Answers and Rationale
can be controlled with diet, exercise, and
Here are the answers and rationale for this exam. Counter
check your answers to those below and tell us your scores. If
you have any disputes or need more clarification on a certain
question, please direct them to the comments section.
1. Answer: C. Left anterior descending artery
 Option C: The left anterior descending artery is the
primary source of blood for the anterior wall of the
heart.
 Options A, B, and D: The circumflex artery
supplies the lateral wall, the internal mammary
artery supplies the mammary, and the right
coronary artery supplies the inferior wall of the
heart.
2. Answer: B. During diastole
 Option B: Although the coronary arteries may
receive a minute portion of blood during systole,
most of the blood flow to coronary arteries is
supplied during diastole.
 Option A: Breathing patterns are irrelevant to
blood flow.
3. Answer: B. Coronary artery disease
 Option B: Coronary artery disease accounts for
over 50% of all deaths in the US.
 Option A: Cancer accounts for approximately
20%.
 Options C and D: Liver failure and renal failure
account for less than 10% of all deaths in the US.
4. Answer: A. Atherosclerosis
 Option A: Atherosclerosis, or plaque formation, is
the leading cause of CAD.
 Option B: DM is a risk factor for CAD but isn’t
the most common cause.
 Option D: Renal failure doesn’t cause CAD, but
the two conditions are related.
 Option C: Myocardial infarction is commonly a
result of CAD.
5. Answer: B. Plaques obstruct the artery
 Option B: Arteries, not veins, supply the coronary
arteries with oxygen and other nutrients.
 Option A: Atherosclerosis is a direct result of
plaque formation in the artery.
 Option D: Hardened vessels can’t dilate properly
and, therefore, constrict blood flow.
6. Answer: C. Heredity
 Option C: Because “heredity” refers to our genetic
makeup, it can’t be changed.
 Option A: Cigarette smoking cessation is a
lifestyle change that involves behavior
modification.
 Option B: Diabetes mellitus is a risk factor that
medication.
 Option D: Altering one’s diet, exercise, and
medication can correct hypertension.
7. Answer: D. 200 mg/dl
 Option D: Cholesterol levels above 200 mg/dl are
considered excessive. They require dietary
restriction and perhaps medication. Exercise also
helps reduce cholesterol levels. The other levels
listed are all below the nationally accepted levels
for cholesterol and carry a lesser risk for CAD.
8. Answer: B. Enhance myocardial oxygenation
 Option B: Enhancing myocardial oxygenation is
always the first priority when a client exhibits signs
and symptoms of cardiac compromise. Without
adequate oxygen, the myocardium suffers damage.
 Option C: Sublingual nitroglycerin is administered
to treat acute angina, but its administration isn’t the
first priority.
 Options A and D: Although educating the client
and decreasing anxiety are important in care
delivery, neither are priorities when a client is
compromised.
9. Answer: C. Oral medication administration
 Option C: Oral medication administration is a
noninvasive, medical treatment for coronary artery
disease.
 Option A: Cardiac catheterization isn’t a treatment
but a diagnostic tool.
 Options B and D: Coronary artery bypass surgery
and percutaneous transluminal coronary
angioplasty are invasive, surgical treatments.
10. Answer: C. Inferior
 Option C: The right coronary artery supplies the
right ventricle or the inferior portion of the heart.
Therefore, prolonged occlusion could produce an
infarction in that area.
 Options A, B, and D: The right coronary artery
doesn’t supply the anterior portion (left ventricle),
lateral portion (some of the left ventricle and the
left atrium), or the apical portion (left ventricle) of
the heart.
11. Answer: A. Chest pain
 Option A: The most common symptom of an MI is
chest pain, resulting from deprivation of oxygen to
the heart.
 Option B: Dyspnea is the second most common
symptom, related to an increase in the metabolic
needs of the body during an MI.
 Option C: Edema is a later sign of heart failure,
often seen after an MI.
  Option D: Palpitations may result from reduced
cardiac output, producing arrhythmias.
12. Answer: B. Left fifth intercostal space, midclavicular
line
 Option B: The correct landmark for obtaining an
apical pulse is the left intercostal space in the
midclavicular line. This is the point of maximum
impulse and the location of the left ventricular
apex.
 Option C: The left second intercostal space in the
midclavicular line is where the pulmonic sounds
are auscultated.
 Option A and D: Normally, heart sounds aren’t
heard in the midaxillary line or the seventh
intercostal space in the midclavicular line.
13. Answer: D. Pulmonary
 Option D: Pulmonary pain is generally described
by these symptoms.
 Option C: Musculoskeletal pain only increases
with movement.
 Options A and B: Cardiac and GI pains don’t
change with respiration.
14. Answer: C. Pulmonic
 Option C: Abnormalities of the pulmonic valve are
auscultated at the second left intercostal space
along the left sternal border.
 Option A: Aortic valve abnormalities are heard at
the second intercostal space, to the right of the
sternum.
 Option B: Mitral valve abnormalities are heard at
the fifth intercostal space in the midclavicular line.
 Option D: Tricuspid valve abnormalities are heard
at the third and fourth intercostal spaces along the
sternal border.
15. Answer: C. Troponin I
 Option C: 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.
 Option A: Lactate dehydrogenase is present in
almost all body tissues and not specific to heart
muscle. LDH isoenzymes are useful in diagnosing
cardiac injury.
 Option B: CBC is obtained to review blood counts,
and a complete chemistry is obtained to review
electrolytes.
 Option D: Because CK levels may rise with
skeletal muscle injury, CK isoenzymes are required
to detect cardiac injury.
16. Answer: D. To decrease oxygen demand on the
client’s heart
 Option D: Morphine is administered because it
decreases myocardial oxygen demand.
 Options A, B, and C: Morphine will also decrease
pain and anxiety while causing sedation, but isn’t
primarily given for those reasons.
17. Answer: C. Coronary artery thrombosis
 Option C: Coronary artery thrombosis causes
occlusion of the artery, leading to myocardial
death.
 Option A: An aneurysm is an outpouching of a
vessel and doesn’t cause an MI.
 Option D: Renal failure can be associated with MI
but isn’t a direct cause.
 Option B: Heart failure is usually the result of an
MI.
18. Answer: C. Potassium
 Option C: Supplemental potassium is given with
furosemide because of the potassium loss that
occurs as a result of this diuretic.
 Options A and D: Chloride and sodium aren’t lost
during diuresis.
 Option B: Digoxin acts to increase contractility but
isn’t given routinely with furosemide.
19. Answer: D. Metabolic
 Option D: Both glucose and fatty acids are
metabolites whose levels increase after a
myocardial infarction.
 Options A and C: Mechanical changes are those
that affect the pumping action of the heart, and
electrophysiologic changes affect conduction.
 Option B: Hematologic changes would affect the
blood.
20. Answer: A. Ventricular dilation
 Option A: Rapid filling of the ventricles causes
vasodilation that is auscultated as S3.
 Option B and D: Increased atrial contraction or
systemic hypertension can result is a fourth heart
sound.
 Option C: Aortic valve malfunction is heard as a
murmur.
21. Answer: A. Left-sided heart failure
 Option A: The left ventricle is responsible for the
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.
 Options B, C, and D: Pulmonic and tricuspid
valve malfunction cause right-sided heart failure.
