1.

An older adult patient who has just arrived in the emergency department has a
pulse deficit of 46 beats. Which intervention would the nurse anticipate for this
patient?
1. Cardiac catheterization
2. Hourly blood pressure checks
3. Electrocardiographic monitoring
4. Emergent synchronized cardioversion

2. During a physical examination of an older patient, the nurse palpates the point of
maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular
line. Which action is the most specific way for the nurse to follow up on this finding?
1. Ask about risk factors for atherosclerosis.
2. Determine family history of heart disease.
3. Assess for symptoms of ventricular hypertrophy.
4. Auscultate carotid arteries for the presence of a bruit.

3. How would the nurse listen to auscultate for S3 or S4 gallops in the mitral area?

1. Use the diaphragm of the stethoscope with the patient lying flat.
2. Use the bell of the stethoscope with the patient in the left lateral position.
3. Use the diaphragm of the stethoscope with the patient in a supine position.
4. Use the bell of the stethoscope with the patient sitting and leaning forward.

4. A patient is being treated for heart failure. Which laboratory test result will the
nurse review to determine the effects of the treatment?
1. Troponin
2. Homocysteine (Hcy)
3. Low-density lipoprotein (LDL)
4. B-type natriuretic peptide (BNP)

5. While doing the hospital admission assessment for a slender older adult, the nurse
observes pulsation of the abdominal aorta in the epigastric area. Which action
would the nurse take?
1. Teach the patient about aneurysms.
2. Notify the hospital rapid response team.
3. Instruct the patient to remain on bed rest.
4. Document the finding in the patient record.
6. A patient is scheduled for a cardiac catheterization with coronary angiography. What
information would the nurse provide before the procedure?

1. It will be important not to move at all during the procedure.

2. A flushed feeling is common when the contrast dye is injected.
3. Monitored anesthesia care will be provided during the procedure.
4. Arterial pressure monitoring will be needed for 24 hours after the test.

7. The nurse notes that a patient who was admitted with heart failure has jugular venous
distention (JVD) when lying flat. Which follow-up action would the nurse take?

1. Encourage the patient to drink more liquids.

2. Assess the apical and radial pulse for a pulse deficit.
3. Observe the neck with the patient elevated 45 degrees.
4. Have the patient bear down to perform the Valsalva maneuver.

8. A patient will be evaluated for rhythm disturbances with a Holter monitor. Which
instruction would the nurse provide?

1. Connect the recorder to a computer once daily.

2. Exercise more than usual while the monitor is in place.
3. Remove the electrodes when taking a shower or tub bath.
4. Keep a diary of daily activities while the monitor is worn.

9. How would the nurse document a loud humming sound auscultated over the patient‘s
abdominal aorta?

1. Thrill
2. Bruit
3. Murmur
4. Normal finding

10. A patient who developed chest pain 4 hours ago may be having a myocardial infarction.
Which laboratory test result would be most helpful in indicating myocardial damage?

1. Troponins
2. Myoglobin
3. Homocysteine (Hcy)
4. Creatine kinase-MB (CK-MB)
11. When assessing a newly admitted patient, the nurse notes a murmur along the left
sternal border. To obtain more information about the murmur, which action would the
nurse take?

1. Palpate the peripheral pulses.

2. Determine the timing of the sound.
3. Find the point of maximal impulse.
4. Compare apical and radial pulse rates.

12. The nurse hears a murmur between the S1 and S2 heart sounds at the patient‘s left fifth
intercostal space and midclavicular line. How will the nurse record this information?

1. Systolic murmur heard at mitral area

2. Systolic murmur heard at Erb‘s point
3. Diastolic murmur heard at aortic area
4. Diastolic murmur heard at the point of maximal impulse

13. A registered nurse (RN) is assessing a patient. Which action observed by charge nurse
requires immediate intervention?

1. The nurse presses on the skin over the tibia for 10 seconds to check for edema.
2. The nurse palpates both carotid arteries simultaneously to compare pulse quality.
3. The nurse documents a murmur heard along the right sternal border as a pulmonic

murmur.

4. The nurse places the patient in the left lateral position to check for the point of

maximal impulse.

