MSN FOR MI & HF

Text Mode

Text Mode – Text version of the exam

1) The nurse should visit which of the following clients

first?

A. The client with diabetes with a blood glucose of 95mg/

dL

B. The client with hypertension being maintained on

Lisinopril

C. The client with chest pain and a history of angina

D. The client with Raynaud’s disease

2) A 23 year old patient in the 27th week of pregnancy has

been hospitalized on complete bed rest for 6 days. She

experiences sudden shortness of breath, accompanied by

chest pain. Which of the following conditions is the most

likely cause of her symptoms?

A. Myocardial infarction due to a history of

atherosclerosis.

B. Pulmonary embolism due to deep vein thrombosis (DVT).

C. Anxiety attack due to worries about her baby’s

health.

D. Congestive heart failure due to fluid overload.

3) What is the primary reason for administering morphine to

a client with myocardial infarction?

A. To sedate the client

B. To decrease the client’s pain

C. To decrease the client’s anxiety

D. To decrease oxygen demand on the client’s heart

4) A patient arrives in the emergency department with

symptoms of myocardial infarction, progressing to

cardiogenic shock. Which of the following symptoms should

the nurse expect the patient to exhibit with cardiogenic

shock?

A. Hypertension.

B. Bradycardia.

C. Bounding pulse.

D. Confusion.

5) In order to be effective, Percutaneous Transluminal

Coronary Angioplasty (PTCA) must be performed within what

time frame, beginning with arrival at the emergency

department after diagnosis of myocardial infarction?

A. 60 minutes

B. 30 minutes

C. 9 days

D. 6-12 months

6) Helen, a nurse from the maternity unit is floated to the

critical care unit because of staff shortage on the evening

shift. Which client would be appropriate to assign to this

nurse? A client with:

A. Dopamine drip IV with vital signs monitored every 5

minutes

B. a myocardial infarction that is free from pain and

dysrhythmias

C. a tracheotomy of 24 hours in some respiratory

distress

D. a pacemaker inserted this morning with intermittent

capture

7) A female client is brought by ambulance to the hospital

emergency room after taking an overdose of barbiturates is

comatose. Nurse Trish would be especially alert for which of

the following?

A. Epilepsy
B. Myocardial Infarction

C. Renal failure

D. Respiratory failure

8) Tissue plasminogen activator (t-PA) is considered for

treatment of a patient who arrives in the emergency

department following onset of symptoms of myocardial

infarction. Which of the following is a contraindication for

treatment with t-PA?

A. Worsening chest pain that began earlier in the

evening.

B. History of cerebral hemorrhage.

C. History of prior myocardial infarction.

D. Hypertension.

9) A patient admitted to the hospital with myocardial

infarction develops severe pulmonary edema. Which of the

following symptoms should the nurse expect the patient to

exhibit?

A. Slow, deep respirations.

B. Stridor.

C. Bradycardia.

D. Air hunger.
10) A 55-year-old client is admitted with chest pain that

radiates to the neck, jaw and shoulders that occurs at rest,

with high body temperature, weak with generalized

sweating and with decreased blood pressure. A myocardial

infarction is diagnosed. The nurse knows that the most

accurate explanation for one of these presenting

adaptations is:

A. Catecholamines released at the site of the infarction

causes intermittent localized pain.

B. Parasympathetic reflexes from the infarcted

myocardium causes diaphoresis.

C. Constriction of central and peripheral blood vessels

causes a decrease in blood pressure.

D. Inflammation in the myocardium causes a rise in the

systemic body temperature.

11) Which of the following is the most common symptom of

myocardial infarction?

A. Chest pain

B. Dyspnea

C. Edema

D. Palpitations
12) Nursing measures for the client who has had an MI

include helping the client to avoid activity that results in

Valsalva’s maneuver. Valsalva’s maneuver may cause

cardiac dysrhythmias, increased venous pressure, increased

intrathoracic pressure and thrombi dislodgement. Which of

the following actions would help prevent Valsalva’s

maneuver? Have the client:

A. Assume a side-lying position

B. Clench her teeth while moving in bed

C. Drink fluids through a straw

D. Avoid holding her breath during activity

13) The nurse is giving discharge teaching to a client 7 days

post myocardial infarction. He asks the nurse why he must

wait 6 weeks before having sexual intercourse. What is the

best response by the nurse to this question?

A. “You need to regain your strength before attempting

such exertion.”

B. “When you can climb 2 flights of stairs without

problems, it is generally safe.”

C. “Have a glass of wine to relax you, then you can try

to have sex.”
D. “If you can maintain an active walking program, you

will have less risk.”

14) Following myocardial infarction, a hospitalized patient is

encouraged to practice frequent leg exercises and ambulate

in the hallway as directed by his physician. Which of the

following choices reflects the purpose of exercise for this

patient?

A. Increases fitness and prevents future heart attacks.

B. Prevents bedsores.

C. Prevents DVT (deep vein thrombosis).

D. Prevent constipations.

15) Alzheimer’s disease is the secondary diagnosis of a

client admitted with myocardial infarction. Which nursing

intervention should appear on this client’s plan of care?

A. Perform activities of daily living for the client to

decease frustration.

B. Provide a stimulating environment.

C. Establish and maintain a routine.

D. Try to reason with the client as much as possible.

16) Which statement best describes the difference between

the pain of angina and the pain of myocardial infarction?

A. Pain associated with angina is relieved by rest.

B. Pain associated with myocardial infarction is always

more severe.

C. Pain associated with angina is confined to the chest

area.

D. Pain associated with myocardial infarction is referred

to the left arm.

17) Patrick who is hospitalized following a myocardial

infarction asks the nurse why he is taking morphine. The

nurse explains that morphine:

A. Decrease anxiety and restlessness

B. Prevents shock and relieves pain

C. Dilates coronary blood vessels

D. Helps prevent fibrillation of the heart

18) An early finding in the EKG of a client with an infarcted

mycardium would be:

A. Disappearance of Q waves

B. Elevated ST segments

C. Absence of P wave

D. Flattened T waves

19) A nurse caring for several patients on the cardiac unit

is told that one is scheduled for implantation of an

automatic internal cardioverter-defibrillator. Which of the

following patients is most likely to have this procedure?

A. A patient admitted for myocardial infarction without

cardiac muscle damage.

B. A post-operative coronary bypass patient, recovering

on schedule.

C. A patient with a history of ventricular tachycardia

and syncopal episodes.

D. A patient with a history of atrial tachycardia and

fatigue.

20) Twenty four hours after admission for an Acute MI,

Jose’s temperature is noted at 39.3 C. The nurse monitors

him for other adaptations related to the pyrexia, including:

A. Shortness of breath

B. Chest pain

C. Elevated blood pressure

D. Increased pulse rate

21) Mr. Duffy is admitted to the CCU with a diagnosis of R/

O MI. He presented in the ER with a typical description of

pain associated with an MI, and is now cold and clammy,

pale and dyspneic. He has an IV of D5W running, and is

complaining of chest pain. Oxygen therapy has not been

started, and he is not on the monitor. He is frightened.

During the first three days that Mr. Duffy is in the CCU, a

number of diagnostic blood tests are obtained. Which of the

following patterns of cardiac enzyme elevation are most

common following an MI?

A. SGOT, CK, and LDH are all elevated immediately.

B. SGOT rises 4-6 hours after infarction with CK and LDH

rising slowly 24 hours later.

C. CK peaks first (12-24 hours), followed by the SGOT

(peaks in 24-36 hours) and then the LDH (peaks 3-4

days).

