1.
A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Tro- ponin levels are elevated. What is the highest priority for nursing management of this client at this time?■ 1. Monitor daily weights and urine output.
■ 2. Permit unrestricted visitation by family and friends.
■ 3. Provide client education on medications and diet.
■ 4. Reduce pain and myocardial oxygen demand.
2.
A client with chest pain is prescribed intrave- nous nitroglycerin (Tridil). Which assessment is of greatest concern for the nurse initiating the nitro- glycerin drip?■ 1. Serum potassium is 3.5 mEq/L.
■ 2. Blood pressure is 88/46.
■ 3. ST elevation is present on the electrocardiogram.
■ 4. Heart rate is 61.
3.
The nurse is caring for a client diagnosed with an anterior myocardial infarction 2 days ago.Upon assessment, the nurse identifi es a new systolic murmur at the apex. The nurse should fi rst:
■ 1. Assess for changes in vital signs.
■ 2. Draw an arterial blood gas.
■ 3. Evaluate heart sounds with the client leaning forward.
■ 4. Obtain a 12 Lead electrocardiogram.
4.
A client with acute chest pain is receiving I.V. morphine sulfate. Which of the following results are intended effects of morphine in this client?Select all that apply.
■ 1. Reduces myocardial oxygen consumption.
■ 2. Promotes reduction in respiratory rate.
■ 3. Prevents ventricular remodeling.
■ 4. Reduces blood pressure and heart rate.
■ 5. Reduces anxiety and fear.
The Nursing Care of Adults with Medical and Surgical
Health Problems
■ The Client with Acute Coronary Syndromes
■ The Client with Heart Failure
■ The Client with Valvular Heart Disease
■ The Client with Hypertension
■ The Client with a Permanent Pacemaker
■ The Client Requiring Cardiopulmonary Resuscitation
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies
The Client with Cardiac Health Problems
T E S T
1
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5.
A client receives fi brinolytic therapy upon admission following a myocardial infarction. He is now receiving an I.V. infusion of heparin sodium at 1,200 units/hour. The dilution is 25,000 units/500 mL.How many milliliters per hour will this client receive?
________________________
mL/hour.6.
A 65-year-old client is admitted to the emer- gency department with a fractured hip. The client has chest pain and shortness of breath. The health care provider orders nitroglycerin tablets. Which should the nurse instruct the client to do?■ 1. Put the tablet under the tongue until it is absorbed.
■ 2. Swallow the tablet with 120 mL of water.
■ 3. Chew the tablet until it is dissolved.
■ 4. Place the tablet between his cheek and gums.
7.
The nurse has completed an assessment on a client with a decreased cardiac output. Which fi nd- ings should receive the highest priority?■ 1. BP 110/62, atrial fi brillation with HR 82, bibasilar crackles.
■ 2. Confusion, urine output 15 mL over the last 2 hours, orthopnea.
■ 3. SpO2 92 on 2 liters nasal cannula, respirations 20, 1+ edema of lower extremities.
■ 4. Weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with exercise.
8.
The nurse notices that a client’s heart rate decreases from 63 to 50 beats per minute on the monitor. The nurse should fi rst:■ 1. Administer Atropine 0.5 mg I.V. push.
■ 2. Auscultate for abnormal heart sounds.
■ 3. Prepare for transcutaneous pacing.
■ 4. Take the client’s blood pressure.
9.
A client is admitted with a myocardial infarc- tion and new onset atrial fi brillation. While auscultat- ing the heart, the nurse notes an irregular heart rate and hears an extra heart sound at the apex after the S2 that remains constant throughout the respiratory cycle. The nurse should document these fi ndings as:■ 1. Heart rate irregular with S3.
■ 2. Heart rate irregular with S4.
■ 3. Heart rate irregular with aortic regurgitation.
■ 4. Heart rate irregular with mitral stenosis.
10.
A 60-year-old male client comes into the emergency department with a complaint of crushing substernal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myo- cardial infarction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocar- diogram (ECG), and 2 mg of morphine sulfate given I.V. The nurse should fi rst:■ 1. Administer the morphine.
■ 2. Obtain a 12-lead ECG.
■ 3. Obtain the blood work.
■ 4. Order the chest radiograph.
11.
When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), the nurse explains that the purpose of the drug is to:■ 1. Help keep him well hydrated.
■ 2. Dissolve clots that he may have.
■ 3. Prevent kidney failure.
■ 4. Treat potential cardiac arrhythmias.
12.