22. Answer: D. Electrocardiogram
  Option D: The ECG is the quickest, most accurate,
and most widely used tool to determine the location
of myocardial infarction.
 Option B: Cardiac enzymes are used to diagnose
MI but can’t determine the location.
 Option C: An echocardiogram is used most widely
to view myocardial wall function after an MI has
been diagnosed.
 Option A: Cardiac catheterization is an invasive
study for determining coronary artery disease and
may also indicate the location of myocardial
damage, but the study may not be performed
immediately.
23. Answer: B. Administer oxygen
 Option B: 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.
 Options A and C: Morphine and sublingual
nitroglycerin are also used to treat MI, but they’re
more commonly administered after the oxygen.
 Option D: An ECG is the most common diagnostic
tool used to evaluate MI.
24. Answer: A. “Tell me about your feeling right now.”
 Option A: Validation of the client’s feelings is the
most appropriate response. It gives the client a
feeling of comfort and safety.
 Options B, C, and D: The other three responses
give the client false hope. No one can determine if
a client experiencing MI will feel or get better and
therefore, these responses are inappropriate.
25. Answer: A. Beta-adrenergic blockers
 Option A: Beta-adrenergic blockers work by
blocking beta receptors in the myocardium,
reducing the response to catecholamines and
sympathetic nerve stimulation. They protect the
myocardium, helping to reduce the risk of another
infarction by decreasing the workload of the heart
and decreasing myocardial oxygen demand.
 Option B: Calcium channel blockers reduce the
workload of the heart by decreasing the heart rate.
 Option C: Narcotics reduce myocardial oxygen
demand, promote vasodilation, and decreased
anxiety.
 Option D: Nitrates reduce myocardial oxygen
consumption by decreasing left ventricular end-
diastolic pressure (preload) and systemic vascular
resistance (afterload).
26. Answer: C. Arrhythmias
 Option C: Arrhythmias, caused by oxygen
deprivation to the myocardium, are the most
common complication of an MI.
 Option A: Cardiogenic shock, another
complication of MI, is defined as the end stage of
left ventricular dysfunction. The condition occurs
in approximately 15% of clients with MI.
 Option B: Because the pumping function of the
heart is compromised by an MI, heart failure is the
second most common complication.
 Option D: Pericarditis most commonly results
from a bacterial or viral infection but may occur
after MI.
27. Answer: B. Heart failure
 Option B: Elevated venous pressure, exhibited as
jugular vein distention, indicates a failure of the
heart to pump.
 Options A and D: Jugular vein distention isn’t a
symptom of abdominal aortic aneurysm or
pneumothorax.
 Option C: An MI, if severe enough, can progress
to heart failure; however, in and of itself, an MI
doesn’t cause jugular vein distention.
28. Answer: C. Raised 30 degrees
 Option C: Jugular venous pressure is measured
with a centimeter ruler to obtain the vertical
distance between the sternal angle and the point of
highest pulsation with the head of the bed inclined
between 15 and 30 degrees.
 Options B and D: Inclined pressure can’t be seen
when the client is supine or when the head of the
bed is raised 10 degrees because the point that
marks the pressure level is above the jaw
(therefore, not visible).
 Option A: In high-Fowler’s position, the veins
would be barely discernible above the clavicle.
29. Answer: A. Apical pulse
 Option A: An apical pulse is essential for
accurately assessing the client’s heart rate before
administering digoxin. The apical pulse is the most
accurate point in the body.
 Option B: Blood pressure is usually only affected
if the heart rate is too low, in which case the nurse
would withhold digoxin.
 Option C: The radial pulse can be affected by
cardiac and vascular disease and therefore, won’t
always accurately depict the heart rate.
 Option D: Digoxin has no effect on respiratory
function.
30. Answer: A. Digoxin
 Option A: One of the most common signs of
digoxin toxicity is the visual disturbance known as
the green halo sign.
 Options B, C, and D: The other medications aren’t
associated with such an effect.
31. Answer: A. Crackles
  Option A: Crackles in the lungs are a classic sign
of left-sided heart failure. These sounds are caused
by fluid backing up into the pulmonary system.
 Option B: Arrhythmias can be associated with
both right and left-sided heart failure. Left-sided
heart failure causes hypertension secondary to an
increased workload on the system.
32. Answer: D. Right-sided heart failure
 Option D: The most accurate area of the body to
assess dependent edema in a bedridden client is the
sacral area. Sacral, or dependent, edema is
secondary to right-sided heart failure.
 Options A, B, and C: Diabetes mellitus,
pulmonary emboli, and renal disease aren’t directly
linked to sacral edema.
33. Answer: C. Oliguria
 Option C: Inadequate deactivation of aldosterone
by the liver after right-sided heart failure leads to
fluid retention, which causes oliguria.
 Options A, B, and D: Adequate urine output,
polyuria, and polydipsia aren’t associated with
right-sided heart failure.
34. Answer: D. Inotropic agents
 Option D: Inotropic agents are administered to
increase the force of the heart’s contractions,
thereby increasing ventricular contractility and
ultimately increasing cardiac output.
 Options A and B: Beta-adrenergic blockers and
calcium channel blockers decrease the heart rate
and ultimately decrease the workload of the heart.
 Option C: Diuretics are administered to decrease
the overall vascular volume, also decreasing the
workload of the heart.
35. Answer: B. Tachycardia
 Option B: Stimulation of the sympathetic nervous
system causes tachycardia and increased
contractility.
 Options A, C, and D: The other symptoms listed
are related to the parasympathetic nervous system,
which is responsible for slowing the heart rate.
36. Answer: D. Right-sided heart failure
 Option D: Weight gain, nausea, and a decrease in
urine output are secondary effects of right-sided
heart failure.
 Option B: Cardiomyopathy is usually identified as
a symptom of left-sided heart failure.
 Option C: Left-sided heart failure causes primarily
pulmonary symptoms rather than systemic ones.
 Option A: Angina pectoris doesn’t cause weight
gain, nausea, or a decrease in urine output.
37. Answer: A. Atherosclerosis
 Option A: Atherosclerosis accounts for 75% of all
abdominal aortic aneurysms. Plaques build up on
the wall of the vessel and weaken it, causing an
aneurysm.
 Options B, C, and D: Although the other
conditions are related to the development of an
aneurysm, none is a direct cause.
38. Answer: B. Distal to the renal arteries
 Option B: The portion of the aorta distal to the
renal arteries is more prone to an aneurysm because
the vessel isn’t surrounded by stable structures,
unlike the proximal portion of the aorta.
 Option A: Distal to the iliac arteries, the vessel is
again surrounded by stable vasculature, making this
an uncommon site for an aneurysm.
 Option C: There is no area adjacent to the aortic
arch, which bends into the thoracic (descending)
aorta.
39. Answer: A. Abdominal aortic aneurysm
 Option A: The presence of a pulsating mass in the
abdomen is an abnormal finding, usually indicating
an outpouching in a weakened vessel, as in
abdominal aortic aneurysm. The finding, however,
can be normal on a thin person.
 Options B, C, and D: Neither an enlarged spleen,
gastritis, nor gastric distention cause pulsation.
40. Answer: A. Abdominal pain
 Option A: Abdominal pain in a client with an
abdominal aortic aneurysm results from the
disruption of normal circulation in the abdominal
region.
 Option D: Lower back pain, not upper, is a
common symptom, usually signifying expansion
and impending rupture of the aneurysm.
