes exenatide for a client
with type 1 diabetes mellitus who takes
insulin. The nurse should plan to take which
most appropriate intervention?
1. Withhold the medication and call the
PHCP, questioning the prescription for the
client.
2. Teach the client about the signs and
symptoms of hypoglycemia and
hyperglycemia.
3. Monitor the client for gastrointestinal
side effects after administering the
medication.
4. Withdraw the insulin from the prefilled
pen into an insulin syringe to prepare for
administration.
17. A client with diabetes mellitus is taking
Humulin NPH insulin and regular
insulin every morning. The nurse should
provide which instructions to the
client? Select all that apply.
1. Hypoglycemia may be experienced
before dinnertime.
2. The insulin dose should be decreased if
illness occurs.
3. The insulin should be administered at
room temperature.
4. The insulin vial needs to be shaken
vigorously to break up the precipitates.
5. The NPH insulin should be drawn into the
syringe first, then the regular insulin.

18. The home health care nurse is visiting a

client who was recently diagnosed with
type 2 diabetes mellitus. The client is
prescribed repaglinide and metformin. The
nurse should provide which instructions to
the client? Select
all that apply.
1. Diarrhea may occur secondary to the
metformin.
2. The repaglinide is not taken if a meal is
skipped.
3. The repaglinide is taken 30 minutes
before eating.
4. A simple sugar food item is carried and
used to treat mild hypoglycemia episodes.
5. Muscle pain is an expected effect of
metformin and may be treated with
acetaminophen.
6. Metformin increases hepatic glucose
production to prevent hypoglycemia
associated with repaglinide.

19. The nurse is providing instructions to

the client newly diagnosed with
diabetes mellitus who has been prescribed
pramlintide. Which instruction
should the nurse include in the discharge
teaching?
1. “Inject the pramlintide at the same time
you take your other medications.”
2. “Take your prescribed pills 1 hour before
or 2 hours after the injection.”
3. “Be sure to take the pramlintide with
food so you don’t upset your stomach.”
4. “Make sure you take your pramlintide
immediately after you eat so you don’t
experience a low blood sugar.”

20. A prescription reads 1000 mL of normal saline

(NS) to infuse over 12 hours.
The drop factor is 15 drops (gtt)/1 mL. The nurse
prepares to set the flow rate
at how many drops per minute? Fill in the blank.
Record your answer to
the nearest whole number.
Answer: _______ drops per minute
21. A prescription reads to administer an intravenous
(IV) dose of 400,000 units of penicillin G benzathine.
The label on the 10-milliliters (mL) ampule sent from
the pharmacy reads penicillin G benzathine, 300,000
units/mL. The nurse prepares how much medication
to administer the correct dose? Fill in
the blank. Record your answer using 1 decimal place.
Answer: _______ mL

22. A prescription reads potassium chloride 30 mEq

to be added to 1000 mL
normal saline (NS) and to be administered over a 10-
hour period. The label
on the medication bottle reads 40 mEq/20 mL. The
nurse prepares how many
milliliters (mL) of potassium chloride to administer
the correct dose of
medication? Fill in the blank.
Answer: _______ mL

23. A prescription reads clindamycin phosphate 0.3 g

in 50 mL normal saline (NS) to be administered
intravenously over 30 minutes. The medication label
reads clindamycin phosphate 900 mg in 6 mL. The
nurse prepares how many milliliters (mL) of the
medication to administer the correct dose? Fill in the
blank.
Answer: _______ mL

24. A prescription reads phenytoin 0.2 g orally twice

daily. The medication label
states that each capsule is 100 mg. The nurse
prepares how many capsule(s)
to administer 1 dose? Fill in the blank.
Answer: _______ capsule(s)

25. A prescription reads 1000 mL of normal saline

0.9% to infuse over 8 hours.
The drop factor is 15 drops (gtt)/1 mL. The nurse sets
the flow rate at how
many drops per minute? Fill in the blank. Record
your answer to the
nearest whole number.
Answer: _______ drops per minute

26. A prescription reads heparin sodium, 1300

units/hr by continuous
intravenous (IV) infusion. The pharmacy prepares the
medication and
delivers an IV bag labeled heparin sodium 20,000
units/250 mL D5W. An
infusion pump must be used to administer the
medication. The nurse sets the
infusion pump at how many milliliters (mL) per hour
to deliver 1300
units/hour? Fill in the blank. Record your answer to
the nearest whole
number.
Answer: _______ mL/hr

27. A prescription reads 3000 mL of D5W to be

administered over a 24-hour
period. The nurse determines that how many
milliliters (mL) per hour will
be administered to the client? Fill in the blank.
Answer: _______ mL/hr

28. Gentamicin sulfate, 80 mg in 100 mL normal

saline (NS), is to be
administered over 30 minutes. The drop factor is 10
drops (gtt)/1 mL. The
nurse sets the flow rate at how many drops per
minute? Fill in the blank.
Record your answer to the nearest whole number.
Answer: _______ drops per minute

29. A prescription reads levothyroxine, 150 mcg

orally daily. The medication
label reads levothyroxine, 0.1 mg/tablet. The nurse
administers how many
tablet(s) to the client? Fill in the blank.
Answer: _______ tablet(s)