D. CK peaks first and remains elevated for 1 to 2 weeks.

22) To prevent a valsalva maneuver in a client recovering

from an acute myocardial infarction, the nurse would

A. Assist the client to use the bedside commode

B. Administer stool softeners every day as ordered

C. Administer antidysrhythmics prn as ordered

D. Maintain the client on strict bed rest

23) A male client with chronic obstructive pulmonary disease

(COPD) is recovering from a myocardial infarction. Because

the client is extremely weak and can’t produce an effective

cough, the nurse should monitor closely for:

A. Pleural effusion.

B. Pulmonary edema.

C. Atelectasis.

D. Oxygen toxicity.

24) A 42-year-old client admitted with an acute myocardial

infarction asks to see his chart. What should the nurse do

first?

A. Allow the client to view his chart

B. Contact the supervisor and physician for approval

C. Ask the client if he has concerns about his care

D. Tell the client that he isn’t permitted to view his

chart.

25) A client with a history of an anterior wall myocardial

infarction is being transferred from the coronary care unit

(CCU) to the cardiac stepdown unit (CSU). While giving

report to the CSU nurse, the CCU nurse says, “His

pulmonary artery wedge pressures have been in the high

normal range.” The CSU nurse should be especially

observant for:

A. hypertension

B. high urine output

C. dry mucous membranes

D. pulmonary crackles

26) Which patient’s nursing care would be most appropriate

for the charge nurse to assign to the LPN, under the

supervision of the RN team leader?

A. A 51-year-old patient with bilateral adrenalectomy

just returned from the post-anesthesia care unit

B. An 83-year-old patient with type 2 diabetes and

chronic obstructive pulmonary disease

C. A 38-year-old patient with myocardial infarction who

is preparing for discharge

D. A 72-year-old patient admitted from long-term care

with mental status changes

27) During the second day of hospitalization of the client

after a Myocardial Infarction. Which of the following is an

expected outcome?

A. Able to perform self-care activities without pain

B. Severe chest pain

C. Can recognize the risk factors of Myocardial

Infarction

D. Can Participate in cardiac rehabilitation walking

program

28) The client with an acute myocardial infarction is

hospitalized for almost one week. The client experiences

nausea and loss of appetite. The nurse caring for the client

recognizes that these symptoms may indicate the:

A. Adverse effects of spironolactone (Aldactone)

B. Adverse effects of digoxin (Lanoxin)

C. Therapeutic effects of propranolol (Indiral)

D. Therapeutic effects of furosemide (Lasix)

29) Dr. Marquez orders a continuous intravenous

nitroglycerin infusion for the client suffering from

myocardial infarction. Which of the following is the most

essential nursing action?

A. Monitoring urine output frequently

B. Monitoring blood pressure every 4 hours

C. Obtaining serum potassium levels daily

D. Obtaining infusion pump for the medication

30) On the evening shift, the triage nurse evaluates several

clients who were brought to the emergency department.

Which in the following clients should receive highest

priority?

A. an elderly woman complaining of a loss of appetite and

fatigue for the past week

B. A football player limping and complaining of pain and

swelling in the right ankle

C. A 50-year-old man, diaphoretic and complaining of

severe chest pain radiating to his jaw

D. A mother with a 5-year-old boy who says her son has

been complaining of nausea and vomited once since

noon

31) Nurse Betty is assigned to the following clients. The

client that the nurse would see first after endorsement?

A. A 34 year-old post operative appendectomy client of

five hours who is complaining of pain.

B. A 44 year-old myocardial infarction (MI) client who is

complaining of nausea.

C. A 26 year-old client admitted for dehydration whose

intravenous (IV) has infiltrated.

D. A 63 year-old post operative’s abdominal hysterectomy

client of three days whose incisional dressing is

saturated with serosanguinous fluid.

32) After a myocardial infarction, a client is placed on a

sodium restricted diet. When the nurse is teaching the

client about the diet, which meal plan would be the most

appropriate to suggest?

A. 3 oz. broiled fish, 1 baked potato, ½ cup canned

beets, 1 orange, and milk

B. 3 oz. canned salmon, fresh broccoli, 1 biscuit, tea,

and 1 apple

C. A bologna sandwich, fresh eggplant, 2 oz fresh fruit,

tea, and apple juice

D. 3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh

green beans, milk, and 1 orange

33) The greatest danger of an uncorrected atrial fibrillation

for a male patient will be which of the following:

A. Pulmonary embolism

B. Cardiac arrest

C. Thrombus formation

D. Myocardial infarction

34) Jose, who had a myocardial infarction 2 days earlier,

has been complaining to the nurse about issues related to

his hospital stay. The best initial nursing response would be

to:

A. Allow him to release his feelings and then leave him

alone to allow him to regain his composure

B. Refocus the conversation on his fears, frustrations

and anger about his condition

C. Explain how his being upset dangerously disturbs his

need for rest

D. Attempt to explain the purpose of different hospital

routines

35) Nurse Patricia finds a female client who is post-

myocardial infarction (MI) slumped on the side rails of the

bed and unresponsive to shaking or shouting. Which is the

nurse next action?

A. Call for help and note the time.

B. Clear the airway

C. Give two sharp thumps to the precordium, and check

the pulse.

D. Administer two quick blows.

36) Which of the following actions is the first priority of

care for a client exhibiting signs and symptoms of coronary

artery disease?

A. Decrease anxiety

B. Enhance myocardial oxygenation

C. Administer sublingual nitroglycerin

D. Educate the client about his symptoms

37) Medical treatment of coronary artery disease includes

which of the following procedures?

A. Cardiac catherization

B. Coronary artery bypass surgery

C. Oral medication therapy

D. Percutaneous transluminal coronary angioplasty

38) Which of the following is the most common symptom of

myocardial infarction (MI)?

A. Chest pain

B. Dyspnea

C. Edema

D. Palpitations

39) Which of the following symptoms is the most likely origin

of pain the client described as knifelike chest pain that

increases in intensity with inspiration?

A. Cardiac

B. Gastrointestinal

C. Musculoskeletal

D. Pulmonary

40) Which of the following blood tests is most indicative of

cardiac damage?

A. Lactate dehydrogenase

B. Complete blood count (CBC)

C. Troponin I

D. Creatine kinase (CK)

41) What is the primary reason for administering

morphine to a client with an MI?

A. To sedate the client

B. To decrease the client’s pain

C. To decrease the client’s anxiety

D. To decrease oxygen demand on the client’s heart

42) Which of the following conditions is most commonly

responsible for myocardial infarction?

A. Aneurysm

B. Heart failure

C. Coronary artery thrombosis

D. Renal failure

43) Which of the following complications is indicated by

a third heart sound (S3)?

A. Ventricular dilation

B. Systemic hypertension

C. Aortic valve malfunction

D. Increased atrial contractions

44) After an anterior wall myocardial infarction, which

of the following problems is indicated by auscultation of

crackles in the lungs?

A. Left-sided heart failure

B. Pulmonic valve malfunction

C. Right-sided heart failure

D. Tricupsid valve malfunction

45) What is the first intervention for a client experiencing

MI?

A. Administer morphine

B. Administer oxygen

C. Administer sublingual nitroglycerin

D. Obtain an ECG

46) Which of the following classes of medications protects

the ischemic myocardium by blocking catecholamines and

sympathetic nerve stimulation?

A. Beta-adrenergic blockers

B. Calcium channel blockers

C. Narcotics

D. Nitrates

47) What is the most common complication of an MI?

A. Cardiogenic shock

B. Heart failure

C. arrhythmias

D. Pericarditis

48) With which of the following disorders is jugular vein

distention most prominent?

A. Abdominal aortic aneurysm

B. Heart failure

C. MI

D. Pneumothorax

49) Toxicity from which of the following medications may

cause a client to see a green-yellow halo around lights?

A. Digoxin

B. Furosemide (Lasix)
C. Metoprolol (Lopressor)

D. Enalapril (Vasotec)

50) Which of the following symptoms is most commonly

associated with left-sided heart failure?

A. Crackles

B. Arrhythmias

C. Hepatic engorgement

D. Hypotension

51) In which of the following disorders would the nurse

expect to assess sacral edema in a bedridden client?

A. Diabetes

B. Pulmonary emboli

C. Renal failure

D. Right-sided heart failure

52) Which of the following symptoms might a client with

right-sided heart failure exhibit?

A. Adequate urine output

B. Polyuria

C. Oliguria

D. Polydipsia

53) Which of the following classes of medications maximizes

cardiac performance in clients with heart failure by

increasing ventricular contractibility?

A. Beta-adrenergic blockers

B. Calcium channel blockers

C. Diuretics

D. Inotropic agents

54) Stimulation of the sympathetic nervous system

produces which of the following responses?

A. Bradycardia

B. Tachycardia

C. Hypotension

D. Decreased myocardial contractility

55) Which of the following conditions is most closely

associated with weight gain, nausea, and a decrease in

urine output?

A. Angina pectoris

B. Cardiomyopathy

C. Left-sided heart failure

D. Right-sided heart failure

56) Which of the following heart muscle diseases is

unrelated to other cardiovascular disease?

A. Cardiomyopathy

B. Coronary artery disease

C. Myocardial infarction

D. Pericardial effusion

57) Which of the following types of cardiomyopathy can be

associated with childbirth?

A. Dilated

B. Hypertrophic

C. Myocarditis

D. Restrictive

58) Septal involvement occurs in which type of

cardiomyopathy?

A. Congestive

B. Dilated

C. Hypertrophic

D. Restrictive

59) Which of the following recurring conditions most

commonly occurs in clients with cardiomyopathy?

A. Heart failure

B. Diabetes

C. MI
D. Pericardial effusion

60) Dyspnea, cough, expectoration, weakness, and edema

are classic signs and symptoms of which of the following

conditions?

A. Pericarditis

B. Hypertension

C. MI

D. Heart failure

61) In which of the following types of cardiomyopathy does

cardiac output remain normal?

A. Dilated

B. Hypertrophic

C. Obliterative

D. Restrictive

62) Which of the following cardiac conditions does a fourth

heart sound (S4) indicate?

A. Dilated aorta

B. Normally functioning heart

C. Decreased myocardial contractility

D. Failure of the ventricle to eject all of the blood

during systole
63) Which of the following classes of drugs is most widely

used in the treatment of cardiomyopathy?

A. Antihypertensives

B. Beta-adrenergic blockers

C. Calcium channel blockers

D. Nitrates

64) If medical treatments fail, which of the following

invasive procedures is necessary for treating

cariomyopathy?

A. Cardiac catherization

B. Coronary artery bypass graft (CABG)

C. Heart transplantation

D. Intra-aortic balloon pump (IABP)

65) Which of the following conditions is associated with a

predictable level of pain that occurs as a result of physical

or emotional stress?

A. Anxiety

B. Stable angina

C. Unstable angina

D. Variant angina

66) Which of the following types of angina is most closely

related with an impending MI?

A. Angina decubitus

B. Chronic stable angina

C. Noctural angina

D. Unstable angina

67) Which of the following conditions is the predominant

cause of angina?

A. Increased preload

B. Decreased afterload

C. Coronary artery spasm

D. Inadequate oxygen supply to the myocardium

68) Which of the following tests is used most often to

diagnose angina?

A. Chest x-ray

B. Echocardiogram

C. Cardiac catherization

D. 12-lead electrocardiogram (ECG)

69) Which of the following results is the primary treatment

goal for angina?

A. Reversal of ischemia

B. Reversal of infarction
C. Reduction of stress and anxiety

D. Reduction of associated risk factors

70) Which of the following interventions should be the first

priority when treating a client experiencing chest pain while

walking?

A. Sit the client down

B. Get the client back to bed

C. Obtain an ECG

D. Administer sublingual nitroglycerin

71) Myocardial oxygen consumption increases as which of

the following parameters increase?

A. Preload, afterload, and cerebral blood flow

B. Preload, afterload, and renal blood flow

C. Preload, afterload, contractility, and heart rate.

D. Preload, afterload, cerebral blood flow, and heart

rate.

72) Which of the following positions would best aid

breathing for a client with acute pulmonary edema?

A. Lying flat in bed

B. Left side-lying

C. In high Fowler’s position

D. In semi-Fowler’s position

73) Which of the following blood gas abnormalities is

initially most suggestive of pulmonary edema?

A. Anoxia

B. Hypercapnia

C. Hyperoxygenation

D. Hypocapnia

74) Which of the following is a compensatory response to

decreased cardiac output?

A. Decreased BP

B. Alteration in LOC

C. Decreased BP and diuresis

D. Increased BP and fluid retention

75) Which of the following actions is the appropriate initial

response to a client coughing up pink, frothy sputum?

A. Call for help

B. Call the physician

C. Start an I.V. line

D. Suction the client

76) Which of the following terms describes the force

against which the ventricle must expel blood?

A. Afterload

B. Cardiac output

C. Overload

D. Preload

77) Acute pulmonary edema caused by heart failure is

usually a result of damage to which of the following areas

of the heart?

A. Left atrium

B. Right atrium

C. Left ventricle

D. Right ventricle

78) An 18-year-old client who recently had an URI is

admitted with suspected rheumatic fever. Which assessment

findings confirm this diagnosis?

A. Erythema marginatum, subcutaneous nodules, and

fever

B. Tachycardia, finger clubbing, and a load S3

C. Dyspnea, cough, and palpitations

D. Dyspnea, fatigue, and synocope

79) A client admitted with angina compains of severe chest

pain and suddenly becomes unresponsive. After establishing

unresponsiveness, which of the following actions should the

nurse take first?

A. Activate the resuscitation team

B. Open the client’s airway

C. Check for breathing

D. Check for signs of circulation

80) A 55-year-old client is admitted with an acute

inferior-wall myocardial infarction. During the admission

interview, he says he stopped taking his metoprolol

(Lopressor) 5 days ago because he was feeling better. Which

of the following nursing diagnoses takes priority for this

client?

A. Anxiety

B. Ineffective tissue perfusion; cardiopulmonary

C. Acute pain

D. Ineffective therapeutic regimen management

81) A client comes into the E.R. with acute shortness of

breath and a cough that produces pink, frothy sputum.

Admission assessment reveals crackles and wheezes, a BP of

85/46, a HR of 122 BPM, and a respiratory rate of 38

breaths/minute. The client’s medical history included DM,

HTN, and heart failure. Which of the following disorders

should the nurse suspect?

A. Pulmonary edema

B. Pneumothorax

C. Cardiac tamponade

D. Pulmonary embolus

82) The nurse coming on duty receives the report from the

nurse going off duty. Which of the following clients should

the on-duty nurse assess first?

A. The 58-year-old client who was admitted 2 days ago

with heart failure, BP of 126/76, and a respiratory

rate of 21 breaths a minute.

B. The 88-year-old client with end-stage right-sided

heart failure, BP of 78/50, and a DNR order.

C. The 62-year-old client who was admitted one day ago

with thrombophlebitis and receiving IV heparin.

D. A 76-year-old client who was admitted 1 hour ago

with new-onset atrial fibrillation and is receiving IV

diltiazem (Cardizem).