 Options B and C: Headache and diaphoresis aren’t
associated with abdominal aortic aneurysm.
41. Answer: D. Lower back pain
 Option D: Lower back pain results from expansion
of an aneurysm. The expansion applies pressure in
the abdominal cavity, and the pain is referred to the
lower back.
 Option A: Abdominal pain is most common
symptom resulting from impaired circulation.
 Option B: Absent pedal pulses are a sign of no
circulation and would occur after a ruptured
aneurysm or in peripheral vascular disease.
 Option C: Angina is associated with
atherosclerosis of the coronary arteries.
42. Answer: B. Arteriogram
 Option B: An arteriogram accurately and directly
depicts the vasculature; therefore, it clearly
delineates the vessels and any abnormalities.
  Option A: An abdominal aneurysm would only be
visible on an X-ray if it were calcified.
 Options C and D: CT scan and ultrasound don’t
give a direct view of the vessels and don’t yield as
accurate a diagnosis as the arteriogram.
43. Answer: B. Aneurysm rupture
 Option B: Rupture of an aneurysm is a life-
threatening emergency and is of the greatest
concern for the nurse caring for this type of client.
 Option A: Hypertension should be avoided and
controlled because it can cause the weakened
vessel to rupture.
 Option D: Diminished pedal pulses, a sign of poor
circulation to the lower extremities, are associated
with an aneurysm but isn’t life-threatening.
 Option C: Cardiac arrhythmias aren’t directly
linked to an aneurysm.
44. Answer: C. Media
ADVERTISEMENTS
 Option C: The factor common to all types of
aneurysms is a damaged media. The media has
more smooth muscle and less elastic fibers, so it’s
more capable of vasoconstriction and vasodilation.
 Options A, B, and D: The interna and externa are
generally no damaged in an aneurysm.
45. Answer: C. Middle lower abdomen to the left of the
midline
 Option C: The aorta lies directly left of the
umbilicus; therefore, any other region is
inappropriate for palpation.
46. Answer: B. HPN
 Option B: Continuous pressure on the vessel walls
from hypertension causes the walls to weaken and
an aneurysm to occur.
 Option C: Atherosclerotic changes can occur with
peripheral vascular diseases and are linked to
aneurysms, but the link isn’t as strong as it is with
hypertension.
 Option D: Only 1% of clients with syphilis
experience an aneurysm.
 Option A: Diabetes mellitus doesn’t have direct
link to aneurysm.
47. Answer: A. Bruit
 Option A: A bruit, a vascular sound resembling
heart murmur, suggests partial arterial occlusion.
 Option B: Crackles are indicative of fluid in the
lungs.
 Option C: Dullness is heard over solid organs,
such as the liver.
 Option D: Friction rubs indicate inflammation of
the peritoneal surface.
48. Answer: B. Severe lower back pain, decreased BP,
decreased RBC, increased WBC
 Option B: Severe lower back pain indicates an
aneurysm rupture, secondary to pressure being
applied within the abdominal cavity. When rupture
occurs, the pain is constant because it can’t be
alleviated until the aneurysm is repaired. Blood
pressure decreases due to the loss of blood. After
the aneurysm ruptures, the vasculature is
interrupted and blood volume is lost, so blood
pressure wouldn’t increase. For the same reason,
the RBC count is decreased – not increase. The
WBC count increases as cells migrate to the site of
injury.
49. Answer: C. Retroperitoneal rupture at the repair site
 Option C: Blood collects in the retroperitoneal
space and is exhibited as a hematoma in the
perineal area. This rupture is most commonly
caused by leakage at the repair site.
 Options A and B: A hernia doesn’t cause vascular
disturbances, nor does a pressure ulcer.
 Option D: Because no bleeding occurs with rapid
expansion of the aneurysm, a hematoma won’t
form.
50. Answer: C. Marfan’s syndrome
 Option C: Marfan’s syndrome results in the
degeneration of the elastic fibers of the aortic
media. Therefore, clients with the syndrome are
more likely to develop an aortic aneurysm.
 Option A: Although cystic fibrosis is hereditary, it
hasn’t been linked to aneurysms.
 Option B: Lupus erythematosus isn’t hereditary.
 Option D: Myocardial infarction is neither
hereditary nor a disease.
51. Answer: D. Surgical intervention
 Option D: When the vessel ruptures, surgery is the
only intervention that can repair it.
 Options A and C: Administration of
antihypertensive medications and beta-adrenergic
blockers can help control hypertension, reducing
the risk of rupture.
 Option B: An aortogram is a diagnostic tool used
to detect an aneurysm.
52. Answer: A. Cardiomyopathy
 Option A: Cardiomyopathy isn’t usually related to
an underlying heart disease such as atherosclerosis.
The etiology in most cases is unknown.
 Options B and C: Coronary artery disease and
myocardial infarction are directly related to
atherosclerosis.
 Option D: Pericardial effusion is the escape of
fluid into the pericardial sac, a condition associated
with pericarditis and advanced heart failure.
53. Answer: A. Dilated
 Option A: Although the cause isn’t entirely
known, cardiac dilation and heart failure may
develop during the last month of pregnancy of the
first few months after birth. The condition may
result from a preexisting cardiomyopathy not
apparent prior to pregnancy.
 Option B: Hypertrophic cardiomyopathy is an
abnormal symmetry of the ventricles that has an
unknown etiology but a strong familial tendency.
 Option C: Myocarditis isn’t specifically associated
with childbirth.
 Option D: Restrictive cardiomyopathy indicates
constrictive pericarditis; the underlying cause is
usually myocardial.
54. Answer: C. Hypertrophic
 Option C: In hypertrophic cardiomyopathy,
hypertrophy of the ventricular septum – not the
ventricle chambers – is apparent.
 Options A, B, and D: This abnormality isn’t seen
in other types of cardiomyopathy.
55. Answer: A. Heart failure
 Option A: Because the structure and function of
the heart muscle is affected, heart failure most
commonly occurs in clients with cardiomyopathy.
 Option C: Myocardial infarction results from
prolonged myocardial ischemia due to reduced
blood flow through one of the coronary arteries.
 Option D: Pericardial effusion is most
predominant in clients with pericarditis. Diabetes
mellitus is unrelated to cardiomyopathy.
56. Answer: A. Cardiomegaly
 Option A: Cardiomegaly denotes an enlarged heart
muscle.
 Option B: Cardiomyopathy is a heart muscle
disease of unknown origin.
 Option C: Myocarditis refers to inflammation of
heart muscle.
 Option D: Pericarditis is an inflammation of the
pericardium, the sac surrounding the heart.
57. Answer: D. Restrictive
 Option D: These are the classic symptoms of heart
failure.
 Option A: Pericarditis is exhibited by a feeling of
fullness in the chest and auscultation of a
pericardial friction rub.
 Option B: Hypertension is usually exhibited by
headaches, visual disturbances, and a flushed face.
Myocardial infarction causes heart failure but isn’t
related to these symptoms.
58. Answer: B. Hypertrophic
 Option B: Cardiac output isn’t affected by
hypertrophic cardiomyopathy because the size of
the ventricle remains relatively unchanged.
 Options A and C: Dilated cardiomyopathy and
restrictive cardiomyopathy all decrease cardiac
output.