30. Cefuroxime sodium, 1 g in 50 mL normal saline

(NS), is to be administered
over 30 minutes. The drop factor is 15 drops (gtt)/1
mL. The nurse sets the
flow rate at how many drops per minute? Fill in the
blank.
Answer: _______ drops per minute

31. A prescription reads 1000 mL D5W to infuse at a

rate of 125 mL/hr. The nurse
determines that it will take how many hours for 1 L
to infuse? Fill in the
blank.
Answer: _______ hour(s)
32. A prescription reads to infuse 1 unit of packed red
blood cells over 4 hours.
The unit of blood contains 250 mL. The drop factor is
10 drops (gtt)/1 mL.
The nurse prepares to set the flow rate at how many
drops per minute? Fill
in the blank. Record your answer to the nearest whole
number.
Answer: _______ drops per minute

33. A prescription reads morphine sulfate, 8 mg stat.

The medication ampule
reads morphine sulfate, 10 mg/mL. The nurse
prepares how many milliliters
(mL) to administer the correct dose? Fill in the blank.
Answer: _______ mL

34. A prescription reads regular insulin, 8 units/hr by

continuous intravenous
(IV) infusion. The pharmacy prepares the medication
and then delivers an IV
bag labeled 100 units of regular insulin in 100 mL
normal saline (NS). An
infusion pump must be used to administer the
medication. The nurse sets the
infusion pump at how many milliliters (mL) per hour
to deliver 8 units/hr?
Fill in the blank.
Answer: _______ mL/hr

35. The intensive care department nurse is calculating

the total intake for a client diagnosed with
hypertensive crisis. The client has received 950 mL
of D5W, 2 IVPB of 100 mL of 0.9% NS, 16 ounces
of water, 8 ounces of milk, and 6 ounces of chicken
broth. The client has had a urinary output of 2,200
mL. What is the total intake for this client?

36. A client is scheduled for a cardiac

catheterization using a radiopaque dye. Which of the
following assessments is most critical before the
procedure?
A. Intake and output
B. Baseline peripheral pulse rates
C. Height and weight
D. Allergy to iodine or shellfish

37. A client with no history of cardiovascular disease

comes into the ambulatory clinic with flu-like
symptoms. The client suddenly complains of chest
pain. Which of the following questions would best
help a nurse to discriminate pain caused by a non-
cardiac problem?
A. “Have you ever had this pain before?”
B. “Can you describe the pain to me?”
C. “Does the pain get worse when you breathe in?”
D. “Can you rate the pain on a scale of 1-10, with ten
(10) being the worst?”

38. Question
A client with myocardial infarction has been
transferred from a coronary care unit to a general
medical unit with cardiac monitoring via telemetry. A
nurse plans to allow for which of the following client
activities?
A. Strict bed rest for 24 hours after transfer.
B. Bathroom privileges and self-care activities.
C. Unsupervised hallway ambulation with distances
under 200 feet.
D. Ad lib activities because the client is monitored.

39. Question
A nurse notes 2+ bilateral edema in the lower
extremities of a client with myocardial infarction who
was admitted two (2) days ago. The nurse would plan
to do which of the following next?
A. Review the intake and output records for the last
two (2) days.
B. Change the time of diuretic administration from
morning to evening.
C. Request a sodium restriction of one (1) g/day
from the physician.
D. Order daily weight starting the following
morning.

40. A client is wearing a continuous cardiac monitor,

which begins to sound its alarm. A nurse sees no
electrocardiogram complexes on the screen. The first
action of the nurse is to:
A. Check the client status and lead placement.
 B. Press the recorder button on the
electrocardiogram console.
C. Call the physician.
D. Call a code blue.

41. Question
A nurse is assessing the blood pressure of a client
diagnosed with primary hypertension. The nurse
ensures accurate measurement by avoiding which of
the following?
A. Seating the client with arm bared, supported, and
at heart level.
B. Measuring the blood pressure after the client has
been seated quietly for 5 minutes.
C. Using a cuff with a rubber bladder that encircles
at least 80% of the limb.
D. Taking a blood pressure within 15 minutes after
nicotine or caffeine ingestion.

42. Question IV heparin therapy is ordered for a

client. While implementing this order, a nurse
ensures that which of the following medications is
available in the nursing unit?
A. Vitamin K
B. Aminocaproic acid
C. Potassium chloride
D. Protamine sulfate

43. Question
A client is at risk for pulmonary embolism and is on
anticoagulant therapy with warfarin (Coumadin). The
client’s prothrombin time is 20 seconds, with a
control of 11 seconds. The nurse assesses that this
result is:
A. The same as the client’s own baseline level.
B. Lower than the needed therapeutic level.
C. Within the therapeutic range.
D. Higher than the therapeutic range.

44. Question
A client who has been receiving heparin therapy also
is started on warfarin. The client asks a nurse why
both medications are being administered. In
formulating a response, the nurse incorporates the
understanding that warfarin:
 A. Stimulates the breakdown of specific clotting
factors by the liver, and it takes two (2)- three (3)
days for this to exert an anticoagulant effect.
B Inhibits synthesis of specific clotting factors in the
liver, and it takes 3-4 days for this medication to
exert an anticoagulant effect.
C. Stimulates production of the body’s own
thrombolytic substances, but it takes 2-4 days for this
to begin.
D. Has the same mechanism of action as Heparin,
and the crossover time is needed for the serum level
of warfarin to be therapeutic.

