Cardiac
Which of the following terms describes the force against which the ventricle must expel blood?
1. Afterload
2. Cardiac output
3. Overload
4. Preload
Answer: 1. Afterload
Afterload refers to the resistance on maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles.
Which of the following types of angina is most closely related with an impending MI?
1. Angina decubitus
2. Chronic stable angina
3. Nocturnal angina
4. Unstable angina
Answer: 4. 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.
What is the first intervention for a client experiencing MI?
1. Administer morphine
2. Administer oxygen
3. Administer sublingual nitroglycerin
4. Obtain an ECG
Answer: 2. 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.
Which of the following results is the primary treatment goal for angina?
1. Reversal of ischemia
2. Reversal of infarction
3. Reduction of stress and anxiety
4. Reduction of associated risk factors
Answer: 1. Reversal of ischemia
Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply.
Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking?
1. Sit the client down
2. Get the client back to bed
3. Obtain an ECG
4. Administer sublingual nitroglycerin
Answer: 1. Sit the client down
The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down.
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?
1. Recent URI
2. Nutritional anemia
3. Peptic ulcer disease
4. A-Fib
3. 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.
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?
1. Apples
2. Tomato juice
3. Whole wheat bread
4. Beef tenderloin
Answer: 2. Tomato juice
Canned foods and juices, such as tomato juice, are typically high in sodium and should be avoided on a sodium-restricted diet.
Which of the following blood tests is most indicative of cardiac damage?
1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)
Answer: 3. 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.
Which of the following positions would best aid breathing for a client with acute pulmonary edema?
1. Lying flat in bed
2. Left side-lying
3. In high Fowler’s position
4. In semi-Fowler’s position
Answer: 3. In high Fowler’s position
A high Fowler’s position promotes ventilation and facilitates breathing by reducing venous return.
Which of the following is a compensatory response to decreased cardiac output?
1. Decreased BP
2. Alteration in LOC
3. Decreased BP and diuresis
4. Increased BP and fluid retention
Answer: 4. 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.
Aspirin is administered to the client experiencing an MI because of its:
1. Antipyretic action
2. Antithrombotic action
3. Antiplatelet action
4. Analgesic action
Answer: 2. 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.
When developing a teaching plan for a client with endocarditis, which of the following points is most essential for the nurse to include?
1. “Report fever, anorexia, and night sweats to the physician.”
2. “Take prophylactic antibiotics after dental work and invasive procedures.”
3. “Include potassium rich foods in your diet.”
4. “Monitor your pulse regularly.”
Answer: 1. “Report fever, anorexia, and night sweats to the physician.”
An essential teaching point is to report signs of relapse, such as fever, anorexia, and night sweats, to the physician.
In which of the following types of cardiomyopathy does cardiac output remain normal?
1. Dilated
2. Hypertrophic
3. Obliterative
4. Restrictive
Answer: 2. 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.
Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease?
1. Decrease anxiety
2. Enhance myocardial oxygenation
3. Administer sublingual nitroglycerin
4. Educate the client about his symptoms
2. Enhance myocardial oxygenation
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?
1. Anxiety
2. Ineffective tissue perfusion; cardiopulmonary
3. Acute pain
4. Ineffective therapeutic regimen management
Answer: 2. 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).
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:
1. Digoxin level
2. Sodium level
3. Potassium level
4. Creatinine level
Answer: 3. 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.
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?
1. Pulmonary edema
2. Pneumothorax
3. Cardiac tamponade
4. Pulmonary embolus
Answer: 1. Pulmonary edema
SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy sputum are late signs of pulmonary edema.
After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?
1. Left-sided heart failure
2. Pulmonic valve malfunction
3. Right-sided heart failure
4. Tricupsid valve malfunction
Answer: 1. 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.
Which of the following reflects the principle on which a client’s diet will most likely be based during the acute phase of MI?
1. Liquids as ordered
2. Small, easily digested meals
3. Three regular meals per day
4. NPO
Answer: 2. 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.
Medical treatment of coronary artery disease includes which of the following procedures?
1. Cardiac catheterization
2. Coronary artery bypass surgery
3. Oral medication therapy
4. Percutaneous transluminal coronary angioplasty
Oral medication therapy
Oral medication administration is a noninvasive, medical treatment for coronary artery disease.
Which of the following is an expected outcome for a client on the second day of hospitalization after an MI?
1. Has severe chest pain
2. Can identify risks factors for MI
3. Agrees to participate in a cardiac rehabilitation walking program
4. Can perform personal self-care activities without pain
Answer: 4. 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.
Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema?
1. Risk for infection related to stasis of alveolar secretions
2. Impaired skin integrity related to pressure
3. Activity intolerance related to pump failure
4. Constipation related to immobility
3. 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.
Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions?
1. Pericarditis
2. Hypertension
3. MI
4. Heart failure
Answer: 4. Heart failure
These are the classic signs of failure.
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?
1. 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.
2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order.
3. The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV heparin.
4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV diltiazem (Cardizem).
Answer: 4. 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.
Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
1. Cardiomyopathy
2. Coronary artery disease
3. Myocardial infarction
4. Pericardial effusion
Answer: 1. Cardiomyopathy
Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown.