Medical-SurgicalNqrsing 517

CardiovascularSystem
157. wtrichof the followingnursinginterventions would be consideredmost importantfor a clientduring
the first severaldaysafter a myocardialinfarction (MI)?
l. Regular diet
2. eedsidecommode
3. Turn,cough,and deepbreathing
4. Active range-of-motionexercises
I 58. fhe nurseis caringfor a clientwho is in right-sidedheartfailure.Thefocusof nursingcareis to
decreasethe workloadof the heart.To facilitatethis goalof care,the nursewouldanticipateadminis-
teringwhichof the followingmedications?
l. Digoxin(Lanoxin)
2. Atorvastatin(Lipitor)
3. Bretylium(Bretylol)
4. Procainamide (Procan)
159. wtrichof the followingcardiacdysrhythmias
wouldbe life-threatening
and would necessitate
immedi-
ate interventionby the nurse?
l. Sinustachycardia
2. etrial fibrillation
3. Iunctionaltachycardia
4. Ventricularfibrillatron

Medicql-SurgigalNursing 521

CardiovascularSystem
163. enexpectedoutcomeforaclientreceivingcholestyramine(Ouestran)
wouldbe
I. Decreased blood pressure
2. Increasedcardiacoutput
3. Decreased serumcholesterol
4. lncreasedperipheralvascularresistance
I 64. e clientis experiencing
sinusbradycardiarelatedto digitalistoxicity.Thenurseshouldbe preparedto
administerwhichof the followingdrugsto increasethe heartrateif the clientbecomessymptomatic?
l. Atropine
2. Lidocaine
3. Verapamil(Calan)
4. Procainamide (Pronestyl)
I 65. ftre nursewouldanticipatethat a temporarypacemaker
would be consideredfor whichtype of
dysrhythmia?
l. Heartblock
2. etrial fibrillation
3. Ventricularfibrillatron
4. Ventriculartachycardia

Medrcal-Surgrcal Nursing 519

CardiovascularSystem
l6O. ftre nurseis caringfor a clientwho is usinga nitroglycerin
transdermalpatch(Nitro-Dur).Whichof the
followingstatements,if madeby the client,shouldindicateto the nursethat furtherteachingis
needed?
l. "t will get up from a chairslowly."
2. "t will reportany blurredvisionor a dry mouth."
3. "l will stop usingthe patchif I get a headache,"
4. "l will put the patchin a differentplaceeachday."
I6l . rhe nurseis assessing a client'sriskfactorsfor heartdisease.Whichof the followingwouldbe most
crucialto note in the history?
l. Familyhistory,hypertension, stress,age
2. Rersonality type,high cholesterol,diabetes,smoking
3. Smoking,hypertension, obesity,diabetes,and high cholesterol
4. Rlcoholconsumption,obesity,diabetes,stress,and high cholesterol
162. rhephysicianrefersaclientforcardiaccatheterization.Thenursewouldexplaintotheclientandhis
familythat the primaryrationalefor performingthis procedureis to
l. Bypassobstructedvessels
2. Assessthe extentof arterial blockage
3. Open and dilate blockedcoronaryarteries
4. Assessthe functionaladequacyofthe valvesand heartmuscles
Answers 518

157. Correct Answer: 2

Rationale:To preventcomplications, it is importantforthe
suchas cardiacruptureand re-infarction,
clientto ceaseanyunnecessary activiw,therebydecreasingcardiacdemands.strainingwhile havinga
bowelmovementon a bedpanwill causeunnecessary increasein cardiacworkload.Thereforeallow-
ing a clientto assumea normaleliminationpositionon a bedsidecommodewill facilitatean easy
bowel movementand conservationof energy.
CL:Analysis NP:lmplementation NTPC:Physiologicallntegity
158. CorrectAnswer:I
Rationale:Digoxinis the drug of choicefor right-sidedheart failure to improvecontractilityand
cardiacoutput. It has a positive inotropic effectby increasingthe forceof contraction,and a negative
chronotropicaction by decreasingthe rate.
CL:Analysis NP:lmplementation NTPC:Physiologicallntegnty
159. CorrectAnswer:4
Rationale:Duringventricularfibrillation,the ventriclesarequiveringand areno longerableto contract
to produceeffectivecardiacoutput. Becausethere is no cardiacoutput, the body is left without a
meansof oxygenation. Life cannotbe sustainedunlessthe conditionis treatedimmediately.
CL: Nplication NP:tusessnent NTPC:Pfrysiolooinltnteqntu

