Cardiovascular System
A patient with long-standing hypertension is noted to have left ventricular hypertrophy on echocardiogram. Which physiologic change most directly led to this finding?
A. Increased preload from fluid retention
B. Decreased contractility over time
C. Increased afterload requiring the ventricle to pump against higher resistance
D. Increased stroke volume during systole
C. Increased afterload requiring the ventricle to pump against higher resistance
In CAD, myocardial ischemia occurs when oxygen __________ exceeds oxygen __________.
Demand; supply
ACS differs from stable CAD primarily because ACS involves:
A. Progressive fixed plaque formation
B. Sudden plaque rupture with thrombus formation
C. Chronic narrowing of coronary vessels
D. Temporary coronary vasospasm without ischemia
B. Sudden plaque rupture with thrombus formation
A patient with primary hypertension and early renal insufficiency (elevated BUN and creatinine) is being started on antihypertensive therapy. Which medication class provides BP control and renal protection?
A. Beta blockers
B. Calcium channel blockers
C. ACE inhibitors
D. Direct vasodilators
C. ACE inhibitors
Remember: ACE inhibitors reduce intraglomerular pressure and slow kidney damage.
A patient with systolic heart failure is prescribed a loop diuretic. What is the primary therapeutic effect of this medication in heart failure?
A. Improves myocardial contractility
B. Reduces preload by decreasing circulating volume
C. Decreases afterload through vasodilation
D. Enhances ventricular relaxation
B. Reduces preload by decreasing circulating volume
A patient develops severe tachycardia following blood loss. Despite the elevated heart rate, cardiac output remains low. What best explains this finding?
A. Tachycardia increases oxygen demand
B. Increased heart rate shortens diastole, limiting ventricular filling
C. Stroke volume automatically decreases with blood loss
D. Afterload increases when heart rate exceeds 100 bpm
B. Increased heart rate shortens diastole, limiting ventricular filling
A patient reports chest discomfort that occurs while mowing the lawn and resolves within 5–10 minutes of resting. Which mechanism best explains these symptoms?
A. Fixed coronary artery narrowing limiting blood flow during exertion
B. Acute plaque rupture with thrombus formation
C. Complete coronary artery occlusion
D. Coronary artery vasospasm at rest
A. Fixed coronary artery narrowing limiting blood flow during exertion
A 62-year-old patient with CAD reports chest pain while walking upstairs. The pain resolves after taking sublingual nitroglycerin. What is the primary therapeutic effect of nitroglycerin in this patient?
A. Decreases platelet aggregation at the site of plaque rupture
B. Increases myocardial contractility
C. Reduces preload and myocardial oxygen demand
D. Prevents thrombus formation in coronary arteries
C. Reduces preload and myocardial oxygen demand
A patient presents with a blood pressure of 186/122 mm Hg, blurred vision, confusion, and shortness of breath. How should the nurse interpret this presentation?
A. Hypertensive urgency
B. Chronic uncontrolled hypertension
C. Hypertensive emergency
D. White coat hypertension
C. Hypertensive emergency
Remember: BP + target organ damage = emergency, regardless of duration
A patient admitted with acute decompensated heart failure is tachypneic (RR 32), hypoxic, and using accessory muscles. Which nursing intervention is the priority?
A. Obtain daily weight
B. Restrict sodium intake
C. Administer beta blockers
D. Position the patient in high Fowler’s and administer oxygen
D. Position the patient in high Fowler’s and administer oxygen
*This patient is in acute respiratory distress. The immediate priority is improving oxygenation and ventilation. High Fowler’s position decreases venous return and reduces pulmonary congestion, while supplemental oxygen improves tissue oxygen delivery.
A decrease in __________ reduces ventricular stretch at the end of diastole, leading to a decrease in stroke volume.
Preload
Which characteristic makes a complicated atherosclerotic lesion the most dangerous?
A. Gradual narrowing of the arterial lumen
B. Increased vessel elasticity
C. Plaque instability leading to thrombus formation
D. Complete endothelial healing
C. Plaque instability leading to thrombus formation
A patient with chronic stable angina presents to the ED with chest pain at rest that is unrelieved by nitroglycerin. ECG shows ST-segment depression, and troponin levels are elevated. How should the nurse interpret these findings?
A. Stable angina
B. Unstable angina
C. NSTEMI
D. STEMI
C. NSTEMI
A patient with hypertensive emergency is started on IV antihypertensive therapy. What is the priority goal of treatment during the initial phase?
A. Gradually reduce MAP to prevent organ ischemia
B. Reduce blood pressure below 120/80 mm Hg
C. Normalize blood pressure rapidly
D. Eliminate symptoms immediately
A. Gradually reduce MAP to prevent organ ischemia
*Too-rapid BP reduction = stroke, renal injury, MI.