83) When developing a teaching plan for a client with

endocarditis, which of the following points is most essential

for the nurse to include?

A. “Report fever, anorexia, and night sweats to the

physician.”

B. “Take prophylactic antibiotics after dental work and

invasive procedures.”

C. “Include potassium rich foods in your diet.”

D. “Monitor your pulse regularly.”

84) A nurse is conducting a health history with a client

with a primary diagnosis of heart failure. Which of the

following disorders reported by the client is unlikely to play

a role in exacerbating the heart failure?

A. Recent URI

B. Nutritional anemia

C. Peptic ulcer disease

D. A-Fib

85) A nurse is preparing for the admission of a client with

heart failure who is being sent directly to the hospital from

the physician’s office. The nurse would plan on having

which of the following medications readily available for use?

A. Diltiazem (Cardizem)

B. Digoxin (Lanoxin)
C. Propranolol (Inderal)

D. Metoprolol (Lopressor)

86) A nurse caring for a client in one room is told by

another nurse that a second client has developed severe

pulmonary edema. On entering the 2nd client’s room, the

nurse would expect the client to be:

A. Slightly anxious

B. Mildly anxious

C. Moderately anxious

D. Extremely anxious

87) A client with pulmonary edema has been on diuretic

therapy. The client has an order for additional furosemide

(Lasix) in the amount of 40 mg IV push. Knowing that the

client also will be started on Digoxin (Lanoxin), a nurse

checks the client’s most recent:

A. Digoxin level

B. Sodium level

C. Potassium level

D. Creatinine level

88) A client who had cardiac surgery 24 hours ago has a

urine output averaging 19 ml/hr for 2 hours. The client

received a single bolus of 500 ml of IV fluid. Urine output

for the subsequent hour was 25 ml. Daily laboratory results

indicate the blood urea nitrogen is 45 mg/dL and the serum

creatinine is 2.2 mg/dL. A nurse interprets the client is at

risk for:

A. Hypovolemia

B. UTI

C. Glomerulonephritis

D. Acute renal failure

89) A nurse is preparing to ambulate a client on the 3rd

day after cardiac surgery. The nurse would plan to do which

of the following to enable the client to best tolerate the

ambulation?

A. Encourage the client to cough and deep breathe

B. Premedicate the client with an analgesic

C. Provide the client with a walker

D. Remove telemetry equipment because it weighs down

the hospital gown.

90) A client’s electrocardiogram strip shows atrial and

ventricular rates of 80 complexes per minute. The PR

interval is 0.14 second, and the QRS complex measures 0.08

second. The nurse interprets this rhythm is:

A. Normal sinus rhythm

B. Sinus bradycardia

C. Sinus tachycardia

D. Sinus dysrhythmia

91) A client has frequent bursts of ventricular tachycardia

on the cardiac monitor. A nurse is most concerned with this

dysrhythmia because:

A. It is uncomfortable for the client, giving a sense of

impending doom.

B. It produces a high cardiac output that quickly leads to

cerebral and myocardial ischemia.

C. It is almost impossible to convert to a normal sinus

rhythm.

D. It can develop into ventricular fibrillation at any

time.

92) A home care nurse is making a routine visit to a client

receiving digoxin (Lanoxin) in the treatment of heart

failure. The nurse would particularly assess the client for:

A. Thrombocytopenia and weight gain

B. Anorexia, nausea, and visual disturbances

C. Diarrhea and hypotension

D. Fatigue and muscle twitching

93) A client with angina complains that the angina pain is

prolonged and severe and occurs at the same time each day,

most often in the morning, On further assessment a nurse

notes that the pain occurs in the absence of precipitating

factors. This type of anginal pain is best described as:

A. Stable angina

B. Unstable angina

C. Variant angina

D. Nonanginal pain

94) The physician orders continuous intravenous

nitroglycerin infusion for the client with MI. Essential

nursing actions include which of the following?

A. Obtaining an infusion pump for the medication

B. Monitoring BP q4h

C. Monitoring urine output hourly

D. Obtaining serum potassium levels daily

95) Aspirin is administered to the client experiencing an MI

because of its:

A. Antipyrectic action
B. Antithrombotic action

C. Antiplatelet action

D. Analgesic action

96) Which of the following is an expected outcome for a

client on the second day of hospitalization after an MI?

A. Has severe chest pain

B. Can identify risks factors for MI

C. Agrees to participate in a cardiac rehabilitation

walking program

D. Can perform personal self-care activities without

pain

97) Which of the following reflects the principle on which a

client’s diet will most likely be based during the acute phase

of MI?

A. Liquids as ordered

B. Small, easily digested meals

C. Three regular meals per day

D. NPO

98) An older, sedentary adult may not respond to emotional

or physical stress as well as a younger individual because of:

A. Left ventricular atrophy

B. Irregular heartbeats

C. peripheral vascular occlusion

D. Pacemaker placement

99) Which of the following nursing diagnoses would be

appropriate for a client with heart failure? Select all that

apply.

A. Ineffective tissue perfusion related to decreased

peripheral blood flow secondary to decreased cardiac

output.

B. Activity intolerance related to increased cardiac

output.

C. Decreased cardiac output related to structural and

functional changes.

D. Impaired gas exchange related to decreased

sympathetic nervous system activity.

100) Which of the following would be a priority nursing

diagnosis for the client with heart failure and pulmonary

edema?

A. Risk for infection related to stasis of alveolar

secretions

B. Impaired skin integrity related to pressure

C. Activity intolerance related to pump failure

D. Constipation related to immobility

101) Captopril may be administered to a client with HF

because it acts as a:

A. Vasopressor

B. Volume expander

C. Vasodilator

D. Potassium-sparing diuretic

102) Furosemide is administered intravenously to a client

with HF. How soon after administration should the nurse

begin to see evidence of the drugs desired effect?

A. 5 to 10 minutes

B. 30 to 60 minutes

C. 2 to 4 hours

D. 6 to 8 hours

103) Which of the following foods should the nurse teach a

client with heart failure to avoid or limit when following a

2-gram sodium diet?

A. Apples

B. Tomato juice

C. Whole wheat bread

D. Beef tenderloin

104) The nurse finds the apical pulse below the 5th

intercostal space. The nurse suspects:

A. Left atrial enlargement

B. Left ventricular enlargement

C. Right atrial enlargement

D. Right ventricular enlargement

Answers and Rationales

1. C. The client with chest pain and a history of angina

. The client with chest pain should be seen first

because this could indicate a myocardial infarction.

The client in answer A has a blood glucose within

normal limits. The client in answer B is maintained on

blood pressure medication. The client in answer D is in

no distress.

2. B. Pulmonary embolism due to deep vein thrombosis

(DVT). In a hospitalized patient on prolonged bed

rest, he most likely cause of sudden onset shortness

of breath and chest pain is pulmonary embolism.

Pregnancy and prolonged inactivity both increase the

risk of clot formation in the deep veins of the legs.

These clots can then break loose and travel to the

lungs. Myocardial infarction and atherosclerosis are

unlikely in a 27-year-old woman, as is congestive

heart failure due to fluid overload. There is no reason

to suspect an anxiety disorder in this patient. Though

anxiety is a possible cause of her symptoms, the

seriousness of pulmonary embolism demands that it be

considered first.

3. D. To decrease oxygen demand on the client’s heart

. Morphine is administered because it decreases

myocardial oxygen demand. Morphine will also decrease

pain and anxiety while causing sedation, but isn’t

primarily given for those reasons.

4. D. Confusion. Cardiogenic shock severely impairs the

pumping function of the heart muscle, causing

diminished blood flow to the organs of the body. This

results in diminished brain function and confusion, as

well as hypotension, tachycardia, and weak pulse.