CL = Cognitive Level NP = Nursing Process NTPC = NCLEX Test Plan Category

Answers

163. CorrectAnswer:7
Rationale:Ouestranis an antihyperlipidemic
drugthat lowersthe serumcholesterolby bindingbile in
the intestinesand removinglow-densitylipoprotein(LDL)and cholesterolfrom plasma.
CL: Analysis NP: Eualuation NTPC:HealthPromotion andMaintenance
164. CorrectAnswer: I
Rationale:Atropine blocksvagusnervestimulation, resultingin an increasedheart rate.The other
optionsare inappropriateand areusedto suppresscardiactachydysrhythmias.
CL:P'pplication NP:lmplementationNTPC:Pfitsiologicallntegrity
165. CorrectAnswer: I
Rationale:The use of a temporarypacemakeris considereda life-savingmeasurefor clients who have
experienced a heartblock.A temporarypacemaker is useduntil the heartblockis resolvedusingmedi-
or a permanentpacemaker
cal interventions is inserted.
CL: Applkation NP:lmplementationNTPC:Phgsiologicallnwittt

CL = Cognitive Level NP = Nursing Process NTPC = NCLEX Test Plan Category

Answerc 520

160.CorrectAnswer:3
Rationale:Headachelasting 5 to 20 minutes is a frequentside effectof initial nitroglycerinetherapy
and probablydoes not warrantstopping use of the patch'
CL:Analysis NP: Evalnation NTPC:Physiologicallntegntg
16l. CorrectAnswer:3
Rationale:Maior risk factorsfor coronaryarterydiseaseare cigarettesmoking,elevatedblood
pressure,obesity,blood glucoselevelsaboveI 30or knowndiabetesmellitus,and elevatedserum
cholesterol.
CL: Application NP: Assessr4ent NTPC:HealtfiPromotion andMaintenance

162. CorrectAnswer:2
Rationale:Cardiaccatheterizationis done in clients to assessthe extent and severityof coronaryartery
blockage.A decisionabout the medical management,angioplasty,or coronaryarterybypasssurgery
will be basedon the resultsof the catheterization
CL: Appliution NP:lmplementation NTPC:Phrlsiologicallnteqrity

c L=c ogn i t i v e L e v e | N P = N ur sin g Pr o ce ssNT PC= NCL EXT e stPl ancategory

Medical:SurgicalNursing 523
CardiovascularSystem
166. Wtrictrof the followinglab resultsis indicativeof a myocardialinfarction?
l. Decreased serumcholesterol
2. Decreased serumDotassium
-phosphokinase
3. Elevatedcreatine (CpK)
4. Elevatedwhite blood cell (wBC)count
167. what pathologicalchangeswouldthe nurseexpectin a clientwith pulmonaryarterystenosis?
I. Respiratoryacidosiswith failureto compensate
2. Increasedpulmonaryblood flow and left ventricularhypertrophy
3. Decreased pulmonaryblood flow and right ventricularhypertrophy
4. Shortnessof breathand increasingcracklesindicatingfluid in the lungs
I 68. fhe nurserecognizesthat a maiorcomplaintin a clientwith Buerger's
diseasewould be
l. Backpainwhenlyingflat
2. Reddenedfeetwhenelevated
3. Chestpain whenwalkingup stairs
4. Legpain with exerciseand reliefwith rest

CardiovascularSystem
169. e clientin the cardiaccareunit is experiencingmultipleprematureventricularcontractions(PVCS).
Whatmedicationshouldthe nurseprepareto administerto the client?
I. Atropine
2. Lidocaine
3. Morphine
4. Epinephrine
I 70. A clientwho hasbeentreatedfor anginapectorishasa percutaneous transluminalcoronaryangio-
plasty(PTCA). Thenurseunderstands that the primarypurposeof this procedureis to
l. AssessmyocardialPerfusion
2. Determineperipheralvesselpatency
3. Improvecardiopulmonary blood flow
4. Increasethe diameterof the coronaryarteries
I7l. fhenurseiscloselymonitoringaclientwithamyocardial forcomplications.Thenurse
infarction(MI)
that hypotensionis a warningsignof
recognizes
l. A secondaryMI
2. Pulmonaryedema
3. Cardiogenicshock
4. Fataldysrhythmias