The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes the car- diac rhythm shown on the electrocardiogram strip below. The nurse identifi es this rhythm as which of the following?■ 1. Atrial fi brillation.
■ 2. Ventricular tachycardia.
■ 3. Premature ventricular contractions (PVCs).
■ 4. Third-degree heart block.
13.
A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders should the nurse question?■ 1. Call for urine output < 30 mL/hour for 2 con- secutive hours.
■ 2. Metoprolol (Lopressor) 5 mg I.V. push.
■ 3. Prepare for a pulmonary artery catheter inser- tion.
■ 4. Titrate Dobutamine (Dobutrex) to keep sys- tolic BP > 100.
14.
If the client who was admitted for myocar- dial infarction (MI) develops cardiogenic shock, which characteristic sign should the nurse expect to observe?■ 1. Oliguria.
■ 2. Bradycardia.
■ 3. Elevated blood pressure.
■ 4. Fever.
15.
The physician orders continuous I.V. nitro- glycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following?■ 1. Obtaining an infusion pump for the medica- tion.
■ 2. Monitoring blood pressure every 4 hours.
■ 3. Monitoring urine output hourly.
■ 4. Obtaining serum potassium levels daily.
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16.
When teaching the client with myocardial infarction (MI), the nurse explains that the pain associated with MI is caused by:■ 1. Left ventricular overload.
■ 2. Impending circulatory collapse.
■ 3. Extracellular electrolyte imbalances.
■ 4. Insuffi cient oxygen reaching the heart muscle.
17.
The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm shown on the electrocardiogram strip below.The nurse identifi es this rhythm as which of the following?
■ 1. Atrial fi brillation.
■ 2. Ventricular tachycardia.
■ 3. Premature ventricular contractions.
■ 4. Sinus tachycardia.
18.
While caring for a client who has sustained a myocardial infarction (MI), the nurse notes eight premature ventricular contractions (PVCs) in 1 minute on the cardiac monitor. The client is receiv- ing an I.V. infusion of 5% dextrose in water (D5W) and oxygen at 2 L/minute. The nurse’s fi rst course of action should be to:■ 1. Increase the I.V. infusion rate.
■ 2. Notify the physician promptly.
■ 3. Increase the oxygen concentration.
■ 4. Administer a prescribed analgesic.
19.
Which of the following is an expected out- come for a client on the second day of hospitaliza- tion after a myocardial infarction (MI)? The client:■ 1. Has severe chest pain.
■ 2. Can identify risk factors for MI.
■ 3. Agrees to participate in a cardiac rehabilita- tion walking program.
■ 4. Can perform personal self-care activities with- out pain.
20.
Which of the following is an expected out- come when a client is recieving an I.V. administra- tion of furosemide?■ 1. Increased blood pressure.
■ 2. Increased urine output.
■ 3. Decreased pain.
■ 4. Decreased premature ventricular contractions.
21.
After a myocardial infarction, the hospital- ized client is taught to move the legs while resting in bed. This type of exercise is recommended pri- marily to help:■ 1. Prepare the client for ambulation.
■ 2. Promote urinary and intestinal elimination.
■ 3. Prevent thrombophlebitis and blood clot for- mation.
■ 4. Decrease the likelihood of pressure ulcer for- mation.
22.
Which of the following refl ects the prin- ciple on which a client’s diet will most likely be based during the acute phase of myocardial infarction?■ 1. Liquids as desired.
■ 2. Small, easily digested meals.
■ 3. Three regular meals per day.
■ 4. Nothing by mouth.
23.
The nurse is assessing clients at a health fair.Which client is at greatest risk for coronary artery disease?
■ 1. A 32-year-old female with mitral valve pro- lapse who quit smoking 10 years ago.
■ 2. A 43-year-old male with a family history of CAD and cholesterol level of 158.
■ 3. A 56-year-old male with an HDL of 60 who takes atorvastatin (Lipitor).
■ 4. A 65-year-old female who is obese with an LDL of 188.
24.
A 58-year-old female with a family history of CAD is being seen for her annual physical exam.Fasting lab test results include: Total cholesterol 198; LDL cholesterol 120; HDL cholesterol 58;
Triglycerides 148; Blood sugar 102; and C-reactive protein (CRP) 4.2. The health care provider informs the client that she will be started on a statin medica- tion and aspirin. The client asks the nurse why she needs to take these medications. Which is the best response by the nurse?
■ 1. “The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a lowfat diet.”