Cardiogenic shock is a serious complication of

myocardial infarction with a high mortality rate.

5. A. 60 minutes . The sixty minute interval is known as

“door to balloon time” for performance of PTCA on a

diagnosed MI patient.

6. B. a myocardial infarction that is free from pain and

dysrhythmias. This client is the most stable with

minimal risk of complications or instability. The nurse

can utilize basic nursing skills to care for this client.

7. D. Respiratory failure . Barbiturates are CNS

depressants; the nurse would be especially alert for

the possibility of respiratory failure. Respiratory

failure is the most likely cause of death from

barbiturate over dose.

8. B. History of cerebral hemorrhage. A history of

cerebral hemorrhage is a contraindication to tPA

because it may increase the risk of bleeding. TPA acts

by dissolving the clot blocking the coronary artery and

works best when administered within 6 hours of onset

of symptoms. Prior MI is not a contraindication to

tPA. Patients receiving tPA should be observed for

changes in blood pressure, as tPA may cause

hypotension.

9. D. Air hunger. Patients with pulmonary edema

experience air hunger, anxiety, and agitation.

Respiration is fast and shallow and heart rate

increases. Stridor is noisy breathing caused by

laryngeal swelling or spasm and is not associated with

pulmonary edema.

10. D. Inflammation in the myocardium causes a rise in

the systemic body temperature. . Temperature may

increase within the first 24 hours and persist as long

as a week.

11. A. Chest pain . The most common symptom of an MI is

chest pain, resulting from deprivation of oxygen to

the heart. Dyspnea is the second most common

symptom, related to an increase in the metabolic

needs of the body during an MI. Edema is a later sign

of heart failure, often seen after an MI. Palpitations

may result from reduced cardiac output, producing

arrhythmias.

12. D. Avoid holding her breath during activity

13. B. “When you can climb 2 flights of stairs without

problems, it is generally safe.” “When you can climb 2

flights of stairs without problems, it is generally

safe.” There is a risk of cardiac rupture at the point

of the myocardial infarction for about 6 weeks. Scar

tissue should form about that time. Waiting until the

client can tolerate climbing stairs is the usual advice

given by health care providers.

14. C. Prevents DVT (deep vein thrombosis). Exercise is

important for all hospitalized patients to prevent deep

vein thrombosis. Muscular contraction promotes

venous return and prevents hemostasis in the lower

extremities. This exercise is not sufficiently vigorous

to increase physical fitness, nor is it intended to

prevent bedsores or constipation.

15. C. Establish and maintain a routine. Establishing and

maintaining a routine is essential to decreasing

extraneous stimuli. The client should participate in

daily care as much as possible. Attempting to reason

with such clients isn’t successful, because they can’t

participate in abstract thinking.

16. A. Pain associated with angina is relieved by

rest. Pain associated with angina is relieved by rest.

Answer B is incorrect because it is not a true

statement. Answer Pain associated with angina is

confined to the chest area is incorrect because pain

associated with angina can be referred to the jaw,

the left arm, and the back. Pain associated with

myocardial infarction is referred to the left arm is

incorrect because pain from a myocardial infarction

can be referred to areas other than the left arm.

17. B. Prevents shock and relieves pain. Morphine is a

central nervous system depressant used to relieve the

pain associated with myocardial infarction, it also

decreases apprehension and prevents cardiogenic

shock.

18. B. Elevated ST segments . This is a typical early

finding after a myocardial infarct because of the

altered contractility of the heart. The other choices

are not typical of MI.

19. C. A patient with a history of ventricular tachycardia

and syncopal episodes. . An automatic internal

cardioverter-defibrillator delivers an electric shock to

the heart to terminate episodes of ventricular

tachycardia and ventricular fibrillation. This is

necessary in a patient with significant ventricular

symptoms, such as tachycardia resulting in syncope. A

patient with myocardial infarction that resolved with

no permanent cardiac damage would not be a

candidate. A patient recovering well from coronary

bypass would not need the device. Atrial tachycardia

is less serious and is treated conservatively with

medication and cardioversion as a last resort.

20. D. Increased pulse rate . Fever causes an increase in

the body’s metabolism, which results in an increase in

oxygen consumption and demand. This need for oxygen

increases the heart rate, which is reflected in the

increased pulse rate. Increased BP, chest pain and

shortness of breath are not typically noted in fever.

21. C. CK peaks first (12-24 hours), followed by the SGOT

(peaks in 24-36 hours) and then the LDH (peaks 3-4

days). Although the timing of initial elevation, peak

elevation, and duration of elevation vary with

sources, current literature favors letter c.

22. B. Administer stool softeners every day as ordered

. Administering stool softeners every day will prevent

straining on defecation which causes the Valsalva

maneuver. If constipation occurs then laxatives would

be necessary to prevent straining. If straining on

defecation produced the valsalva maneuver and rhythm

disturbances resulted then antidysrhythmics would be

appropriate.

23. C. Atelectasis. In a client with COPD, an ineffective

cough impedes secretion removal. This, in turn, causes

mucus plugging, which leads to localized airway

obstruction — a known cause of atelectasis. An

ineffective cough doesn’t cause pleural effusion (fluid

accumulation in the pleural space). Pulmonary edema

usually results from left-sided heart failure, not an

ineffective cough. Although many noncardiac

conditions may cause pulmonary edema, an ineffective

cough isn’t one of them. Oxygen toxicity results from

prolonged administration of high oxygen

concentrations, not an ineffective cough.

24. C. Ask the client if he has concerns about his care

25. D. pulmonary crackles . High pulmonary artery wedge

pressures are diagnostic for left-sided heart failure.

With leftsided heart failure, pulmonary edema can

develop causing pulmonary crackles. In leftsided heart

failure, hypotension may result and urine output will

decline. Dry mucous membranes aren’t directly

associated with elevated pulmonary artery wedge

pressures.

26. B. An 83-year-old patient with type 2 diabetes and

chronic obstructive pulmonary disease . The 83-year-

old patient has no complicating factors at the

moment. Providing care for stable and uncomplicated

patients is within the LPN’s educational preparation

and scope of practice, with the care always being

provided under the supervision and direction of the

RN. The RN should assess the newly post-operative

patient and the new admission. The patient who is

preparing for discharge after MI may need some

complex teaching. Focus: Delegation/supervision,

assignment

27. A. Able to perform self-care activities without pain

. By the 2nd day of hospitalization after suffering a

Myocardial Infarction, Clients are able to perform

care without chest pain

28. B. Adverse effects of digoxin (Lanoxin) . Toxic levels

of Lanoxin stimulate the medullary chemoreceptor

trigger zone, resulting in nausea and subsequent

anorexia.

29. D. Obtaining infusion pump for the medication

. Administration of Intravenous Nitroglycerin infusion

requires pump for accurate control of medication.

30. C. A 50-year-old man, diaphoretic and complaining of

severe chest pain radiating to his jaw . These are

likely signs of an acute myocardial infarction (MI). An

acute MI is a cardiovascular emergency requiring

immediate attention. Acute MI is potentially fatal if

not treated immediately.

31. B. A 44 year-old myocardial infarction (MI) client who

is complaining of nausea. Nausea is a symptom of

impending myocardial infarction (MI) and should be

assessed immediately so that treatment can be

instituted and further damage to the heart is avoided.

32. D. 3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh

green beans, milk, and 1 orange . Canned fish and

vegetables and cured meats are high in sodium. This

meal does not contain any canned fish and/or

vegetables or cured meats

33. C. Thrombus formation

34. B. Refocus the conversation on his fears, frustrations

and anger about his condition . This provides the

opportunity for the client to verbalize feelings

underlying behavior and helpful in relieving anxiety.