59. Answer: D. Failure of the ventricle to eject all the
blood during systole
 Option D: An S4 occurs as a result of increased
resistance to ventricular filling after atrial
contraction. This increased resistance is related to
decrease compliance of the ventricle.
 Option A: A dilated aorta doesn’t cause an extra
heart sound, though it does cause a murmur.
 Option C: Decreased myocardial contractility is
heard as a third heart sound.
 Option B: An s4 isn’t heard in a normally
functioning heart.
60. Answer: B. Beta-adrenergic blockers
 Option B: By decreasing the heart rate and
contractility, beta-adrenergic blockers improve
myocardial filling and cardiac output, which are
primary goals in the treatment of cardiomyopathy.
 Option A: Antihypertensives aren’t usually
indicated because they would decrease cardiac
output in clients who are often already hypotensive.
 Option C: Calcium channel blockers are
sometimes used for the same reasons as beta-
adrenergic blockers; however, they aren’t as
effective as beta-adrenergic blockers and cause
increase hypotension.
 Option D: Nitrates aren’t’ used because of their
dilating effects, which would further compromise
the myocardium.
Answers and Rationale
1. Answer: 2. Enhance myocardial oxygenation
Enhancing myocardial oxygenation is always the first
priority when a client exhibits signs or symptoms of cardiac
compromise. Without adequate oxygenation, the
myocardium suffers damage.
 Options A and D: Although educating the client
and decreasing anxiety are important in care
delivery, neither are priorities when a client is
compromised.
 Option C: Sublingual nitroglycerin is administered
to treat acute angina, but the administration isn’t
the first priority.
2. Answer: 3. Oral medication therapy
Oral medication administration is a noninvasive, medical
treatment for coronary artery disease.
 ADVERTISEMENTS
 Option A: Cardiac catheterization isn’t a treatment,
but a diagnostic tool.
 Options B and D: Coronary artery bypass surgery
and percutaneous transluminal coronary
angioplasty are invasive, surgical treatments.
3. Answer: 1. Chest pain
The most common symptom of an MI is chest pain,
resulting from deprivation of oxygen to the heart.
 Option B: Dyspnea is the second most common
symptom, related to an increase in the metabolic
needs of the body during an MI.
 Option C: Edema is a later sign of heart failure,
often seen after an MI.
 Option D: Palpitations may result from reduced
cardiac output, producing arrhythmias.
4. Answer: 4. Pulmonary
Pulmonary pain is generally described by these symptoms.
 Options A and B: Cardiac and GI pains don’t
change with respiration.
 Option C: Musculoskeletal pain only increases with
movement.
5. 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.
 Option A: Lactate dehydrogenase (LDH) is present
in almost all body tissues and not specific to heart
muscle. LDH isoenzymes are useful in diagnosing
a cardiac injury.
 Option B: CBC is obtained to review blood counts,
and a complete chemistry is obtained to review
electrolytes.
 Option D: Because CK levels may rise with a
skeletal muscle injury, CK isoenzymes are required
to detect cardiac injury.
6. Answer: 4. To decrease oxygen demand on the client’s
heart
Morphine is administered because it decreases myocardial
oxygen demand.
 Options A, B, and C: Morphine will also decrease
pain and anxiety while causing sedation, but it isn’t
primarily given for those reasons.
7. Answer: 3. Coronary artery thrombosis
Coronary artery thrombosis causes an inclusion of the
artery, leading to myocardial death.
 Option A: An aneurysm is an outpouching of a
vessel and doesn’t cause an MI.
 Option B: Heart failure is usually a result from an
MI.
 Option D: Renal failure can be associated with MI
but isn’t a direct cause.
8. Answer: 1. Ventricular dilation
Rapid filling of the ventricle causes vasodilation that is
auscultated as S3.
 Option B and D: Increased atrial contraction or
systemic hypertension can result in a fourth heart
sound.
 Option C: Aortic valve malfunction is heard as a
murmur.
9. 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.
 Options B, C, and D: Pulmonic and tricuspid valve
malfunction cause right-sided heart failure.
10. 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.
 Options A and C: Morphine and nitro are also used
to treat MI, but they’re more commonly
administered after the oxygen.
 Option D: An ECG is the most common diagnostic
tool used to evaluate MI.
11. Answer: 1. Beta-adrenergic blockers
Beta-adrenergic blockers work by blocking beta receptors in
the myocardium, reducing the response to catecholamines
and sympathetic nerve stimulation. They protect the
myocardium, helping to reduce the risk of another infarction
by decreasing myocardial oxygen demand.
 Option B: Calcium channel blockers reduce the
workload of the heart by decreasing the heart rate.
 Option C: Narcotics reduce myocardial oxygen
demand, promote vasodilation, and decrease
anxiety.
 Option D: Nitrates reduce myocardial oxygen
consumption by decreasing left ventricular end-
diastolic pressure (preload) and systemic vascular
resistance (afterload).
12. Answer: 3. Arrhythmias
Arrhythmias, caused by oxygen deprivation to the
myocardium, are the most common complication of an MI.
 Option A: Cardiogenic shock, another complication
of an MI, is defined as the end stage of left
ventricular dysfunction. This condition occurs in
approximately 15% of clients with MI.
 Option B: Because the pumping function of the
heart is compromised by an MI, heart failure is the
second most common complication.
 Option D: Pericarditis most commonly results from
a bacterial or viral infection but may occur after the
MI.
13. Answer: 2. Heart failure
Elevated venous pressure, exhibited as jugular vein
distention, indicates a failure of the heart to pump.
 Options A and D: JVD isn’t a symptom of
abdominal aortic aneurysm or pneumothorax.
 Option C: An MI, if severe enough, can progress to
heart failure, however, in and of itself, an MI
doesn’t cause JVD.
14. Answer: 1. Digoxin
One of the most common signs of digoxin toxicity is the
visual disturbance known as the “green-yellow halo sign.”
The other medications aren’t associated with such an effect.
15. Answer: 1. Crackles
Crackles in the lungs are a classic sign of left-sided heart
failure. These sounds are caused by fluid backing up into the
pulmonary system.
 Option B: Arrhythmias can be associated with both
right- and left-sided heart failure.
 Option D: Left-sided heart failure causes
hypertension secondary to an increased workload
on the system.
16. Answer: 4. Right-sided heart failure
The most accurate area on the body to assess dependent
edema in a bed-ridden client is the sacral area. Sacral, or
dependent, edema is secondary to right-sided heart failure.
17. Answer: 3. Oliguria
Inadequate deactivation of aldosterone by the liver after
right-sided heart failure leads to fluid retention, which
causes oliguria.
18. Answer: 4. Inotropic agents
Inotropic agents are administered to increase the force of the
heart’s contractions, thereby increasing ventricular
contractility and ultimately increasing cardiac output.
19. Answer: 2. Tachycardia
Stimulation of the sympathetic nervous system causes
tachycardia and increased contractility. The other symptoms
listed are related to the parasympathetic nervous system,
which is responsible for slowing the heart rate.
20. Answer: 4. Right-sided heart failure
Weight gain, nausea, and a decrease in urine output are
secondary effects of right-sided heart failure.
 Option A: Angina pectoris doesn’t cause weight
gain, nausea, or a decrease in urine output.
 Option B: Cardiomyopathy is usually identified as
a symptom of left-sided heart failure.
 Option C: Left-sided heart failure causes primarily
pulmonary symptoms rather than systemic ones.