14. Which action will the nurse implement for a patient who arrives for a calcium-scoring
CT scan?

1. Insert an IV catheter.
2. Instruct the patient to lie still.
3. Administer oral sedative medications.
4. Confirm that the patient has been fasting.
15. Which information obtained by the nurse who is admitting the patient for magnetic
resonance imaging (MRI) will be important to report to the health care provider before the
MRI?

1. The patient has an allergy to shellfish.

2. The patient has a history of atherosclerosis.
3. The patient has a permanent cardiac pacemaker.
4. The patient took the prescribed heart medications today.

16. The nurse is monitoring a patient who is undergoing exercise (stress) testing on a
treadmill. Which assessment finding requires the most rapid action by the nurse?

1. Patient reports feeling tired

2. Sinus tachycardia at a rate of 110 beats/min
3. Inversion of T waves on the electrocardiogram
4. Blood pressure (BP) increase from 134/68 to 150/80 mm Hg

17. The standard policy on the cardiac unit states, ―Notify the health care provider for
mean arterial pressure (MAP) less than 70 mm Hg.ǁ Which patient‘s status would the
nurse report to the health care provider?

1. Postoperative patient with a BP of 116/42 mm Hg.

2. Newly admitted patient with a BP of 150/87 mm Hg.
3. Patient with left ventricular failure who has a BP of 110/70 mm Hg.
4. Patient with a myocardial infarction who has a BP of 140/86 mm Hg.

18. The nurse is admitting a patient for a cardiac catheterization and coronary angiogram.
Which information is important for the nurse to communicate to the health care provider
before the test?

1. The patient‘s pedal pulses are +1.

2. The patient is allergic to contrast dye.
3. The patient had a heart attack 1 year ago.
4. The patient has not eaten anything today.

19. A transesophageal echocardiogram (TEE) is planned for a patient hospitalized with

possible endocarditis. Which action included in the standard TEE orders will the nurse
need to accomplish first?

1. Start an IV line.
2. Start O2 per nasal cannula.
3. Place the patient on NPO status.
 4. Give lorazepam (Ativan) 1 mg IV.

20. The nurse and assistive personnel (AP) on the telemetry unit are caring for four
patients. Which action could the nurse delegate to the AP?

1. Teaching a patient about exercise electrocardiography

2. Attaching ECG monitoring electrodes after a patient bathes
3. Monitoring a patient after a transesophageal echocardiogram
4. Checking the patient‘s catheter site after a coronary angiogram

21. The nurse is reviewing the laboratory results for newly admitted patients on the
cardiovascular unit. Which laboratory result is most important to communicate rapidly to
the health care provider?

1. High troponin I level

2. Increased triglyceride level
3. Very low homocysteine level
4. Elevated C-reactive protein level

23. Which hemodynamic parameter most directly reflects the effectiveness of drugs given to
reduce a patient‘s left ventricular afterload?

1. Cardiac output (CO)

2. Systemic vascular resistance (SVR)
3. Pulmonary vascular resistance (PVR)
4. Pulmonary artery wedge pressure (PAWP)

24. After surgery, a patient‘s central venous pressure (CVP) monitor indicates low
pressures. Which action would the nurse take?

1. Administer IV diuretic medications.

2. Increase the IV fluid infusion per protocol.
3. Increase the infusion rate of IV vasodilators.
4. Elevate the head of the patient‘s bed to 45 degrees.

25. Which parameter will the nurse use to evaluate changes in a patient‘s right
ventricular afterload?
1. Central venous pressure (CVP)
2. Systemic vascular resistance (SVR)
3. Pulmonary vascular resistance (PVR)
 4. Pulmonary artery wedge pressure (PAWP)

26. A patient requires arterial pressure monitoring. Which action would the nurse plan
to take?
1. Balance and calibrate the monitoring equipment every 2 hours.
2. Position the zero-reference stopcock line level with the phlebostatic axis.
3. Disconnect the low pressure alarm to avoid disturbing the patient‘s sleep.
4. Ensure that the patient is supine with the head of the bed flat for all readings.

27. Which measurement would be the most sensitive indicator of cardiac function?

1. Central venous pressure (CVP)

2. Systemic vascular resistance (SVR)
3. Pulmonary vascular resistance (PVR)
4. Pulmonary artery wedge pressure (PAWP)

28. Which action would the nurse take first when the low pressure alarm sounds for a
patient who has an arterial line in the left radial artery?