Medical.SursicalNursins 527

CardiovascularSystem
172. e clientis experiencingleft ventrlcularfailure.Whichof the followingclinicalmanifestations
is indica-
tive of the condition?
l. orthopnea
2. Low blood pressure
3. Pulsating neckveins
4. Edemain the left arm
179. eOl-year-oldwomanstatesthat sherecentlybeganto developpain in the left calfwhenclimbingthe
stairsto her apartment.Thispain is relievedby sittingand restingfor about 2 minutes,then she is able
to resumeactivities.Thisclient is most likelyexperiencing
l. Claudication
2. Muscularcramping
3. Venousinsufficiency
4. Soremusclesfrom overexertion
I 74. rhe nurserespondsto the cardiacmonitoralarmof a client and notesthat the clienthasatrialflutter.
and sittingup in bed watchingTV.Whichof the followingactions
Theclient is awake,responsive,
shouldthe nursetakefirst?
l. Institutecarotidsinusmassage
2. Assessthe clientfor dyspnea
3. Initiatecardiopulmonaryresuscitation
4. Placethe clientin Trendelenburgposition
Answers 524

166. CorrectAnswer:3
Rationale:Cardiacenzymessuch as CPK,LDH, and troponin are releasedspecificallyby the myocar'
dial cellswheniniuredand aredetectedin the blood.
CL:Knowledge NP:fusgssnetlt NTPC;Pfrysiolo4icallntegntq

167. Correct Answer: 3

Rationale:Pulmonaryarterystenosiscausesthe blood flow to the lungs to be decreasedand resultsin
rightventricularhypertrophy. Themost commoncauseof pulmonaryhypertension is left-sidedheart
failurethat resultsin increasedpulmonaryblood flow and pressure.
CL:Arnalysis NP:fusessilaentNTPC:Pfiysiolo4icallntegritg
168. Correct Answer: 4
Rationale:Buerger'sdiseaseis characterizedby inflammationof the arteriesand veins of the lower
A sensitivityto coldand paresthesias
Thiscausespain in the legsand feetwith exercise.
extremities.
alsoareoftenseenwith this condition.
CL: Analysis NP:Assessnent NTPC:Pfrrsioloqifillntegnta

CL = Cognitive Level NP = Nursing Process NTPC = NCLEX Test Plan Category

Answers 526

169. Correct Answer: 2

Rationale:Lidocainesuppressesventriculardysrhythmiasand raisesthe ventricularfibrillation thresh-
old. Lidocainehasno effecton contractilityor systemicarterialpressure.
CL: Analgsis NP:lmplementationNTPC:Pftysiolo4icallntegritA
170. CorrectAnswer:4
Rationale:In PTCAthe diameterof an occludedor stenosedarteryis increasedby insertinga balloon
catheter,whichis then inflated.Theinflatedballooncompresses
the atherosclerosis and/orstretches
the bore of the vesselresultingin the therapeuticeffect.
CL:Comprehension NP:Analysis NTPC:Pftysiolo4icallntegitA
l7l. CorrectAnswer:3
Rationale:
Oneof the initialcardinalsignsof cardiogenic
shockis a slow,steadydropin blood
pressure.
CL:Applkation NP:Ass?ssne,4t NTPC: Physiolo4icallntegnty

CL = CognitiveLevel NP = NursingProcess NTPC= NCLEXTestPlanCategory

Answers

172. CorrectAnswer: I
Rationale:Orthopnea,which is difficulty breathingexceptwhen sitting or standing,is a symptomof
advancedheartfailure,especiallyof left-sidedfailure.Whenthe heartfailsas a pump,blood backsup
into the lungs,causingincreasedfluid to leakfrom the alveolarmembrane.
CL: Analysis NP;fusessnert NTPC:PhUsiolo4icallntegitg
173. CorrectAnswer: I
Rationale:lntermittent claudicationfeels like a crampand is causedby decreasedblood flow to an
extremityduring activity.It is usuallyrelievedby a few minutes of rest.
CL: Analgsis NP:AssessnrerltNTPC:PhgsiologicallntegntA
174. Correct Answer: 2
Rationale:Becausethe client is awakeand responsive,the next action should be to further assessthe
clientto ascertainstabilityand possiblecauseof the dysrhythmia.
CL' P,ppliution NP:lmplementationNTPC:Phrlsiologicallntegntrl