■ 2. “The triglycerides are elevated and will not return to normal without these medications.”
■ 3. “The CRP is elevated indicating infl ammation seen in cardiovascular disease, which can be lowered by the medications ordered.”
■ 4. “The medications are not indicated since your lab values are all normal.”
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31.
Crackles heard on lung auscultation indicate which of the following?■ 1. Cyanosis.
■ 2. Bronchospasm.
■ 3. Airway narrowing.
■ 4. Fluid-fi lled alveoli.
32.
A 68-year-old female client on day 2 after hip surgery has no cardiac history but reports hav- ing chest heaviness. The fi rst nursing action should be to:■ 1. Inquire about the onset, duration, severity, and precipitating factors of the heaviness.
■ 2. Administer oxygen via nasal cannula.
■ 3. Offer pain medication for the chest heaviness.
■ 4. Inform the physician of the chest heaviness.
33.
The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?■ 1. Cancer.
■ 2. Hypertension.
■ 3. Liver disease.
■ 4. Myocardial damage.
34.
An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of:■ 1. Left ventricular atrophy.
■ 2. Irregular heartbeats.
■ 3. Peripheral vascular occlusion.
■ 4. Pacemaker placement.
35.
During the previous few months, a 56-year- old woman felt brief twinges of chest pain while working in her garden and has had frequent epi- sodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confi rms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency.She states that she visits an invalid friend twice a week and now cannot walk up the second fl ight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could sug- gest would most likely help the client prevent this problem?
■ 1. Visit her friend early in the day.
■ 2. Rest for at least an hour before climbing the stairs.
■ 3. Take a nitroglycerin tablet before climbing the stairs.
■ 4. Lie down once she reaches the friend’s apartment.
25.
If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modifi cation may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by:■ 1. Explaining how the old behavior leads to poor health.
■ 2. Withholding praise until the new behavior is well established.
■ 3. Rewarding the client whenever the acceptable behavior is performed.
■ 4. Instilling mild fear into the client to extin- guish the behavior.
26.
Alteplase recombinant, or tissue plasmi- nogen activator (t-PA), a thrombolytic enzyme, is administered during the fi rst 6 hours after onset of myocardial infarction (MI) to:■ 1. Control chest pain.
■ 2. Reduce coronary artery vasospasm.
■ 3. Control the arrhythmias associated with MI.
■ 4. Revascularize the blocked coronary artery.
27.
After the administration of t-PA, the assess- ment priority is to:■ 1. Observe the client for chest pain.
■ 2. Monitor for fever.
■ 3. Monitor the 12-lead electrocardiogram (ECG) every 4 hours.
■ 4. Monitor breath sounds.
28.
When monitoring a client who is receiv- ing tissue plasminogen activator (t-PA), the nurse should have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following?■ 1. Cardiac arrhythmias.
■ 2. Hypertension.
■ 3. Seizure.
■ 4. Hypothermia.
29.
Contraindications to the administration of tissue plasminogen activator (t-PA) include which of the following?■ 1. Age greater than 60 years.
■ 2. History of cerebral hemorrhage.
■ 3. History of heart failure.
■ 4. Cigarette smoking.
30.
A client has driven himself to the emer- gency department. He is 50 years old, has a history of hypertension, and informs the nurse that his father died from a heart attack at age 60. The client is presently complaining of indigestion. The nurse connects him to an electrocardiogram monitor and begins administering oxygen at 2 L/minute per nasal cannula. The nurse’s next action would be to:■ 1. Call for the physician.
■ 2. Start an I.V. line.
■ 3. Obtain a portable chest radiograph.
■ 4. Draw blood for laboratory studies.
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42.
A client has a throbbing headache when nitroglycerin is taken for angina.The nurse should instruct the client that:
■ 1. Acetaminophen (Tylenol) or Ibuprofen (Advil) can be taken for this common side effect.
■ 2. Nitroglycerin should be avoided if the client is experiencing this serious side effect.
■ 3. Taking the nitroglycerin with a few glasses of water will reduce the problem.
■ 4. The client should lie in a supine position to alleviate the headache.
43.
Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?■ 1. Take one tablet every 2 to 5 minutes until the pain stops.
■ 2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes.
■ 3. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after three tablets.
■ 4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.
44.
A client with angina has been taking nife- dipine. The nurse should teach the client to:■ 1. Monitor blood pressure monthly.
■ 2. Perform daily weights.
■ 3. Inspect gums daily.
■ 4. Limit intake of green leafy vegetables.