1. Observe for dysrhythmias.

2. Fast flush the arterial line.
3. Check the left hand for pallor.
4. Re-zero the monitoring equipment.

29. Which action would the nurse take when preparing to assist with the insertion of a
pulmonary artery catheter?

1. Determine if the cardiac troponin level is elevated.

2. Place the patient on NPO status before the procedure.
3. Auscultate heart sounds before and during catheter insertion.
4. Assure that the cardiac monitor is visible during the procedure.

30. The nurse is assisting with the placement of a pulmonary artery (PA) catheter. What
would the nurse expect to see on the monitor during the procedure as an indication that the
catheter with inflated balloon is placed correctly?

1. PA pressure waveform
2. PA wedge pressure (PAWP) waveform
3. Tracing of the systemic arterial pressure
4. Tracing of the systemic vascular resistance
31. Which finding by the nurse caring for a patient with a right radial arterial line indicates
a need for the nurse to take action?

1. The left hand feels warmer than the right hand.

2. The mean arterial pressure (MAP) is 77 mm Hg.
3. The system is delivering 3 mL of flush solution per hour.
4. The flush bag and tubing were changed 2 days previously.

32. The nurse is caring for a patient who has an arterial catheter in the left radial artery for
arterial pressure–based cardiac output (APCO) monitoring. Which information obtained
by the nurse requires a report to the health care provider?

1. The patient has a positive Allen test result.

2. There is redness at the catheter insertion site.
3. The mean arterial pressure (MAP) is 86 mm Hg.
4. The dicrotic notch is visible in the arterial waveform.

33. A patient with respiratory failure has arterial pressure–based cardiac output (APCO)
monitoring and is receiving mechanical ventilation with peak end-expiratory pressure
(PEEP) of 12 cm H2O. Which information indicates that a change in the ventilator settings
may be required?

1. The arterial pressure is 90/46.

2. The heart rate is 58 beats/min.
3. The stroke volume is increased.
4. The stroke volume variation is 12%.

Chapter 36: Hypertension

Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE

1. Which action would the nurse in the hypertension clinic take to obtain an accurate
baseline blood pressure (BP) for a new patient?

1. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.

2. Have the patient sit in a chair with the feet flat on the floor.
3. Assist the patient to the supine position for BP measurement.
4. Obtain two BP readings in the dominant arm and average the results.

2. Which information about a patient newly diagnosed with elevated blood pressure is
most important for the nurse to address with the patient?
1. Low dietary fiber intake
2. No regular physical exercise
3. Drinks a beer with dinner every night
 4. Weight is 5 pounds above ideal weight

3. Which action would the nurse take when giving the first dose of oral labetalol to a
patient hospitalized with hypertension?
1. Encourage the use of hard candy to prevent dry mouth.
2. Teach the patient that headaches often occur with this drug.
3. Instruct the patient to call for help if heart palpitations occur.
4. Ask the patient to request assistance before getting out of bed.

4. After the nurse teaches the patient with stage 1 hypertension about diet
modifications, which diet choice indicates that the teaching has been effective?
1. The patient avoids eating nuts or nut butters.
2. The patient restricts intake of chicken and fish.
3. The patient drinks low-fat milk with each meal.
4. The patient has two cups of coffee in the morning.

Which information would the nurse teach the patient who has been prescribed
captopril?

5. Include high-potassium foods such as bananas in the diet.

6. Increase fluid intake if dryness of the mouth is a problem.
7. Change position slowly to help prevent dizziness and falls.
8. Check the blood pressure in both arms before taking the drug.

6. Propranolol (Inderal) is newly prescribed for a patient diagnosed with hypertension.

Which information in the patient‘s history would prompt the nurse to consult with the
health care provider before giving this drug?

1. Asthma
2. Daily alcohol use
3. Peptic ulcer disease
4. Myocardial infarction (MI)

7. A 62-yr-old patient who has no history of hypertension has a blood pressure (BP) of
198/110 mm Hg during a routine wellness check. After reconfirming the BP, which
information would the nurse provide to the patient?

1. A BP recheck should be scheduled in a few weeks.

2. Dietary sodium and fat content should be decreased.
3. Diagnosis, treatment, and monitoring will be needed.
 4. There is danger of a stroke, requiring hospitalization.