21. Answer: 1. Cardiomyopathy
Cardiomyopathy isn’t usually related to an underlying heart
disease such as atherosclerosis. The etiology in most cases is
unknown.
 Options B and C: CAD and MI are directly related
to atherosclerosis.
 Option D:Pericardial effusion is the escape of fluid
into the pericardial sac, a condition associated with
Pericarditis and advanced heart failure.
22. Answer: 1. Dilated
Although the cause isn’t entirely known, cardiac dilation
and heart failure may develop during the last month of
pregnancy or the first few months after birth. The condition
may result from a preexisting cardiomyopathy not apparent
prior to pregnancy.
 Option B: Hypertrophic cardiomyopathy is an
abnormal symmetry of the ventricles that has an
unknown etiology but a strong familial tendency.
 Option C: Myocarditis isn’t specifically associated
with childbirth.
 Option D: Restrictive cardiomyopathy indicates
constrictive pericarditis; the underlying cause is
usually myocardial.
23. Answer: 3. Hypertrophic
In hypertrophic cardiomyopathy, hypertrophy of the
ventricular septum—not the ventricle chambers—is
apparent. This abnormality isn’t seen in other types of
cardiomyopathy.
24. Answer: 1. Heart failure
Because the structure and function of the heart muscle is
affected, heart failure most commonly occurs in clients with
cardiomyopathy.
 Option C: MI results from prolonged myocardial
ischemia due to reduced blood flow through one of
the coronary arteries.
  Option D: Pericardial effusion is most predominant
in clients with pericarditis.
25. Answer: 4. Heart failure
These are the classic signs of failure.
 Option A: Pericarditis is exhibited by a feeling of
fullness in the chest and auscultation of a
pericardial friction rub.
 Option B: Hypertension is usually exhibited by
headaches, visual disturbances, and a flushed face.
 Option D: MI causes heart failure but isn’t related
to these symptoms.
26. 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.
27. Answer: 4. Failure of the ventricle to eject all of the
blood during systole
An S4 occurs as a result of increased resistance to
ventricular filling after atrial contraction. The increased
resistance is related to decreased compliance of the
ventricle.
 Option A: A dilated aorta doesn’t cause an extra
heart sound, though it does cause a murmur.
 Option B: An S4 isn’t heard in a normally
functioning heart.
 Option C: Decreased myocardial contractility is
heard as a third heart sound.
28. Answer: 2. Beta-adrenergic blockers
By decreasing the heart rate and contractility, beta-blockers
improve myocardial filling and cardiac output, which are
primary goals in the treatment of cardiomyopathy.
 Option A: Antihypertensives aren’t usually
indicated because they would decrease cardiac
output in clients who are already hypotensive.
 Option C: Calcium channel blockers are
sometimes used for the same reasons as beta-
blockers; however, they aren’t as effective as beta-
blockers and cause increased hypotension.
 Option D: Nitrates aren’t used because of their
dilating effects, which would further compromise
the myocardium.
29. Answer: 3. Heart transplantation
The only definitive treatment for cardiomyopathy that can’t
be controlled medically is a heart transplant because the
damage to the heart muscle is irreversible.
30. Answer: 2. Stable angina
The pain of stable angina is predictable in nature, builds
gradually, and quickly reaches maximum intensity.
 Option C: Unstable angina doesn’t always need a
trigger, is more intense, and lasts longer than stable
angina.
 Option D: Variant angina usually occurs at rest—
not as a result of exercise or stress.
31. 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.
32. Answer: 4. Inadequate oxygen supply to the
myocardium
Inadequate oxygen supply to the myocardium is responsible
for the pain accompanying angina.
 Option A: Increased preload would be responsible
for right-sided heart failure.
 Option B: Decreased afterload causes increased
cardiac output.
 Option C: Coronary artery spasm is responsible for
variant angina.
33. Answer: 4. 12-lead electrocardiogram (ECG)
The 12-lead ECG will indicate ischemia, showing T-wave
inversion. In addition, with variant angina, the ECG shows
ST-segment elevation.
 Option A: A chest x-ray will show heart
enlargement or signs of heart failure, but isn’t used
to diagnose angina.
34. Answer: 1. Reversal of ischemia
Reversal of the ischemia is the primary goal, achieved by
reducing oxygen consumption and increasing oxygen
supply.
 Option B: An infarction is permanent and can’t be
reversed.
35. Answer: 1. Sit the client down
The initial priority is to decrease the oxygen consumption;
this would be achieved by sitting the client down.
 Option B and D: After the ECG, sublingual nitro
would be administered. When the client’s condition
is stabilized, he can be returned to bed.
 Option C: An ECG can be obtained after the client
is sitting down.
36. Answer: 3. Preload, afterload, contractility, and
heart rate.
Myocardial oxygen consumption increases as preload,
afterload, renal contractility, and heart rate increase.
Cerebral blood flow doesn’t directly affect myocardial
oxygen consumption.
37. Answer: 3. In high Fowler’s position
A high Fowler’s position promotes ventilation and facilitates
breathing by reducing venous return.
 Options A and B: Lying flat and side-lying
positions worsen the breathing and increase the
workload of the heart.
 Option D: Semi-Fowler’s position won’t reduce the
workload of the heart as well as the Fowler’s
position will.
38. Answer: 4. Hypocapnia
In an attempt to compensate for increased work of breathing
due to hyperventilation, carbon dioxide decreases, causing
hypocapnea. If the condition persists, CO2 retention occurs
and hypercapnia results.
39. 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.
 Option A: Blood pressure doesn’t initially drop in
response to the compensatory mechanism of the
body.
 Option B: Alteration in LOC will occur only if the
decreased cardiac output persists.
40. Answer: 1. Call for help
Production of pink, frothy sputum is a classic sign of acute
pulmonary edema. Because the client is at high risk for
decompensation, the nurse should call for help but not leave
the room. The other three interventions would immediately
follow.
41. 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.
 Option B: Cardiac output is the amount of blood
expelled by the heart per minute.
 Option C: Overload refers to an abundance of
circulating volume.
 Option D: Preload is the volume of blood in the
ventricle at the end of diastole.
42. Answer: 3. Left ventricle
The left ventricle is responsible for the majority of force for
the cardiac output. If the left ventricle is damaged, the
output decreases and fluid accumulates in the interstitial and
alveolar spaces, causing pulmonary edema.
 Option A: Damage to the left atrium would
contribute to heart failure but wouldn’t affect
cardiac output or, therefore, the onset of pulmonary
edema.
 Options B and D: If the right atrium and right
ventricle were damaged, right-sided heart failure
would result.
43. Answer: 1. Erythema marginatum, subcutaneous
nodules, and fever
Diagnosis of rheumatic fever requires that the client have
either two major Jones criteria or one minor criterion plus
evidence of a previous streptococcal infection. Major criteria
include carditis, polyarthritis, Sydenham’s chorea,
subcutaneous nodules, and erythema marginatum (transient,
non pruritic macules on the trunk or inner aspects of the
upper arms or thighs). Minor criteria include fever,
arthralgia, elevated levels of acute phase reactants, and a
prolonged PR-interval on ECG.
44. Answer: 1. Activate the resuscitation team
Immediately after establishing unresponsiveness, the nurse
should activate the resuscitation team. The next step is to
open the airway using the head-tilt, chin-lift maneuver and
check for breathing (looking, listening, and feeling for no
more than 10-seconds). If the client isn’t breathing, give two
slow breaths using a bag mask or pocket mask. Next, check
for signs of circulation by palpating the carotid pulse.