45. Question
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
two (2) mg of morphine given intravenously. The
nurse should first:
A. Administer the morphine.
B. Obtain a 12-lead ECG.
C. Obtain the lab work.
D. Order the chest x-ray.

46. Question
When administered a thrombolytic drug to the client
experiencing an MI, the nurse explains to him that
the purpose of this drug is to:
A. Help keep him well hydrated.
B. Dissolve clots he may have.
C. Prevent kidney failure.
D. Treat potential cardiac arrhythmias.

47. Question
When interpreting an ECG, the nurse would keep in
mind which of the following about the P wave?
Select all that apply.
A. Reflects electrical impulse beginning at the SA
node.
B. Indicated electrical impulse beginning at the AV
node.
C. Reflects atrial muscle depolarization.
D. Identifies ventricular muscle depolarization.
E. Has a duration of normally 0.11 seconds or less.
48. Question
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:
A. Call for the doctor.
B. Start an intravenous line.
C. Obtain a portable chest radiograph.
D. Draw blood for laboratory studies.

49. Question
The nurse receives emergency laboratory results for a
client with chest pain and immediately informs the
physician. An increased myoglobin level suggests
which of the following?
A. Cancer
B. Hypertension
C. Liver disease
D. Myocardial infarction

50. Question
The most important long-term goal for a client with
hypertension would be to:
A. Learn how to avoid stress.
B. Explore a job change or early retirement.
C. Make a commitment to long-term therapy.
D. Control high blood pressure.

51. Question
Hypertension is known as the silent killer. This
phrase is associated with the fact that hypertension
often goes undetected until symptoms of other system
failures occur. This may occur in the form of:
A. Cerebrovascular accident
B. Liver disease
C. Myocardial infarction
D. Pulmonary disease
52. Question
Which of the following symptoms should the nurse
teach the client with unstable angina to report
immediately to her physician?
A. A change in the pattern of her pain.
B. Pain during sex.
C. Pain during an argument with her husband.
D. Pain during or after an activity such as lawn
mowing.

53. Question
The physician refers the client with unstable angina
for a cardiac catheterization. The nurse explains to
the client that this procedure is being used in this
specific case to:
A. Open and dilate the blocked coronary arteries.
B. Assess the extent of arterial blockage.
C. Bypass obstructed vessels.
D. Assess the functional adequacy of the valves and
heart muscle.
54. Question
As an initial step in treating a client with angina, the
physician prescribes nitroglycerin tablets, 0.3mg
given sublingually. This drug’s principal effects are
produced by:
A. Antispasmodic effect on the pericardium.
B. Causing an increased myocardial oxygen demand.
C. Vasodilation of peripheral vasculature.
D. Improved conductivity in the myocardium.

55. Question
Sublingual nitroglycerin tablets begin to work within
1 to 2 minutes. How should the nurse instruct the
client to use the drug when chest pain occurs?
A. Take one (1) tablet every two (2) to five (5)
minutes until the pain stops.
B. Take one (1) tablet and rest for ten (10) minutes.
Call the physician if pain persists after ten (10)
minutes.
 C. Take one (1) tablet, then an additional tablet
every 5 minutes for a total of three (3) tablets. Call
the physician if pain persists after three (3) tablets.
D. Take one (1) tablet. If pain persists after five (5)
minutes, take two (2) tablets. If pain persists five (5)
minutes later, call the physician.

56. Question
Which of the following clients is at greatest risk for
digital toxicity?

A. A 25-year-old client with congenital heart

disease.
B. A 50-year-old client with CHF.
C. A 60-year-old client after myocardial infarction.
D. An 80-year-old client with CHF.
57. Question
Which of the following is a contraindication for
digoxin administration?

A. Blood pressure of 140/90.

B. Heart rate above 80.
C. Heart rate below 60.
D. Respiratory rate above 20.

58. Question
The action of medication is inotropic when it:

A. Decreased afterload.
B. Increases heart rate.
C. Increases the force of contraction.
D. Is used to treat CHF.

59. Question
Which is the most appropriate action for the nurse to
take before administering digoxin?

A. Monitor potassium level.

B. Assess blood pressure.
C. Evaluate urinary output.
D. Avoid giving with thiazide diuretic.

60. Question
The therapeutic drug level for digoxin is:
A. 0.1-2.0 ng/mg
B. 1.0-2.0 ng/mg
C. 0.1-0.5 ng/mg
D. 0.5-2.0 ng/mg

61. Question
Blurred vision or halos are signs of:

A. Subtherapeutic digoxin levels.

B. Digoxin toxicity.
C. Nothing related to digoxin.
D. Corneal side effects of digoxin.
62. Amrinone (Inocor) is used for short term therapy
for CHF and acts by which of the following
mechanisms?

A. Increasing stroke volume and heart rate.

B. Slowing ventricular rate and increasing cardiac
output.
C. Vasodilating and increasing peripheral vascular
resistance.
D. Increasing cardiac output and enhancing renal
perfusion.

63. Question
Before giving milrinone (Primacor) by an IV infusion
to a client with symptoms of CHF, which of the
following nursing actions is necessary?

A. Record sodium level.

B. Administer loading dose over 15 minutes.
C. Assess CV status.
D. Review medication regimen to identify if client is
on IV furosemide (Lasix)

64. Question
When administering an antiarrhythmic agent, which
of the following assessment parameters is the most
important for the nurse to evaluate?