8. Which action will be included in the plan of care for a patient who is receiving
intravenous nicardipine to treat a hypertensive emergency?

1. Keep the patient NPO to prevent aspiration caused by nausea and possible

vomiting.

2. Organize nursing activities so that the patient has 8 hours of undisturbed sleep at

night.

3. Refer patient to physical therapy to avoid complications associated with

immobility.

4. Use an automated noninvasive blood pressure machine to obtain frequent

measurements.

9. The nurse has just finished teaching a hypertensive patient about a newly
prescribed drug, ramipril (Altace). Which patient statement indicates that more
teaching is needed?
1. ―The medication may not work well if I take aspirin.ǁ
2. ―I can expect some swelling around my lips and face.ǁ
3. ―The doctor may order a blood potassium level occasionally.ǁ
4. ―I will call the doctor if I notice that I have a frequent cough.ǁ

10. A patient with hypertension received the first dose of nadolol (Corgard) during the
previous shift. Which information indicates that the patient needs immediate
intervention?
1. The patient‘s pulse has dropped from 68 to 57 beats/min.
2. The patient reports that the fingers and toes feel quite cold.
3. The patient has developed wheezes throughout the lung fields.
4. The patient‘s blood pressure (BP) reading is now 158/92 mm Hg.

11. An older patient has been diagnosed with possible white coat hypertension. Which
planned action by the nurse addresses that suspected cause of the hypertension?
1. Schedule the patient for regular BP checks in the clinic.
2. Instruct the patient about the need to decrease stress levels.
3. Teach the patient how to self-monitor and record BPs at home.
 4. Tell the patient and caregiver that major dietary changes are needed.

12. Which blood pressure (BP) finding by the nurse indicates that no changes in
therapy are needed for a 48-yr-old patient with newly diagnosed hypertension?
1. 98/56 mm Hg
2. 128/76 mm Hg
3. 128/92 mm Hg
4. 142/78 mm Hg

13. Which information is important for the nurse to include when teaching a patient
newly diagnosed with hypertension?
1. Most people can control hypertension through dietary changes.
2. Annual BP checks are needed to monitor treatment effectiveness.
3. Hypertension is usually asymptomatic until organ damage occurs.
4. Increasing physical activity controls hypertension for most people.

14. The nurse on the intermediate care unit received change-of-shift report on four patients
with hypertension. Which patient would the nurse assess first?

1. 48-yr-old with a BP of 160/92 mm Hg who reports chest pain

2. 50-yr-old with a BP of 190/104 mm Hg whose creatinine is 1.7 mg/dL
3. 52-yr-old with a BP of 198/90 mm Hg who has intermittent claudication
4. 43-yr-old with a BP of 172/98 mm Hg whose urine shows microalbuminuria

15. The nurse is reviewing the laboratory test results for a patient who has recently been
diagnosed with hypertension. Which result is important to communicate to the health care
provider?

1. Serum creatinine of 2.8 mg/dL

2. Serum potassium of 4.5 mEq/L
3. Serum hemoglobin of 14.7 g/dL
4. Blood glucose level of 96 mg/dL
16. A patient who has a history of hypertension treated with a diuretic and clonidine
(Catapres) arrives in the emergency department. The patient reports a severe headache
and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question would the
nurse ask to follow up on these findings?

1. ―Have you recently taken any antihistamines?ǁ

2. ―Have you consistently taken your medications?ǁ
3. ―Did you take any acetaminophen (Tylenol) today?ǁ
4. ―Have there been recent stressful events in your life?ǁ

17. The nurse is assessing a patient who has been admitted to the intensive care unit (ICU)
with a hypertensive emergency. Which finding is most urgent to report to the health care
provider?

1. Urine output over 8 hours is 250 mL less than the fluid intake.
2. The patient cannot move the left arm and leg when asked to do so.
3. Tremors are noted in the fingers when the patient extends the arms.
4. The patient reports a headache with pain at level 7 of 10 (0 to 10 scale).

18. A patient with hypertension who was prescribed atenolol (Tenormin) 2 weeks ago
returns to the health clinic for a follow-up visit. The blood pressure (BP) is unchanged from
the previous visit. Which action would the nurse take first?

1. Tell the patient why a change in drug dosage is needed.

2. Ask the patient if the medication is being taken as prescribed.
3. Review with the patient any lifestyle changes made to help control BP.
4. Teach the patient that multiple drugs are often needed to treat hypertension.