A patient with suspected heart failure has a BNP level of 828 pg/mL and an EF of 25%. How should the nurse interpret these findings?
A. Findings suggest acute decompensated heart failure
B. Findings are consistent with compensated heart failure
C. Findings indicate isolated right-sided heart failure
D. Findings rule out cardiac involvement
A. Findings suggest acute decompensated heart failure
A BNP of 828 pg/mL is significantly elevated and indicates acute worsening of heart failure. Combined with a severely reduced EF (25%), these findings point to acute decompensated HF rather than compensated or chronic stable HF.
Remember: Compensated/Chronic is more stable with mild symptoms. BP should be <400ish. Patient is stable.
If a patient’s heart rate is 90 beats/min and their stroke volume is 60 mL/beat, their cardiac output is __________mL?
5400mL
Which finding best supports a diagnosis of chronic stable angina rather than ACS?
A. Chest pain occurring at rest
B. ST-segment elevation on ECG
C. Troponin elevation
D. Chest pain relieved with rest or nitroglycerin
D. Chest pain relieved with rest or nitroglycerin
A patient undergoes PCI with stent placement following a STEMI. Which discharge teaching statement indicates the greatest need for further education?
A. “I’ll take my statin every night as prescribed.”
B. “I should report any new chest pain immediately.”
C. “The stent fixed my heart disease, so lifestyle changes aren’t necessary.”
D. “I will continue my antiplatelet medications as directed.”
C. “The stent fixed my heart disease, so lifestyle changes aren’t necessary.”
A patient newly prescribed hydrochlorothiazide asks how the medication lowers blood pressure. Which explanation is most accurate?
A. “It relaxes arterial smooth muscle to lower resistance.”
B. “It prevents aldosterone from causing fluid retention.”
C. “It blocks sympathetic stimulation of the heart.”
D. “It increases sodium and water excretion, reducing circulating volume.”
D. “It increases sodium and water excretion, reducing circulating volume.”
A patient with chronic heart failure is prescribed a beta blocker. Which assessment finding would require the nurse to question administration of this medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 142/88 mm Hg
C. Mild bilateral lower extremity edema
D. History of myocardial infarction
A. Heart rate of 58 beats per minute
A patient receives aggressive IV fluids for dehydration. Shortly after, the nurse notes an increase in stroke volume. Which mechanism best explains this change?
A. Reduced afterload improves ventricular ejection
B. Increased preload enhances ventricular contraction
C. Increased contractility occurs in response to volume expansion
D. Decreased heart rate allows longer ventricular filling
B. Increased preload enhances ventricular contraction
A 59-year-old patient with known coronary artery disease reports chest tightness while shoveling snow. The pain resolves after resting and taking sublingual nitroglycerin. Vital signs are stable. ECG shows no ST-segment elevation, and troponin levels are within normal limits.
Which long-term medication regimen is most appropriate to reduce this patient’s risk of progression to acute coronary syndrome?
A. Sublingual nitroglycerin as needed only
B. Enoxaparin and clopidogrel indefinitely
C. Morphine and oxygen therapy during exertion
D. Aspirin, statin therapy, and a beta blocker
D. Aspirin, statin therapy, and a beta blocker
The patient has chronic stable angina, not ACS
Stable angina needs prevention and workload reduction — not emergency meds.
A patient presents with severe chest pain, diaphoresis, and nausea. The provider suspects ACS. Which nursing action is most appropriate to perform first?
A. Obtain baseline cardiac biomarkers
B. Administer high-dose statin therapy
C. Initiate oxygen therapy and obtain a 12-lead ECG
D. Prepare the patient for cardiac catheterization
C. Initiate oxygen therapy and obtain a 12-lead ECG
A 64-year-old patient with long-standing primary hypertension presents with a blood pressure of 178/102 mm Hg. Laboratory results show elevated BUN and creatinine, and ECG reveals left ventricular hypertrophy. The provider plans to start antihypertensive therapy. Which outcome best indicates successful long-term blood pressure management in this patient?
A. Rapid reduction of blood pressure to 120/80 mm Hg within 24 hours
B. Resolution of symptoms such as dizziness and palpitations
C. Slowing of progression of target organ damage over time
D. Immediate normalization of renal laboratory values
C. Slowing of progression of target organ damage over time
Which patient statement indicates effective understanding of self-management for chronic heart failure?
A. “I’ll call my provider if I gain more than 2–3 pounds in a day.”
B. “I will weigh myself once a week after dinner.”
C. “I should drink more fluids if I feel short of breath.”
D. “Once my symptoms improve, I can stop my medications.”
A. “I’ll call my provider if I gain more than 2–3 pounds in a day.”