45. 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).
 Options A, C, and D: Anxiety, acute pain, and
ineffective therapeutic regimen management are
appropriate but don’t take priority.
46. Answer: 1. Pulmonary edema
SOB, tachypnea, low BP, tachycardia, crackles, and a cough
producing pink, frothy sputum are late signs of pulmonary
edema.
47. 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.
48. 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.
 Option B: To prevent further endocarditis episodes,
prophylactic antibiotics are taken before and
sometimes after dental work, childbirth, or GU, GI,
or gynecologic procedures.
 Options C and D: A potassium-rich diet and daily
pulse monitoring aren’t necessary for a client with
endocarditis.
49. Answer: 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.
50. Answer: 2. Digoxin (Lanoxin)
Digoxin exerts a positive inotropic effect on the heart while
slowing the overall rate through a variety of mechanisms.
Digoxin is the medication of choice to treat heart failure.
 Options A, C, and D: Diltiazem (calcium channel
blocker) and propranolol and metoprolol (beta
blockers) have a negative inotropic effect and
would worsen the failing heart.
51. Answer: 4. Extremely anxious
Pulmonary edema causes the client to be extremely agitated
and anxious. The client may complain of a sense of
drowning, suffocation, or smothering.
52. 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.
53. Answer: 4. Acute renal failure
The client who undergoes cardiac surgery is at risk for renal
injury from poor perfusion, hemolysis, low cardiac output,
or vasopressor medication therapy. Renal insult is signaled
by decreased urine output and increased BUN and creatinine
levels. The client may need medications such as dopamine
(Intropin) to increase renal perfusion and possibly could
need peritoneal dialysis or hemodialysis.
54. Answer: 2. Premedicate the client with an analgesic
The nurse should encourage regular use of pain medication
for the first 48 to 72 hours after cardiac surgery because
analgesia will promote rest, decrease myocardial oxygen
consumption resulting from pain, and allow better
participation in activities such as coughing, deep breathing,
and ambulation.
ADVERTISEMENTS
 Options A and C will not help in tolerating
ambulation.
 Option D: Removal of telemetry equipment is
contraindicated unless prescribed.
55. Answer: 1. Normal sinus rhythm
56. Answer: 4. It can develop into ventricular fibrillation
at any time.
Ventricular tachycardia is a life-threatening dysrhythmia
that results from an irritable ectopic focus that takes over as
the pacemaker for the heart.
 Option A: Client’s frequently experienced a feeling
of impending death. Ventricular tachycardia is
treated with antiarrhythmic medications or
magnesium sulfate, cardioversion (client awake), or
defibrillation (loss of consciousness).
 Option B: The low cardiac output that results can
lead quickly to cerebral and myocardial ischemia.
 Option D: Ventricular tachycardia can deteriorate
into ventricular fibrillation at any time.
57. Answer: 2. Anorexia, nausea, and visual disturbances
The first signs and symptoms of digoxin toxicity in adults
include abdominal pain, N/V, visual disturbances (blurred,
yellow, or green vision, halos around lights), bradycardia,
and other dysrhythmias.
58. Answer: 3. Variant angina
Variant angina, or Prinzmetal’s angina, is prolonged and
severe and occurs at the same time each day, most often in
the morning.
 Option A: Stable angina is induced by exercise and
is relieved by rest or nitroglycerin tablets.
 Option B: Unstable angina occurs at lower and
lower levels of activity and rest, is less predictable
and is often a precursor of myocardial infarction.
59. Answer: 1. Obtaining an infusion pump for the
medication
IV nitro infusion requires an infusion pump for precise
control of the medication.
 Option B: BP monitoring would be done with a
continuous system, and more frequently than every
4 hours.
 Option C: Hourly urine outputs are not always
required.
 Option D: Obtaining serum potassium levels is not
associated with nitroglycerin infusion.
60. 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.
61. 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.
62. 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.
 Options A and D: Clients are not prescribed a diet
of liquids only or NPO unless their condition is
very unstable.
63. Answer: 1. Left ventricular atrophy
In older adults who are less active and do not exercise the
heart muscle, atrophy can result. Disuse or deconditioning
can lead to abnormal changes in the myocardium of the
older adult. As a result, under sudden emotional or physical
stress, the left ventricle is less able to respond to the
increased demands on the myocardial muscle.
64. Answer: A and C.
HF is a result of structural and functional abnormalities of
the heart tissue muscle. The heart muscle becomes weak and
does not adequately pump the blood out of the chambers. As
a result, blood pools in the left ventricle and backs up into
the left atrium, and eventually into the lungs. Therefore,
greater amounts of blood remain in the ventricle after
contraction thereby decreasing cardiac output. In addition,
this pooling leads to thrombus formation and ineffective
tissue perfusion because of the decrease in blood flow to the
other organs and tissues of the body. Typically, these clients
have an ejection fraction of less than 50% and poorly
tolerate activity.
 Option B: Activity intolerance is related to a
decrease, not increase, in cardiac output.
 Option D: Gas exchange is impaired. However, the
decrease in cardiac output triggers compensatory
mechanisms, such as an increase in sympathetic
nervous system activity.
65. Answer: 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.
 Options A, B, and D: The client could be at risk for
infection related to stasis of secretions or impaired
skin integrity related to pressure. However, these
are not the priority nursing diagnoses for the client
with HF and pulmonary edema, nor is constipation
related to immobility.
66. Answer: 3. Vasodilator
ACE inhibitors have become the vasodilators of choice in
the client with mild to severe HF. Vasodilator drugs are the
only class of drugs clearly shown to improve survival in
overt heart failure.
67. Answer: 1. 5 to 10 minutes
After IV injection of furosemide, diuresis normally begins in
about 5 minutes and reaches its peak within about 30
minutes. Medication effects last 2 to 4 hours.
68. 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.
69. Answer: 2. Left ventricular enlargement
A normal apical impulse is found under over the apex of the
heart and is typically located and auscultated in the left fifth
intercostal space in the midclavicular line. An apical
impulse located or auscultated below the fifth intercostal
space or lateral to the midclavicular line may indicate left
ventricular enlargement.
70. Answer: 3. Left anterior descending artery
The left anterior descending artery is the primary source of
blood for the anterior wall of the heart.
 Options A, B, and D: The circumflex artery
supplies the lateral wall, the internal mammary
artery supplies the mammary, and the right
coronary artery supplies the inferior wall of the
heart.
PEDIA
Answers and Rationale
1. Answer: D. Aneurysm formation
 Option D: Kawasaki disease is a rare childhood
illness that affects the blood vessels. 20% to 25%
of children can develop aneurysm formation if not
intervened. Treatment depends on the degree of the
disease, but is often immediate treatment with IV
gamma globulin or aspirin. Corticosteroids can
sometimes lessen impending complications.
Children who experience the disease usually need
lifelong follow-up appointments to keep an eye on
heart health.
2. Answer: C. Normal weight for age
 Option C: Adequate weight for height
demonstrates adequate nutritional intake and lack
of edema.
 Option A: Daily use of antibiotic is not indicated
in heart failure.
 Option B: A pulse rate less than 50 beats/minute,
bradycardia, probably indicates digoxin toxicity.
 Option D: An elevated RBC count demonstrates
polycythemia.