19. The registered nurse (RN) is caring for a patient with a hypertensive crisis who is
receiving sodium nitroprusside. Which nursing action can the nurse delegate to an
experienced licensed practical/vocational nurse (LPN/VN)?
1. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).
2. Assess the patient‘s environment for adverse stimuli that might increase BP.
3. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg.
4. Set up the automatic noninvasive BP machine to take readings every 15 minutes.

20. The charge nurse observes a new registered nurse (RN) doing discharge teaching for
a patient with hypertension who has a prescription for enalapril (Vasotec). Which
statement by the new nurse to the patient requires the charge nurse‘s intervention?
1. ―Make an appointment with the dietitian for teaching.ǁ
2. ―Increase your dietary intake of high-potassium foods.ǁ
 3. ―Check your blood pressure at home at least once a day.ǁ
4. ―Move slowly when moving from lying to sitting to standing.ǁ

21. A patient is receiving IV furosemide to treat stage 2 hypertension. Which assessment

finding is most important to report to the health care provider?

1. Blood glucose level of 175 mg/dL

2. Serum potassium level of 3.0 mEq/L
3. Orthostatic systolic BP decrease of 12 mm Hg
4. Current blood pressure (BP) reading of 168/94 mm Hg

22. Which action would the nurse take first to assist a patient with newly diagnosed stage 1
hypertension in making needed dietary changes?

1. Collect a detailed diet history.

2. Provide a list of low-sodium foods.
3. Help the patient make an appointment with a dietitian.
4. Teach the patient about foods that are high in potassium.

23. The nurse is caring for a 70-yr-old patient who takes hydrochlorothiazide and enalapril
(Norvasc). The patient‘s blood pressure (BP) continues to be high. Which patient
information may indicate a need for a change?

1. Patient takes a daily multivitamin tablet.

2. Patient uses ibuprofen to treat osteoarthritis.
3. Patient checks BP daily just after getting up.
4. Patient drinks wine three to four times a week.

COMPLETION

1. The nurse measures a patient‘s blood pressure as 172/82 mm Hg. What is the patient‘s mean
arterial pressure (MAP)? _________

ANS:
112 mm Hg

MAP = (SBP + 2 DBP)/3.

Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome Harding:
Lewis’s Medical-Surgical Nursing, 12th Edition
MULTIPLE CHOICE

1. The nurse is developing a teaching plan for a patient with coronary artery disease
(CAD). Which factor would the nurse focus on during the teaching session?
1. Family history of coronary artery disease
2. Elevated low-density lipoprotein (LDL) level
3. Greater risk associated with the patient‘s gender
4. Increased risk of cardiovascular disease with aging

2. Which nursing intervention is likely to be most effective when assisting the patient
with coronary artery disease to make dietary changes?
1. Inform the patient about a diet containing no saturated fat and minimal salt.
2. Emphasize the increased cardiac risk unless the patient makes dietary changes.
3. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
4. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet.

3. The nurse is admitting a patient who has chest pain. Which assessment data suggest that
the pain may be from an acute myocardial infarction?

1. The pain increases with deep breathing.

2. The pain has lasted longer than 30 minutes.
3. The pain is relieved after the patient takes nitroglycerin.

d. The pain is reproducible when the patient raises the arms.

4. Which patient statement would help the nurse confirm the previous diagnosis of chronic
stable angina?

1. ―The pain wakes me up at night.ǁ

2. ―The pain is level 3 to 5 (0 to 10 scale).ǁ
3. ―The pain has gotten worse over the last week.ǁ
4. ―The pain goes away with a nitroglycerin tablet.ǁ

5. Which patient statement indicates that the nurse‘s teaching about sublingual
nitroglycerin (Nitrostat) has been effective?
1. ―I can expect nausea as a side effect of nitroglycerin.ǁ
2. ―I should only take nitroglycerin when I have chest pain.ǁ
3. ―Nitroglycerin helps prevent a clot from blocking blood flow to my heart.ǁ
4. ―I will call an ambulance if I have pain 5 minutes after taking nitroglycerin.ǁ
 6. Which statement made by a patient with coronary artery disease indicates that
further diet teaching is needed?
1. ―I will switch from whole milk to 1% milk.ǁ
2. ―I like salmon and I will plan to eat it more often.ǁ
3. ―I can have a glass of wine with dinner if I want one.ǁ
4. ―I will miss being able to eat peanut butter sandwiches.ǁ