A. ECG.
B. Pulse rate.
C. Respiratory rate.
D. Blood pressure.
65. Question
Which of the following blood tests will tell the nurse
that an adequate amount of drug is present in the
blood to prevent arrhythmias?

A. Serum chemistries.
B. Complete blood counts.
C. Drug levels.
D. None of the above

66. Question
Which of the following drugs should be used only in
situations in which the client can be very closely
monitored, such as a critical care unit?

A. bretylium (Bretylol).
B. digoxin (Lanoxin).
C. quinidine (Cardioquin).
D. inderal (Propranolol).

67. Question
When administering dopamine (Intropin), it is most
important for the nurse to know that:

A. The drug's action varies according to the dose.

B. The drug may be used instead of fluid
replacement.
C. The drug cannot be directly mixed in solutions
containing bicarbonate or aminophylline.
D. The lowest dose to produce the desired effect
should be used.
68. Conduction defects will most likely be an adverse
associated with the use of:

A. verapamil (Isoptin)
B. nifedipine (Adalat CC)
C. diltiazem (Cardizem)
D. felodipine (Plendil)

69. Question
Which of the following calcium channel blockers has
the most potent peripheral smooth muscle dilator
effect?

A. diltiazem (Cardizem)
B. nifedipine (Adalat CC)
C. nimodipine (Nymalize)
D. verapamil (Calan)

70. Question
Which of the following effects of calcium channel
blockers causes a reduction in blood pressure?

A. Increased cardiac output.

B. Decreased peripheral vascular resistance.
C. Decreased renal blood flow.
D. Calcium influx into cardiac muscles.
71. Question
Jason James is taking ß blockers, all of the following
should be included in his assessment except:

A. Pulmonary function tests.

B. Baseline ECG.
C. Glucose level.
D. Blood pressure.

72. Question
Routine laboratory monitoring in clients taking ß
blockers should include:

A. Sodium.
B. Glucose.
C. Thyrotropin.
D. Creatine phosphokinase.

73. Question
ß blockers should be avoided in which of the
following conditions?

A. Bronchoconstriction.
B. Hypertension.
C. Angina.
D. Myocardial infarction.

74. Question
As a knowledgeable nurse, you know that the action
of nitrates is:

A. Smooth muscle contraction.

B. Vasoconstriction.
C. Smooth muscle relaxation.
D. Increase preload.

75. Question
A 50-year-old client is prescribed to take nitrate each
day for his condition. As a competent nurse, you
know the result of nitrate administration is:

A. Decreased myocardial oxygen demand.

B. Increased myocardial oxygen demand.
C. Increased left ventricular end-diastolic volume.
D. Increased atrial pressure

76. Question
A student nurse is asked to give an example of a
long-acting nitrate. He is correct by saying:

A. Nitroglycerin sublingual.
B. Nitroglycerin IV.
C. Isosorbide PO.
D. Nitroglycerin transmucosal.

77. Question
When nitrates are administered early to the acute MI
client, the effect is:

A. Hypotension.
B. Bradycardia.
C. Reduced mortality.
D. Reduced morbidity.

78. Question
When teaching about nitrate administration, the nurse
should instruct the client to:

A. Change position slowly.

B. Take a pulse daily.
C. Reduce salt intake.
D. Chew the sustained-release tablets.

79. Question
Raymund is reviewing cardiovascular drugs for his
upcoming exam. For a well-prepared student, he
should know that vasodilators are agents that:

A. Relax smooth muscles.

B. Are used to treat hypotension.
C. Stimulate the adrenergic receptors of peripheral
sympathetic nerves.
D. Cause respiratory depression.
80. Question
A client arrives in the emergency with complaints of
chest pain and is diagnosed with acute MI. A
morphine 4mg IV was given 5 minutes ago. Which of
the following assessments made by the nurse
indicates a further immediate action?

A. Respiratory rate from 20 bpm to 12 bpm.

B. Blood pressure from 120/70 to 100/60 mmHg.
C. The client still complains of chest pain with a
pain scale of 2/10.
D. Cardiac rate of 103 bpm and a normal sinus
rhythm of the ECG.

81. Question
A nurse is monitoring a client who is taking digoxin
(Lanoxin). All of which are the side effects
associated with the medication, except?

A. Anorexia.
B. Blurred vision.
C. Diarrhea.
D. Tremors.

82. Question
A nurse is providing instructions to a client who is on
nicotinic acid for the treatment of hyperlipidemia.
Which statement made by the nurse indicates a
comprehension of the instructions?
 A. "I should take aspirin 30 minutes before nicotinic
acid".
B. "I will drink alcohol in moderation".
C. "Yellowing of the skin is a common side effect".
D. "This medication is taken on an empty stomach".

83. Question
A nurse is giving instruction to a client who is
receiving cholestyramine (Questran) for the treatment
of hyperlipidemia. Which of the following statements
made by the client indicates the need for further
instructions?

A. "This medication comes in a powder that must be

mixed with juice or water before administration".
B. "I will avoid eating foods rich in saturated fats".
C. "I will take my vitamin C 30 minutes after
cholestyramine".
 D. "Constipation, belching and heartburn are some
of the side effects".