3. Answer: B. Ventricular septal defect, overriding aorta,
pulmonic stenosis (PS), and right ventricular
hypertrophy
 Option B: The defects associated with tetralogy of
Fallot include ventricular septal defect, overriding
aorta, pulmonic stenosis (PS), and right ventricular
hypertrophy.
 Option A: The aorta exiting from the right
ventricle with no communication between the
systemic and pulmonic circulation describes the
defects associated with transposition of the great
vessels.
 Option C: Coarctation of aorta and aortic and
mitral valve stenosis are defects associated with
tricuspid atresia. Severe coarctation of aorta, severe
aortic valvular stenosis or atresia, and severe mitral
valve stenosis or atresia are defects associated with
hypoplastic left heart syndrome.
 Option D: Also, the left ventricle, aortic valve,
mitral valve, and ascending aorta usually are small
or hypoplastic.
4. Answer: C. Obstruction of blood flow from the right
ventricle
 Option C: PS refers to an obstruction of blood
flow from the right ventricle.
 Option A: Truncus arteriosus involves a single
vessel arising from both ventricles.
 Option D: Total anomalous pulmonary venous
communications involve the return of blood to the
heart without entry into the left atrium and
obstruction of blood flow from the left ventricle.
5. Answer: B. Absent or diminished femoral pulses
 Option B: Absent or diminished femoral pulse is a
classic characteristic of coarctation of aorta.
 Option C: Severe cyanosis at birth is seen in such
defects as transposition of the great vessels.
 Options A, D: Tet episodes and squatting are
characteristic of tetralogy of Fallot.
6. Answer: A. Treating streptococcal throat infections
with an antibiotic
 Option A: Rheumatoid fever results from
improperly treated group beta-hemolytic
streptococcal infections, usually pharyngitis.
Therefore, prompt treatment of streptococcal throat
infections with an antibiotic is a key preventive
measure.
 Option B: Initial prevention is not possible once
the child has rheumatic fever. However, the child
will be treated with penicillin to prevent a
recurrence of streptococcal infections.
 Option C: A corticosteroid may be used to reduce
inflammation during treatment of rheumatic fever,
not as a preventive measure.
 Option D: An antibiotic is given to children with
cardiac disease to prevent carditis, not rheumatic
fever.
7. Answer: C. Extreme bradycardia
 Option C: Extreme bradycardia is a cardinal sign
of digoxin toxicity
 Options A, B, D: Headache, respiratory distress,
and constipation are not related to digoxin toxicity.
8. Answer: C. Scheduling care to provide for
uninterrupted rest periods
 Option C: Organizing nursing care to provide for
uninterrupted periods of sleep reduces cardiac
demand.
 Option A: Feeding time should be restricted to a
maximum of 45 minutes or discontinued sooner if
the infant tires.
 Option B: In an attempt to get her own way, the
child may cry. Excessive crying should be limited;
however, appropriate limit setting should still be
observed.
 Option D: Developing and implementing a
consistent care plan can be important, but it is not
related to decreasing cardiac demands or workload.
9. Answer: A. Replacing regular nipples with easy-to-
suck ones
 Option A: The nurse should replace regular
nipples with easy-to-suck-ones because the infant
may tire instantly with regular nipples and thus
would not be able to suck sufficiently.
 Options B, C: Also to prevent tiring, small
frequent feedings lasting no more than 45 minutes,
rather than large evenly spaced feedings or ones
lasting longer than 1 hour, should be given.
  Option D: Typically, the infant receives a low-
sodium, high-calorie diet.
10. Answer: D. Apex
 Option D: The blunt, rounded point of the heart is
the apex.
 Option A: The larger, flat portion at the opposite is
the base.
 Option B: The pericardium is also called the
pericardial sac. It has a fibrous outer layer and a
thin inner layer that surrounds the heart.
 Option C: The aorta is the largest artery
that carries blood from the left ventricle to the
body.
11. Answer: D. 5—1—3—4—2
 Option D: The SA node is the natural pacemaker
of the heart. The electrical stimulus from the SA
node eventually reaches the AV node and is
delayed briefly so that the contracting atria have
enough time to pump all the blood into the
ventricles. Once the atria are empty of blood the
valves between the atria and ventricles close. At
this point, the atria begin to refill and the electrical
stimulus passes through the AV node and Bundle
of His into the Bundle branches and Purkinje
fibers.
12. Answer: B, C, and D
 Option B: The SA node consists of a cluster of
cells that are situated in the upper part of the wall
of the right atrium (the right upper chamber of the
heart).
 Option C: When action potentials reach the AV
node, they spread slowly through it.
 Option D: Action potentials pass slowly through
the atrioventricular node.
 Option A: The SA node is the heart’s natural
pacemaker.
13. Answer: D. Tetralogy of Fallot
ADVERTISEMENTS
 Option D: Tetralogy of Fallot consists of four
major anomalies: ventricular septal defect, right
ventricular hypertrophy, pulmonic stenosis (PS),
aorta overriding the ventricular septal defect. PS
impedes the flow of blood to the lungs, causing
increased pressure in the right ventricle, forcing
deoxygenated blood through the septal defect the
left ventricle. As a result of this decreased
pulmonary flow, deoxygenated blood is shunted
into the systemic circulation. The increased
workload on the right ventricle causes hypertrophy.
The overriding aorta receives blood from both the
right and left ventricles. This is the definition of
defect with decreased pulmonary blood flow where
unoxygenated blood is shunted into the systemic
circulation.
 Options A,B: Coarctation of aorta and AS are
obstructive defects where obstruction, not shunting,
is the problem.
 Option C: With PDA, blood flows from the aorta
through the PDA and back to the pulmonary artery
and lungs (shunting of oxygenated blood to the
pulmonic system), causing increased pulmonary
vascular congestion.
14. Answer: D. Jatene Procedure
 Option D: The Jatene procedure, arterial switch
operation or arterial switch, is an open heart
surgical procedure used to correct dextro-
transposition of the great arteries (d-TGA).
 Option B: The Rastelli operation was originally
used for the repair of d-transposition of the great
vessels with ventricular septal defect and
pulmonary stenosis. It has subsequently been
utilized for a variety of congenital heart defects
characterized by two ventricles and overriding of
the aorta with severe pulmonary stenosis or
pulmonary atresia. Pulmonary atresia with
ventricular septal defect and double outlet right
ventricle with pulmonary stenosis or atresia are
anatomic subtypes also frequently submitted for the
Rastelli procedure. Cyanosis is the prevailing
preoperative pathophysiology.
 Option A: A Balloon Atrial Septostomy (Rashkind
procedure) is a procedure that is used to create an
opening in the wall between the upper chambers of
the heart (atria). This is performed in certain cases
to improve blood oxygenation, particularly for
congenital heart defects. A deflated balloon
catheter is guided into the heart and into a small
hole in the atrial septum. The balloon is then
inflated, created a larger hole in the atrial septum.
 Option C: The purpose of PAB is to lessen
pulmonary artery pressure and excess pulmonary
blood flow. PAB requires the insertion of a band
around the pulmonary artery to reduce blood flow
into the lungs. A variety of banding materials are
used; one commonly used material is
polytetrafluoroethylene.