7. Which patient statement indicates that the nurse‘s teaching about carvedilol (Coreg)
for preventing anginal episodes has been effective?
1. ―Carvedilol will help my heart muscle work harder.ǁ
2. ―It is important not to suddenly stop taking the carvedilol.ǁ
3. ―I can expect to feel short of breath when taking carvedilol.ǁ
4. ―Carvedilol will increase the blood flow to my heart muscle.ǁ

8. A patient who has had chest pain for several hours is admitted with a diagnosis of
rule out acute myocardial infarction (AMI). Which laboratory test is most specific
for the nurse to monitor in determining whether the patient has had an AMI?
1. Myoglobin
2. Homocysteine
3. C-reactive protein
4. Cardiac-specific troponin

9. Diltiazem is prescribed for a patient newly diagnosed with Prinzmetal‘s (variant) angina.
Which action of diltiazem is accurate for the nurse to include in the teaching plan?

1. Reduces heart palpitations.

2. Prevents coronary artery plaque.
3. Decreases coronary artery spasms.
4. Increases contractile force of the heart.

10. Which data indicates to the nurse that the patient with stable angina is experiencing
a side effect of metoprolol?
1. Patient is restless and agitated.
2. Patient reports feeling anxious.
3. Blood pressure is 90/54 mm Hg.
4. Heart monitor shows normal sinus rhythm.
 11. Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left
ventricular dysfunction. Which data would indicate to the nurse that the drug is
effective?
1. Decreased blood pressure and heart rate
2. Improvement in the strength of the distal pulses
3. Fewer complaints of having cold hands and feet
4. Participation in daily activities without chest pain

12. Heparin is ordered for a patient with a non–ST-segment-elevation myocardial

infarction (NSTEMI). How should the nurse explain the purpose of the heparin to
the patient?
1. ―Heparin enhances platelet aggregation at the plaque site.ǁ
2. ―Heparin decreases the size of the coronary artery plaque.ǁ
3. ―Heparin prevents the development of new clots in the coronary arteries.ǁ
4. ―Heparin dissolves clots that are blocking blood flow in the coronary arteries.ǁ

13. Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for
a patient with a myocardial infarction (MI)?
1. Monitor heart rate.
2. Ask about chest pain.
3. Check blood pressure.
4. Observe for dysrhythmias.

14. A patient is admitted to the emergency department and diagnosed as having an ST-
segment-elevation myocardial infarction (STEMI). Which question would the nurse
ask to determine whether the patient is a candidate for thrombolytic therapy?
1. ―Do you have any allergies?ǁ
2. ―Did you take aspirin today?ǁ
3. ―What time did your pain begin?ǁ

15. A patient who has recently had an acute myocardial infarction (AMI) ambulates in the
hospital hallway. Which data would indicate to the nurse that the patient should stop and
rest?

1. O2 saturation drops from 99% to 95%.

2. Heart rate increases from 66 to 98 beats/min.
3. Respiratory rate goes from 14 to 20 breaths/min.
4. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.
 16. The nurse is administering a thrombolytic agent to a patient having an acute
myocardial infarction. Which patient data indicates that the nurse should stop the
drug infusion?
1. Bleeding from the gums
2. An increase in blood pressure
3. Decreased level of consciousness
4. A nonsustained episode of ventricular tachycardia

17. A patient recovering from a myocardial infarction (MI) develops chest pain on day
3 that increases when taking a deep breath and is relieved by leaning forward.
Which action would the nurse take as focused follow-up on this symptom?

1. Assess both feet for pedal edema.

2. Palpate the radial pulses bilaterally.
3. Auscultate for a pericardial friction rub.
4. Check the heart monitor for dysrhythmias.

18. In preparation for discharge, the nurse teaches a patient with chronic stable angina how
to use the prescribed short-acting and long-acting nitrates. Which patient statement
indicates that the teaching has been effective?