84. Question
A nurse is interviewing a client who is about to
receive metoprolol. Upon the history taking, the
client is also taking insulin. Which of the following
statements made by the nurse will correctly explain
the possible interaction of these medications?

A. "This medication will maintain the blood sugar

level on a normal range".
B. "This medication will have no effect on blood
sugar level".
C. "This medication may mask some of the
symptoms of hypoglycemia such as tremor,
palpitation, and rapid heartbeat.
 D. "This medication may mask some of the
symptoms of hyperglycemia such as headache,
increased thirst, and blurred vision".

85. Question
A client with myocardial infarction is receiving tissue
plasminogen activator, alteplase (Activase, tPA).
While on the therapy, the nurse plans to prioritize
which of the following?

A. Observe for neurological changes.

B. Monitor for any signs of renal failure.
C. Check the food diary.
D. Observe for signs of bleeding.
86. Question
A nurse is providing health teachings regarding
antiplatelet medications. Which of the following is
not true regarding the use of this medication?

A. Antiplatelet medication inhibits the aggregation

of platelets in the clotting process, thereby
prolonging bleeding time.
B. Antiplatelet medications cannot be used with
anticoagulants.
C. Take the medication with food to prevent
gastrointestinal upset.
D. A routine bleeding time is monitored during the
therapy.

87. Question
A client who is receiving streptokinase therapy
suddenly had a nosebleed. The nurse ensures the
availability of which of the following medication?

A. vitamin K (Mephyton).
B. deferoxamine (Desferal).
C. aminocaproic acid (Amicar).
D. diphenhydramine (Benadryl).

88. Question
A client with deep vein thrombosis is receiving
Streptokinase (Streptase). The nurse would notify the
physician if which of the following assessments is
noted?

A. A temperature of 99.2° Fahrenheit.

B. A pulse rate of 99 beats per minute.
C. A respiratory rate of 25 breaths per minute.
D. A blood pressure of 185/110 mm Hg.

89. Question
A client is receiving a continuous infusion of
streptokinase (Streptase). The client suddenly
complains of a difficulty of breathing, itchiness, and
nausea. Which of the following should be the priority
action of the nurse?

A. Stop the infusion and notify the physician.

B. Administer protamine sulfate and provide oxygen
therapy.
C. Administer antihistamine then continue the
infusion.
D. Slow the infusion and administer oxygen.
90. Question
A client is receiving intravenous heparin therapy. The
nurse ensures the availability of which of the
following medication?

A. acetylcysteine (Mucomyst).
B. calcium gluconate (Calcium gluconate).
C. vitamin K (Mephyton).
D. protamine sulfate (Protamine).

91. Question
A client with atrial fibrillation is receiving a
continuous heparin infusion at 1,000 units/hr. The
nurse observes that the client is receiving the
therapeutic effect based on which of the following
results?
 A. Activated partial thromboplastin time of 30
seconds.
B. Activated partial thromboplastin time of 60
seconds.
C. Activated partial thromboplastin time of 120
seconds.
D. Activated partial thromboplastin time of 15
seconds.

92. Question
A nurse is caring for a client receiving a heparin
intravenous (IV) infusion. The nurse expects that
which of the following laboratory will be prescribed
to monitor the therapeutic effect of heparin?

A. Prothrombin time (PT).

B. Activated partial thromboplastin time (aPTT).
C. Hematocrit (Hgb).
D. Hemoglobin (Hct).

93. Question
A nurse is providing instructions to a client who is
receiving warfarin sodium (Coumadin). Which
statement made by the client indicates the need for
further instruction?

A. "I will observe the color of my urine and stool".

B. "I will take Ecotrin (Enteric-coated aspirin) for
my headaches".
C. "I will avoid drinking alcohol".
D. "I will use a hair removing cream on my legs".
94. Question
During the warfarin (Coumadin) administration, the
nurse can expect that the initial extension of PT
occurs within how many hours after therapy begins?

A. 1 to 2
B. 4 to 6
C. 8 to 12
D. 12 to 24

95. Question
Which drug is used to stop bleeding associated with
heparin overdose?
A. urokinase (Abbokinase).
B. aminocaproic acid (Amicar).
C. protamine sulfate (Protamine).
D. vitamin K (AquaMEPHYTON

96. Question
The half-life of heparin is:

A. 10 minutes
B. 1 to 1.5 hours
C. 8 to 12 hours
D. 1 to 2 days
97. Question
SC heparin should be administered in the:

A. Flank.
B. Abdominal fat.
C. Leg.
D. Gluteal area.

98. Question
Parenteral anticoagulants work by disrupting:
A. Formation of thromboplastin.
B. Conversion of prothrombin to thrombin.
C. Vitamin K-dependent clotting factors.
D. Conversion of prothrombin to fibrin.

99. Question
Which of the following lipid-lowering agents has the
common side effect of constipation?

A. lovastatin (Mevacor).
B. colestipol (Colestid).
C. gemfibrozil (Lopid).
D. niacin (Nicotinic acid).
100. Question
Which of the following vitamins may not be
absorbed properly when giving bile acid
sequestrants?