Anxiety can be a stressor which can activate the

sympathoadrenal response causing the release of

catecholamines that can increase cardiac contractility

and workload that can further increase myocardial

oxygen demand.

35. A. Call for help and note the time. Having established,

by stimulating the client, that the client is

unconscious rather than sleep, the nurse should

immediately call for help. This may be done by dialing

the operator from the client’s phone and giving the

hospital code for cardiac arrest and the client’s room

number to the operator, of if the phone is not

available, by pulling the emergency call button. Noting

the time is important baseline information for cardiac

arrest procedure.

36. B. Enhance myocardial oxygenation. Enhancing

myocardial oxygenation is always the first priority

when a client exhibits signs or symptoms of cardiac

compromise. Without adequate oxygenation, the

myocardium suffers damage. Sublingual nitroglycerin

is administered to treat acute angina, but

administration isn’t the first priority. Although

educating the client and decreasing anxiety are

important in care delivery, neither are priorities when

a client is compromised.

37. C. Oral medication therapy. Oral medication

administration is a noninvasive, medical treatment for

coronary artery disease. Cardiac catherization isn’t a

treatment, but a diagnostic tool. Coronary artery

bypass surgery and percutaneous transluminal

coronary angioplasty are invasive, surgical

treatments.

38. A. Chest pain. The most common symptom of an MI is

chest pain, resulting from deprivation of oxygen to

the heart. Dyspnea is the second most common

symptom, related to an increase in the metabolic

needs of the body during an MI. Edema is a later sign

of heart failure, often seen after an MI. Palpitations

may result from reduced cardiac output, producing

arrhythmias.

39. D. Pulmonary. Pulmonary pain is generally described by

these symptoms. Musculoskeletal pain only increases

with movement. Cardiac and GI pains don’t change

with respiration.

40. C. Troponin I. Troponin I levels rise rapidly and are

detectable within 1 hour of myocardial injury.

Troponin I levels aren’t detectable in people without

cardiac injury. Lactate dehydrogenase (LDH) is

present in almost all body tissues and not specific to

heart muscle. LDH isoenzymes are useful in diagnosing

cardiac injury. CBC is obtained to review blood

counts, and a complete chemistry is obtained to review

electrolytes. Because CK levels may rise with skeletal

muscle injury, CK isoenzymes are required to detect

cardiac injury.
41. D.To decrease oxygen demand on the client’s

heart. Morphine is administered because it decreases

myocardial oxygen demand. Morphine will also decrease

pain and anxiety while causing sedation, but it isn’t

primarily given for those reasons.

42. C. Coronary artery thrombosis . Coronary artery

thrombosis causes an inclusion of the artery, leading

to myocardial death. An aneurysm is an outpouching

of a vessel and doesn’t cause an MI. Renal failure can

be associated with MI but isn’t a direct cause. Heart

failure is usually a result from an MI.

43. A.Ventricular dilation. Rapid filling of the ventricle

causes vasodilation that is auscultated as S3.

Increased atrial contraction or systemic hypertension

can result in a fourth heart sound. Aortic valve

malfunction is heard as a murmur.

44. A. Left-sided heart failure. The left ventricle is

responsible for most of the cardiac output. An

anterior wall MI may result in a decrease in left

ventricular function. When the left ventricle doesn’t

function properly, resulting in left-sided heart

failure, fluid accumulates in the interstitial and

alveolar spaces in the lungs and causes crackles.

Pulmonic and tricuspid valve malfunction causes right

sided heart failure.

45. B. Administer oxygen. Administering supplemental

oxygen to the client is the first priority of care. The

myocardium is deprived of oxygen during an

infarction, so additional oxygen is administered to

assist in oxygenation and prevent further damage.

Morphine and nitro are also used to treat MI, but

they’re more commonly administered after the oxygen.

An ECG is the most common diagnostic tool used to

evaluate MI.

46. A. Beta-adrenergic blockers. Beta-adrenergic blockers

work by blocking beta receptors in the myocardium,

reducing the response to catecholamines and

sympathetic nerve stimulation. They protect the

myocardium, helping to reduce the risk of another

infarction by decreasing myocardial oxygen demand.

Calcium channel blockers reduce the workload of the

heart by decreasing the heart rate. Narcotics reduce

myocardial oxygen demand, promote vasodilation, and

decrease anxiety. Nitrates reduce myocardial oxygen

consumption by decreasing left ventricular end-

diastolic pressure (preload) and systemic vascular

resistance (afterload).

47. C. arrhythmias. Arrhythmias, caused by oxygen

deprivation to the myocardium, are the most common

complication of an MI. Cardiogenic shock, another

complication of an MI, is defined as the end stage of

left ventricular dysfunction. This condition occurs in

approximately 15% of clients with MI. Because the

pumping function of the heart is compromised by an

MI, heart failure is the second most common

complication. Pericarditis most commonly results from

a bacterial or viral infection but may occur after the

MI.

48. B. Heart failure. Elevated venous pressure, exhibited

as jugular vein distention, indicates a failure of the

heart to pump. JVD isn’t a symptom of abdominal

aortic aneurysm or pneumothorax. An MI, if severe

enough, can progress to heart failure, however, in

and of itself, an MI doesn’t cause JVD.

49. A. Digoxin. One of the most common signs of digoxin

toxicity is the visual disturbance known as the

“green-yellow halo sign.” The other medications

aren’t associated with such an effect.

50. A. Crackles. Crackles in the lungs are a classic sign of

left-sided heart failure. These sounds are caused by

fluid backing up into the pulmonary system.

Arrhythmias can be associated with both right- and

left-sided heart failure. Left-sided heart failure

causes hypertension secondary to an increased

workload on the system.

51. D. Right-sided heart failure. The most accurate area

on the body to assess dependent edema in a bed-

ridden client is the sacral area. Sacral, or dependent,

edema is secondary to right-sided heart failure.

52. C. Oliguria. Inadequate deactivation of aldosterone by

the liver after right-sided heart failure leads to fluid

retention, which causes oliguria.

53. D. Inotropic agents. Inotropic agents are

administered to increase the force of the heart’s

contractions, thereby increasing ventricular

contractility and ultimately increasing cardiac output.

54. B. Tachycardia. Stimulation of the sympathetic

nervous system causes tachycardia and increased

contractility. The other symptoms listed are related to

the parasympathetic nervous system, which is

responsible for slowing the heart rate.

55. D. Right-sided heart failure. Weight gain, nausea,

and a decrease in urine output are secondary effects

of right-sided heart failure. Cardiomyopathy is

usually identified as a symptom of left-sided heart

failure. Left-sided heart failure causes primarily

pulmonary symptoms rather than systemic ones.

Angina pectoris doesn’t cause weight gain, nausea, or

a decrease in urine output.

56. A. Cardiomyopathy. Cardiomyopathy isn’t usually

related to an underlying heart disease such as

atherosclerosis. The etiology in most cases is

unknown. CAD and MI are directly related to

atherosclerosis. Pericardial effusion is the escape of

fluid into the pericardial sac, a condition associated

with Pericarditis and advanced heart failure.

57. A. Dilated. Although the cause isn’t entirely known,

cardiac dilation and heart failure may develop during

the last month of pregnancy or the first few months

after birth. The condition may result from a

preexisting cardiomyopathy not apparent prior to

pregnancy. Hypertrophic cardiomyopathy is an

abnormal symmetry of the ventricles that has an

unknown etiology but a strong familial tendency.