1. ―I will sit down before I put the nitroglycerin under my tongue.ǁ

2. ―I will check my pulse rate before I take any nitroglycerin tablets.ǁ
3. ―I will put the nitroglycerin patch on as soon as I get any chest pain.ǁ
4. ―I will remove the nitroglycerin patch before taking sublingual nitroglycerin.ǁ

19. The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD)
event and has no evidence of an acute myocardial infarction (AMI). Which information
would the nurse anticipate teaching the patient?

1. Sudden cardiac death events rarely reoccur.

2. Additional diagnostic testing will be required.
3. Long-term anticoagulation therapy will be needed.
4. Limiting physical activity will prevent future SCD events.

20. A patient with diabetes mellitus and chronic stable angina has a new order for
captopril. Which information would the nurse teach this patient about the primary
purpose of captopril?
1. Decreases the heart rate.
2. Controls blood glucose levels.
3. Prevents changes in heart muscle.
 4. Reduces the frequency of chest pain.

21. After having a myocardial infarction (MI) and successful percutaneous coronary
intervention, the patient states, ―It was just a little chest pain. As soon as I get out
of here, I‘m going for my vacation as planned.ǁ Which reply would be most
appropriate for the nurse to make?
1. ―What do you think caused your chest pain?ǁ
2. ―Where are you planning to go for your vacation?ǁ
3. ―Sometimes plans need to change after a heart attack.ǁ

22. The nurse is evaluating the effectiveness of preoperative teaching with a patient
scheduled for coronary artery bypass graft (CABG) surgery using the internal
mammary artery. Which patient statement indicates that additional teaching is
needed?
1. ―They will circulate my blood with a machine during surgery.ǁ
2. ―I will have incisions in my leg where they will remove the vein.ǁ
3. ―They will use an artery near my heart to go around the area that is blocked.ǁ
4. ―I will need to take aspirin every day after the surgery to keep the graft open.ǁ

23. A patient who is recovering from an acute myocardial infarction (AMI) asks the
nurse about safely resuming sexual intercourse. Which response by the nurse
provides the most useful information for the patient?
1. ―Most patients are able to enjoy intercourse without any complications.ǁ
2. ―Sexual activity uses about as much energy as climbing two flights of stairs.ǁ
3. ―The doctor will provide sexual guidelines when your heart is strong enough.ǁ
4. ―Holding and cuddling are good ways to maintain intimacy after a heart attack.ǁ

24. A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which action
would the nurse take?

1. Administer the medication at the patient‘s usual bedtime.

2. Have the patient take the colesevelam 1 hour before breakfast.
3. Give the patient‘s other medications 3 hours after colesevelam.
4. Have the patient take the dose at the same time as the prescribed aspirin.
25. The nurse is caring for a patient who was admitted to the coronary care unit following
an acute myocardial infarction (AMI) and percutaneous coronary intervention the
previous day. Which information would the nurse plan to provide today?

1. Typical emotional responses to AMI

2. When cardiac rehabilitation will begin
3. Pathophysiology of coronary artery disease
4. Information regarding discharge medications

26. A patient who has recently started taking pravastatin (Pravachol) and niacin
reports several new symptoms to the nurse. Which information is most important to
communicate to the health care provider?
1. Generalized muscle aches and pains
2. Dizziness with rapid position changes
3. Nausea when taking the drugs before meals
4. Flushing and pruritus after taking the drugs

27. A patient who is being admitted to the emergency department with intermittent
chest pain gives the following list of daily medications to the nurse. Which
medication has the most immediate implications for the patient‘s care?
1. Sildenafil (Viagra)
2. Furosemide (Lasix)
3. Warfarin (Coumadin)
4. Diltiazem (Cardizem)

28. Which assessment finding in a patient who has had coronary artery bypass grafting
using a right radial artery graft is most important for the nurse to communicate to the
health care provider?

1. Complaints of incisional chest pain

2. Pallor and weakness of the right hand
3. Fine crackles heard at both lung bases
4. Redness on both sides of the sternal incision

29. The nurse is caring for a patient who has just arrived on the telemetry unit after
having cardiac catheterization. Which task could the nurse delegate to a licensed
practical/vocational nurse (LPN/VN)?
1. Teach the patient about the postprocedure plan of care.
2. Give the scheduled aspirin and lipid-lowering medication.
3. Perform the initial assessment of the catheter insertion site.
4. Titrate the heparin infusion according to the agency protocol.
 30. Which electrocardiographic (ECG) change by a patient with chest pain is most
important for the nurse to report rapidly to the health care provider?