A. Vitamin B.
B. Vitamin C.
C. Vitamin B12.
D. Vitamin K.

101. Question
As a competent nurse, you know that the most
significant contraindication for therapy with lipid-
lowering agent is:

A. Renal disease.
B. Diabetes.
C. Liver disease.
D. Cardiac disease.

102. Question
For lipid-lowering agents to be successful, drug
therapy must lower:

A. HDL.
B. LDL.
C. Total fat.
D. All of the above

103. Question
Kylie is reviewing drugs related to cardiovascular
therapies. She should be aware that the desired action
of lipid-lowering agents is to:

A. Decrease high-density lipoprotein (HDL).

B. Increase total cholesterol (TC).
C. Increase low-density lipoprotein (LDL).
D. Increase high-density lipoprotein (HDL).

104. Question
The nurse is giving instructions to a client
receiving cholestyramine (Prevalite). Which
statement made by the client indicates a need for
further teachings?

A. "This medication will help lower my

cholesterol".
B. "I will continue taking my multivitamins".
C. "I will sip the cholestyramine powder for a
long time for faster absorption".
D. "I will include a high fiber rich food in my
diet".

105. Question
Which of the following conditions can you safely
administer metoclopramide (Reglan)?

A. Patient with bowel obstruction

B. Patient with gastrointestinal hemorrhage
C. Patient undergoing radiation
D. Patients with pheochromocytoma

106. Question
A client has been taking Ibuprofen for a while and
was given misoprostol (Cytotec). Which of the
following is exhibiting the therapeutic effect of
Cytotec?

A. Relief of constipation
B. Relief of diarrhea
C. Relief intestinal obstruction
D. Relief of Gastric Ulcers
107. Question
A geriatric patient is prescribed with cimetidine
(Tagamet) for the treatment of heartburn. Which
of the following is the most frequent CNS side
effect of the medication?

A. Agitation
B. Drowsiness
C. Headache
D. Somnolence

108. Question
A nurse is administering an IV bolus of cimetidine
(Tagamet). Which of the following should the
nurse monitor closely follow the administration?

A. Respiratory rate
B. Skin turgor
C. Blood pressure
D. Temperature

109. Question
A client has been given loperamide hydrochloride
(Imodium). Which of the following conditions is
the medication indicated for?

A. Abdominal pain
B. Patients with an ileostomy
C. Bloody Diarrhea
D. Acute dysentery

110. Question
A client has been given ondansetron (Zofran). For
which of the following post-operative condition
should the nurse administer this medication?

A. Abdominal infection
B. Incisional pain
C. Atelectasis
D. Vomiting
111. Question
A client with a duodenal ulcer is diagnosed with
H. pylori infection. The physician prescribed
amoxicillin (Wymox), pantoprazole (Prevacid),
and clarithromycin (Biaxin). Which statement
made by the nurse correctly explains the purpose
of these medications?

A. "These medicines will minimize acid

production and will coat the ulcer".
B. "These medicines will stop the acid production
and will kill the bacteria".
C. "The ulcer will heal because the medications
will kill the bacteria".
D. "These medicines will control the ulcer and
motion sickness".

112. Question
A patient with Crohn’s disease is receiving an
infusion therapy of infliximab (Remicade). Which
of the following should the nurse do while the
patient is on this medication?

A. Monitoring liver function test prior to the

infusion
B. Monitoring the vomiting episodes
C. Monitoring the frequency and consistency of
bowel movements
D. Monitoring urine output and orientation

113.Question
A client has been prescribed sucralfate (Carafate)
for the treatment of gastric ulcers. The nurse
instructs the client that this medication is taken?
A. 1 hour before meals
B. 1 hour after meals
C. At the same time with an antacid
D. Lunch time

114. Question
Tincture of opium is given to a patient who is
having diarrheal episodes. Which of the following
is true regarding this medication?

A. Opium tincture is not a controlled substance.

B. Opium tincture can be used with medications
like naltrexone and buprenorphine.
C. Has an unpleasant taste and it can be diluted
with 15-30 ml water.
D. It increases intestinal motility and peristalsis.
115. Question
A nurse is giving medicine instructions to a client
with hemorrhoids who is receiving a Mineral oil.
Which of the following statements made by the
client indicates further teaching?

A. "I can take it at least 2 hours before bedtime".

B. "It can interfere with the absorption of the
vitamin E that I am taking".
C. "If I miss a dose of mineral oil liquid, I'll take
it as soon as I remember".
D. "I can use mineral oil liquid for an extended
period to prevent further damage".

116. Question
A nurse is giving discharge instructions to a client
who is receiving a bulk-forming laxative as part of
the home medications. All of which are examples
of bulk-forming laxative, except?

A. docusate Sodium (Colace)

B. methylcellulose (Citrucel)
C. polycarbophil (Fibercon)
D. psyllium (Metamucil)

117. Question
A client with a history of chest pain is admitted to
irritable bowel syndrome. As a nurse, which of the
following medicines will you least expect to be a
part of the medical management?

A. alosetron (Lotronex)
B. tegaserod (Zelnorm)
C. lubiprostone (Amitiza)
D. loperamide (Imodium)

118. Question
What is the priority nursing intervention for a
client receiving antiemetic?

A. Monitor intake and output

B. Keep items far away from the bed
C. Give the client privacy by letting him walk
around the room
D. Keep bed in low position with side rails up
119. Question
An osmotic laxative will be prescribed for a client.
The nurse understands which medications are
osmotic laxative? Select all that apply

A. senna (Senokot)
B. mineral Oil (Kondremul)
C. polyethylene glycol and electrolytes
(GoLYTELY)
D. sodium Phosphate (Fleet enema)
E. bisacodyl (Dulcolax)

120. Question
Which of the following statements best describes
the action of antacids?

A. Antacids neutralize gastric acid

B. Antacids block the production of gastric acid
C. Antacids block dopamine
D. Antacids enhance the action of acetylcholine

121. Question
Jam is under chemotherapy in which nausea is an
expected side effect. Which of the following drugs
is indicated to prevent such side effects?

