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
dn 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, afterloaf 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.vSlightly 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

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.

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.

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.

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.

A. 60 minutes . The sixty minute interval is known as “door to balloon time” for performance of PTCA on
a diagnosed MI patient.

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.

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.

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.

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.

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.

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.

D. Avoid holding her breath during activity

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.

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.

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.

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.

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.

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.

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.

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.
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.

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.

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.

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

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.

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

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

B. Adverse effects of digoxin (Lanoxin) . Toxic levels of Lanoxin stimulate the medullary chemoreceptor
trigger zone, resulting in nausea and subsequent anorexia.

D. Obtaining infusion pump for the medication . Administration of Intravenous Nitroglycerin infusion
requires pump for accurate control of medication.

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.
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.

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

C. Thrombus formation

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.

A. Call for help and note the time.

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.

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.

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.

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.

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.

A. Pulmonary edema. SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy
sputum are late signs of pulmonary edema.

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.

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.

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.

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.

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.

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.

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.

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.

A. Normal sinus rhythm

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.