1. Inverted P wave
2. Sinus tachycardia
3. ST-segment elevation
4. First-degree atrioventricular block

31. A patient with acute coronary syndrome has returned to the coronary care unit after
having angioplasty with stent placement. Which assessment data indicate the need for
immediate action by the nurse?

a. Report of chest pain

Heart rate 102 beats/min

Pedal pulses 1+ bilaterally

Blood pressure 103/54 mm Hg

32. A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation
myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40
mm Hg, and heart rate is 132 beats/min. Based on this information, which patient
problem is the priority?
1. Acute pain
2. Deficient knowledge
3. Impaired cardiac function
4. Health maintenance alteration

33. When admitting a patient with a non–ST-segment-elevation myocardial infarction

(NSTEMI) to the intensive care unit, which action would the nurse perform first?
1. Attach the heart monitor.
2. Obtain the blood pressure.
3. Assess the peripheral pulses.
4. Auscultate the breath sounds.

34. Which information about a patient receiving thrombolytic therapy for an acute
myocardial infarction is most important for the nurse to communicate to the health care
provider?

1. An increase in troponin levels from baseline

2. A large bruise at the patient‘s IV insertion site
3. No change in the patient‘s reported level of chest pain
 4. A decrease in ST-segment elevation on the electrocardiogram

35. The nurse obtains the following data when assessing a patient who experienced an ST-
segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is
most important to report to the health care provider?

1. The troponin level is elevated.

2. The patient denies having a heart attack.
3. Bilateral crackles in the mid-lower lobes.
4. Occasional premature atrial contractions (PACs).

36. A patient had a non–ST-segment-elevation myocardial infarction (NSTEMI) 3 days

ago. Which nursing intervention is appropriate for the registered nurse (RN) to
delegate to an experienced licensed practical/vocational nurse (LPN/VN)?
1. Reinforcement of teaching about the prescribed medications
2. Evaluation of the patient‘s response to walking in the hallway
3. Completion of the referral form for a home health nurse follow-up
4. Education of the patient about the pathophysiology of heart disease

A patient who has chest pain is admitted to the emergency department (ED), and all
of the following items are prescribed. Which one would the nurse arrange to be
completed first?

5. Chest x-ray
6. Troponin level
7. Electrocardiogram (ECG)

d. Insertion of a peripheral IV

38. After receiving change-of-shift report about the following four patients on the cardiac
care unit, which patient would the nurse assess first?

1. A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest

pain

2. A 56-year-old patient with variant angina who is scheduled to receive nifedipine

 (Procardia)

3. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is

anxious about today‘s planned discharge

4. A 59-year-old patient with unstable angina who has just returned after a

percutaneous coronary intervention (PCI)

39. To improve the physical activity level for a 68-year-old patient who is mildly obese,
which action would the nurse plan to take?

1. Stress that weight loss is a major benefit of increased exercise.

2. Determine what kind of physical activities the patient usually enjoys.
3. Tell the patient that older adults should exercise for no more than 20 minutes at a time.
4. Teach the patient to include a short warm-up period at the beginning of physical activity.

40. Which patient at the cardiovascular clinic requires the most immediate action by
the nurse?
1. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL
2. Patient with stable angina whose chest pain has recently increased in frequency
3. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL
4. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

41. The nurse reviews information shown in the accompanying figure from the medical
records of a 43-year-old patient. Which risk factor modification for coronary artery
disease would the nurse include in patient teaching?
1. Importance of daily physical activity
2. Effect of weight loss on blood pressure
3. Dietary changes to improve lipid levels
4. Cardiac risk associated with previous tobacco use
 42. After reviewing a patient‘s history, vital signs, physical assessment, and laboratory
data, which information shown in the accompanying figure is most important for
the nurse to communicate to the health care provider?

1. Hyperglycemia
2. Bilateral crackles
3. Q waves on ECG
4. Elevated troponin

ANS: B
Bilateral crackles suggests that the patient may be developing heart failure, a complication of
myocardial infarction (MI). Hyperglycemia is common after MI because of the inflammatory
process that occurs with tissue necrosis. Troponin levels will be elevated for several days after
MI. Q waves often develop with ST-segment-elevation MI.