Myocarditis isn’t specifically associated with

childbirth. Restrictive cardiomyopathy indicates

constrictive pericarditis; the underlying cause is

usually myocardial.

58. C. Hypertrophic. In hypertrophic cardiomyopathy,

hypertrophy of the ventricular septum—not the

ventricle chambers—is apparent. This abnormality

isn’t seen in other types of cardiomyopathy.

59. A. Heart failure. Because the structure and function

of the heart muscle is affected, heart failure most

commonly occurs in clients with cardiomyopathy. MI

results from prolonged myocardial ischemia due to

reduced blood flow through one of the coronary

arteries. Pericardial effusion is most predominant in

clients with pericarditis.

60. D. Heart failure. These are the classic signs of

failure. Pericarditis is exhibited by a feeling of

fullness in the chest and auscultation of a pericardial

friction rub. Hypertension is usually exhibited by

headaches, visual disturbances, and a flushed face. MI

causes heart failure but isn’t related to these

symptoms.

61. B. Hypertrophic. Cardiac output isn’t affected by

hypertrophic cardiomyopathy because the size of the

ventricle remains relatively unchanged. All of the rest

decrease cardiac output.

62. D. Failure of the ventricle to eject all of the blood

during systole. An S4 occurs as a result of increased

resistance to ventricular filling after atrial

contraction. The increased resistance is related to

decreased compliance of the ventricle. A dilated aorta

doesn’t cause an extra heart sound, though it does

cause a murmur. Decreased myocardial contractility is

heard as a third heart sound. An S4 isn’t heard in a

normally functioning heart.

63. B. Beta-adrenergic blockers. By decreasing the heart

rate and contractility, beta-blockers improve

myocardial filling and cardiac output, which are

primary goals in the treatment of cardiomyopathy.

Antihypertensives aren’t usually indicated because

they would decrease cardiac output in clients who are

already hypotensive. Calcium channel blockers are

sometimes used for the same reasons as beta-

blockers; however, they aren’t as effective as beta-

blockers and cause increased hypotension. Nitrates

aren’t used because of their dilating effects, which

would further compromise the myocardium.

64. C. Heart transplantation. The only definitive

treatment for cardiomyopathy that can’t be controlled

medically is a heart transplant because the damage to

the heart muscle is irreversible.

65. B. Stable angina. The pain of stable angina is

predictable in nature, builds gradually, and quickly

reaches maximum intensity. Unstable angina doesn’t

always need a trigger, is more intense, and lasts

longer than stable angina. Variant angina usually

occurs at rest—not as a result of exercise or stress.

66. D. Unstable angina. Unstable angina progressively

increases in frequency, intensity, and duration and is

related to an increased risk of MI within 3 to 18

months.

67. D. Inadequate oxygen supply to the myocardium.

Inadequate oxygen supply to the myocardium is

responsible for the pain accompanying angina.

Increased preload would be responsible for right-sided

heart failure. Decreased afterload causes increased

cardiac output. Coronary artery spasm is responsible

for variant angina.

68. D.12-lead electrocardiogram (ECG). The 12-lead ECG

will indicate ischemia, showing T-wave inversion. In

addition, with variant angina, the ECG shows ST-

segment elevation. A chest x-ray will show heart

enlargement or signs of heart failure, but isn’t used

to diagnose angina.

69. A. Reversal of ischemia. Reversal of the ischemia is

the primary goal, achieved by reducing oxygen

consumption and increasing oxygen supply. An

infarction is permanent and can’t be reversed.

70. A. Sit the client down. The initial priority is to

decrease the oxygen consumption; this would be

achieved by sitting the client down. An ECG can be

obtained after the client is sitting down. After the

ECGm sublingual nitro would be administered. When

the client’s condition is stabilized, he can be returned

to bed.

71. C. Preload, afterload, contractility, and heart

rate. Myocardial oxygen consumption increases as

preload, afterload, renal contractility, and heart rate

increase. Cerebral blood flow doesn’t directly affect

myocardial oxygen consumption.

72. C. In high Fowler’s position. A high Fowler’s position

promotes ventilation and facilitates breathing by

reducing venous return. Lying flat and side-lying

positions worsen the breathing and increase workload

of the heart. Semi-Fowler’s position won’t reduce the

workload of the heart as well as the Fowler’s position

will.

73. D. Hypocapnia. In an attempt to compensate for

increased work of breathing due to hyperventilation,

carbon dioxide decreases, causing hypocapnea. If the

condition persists, CO2 retention occurs and

hypercapnia results.

74. D. Increased BP and fluid retention. The body

compensates for a decrease in cardiac output with a

rise in BP, due to the stimulation of the sympathetic

NS and an increase in blood volume as the kidneys

retain sodium and water. Blood pressure doesn’t

initially drop in response to the compensatory

mechanism of the body. Alteration in LOC will occur

only if the decreased cardiac output persists.

75. A. Call for help. Production of pink, frothy sputum is

a classic sign of acute pulmonary edema. Because the

client is at high risk for decompensation, the nurse

should call for help but not leave the room. The other

three interventions would immediately follow.

76. A. Afterload. Afterload refers to the resistance

normally maintained by the aortic and pulmonic valves,

the condition and tone of the aorta, and the

resistance offered by the systemic and pulmonary

arterioles. Cardiac output is the amount of blood

expelled by the heart per minute. Overload refers to

an abundance of circulating volume. Preload is the

volume of blood in the ventricle at the end of diastole.

77. C. Left ventricle. The left ventricle is responsible for

the majority of force for the cardiac output. If the

left ventricle is damaged, the output decreases and

fluid accumulates in the interstitial and alveolar

spaces, causing pulmonary edema. Damage to the left

atrium would contribute to heart failure but wouldn’t

affect cardiac output or, therefore, the onset of

pulmonary edema. If the right atrium and right

ventricle were damaged, right-sided heart failure

would result.

78. A. Erythema marginatum, subcutaneous nodules, and

fever. Diagnosis of rheumatic fever requires that the

client have either two major Jones criteria or one

minor criterion plus evidence of a previous

streptococcal infection. Major criteria include

carditis, polyarthritis, Sydenham’s chorea,

subcutaneous nodules, and erythema maginatum

(transient, nonprurtic macules on the trunk or inner

aspects of the upper arms or thighs). Minor criteria

include fever, arthralgia, elevated levels of acute

phase reactants, and a prolonged PR-interval on ECG.

79. A. Activate the resuscitation team. Immediately after

establishing unresponsiveness, the nurse should

activate the resuscitation team. The next step is to

open the airway using the head-tilt, chin-lift

maneuver and check for breathing (looking, listening,

and feeling for no more than 10-seconds). If the

client isn’t breathing, give two slow breaths using a

bag mask or pocket mask. Next, check for signs of

circulation by palpating the carotid pulse.

80. B. Ineffective tissue perfusion; cardiopulmonary. MI

results from prolonged myocardial ischemia caused by

reduced blood flow through the coronary arteries.

Therefore, the priority nursing diagnosis for this

client is Ineffective tissue perfusion

(cardiopulmonary) . Anxiety, acute pain, and

ineffective therapeutic regimen management are

appropriate but don’t take priority.

81. A. Pulmonary edema. SOB, tachypnea, low BP,

tachycardia, crackles, and a cough producing pink,

frothy sputum are late signs of pulmonary edema.

82. D. A 76-year-old client who was admitted 1 hour ago

with new-onset atrial fibrillation and is receiving IV

diltiazem (Cardizem). The client with A-fib has the

greatest potential to become unstable and is on IV

medication that requires close monitoring. After

assessing this client, the nurse should assess the

client with thrombophlebitis who is receiving a heparin

infusion, and then go to the 58-year-old client

admitted 2-days ago with heart failure (her s/s are

resolving and don’t require immediate attention). The

lowest priority is the 89-year-old with end stage

right-sided heart failure, who requires time

consuming supportive measures.