CL = CoenitiE LerE NP = Nu6ing P'Irc NTPC = ltcl.il Test Plan Cregqr-

Medical-SurgicalNursing 529

CardiovascularSystem
175. fhe nurseis assessing maleclientcomplainingof chestpain.If this clientis experiencing
a 46-year-old
a myocardialinfarction(MI),he is most likelyto makewhichof the followingstatements?
l. '"Ihe pain comesand goes."
2. "f think I am havinga heartattack."
3. "l've beenhavingpain for a dayor two."
4. "lt feelslike an elephantstandingon my chest."
I 76. rhe nursenotes that a client has a historyof paroxysmalatrial tachycardia(PAT).This dysrhythmiais
characterizedby a heart rate
l. of to ob pm
2. Greaterthan250bpm
3. Betweenl00and 150bpm
4. Betweenl50and 250bpm
I 77. to obtain an accuratecentralvenouspressure(CVP)readingwith a CVPcatheter,the nurseshould
placethe client in whichof the followingpositions?
l. Horizontally
2. Left side-lying
3. night side-lying
4. Low Fowler'soosition

Medical-SurgicalNursing

CardiovascularSystem
I 78. fhe nurseunderstandsthat the pain of anginapectorisis primarilyproducedby
l. Atherosclerosis
2. Myocardialischemia
3. Movementof a thromboemboli
4. Coronaryarteryvasoconstriction
179. fhe nurseis analyzingECGstripsof clientsin the cardiaccareunit.Whichof the followingECGfind,
ingswouldthe nurserecognize as mostdiagnosticof a myocardialinfarction(MI)?
l. ProlongedP wave
2. Changesin heartrate
3. ons abnormalities
4. HeightenedT wave
180. R clientis suspectedof havingan abdominalaorticaneurysm.Whichof the followingquestionsis
priorityfor the nurseto askfirst?
l. "Do you haveanybackpain?"
2. "Doyou get frequentheadaches?"
3. "Haveyou everhad any blood in your urine?"
4. "Haveyou noticedany changesin the colorof your bowelmovements?"
Answers 530

175. CorrectAnswer:4
Rationale:Theclientexperiencingan MI will complainof pressurelike
pain that is indicativeof the
descriptionof an elephantstandingon the client'schest.
CL: Application NP:Assessnent NTPC:Plysiologicallnteqntu
176. Correct Answer: 4
Rationale:PATis characterizedby a heart rate of between I 50 and 250bpm. A rate of 100bpm is the
upperlimit for a normalheartrate,and a rateof 100to 150is the rangefor a sinustachycardia.
CL:ComprehensionNP: AssessmentNTPC:Physiological IntegitA
177. Correct Answer: I
Rationale:To obtain an accurateCVPreading,the client must be in a horizontalposition so that the
zero referencepoint at the level of the right atrium is levelwith the zero markon the manometer.
CL:Application NP: ImplementationNTPC:Pfr4siolo4icallntqity

CL = Cognitive Level NP = Nursing Process NTPC = NCLEX Test Plan Category

Answers 532

178. Correct Answer: 2

Rationale:The pain of anginapectorisis pathophysiologicallycausedby an inadequateoxygensupply
to the myocardium, causingischemia.Theotherchoicesmay leadto myocardialischemia,but are
secondary causes.
CL:ComprehensionNP:Analysis NTPC:Phgsiological lntegritA
I79. Correct Answer: 3
Rationale:Abnormalchangesin the QRScomplexusuallysignalan MI.
CL:Application NP:Assessnznt NTPC:Pfrysiolo4icallntegitq
I80. CorrectAnswer: I
Rationale:Althoughan abdominalaorticaneurysmis usuallyasymptomatic, someclientsmayhave
abdominalor backpain.A pulsatingmassin the abdomenwith or without pain mayindicatethe
aneurysmis enlargedor possiblydissecting.
CL:Analysis NP:AsszssnentNTPC:Pfrysiolo4icallnteqritA

CL = Cognitive Level NP = Nursing Process NTPC = NCLEX Test Plan Category