A. metoclopramide
B. cimetidine
C. tagamet
D. famotidine
122. Question
Which of the following drugs will reduce the
effectiveness of sucralfate?

A. ranitidine
B. sucralfate
C. metoclopramide
D. meclizine

123. Question
Extrapyramidal symptoms are a side effect of
which of the following drugs?

A. ranitidine
B. omeprazole
C. famotidine
D. metoclopramide

124. A client with a history of type 2 diabetes is

admitted to the hospital with chest pain. The client is
scheduled for a cardiac catheterization. Which
medication would need to be withheld for 24 hours
before the procedure and for 48 hours after the
procedure?
1. Glipizide
2. Metformin
3. Repaglinide
4. Regular insulin

125. A client in sinus bradycardia, with a heart rate

of 45 beats per minute and blood pressure of 82/60
mm Hg, reports dizziness. Which intervention
should the nurse anticipate will be prescribed?
1. Administer digoxin.
2. Defibrillate the client.
3. Continue to monitor the client.
4. Prepare for transcutaneous pacing.

126. The nurse in a medical unit is caring for a client

with heart failure. The client suddenly develops
extreme dyspnea, tachycardia, and lung crackles. The
nurse immediately asks another nurse to contact the
primary health care provider and prepares to
implement which priority interventions? Select all
that apply.
1. Administering oxygen
2. Inserting a Foley catheter
3. Administering furosemide
4. Administering morphine sulfate intravenously
5. Transporting the client to the coronary care unit
6. Placing the client in a low-Fowler’s side-lying
position

127. A client with myocardial infarction suddenly

becomes tachycardic, shows signs of air hunger, and
begins coughing frothy, pink-tinged sputum. Which
finding would the nurse anticipate when auscultating
the client’s breath sounds?
1. Stridor
2. Crackles
3. Scattered rhonchi
4. Diminished breath sounds

128. A client with myocardial infarction is

developing cardiogenic shock. What condition should
the nurse carefully assess the client for?
1. Pulsus paradoxus
2. Ventricular dysrhythmias
3. Rising diastolic blood pressure
4. Falling central venous pressure

129. A client who had cardiac surgery 24 hours ago

has had a urine output averaging 20 mL/hr for 2
hours. The client received a single bolus of 500 mL
of intravenous fluid. Urine output for the subsequent
hour was 25 mL. Daily laboratory results indicate
that the blood urea nitrogen level is 45 mg/dL
(16 mmol/L) and the serum creatinine level is 2.2
mg/dL (194 mcmol/L). On the basis of these
findings, the nurse would anticipate that the client is
at risk for which problem?
1. Hypovolemia
2. Acute kidney injury
3. Glomerulonephritis
4. Urinary tract infection
130. The nurse is reviewing an electrocardiogram
rhythm strip. The P waves and QRS complexes are
regular. The PR interval is 0.16 seconds, and QRS
complexes measure 0.06 seconds. The overall heart
rate is 64 beats per minute. Which action should the
nurse take?
1. Check vital signs.
2. Check laboratory test results.
3. Monitor for any rhythm change.
4. Notify the primary health care provider.

131. A client is wearing a continuous cardiac

monitor, which begins to sound its alarm. The nurse
sees no electrocardiographic complexes on the
screen. Which is the priority nursing action?
1. Call a code.
2. Check the client’s status.
3. Call the health care provider.
4. Document the lack of complexes.

132. The nurse is watching the cardiac monitor and

notices that a client’s rhythm
suddenly changes. There are no P waves, the QRS
complexes are wide, and the ventricular rate is
regular but more than 140 beats per minute. The
nurse The nurse determines that the client is
experiencing which dysrhythmia?
1. Sinus tachycardia
2. Ventricular fibrillation
3. Ventricular tachycardia
4. Premature ventricular contractions

133. A client has frequent bursts of ventricular

tachycardia on the cardiac monitor. What should the
nurse be most concerned about with this
dysrhythmia?
1. It can develop into ventricular fibrillation at any
time.
2. It is almost impossible to convert to a normal
rhythm.
3. It is uncomfortable for the client, giving a sense of
impending doom.
4. It produces a high cardiac output with cerebral and
myocardial ischemia.

134. A client is having frequent premature ventricular

contractions. The nurse should place priority on
assessment of which item?
1. Causative factors, such as caffeine
2. Sensation of fluttering or palpitations
3. Blood pressure and oxygen saturation
4. Precipitating factors, such as infection
135. The client has developed atrial fibrillation, with
a ventricular rate of 150 beats per minute. The nurse
should assess the client for which associated signs
and/or symptoms? Select all that apply.
1. Syncope
2. Dizziness
3. Palpitations
4. Hypertension
5. Flat neck veins

136. The nurse is watching the cardiac monitor, and a

client’s rhythm suddenly changes. There are no P
waves; instead, there are fibrillatory waves before
each QRS complex. How should the nurse interpret
the client’s heart
rhythm?
1. Atrial fibrillation
2. Sinus tachycardia
3. Ventricular fibrillation
4. Ventricular tachycardia

137. The nurse is assisting to defibrillate a client in

ventricular fibrillation. After placing the pads on the
client’s chest and before discharging the device,
which intervention is a priority?
1. Ensure that the client has been intubated.
2. Set the defibrillator to the “synchronize” mode.
3. Administer an amiodarone bolus intravenously.
4. Confirm that the rhythm is ventricular fibrillation.