83. A.“Report fever, anorexia, and night sweats to the

physician.” The most essential teaching point is to

report signs of relapse, such as fever, anorexia, and

night sweats, to the physician. To prevent further

endocarditis episodes, prophylactic antibiotics are

taken before and sometimes after dental work,

childbirth, or GU, GI, or gynecologic procedures. A

potassium-rich diet and daily pulse monitoring aren’t

necessary for a client with endocarditis.

84. C. Peptic ulcer disease. Heart failure is precipitated

or exacerbated by physical or emotional stress,

dysrhythmias, infections, anemia, thyroid disorders,

pregnancy, Paget’s disease, nutritional deficiencies

(thiamine, alcoholism), pulmonary disease, and

hypervolemia.

85. B. Digoxin (Lanoxin). Digoxin exerts a positive

inotropic effect on the heart while slowing the overall

rate through a variety of mechanisms. Digoxin is the

medication of choice to treat heart failure. Diltiazem

(calcium channel blocker) and propranolol and

metoprolol (beta blockers) have a negative inotropic

effect and would worsen the failing heart.

86. D. Extremely anxious. Pulmonary edema causes the

client to be extremely agitated and anxious. The

client may complain of a sense of drowning,

suffocation, or smothering.

87. C. Potassium level. The serum potassium level is

measured in the client receiving digoxin and

furosemide. Heightened digitalis effect leading to

digoxin toxicity can occur in the client with

hypokalemia. Hypokalemia also predisposes the client

to ventricular dysrhythmias.

88. D. Acute renal failure. The client who undergoes

cardiac surgery is at risk for renal injury from poor

perfusion, hemolysis, low cardiac output, or

vasopressor medication therapy. Renal insult is

signaled by decreased urine output, and increased BUN

and creatinine levels. The client may need medications

such as dopamine (Intropin) to increase renal

perfusion and possibly could need peritoneal dialysis or

hemodialysis.

89. B. Premedicate the client with an analgesic. The nurse

should encourage regular use of pain medication for

the first 48 to 72 hours after cardiac surgery because

analgesia will promote rest, decrease myocardial

oxygen consumption resulting from pain, and allow

better participation in activities such as coughing,

deep breathing, and ambulation. Encouraging the

client to cough and deep breathe and providing the

client with a walker will not help in tolerating

ambulation. Removal of telemetry equipment is

contraindicated unless prescribed.

90. A. Normal sinus rhythm

91. D. It can develop into ventricular fibrillation at any

time. Ventricular tachycardia is a life-threatening

dysrhythmia that results from an irritable ectopic

focus that takes over as the pacemaker for the heart.

The low cardiac output that results can lead quickly to

cerebral and myocardial ischemia. Client’s frequently

experience a feeling of impending death. Ventricular

tachycardia is treated with antidysrhythmic

medications or magnesium sulfate, cardioversion

(client awake), or defibrillation (loss of

consciousness), Ventricular tachycardia can

deteriorate into ventricular defibrillation at any time.

92. B. Anorexia, nausea, and visual disturbances. The

first signs and symptoms of digoxin toxicity in adults

include abdominal pain, N/V, visual disturbances

(blurred, yellow, or green vision, halos around lights),

bradycardia, and other dysrhythmias.

93. C. Variant angina. Stable angina is induced by

exercise and is relieved by rest or nitroglycerin

tablets. Unstable angina occurs at lower and lower

levels of activity and rest, is less predictable, and is

often a precursor of myocardial infarction. Variant

angina, or Prinzmetal’s angina, is prolonged and

severe and occurs at the same time each day, most

often in the morning.

94. A. Obtaining an infusion pump for the medication. IV

nitro infusion requires an infusion pump for precise

control of the medication. BP monitoring would be

done with a continuous system, and more frequently

than every 4 hours. Hourly urine outputs are not

always required. Obtaining serum potassium levels is

not associated with nitroglycerin infusion.

95. B. Antithrombotic action. Aspirin does have

antipyretic, antiplatelet, and analgesic actions, but

the primary reason ASA is administered to the client

experiencing an MI is its antithrombotic action.

96. D. Can perform personal self-care activities without

pain. By day 2 of hospitalization after an MI, clients

are expected to be able to perform personal care

without chest pain. Day 2 hospitalization may be too

soon for clients to be able to identify risk factors for

MI or begin a walking program; however, the client

may be sitting up in a chair as part of the cardiac

rehabilitation program. Severe chest pain should not

be present.

97. B. Small, easily digested meals. Recommended dietary

principles in the acute phase of MI include avoiding

large meals because small, easily digested foods are

better digested foods are better tolerated. Fluids are

given according to the client’s needs, and sodium

restrictions may be prescribed, especially for clients

with manifestations of heart failure. Cholesterol

restrictions may be ordered as well. Clients are not

prescribed a diet of liquids only or NPO unless their

condition is very unstable.

98. A. Left ventricular atrophy. In older adults who are

less active and do not exercise the heart muscle,

atrophy can result. Disuse or deconditioning can lead

to abnormal changes in the myocardium of the older

adult. As a result, under sudden emotional or physical

stress, the left ventricle is less able to respond to the

increased demands on the myocardial muscle.

99. A. Ineffective tissue perfusion related to decreased

peripheral blood flow secondary to decreased cardiac

output. and C. Decreased cardiac output related

to structural and functional changes. HF is a result of

structural and functional abnormalities of the heart

tissue muscle. The heart muscle becomes weak and

does not adequately pump the blood out of the

chambers. As a result, blood pools in the left ventricle

and backs up into the left atrium, and eventually into

the lungs. Therefore, greater amounts of blood

remain in the ventricle after contraction thereby

decreasing cardiac output. In addition, this pooling

leads to thrombus formation and ineffective tissue

perfusion because of the decrease in blood flow to the

other organs and tissues of the body. Typically, these

clients have an ejection fraction of less than 50% and

poorly tolerate activity. Activity intolerance is related

to a decrease, not increase, in cardiac output. Gas

exchange is impaired. However, the decrease in

cardiac output triggers compensatory mechanisms,

such as an increase in sympathetic nervous system

activity.

100. C. Activity intolerance related to pump failure.

Activity intolerance is a primary problem for clients

with heart failure and pulmonary edema. The

decreased cardiac output associated with heart failure

leads to reduced oxygen and fatigue. Clients

frequently complain of dyspnea and fatigue. The client

could be at risk for infection related to stasis of

secretions or impaired skin integrity related to

pressure. However, these are not the priority nursing

diagnoses for the client with HF and pulmonary

edema, nor is constipation related to immobility.

101. C. Vasodilator. ACE inhibitors have become the

vasodilators of choice in the client with mild to severe

HF. Vasodilator drugs are the only class of drugs

clearly shown to improve survival in overt heart

failure.

102. A. 5 to 10 minutes. After IV injection of furosemide,

diuresis normally begins in about 5 minutes and

reaches its peak within about 30 minutes. Medication

effects last 2 to 4 hours.

103. B. Tomato juice. Canned foods and juices, such as

tomato juice, are typically high in sodium and should

be avoided in a sodium-restricted diet.

104. B. Left ventricular enlargement. A normal apical

impulse is found under over the apex of the heart and

is typically located and auscultated in the left fifth

intercostal space in the midclavicular line. An apical

impulse located or auscultated below the fifth

intercostal space or lateral to the midclavicular line

may indicate left ventricular enlargement.