Cardio 2/11/14 10:33 AM

1. A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? a. Intake and output b. Baseline peripheral pulse rates c. Height and weight d. Allergy to iodine or shellfish 2. A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem? a. “Have you ever had this pain before?” b. “Can you describe the pain to me?” c. “Does the pain get worse when you breathe in?” d. “Can you rate the pain on a scale of 1-10, with 10 being the worst?” 3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities? a. Strict bed rest for 24 hours after transfer b. Bathroom privileges and self-care activities c. Unsupervised hallway ambulation with distances under 200 feet d. Ad lib activities because the client is monitored. 4. A nurse notes 2+ bilateral edema in the lower extremities of a client withmyocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? a. Review the intake and output records for the last 2 days b. Change the time of diuretic administration from morning to evening c. Request a sodium restriction of 1 g/day from the physician. d. Order daily weights starting the following morning. 5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: a. Check the client status and lead placement b. Press the recorder button on the electrocardiogram console.

c. Call the physician d. Call a code blue 6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? a. Seating the client with arm bared, supported, and at heart level. b. Measuring the blood pressure after the client has been seated quietly for 5 minutes. c. Using a cuff with a rubber bladder that encircles at least 80% of the limb. d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion. 7. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit? a. Vitamin K b. Aminocaporic acid c. Potassium chloride d. Protamine sulfate 8. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: a. The same as the client’s own baseline level b. Lower than the needed therapeutic level c. Within the therapeutic range d. Higher than the therapeutic range 9. A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin: a. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect. b. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. c. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.

d. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic. 10. A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first: a. Administer the morphine b. Obtain a 12-lead ECG c. Obtain the lab work d. Order the chest x-ray 11. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to: a. Help keep him well hydrated b. Dissolve clots he may have c. Prevent kidney failure d. Treat potential cardiac arrhythmias. 12. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply. a. Reflects electrical impulse beginning at the SA node b. Indicated electrical impulse beginning at the AV node c. Reflects atrial muscle depolarization d. Identifies ventricular muscle depolarization e. Has duration of normally 0.11 seconds or less. 13. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to: a. Call for the doctor b. Start an intravenous line c. Obtain a portable chest radiograph d. Draw blood for laboratory studies

14. 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? a. Cancer b. Hypertension c. Liver disease d. Myocardial infarction 15. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II. 16. The most important long-term goal for a client with hypertension would be to: a. Learn how to avoid stress b. Explore a job change or early retirement c. Make a commitment to long-term therapy d. Control high blood pressure 17. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of: a. Cerebrovascular accident b. Liver disease c. Myocardial infarction d. Pulmonary disease 18. 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 episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her

evaluation confirms 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 is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem? a. Visit her friend earlier in the day. b. Rest for at least an hour before climbing the stairs. c. Take a nitroglycerin tablet before climbing the stairs. d. Lie down once she reaches the friend’s apartment. 19. Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician? a. A change in the pattern of her pain b. Pain during sex c. Pain during an argument with her husband d. Pain during or after an activity such as lawnmowing 20. The physician refers the client with unstable angina for a cardiac catherization. The nurse explains to the client that this procedure is being used in this specific case to: a. Open and dilate the blocked coronary arteries b. Assess the extent of arterial blockage c. Bypass obstructed vessels d. Assess the functional adequacy of the valves and heart muscle.

Cardio Answers 2/11/14 10:33 AM

1. ANSWER D. This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure. 2. ANSWER C. Chest pain is assessed by using the standard pain assessment parameters. Options A, B, and D may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration. 3. ANSWER B. On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet). 4. ANSWER A. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms. 5. ANSWER A. Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. 6. ANSWER D. BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy. 7. ANSWER D. The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin. 8. ANSWER C. The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client’s control

value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range. 9. ANSWER B. Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited. 10. ANSWER A. Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain. 11. ANSWER B. Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage. 12. ANSWERS A, C, E. In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height. 13. ANSWER B. Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line. 14. ANSWER D. Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less than 90 mg/L is normal). 15. ANSWER A. Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction. 16. ANSWER C. Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance. 17. ANSWER A. Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA’s can be related to long-term

hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease. 18. ANSWER C. Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode. 19. ANSWER A. The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD. 20. ANSWER B. Cardiac catherization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catherization results.

2/11/14 10:33 AM