138. A client in ventricular fibrillation is about to be

defibrillated. To convert this rhythm effectively, the
monophasic defibrillator machine should be set at
which energy level (in joules, J) for the first delivery?
1. 50 J
2. 120 J
3. 200 J
4. 360 J

139. The nurse should evaluate that defibrillation of a

client was most successful if which observation was
made?
1. Arousable, sinus rhythm, blood pressure (BP)
116/72 mm Hg
2. Nonarousable, sinus rhythm, BP 88/60 mm Hg
3. Arousable, marked bradycardia, BP 86/54 mm Hg
4. Nonarousable, supraventricular tachycardia, BP
122/60 mm Hg
140. The nurse is evaluating a client’s response to
cardioversion. Which
assessment would be the priority?
1. Blood pressure
2. Airway patency
3. Oxygen flow rate
4. Level of consciousness

141. The nurse is caring for a client who has just had
implantation of an automatic internal cardioverter-
defibrillator. The nurse should assess which item
based on priority?
1. Anxiety level of the client and family
2. Activation status and settings of the device
3. Presence of a MedicAlert card for the client to
carry
4. Knowledge of restrictions on postdischarge
physical activity
142. A client’s electrocardiogram strip shows atrial
and ventricular rates of 110
beats per minute. The PR interval is 0.14 seconds, the
QRS complex measures
0.08 seconds, and the PP and RR intervals are
regular. How should the nurse
interpret this rhythm?
1. Sinus tachycardia
2. Sinus bradycardia
3. Sinus dysrhythmia
4. Normal sinus rhythm

143. The nurse is evaluating the condition of a client

after pericardiocentesis performed to treat cardiac
tamponade. Which observation would indicate
that the procedure was effective?
1. Muffled heart sounds
2. Client reports dyspnea
3. A rise in blood pressure
4. Jugular venous distention

144. A client with variant angina is scheduled to

receive an oral calcium channel blocker twice daily.
Which statement by the client indicates the need for
further teaching?
1. “I should notify my cardiologist if my feet or legs
start to swell.”
2. “I am supposed to report to my cardiologist if my
pulse rate
decreases below 60.”
3. “Avoiding grapefruit juice will definitely be a
challenge for me,
since I usually drink it every morning with
breakfast.”
4. “My spouse told me that since I have developed
this problem, we
are going to stop walking in the mall every morning.”

145. A patient is being discharged home on

Hydrochlorothiazide (HCTZ) for treatment of
hypertension. Which of the following statements by
the patient indicates they understood your discharge
teaching about this medication?*
1. I will monitor my glucose levels closely because
this medication may mask symptoms of
hypoglycemia.
2. I will make sure I consume foods high in
potassium.
3.I understand a dry cough is a common side effect
with this medication.
4. I will only take this medication if my blood
pressure is high.
146. Which of the following patients does not have a
risk factor for hypertension?*
1. A 25 year old male with a BMI of 35.
2. A 68 year old male who reports smoking 2 packs
of cigarettes a day.
3. A 35 year old female with a total cholesterol level
of 100.
4. A 40 year old female with a family history of
hypertension and diabetes.

147. A patient with hypertension is started on a new

medication for treatment and is reporting a
continuous dry cough. Which of the following
medications do you suspect is causing this problem?
1. Labetalol
2. Losartan
3. Lisinopril
4. Hydrochlorothiazide

148. .Which of the following patients is not a

candidate for a beta blocker medication?*
1. A 55 year old male with a history of two heart
attacks.
2.A 39 year old female with asthma.
3. A 25 year old female with migraines.
4. A 45 year old male with angina.
149. Which family of drugs are the following
medications considered: Amlodipine, Verapamil,
Diltiazem?*
1.Beta blockers (BB)
2.Calcium Channel Blockers (CCBs)
3. Angiotension Receptor Blockers (ARBs)
4. ACE Inhibitors (ACEI)

150. Which of the following systems of the body are

affected by hypertension?*
1.Cardiovascular, brain, kidney, eyes
2.None of the options are correct
3.Brain, respiratory, kidney, cardiovascular
4. Cardiovascular, gastrointestinal, reproductive, and
kidney
151.Non-pharmacological techniques can help lower
blood pressure. Which of the following is not
considered one of these types of techniques?*
1. Multivitamins
2. Limiting caffeine
3. Dietary changes
4. Smoking cessation

152. Which of the following drugs is NOT

considered an Angiotension Receptor Blocker
(ARBs) medication used in hypertension?*
1.Catapres
2.Benicar
3.Losartan
4.Valsartan
153. A patient is scheduled to take Captopril. When
is the best time to administer this medication?*
1. 1 hour before a meal
2. At bedtime
3. In the morning
4. 30 minutes after a meal

154. True or False: Most patients with hypertension

are asymptomatic.
True
False