15. Answer: B. Shunts the combined cardiac output
from the pulmonary artery to the systemic circulation
 Option B: In the developing fetus, the ductus
arteriosus, also called the ductus Botalli, is a blood
vessel connecting the pulmonary artery to the
proximal descending aorta. It allows most of the
blood from the right ventricle to bypass the fetus’s
fluid-filled non-functioning lungs.

CVD Ana Phy
1. Specialized cell membrane structures that decrease
electrical resistance between the cells allowing action
potentials to pass efficiently from one cell to adjacent
cells are the:
A. Extensive capillary network
B. Intercalated disks
C. Mitochondria
D. Gap junctions
1. Answer: D. Gap junctions
D: Gap junctions are a specialized intercellular connection
between a multitude of animal cell-types. They directly
connect the cytoplasm of two cells, which allows various
molecules, ions and electrical impulses to directly pass
through a regulated gate between cells.
A: Extensive capillary networks allows abundant supply of
oxygen and nutrients on tissues such as skeletal muscle,
liver, and kidney.
B: Intercalated disks support synchronized contraction of
cardiac tissue. They occur at the Z-line of the sarcomere and
can be visualized easily when observing a longitudinal
section of the tissue.
C: Mitochondrion is an organelle found in large numbers in
most cells, in which the biochemical processes of respiration
and energy production occur.
2. Complete the diagram so that it will show the correct
route of blood in the heart.
A. (1) Tricuspid Valve, (2) Aortic Valve, (3) Pulmonary
Circulation, (4) Mitral Valve, (5) Pulmonic Valve
B. (1) Mitral Valve, (2) Pulmonic Valve, (3) Pulmonary
Circulation, (4) Tricuspid Valve, (5) Aortic Valve
C. (1) Mitral Valve, (2) Aortic Valve, (3) Pulmonary
Circulation, (4) Tricuspid Valve, (5) Pulmonic Valve
D. (1) Tricuspid Valve, (2) Pulmonic Valve, (3) Pulmonary
Circulation, (4) Mitral Valve, (5) Aortic Valve
2. Answer: D. (1) Tricuspid Valve, (2) Pulmonic Valve,
(3) Pulmonary Circulation, (4) Mitral Valve, (5) Aortic
Valve
Blood enters the heart through two large veins, the inferior
and superior vena cava, emptying oxygen-poor blood from
the body into the right atrium. As the atrium contracts, blood
flows from your right atrium into your right ventricle
through the open tricuspid valve. When the ventricle is full,
the tricuspid valve shuts. This prevents blood from flowing
backward into the right atrium while the ventricle contracts.
As the ventricle contracts, blood leaves the heart through the
pulmonic valve, into the pulmonary artery and to the lungs,
where it is oxygenated. The oxygenated blood then returns
to the heart through the pulmonary veins. The pulmonary
veins empty oxygen-rich blood from the lungs into the left
atrium. As the atrium contracts, blood flows from your left
atrium into your left ventricle through the open mitral valve.
When the ventricle is full, the mitral valve shuts. This
prevents blood from flowing backward into the atrium while
the ventricle contracts. As the ventricle contracts, blood
leaves the heart through the aortic valve, into the aorta, and
to the body.
3. It is considered as the bluntly rounded portion of the
heart
A. Aorta
B. Apex
C. Base
D. Pericardium
3. Answer: B. Apex
B: The blunt, rounded point of the heart is the apex.
A: The aorta is the largest artery that carries blood from the
left ventricle to the body.
C: The larger, flat portion at the opposite is the base.
D. The pericardium is also called the pericardial sac. It has
a fibrous outer layer and a thin inner layer that surrounds the
heart.
4. Which event will NOT occur during depolarization
phase?
A. Na+ channels open
B. Ca+ channels open
C. K+ channels open
D. None of the above
4. Answer: C. K+ channels open
Na+ channels open, increasing the permeability of the cell
membrane to Na+. Sodium ions then diffuse into the cell,
causing depolarization. This causes K+ channels to close
quickly, decreasing the permeability of the cell membrane to
K+. The decreased diffusion of K+ out of the cell also causes
depolarization. Ca2+ channels slowly open, increasing the
permeability of cell membrane to Ca2+. Calcium ions then
diffuse into the cell and cause depolarization.
5. Which of these statements regarding the conduction
system of the heart is TRUE?
A. The sinoatrial (SA) node of the heart acts as the
pacemaker.
B. The SA node is located on the upper wall of the left
atrium.
C. The AV node conducts action potentials rapidly through
it.
D. Action potentials are carried slowly through the
atrioventricular bundle.
5. Answer: A. The sinoatrial (SA) node of the heart acts
as the pacemaker.
A: The SA node is the heart’s natural pacemaker.
B: The SA node consists of a cluster of cells that are situated
in the upper part of the wall of the right atrium (the right
upper chamber of the heart).
C: When action potentials reach the AV node, they spread
slowly through it.
D: Action potentials pass slowly through the atrioventricular
node.
6. In a normal electrocardiogram (ECG or EKG),
A. The P wave results from repolarization of the atria.
B. The QRS complex results from depolarization of the
ventricles.
C. The T wave represents repolarization of the auricles.
D. During the P-R interval, the ventricle contract.
6. Answer: B. The QRS complex results from
depolarization of the ventricles.
B: The QRS complex consists of three individual waves: the
Q, R, and S waves. The QRS complex results from
depolarization of the ventricles, and the beginning of the
QRS complex precedes ventricular contraction.
A: The P wave results from depolarization of the atrial
myocardium, and the beginning of the P wave precedes the
onset of atrial contraction.
C: The T wave represents the repolarization of the
ventricles, and the beginning of the T wave precedes
ventricular relaxation.
D: During the P-R interval, the atria contract and begin to
relax.
7. During the Ventricular Systole, atrioventricular valves
open, semilunar valves close. The statement is:
A. True
B. False
C. Partially true
D. Partially false
7. Answer: B. False
During ventricular systole, contraction of the ventricles
causes pressure in the ventricle to increase. Almost
immediately the AV valves close (the first heart sound). The
pressure in the ventricle continues to increase. Continued
ventricular contraction causes the pressure in the ventricle to
exceed in the pulmonary trunk and aorta. As a result, the
semilunar are forced open and blood is ejected into the
pulmonary trunk and aorta.
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8. This sound is produced during the closure of the
semilunar valves.
A. lubb
B. dupp
C. lubb dupp
D. lubb duppshhh
8. Answer: B. dupp
B: The second heart sound can be represented by dupp. It
occurs at the beginning of ventricular diastole and results
from closure of the semilunar valves.
A: The first heart sound can be represented by the syllable
lubb. It occurs at the beginning of ventricular systole and
results from closure of the AV valves.
9. Which of these statements correctly applies to intrinsic
regulation of the heart?
A. Starling’s law of the heart has a major influence on
cardiac output.
B. As venous return increases, cardiac output decreases.
C. In response to stretch, cardiac muscle fibers contract with
less force.
D. In response to stretch, there is a slight decrease in heart
rate.
9. Answer: A. Starling’s law of the heart has a major
influence on cardiac output.
A: The relationship between preload and stroke volume is
called Starling’s law of the heart.
B: As venous return increased, resulting in an increased
preload, cardiac output increases.
C: In response to increased preload, cardiac muscle fibers
contract with greater force.
D: In response to stretch, there is a slight increase in heart
rate.
10. Repolarization of the ventricles is shown as the
__________ on an ECG or EKG.
A. P wave
B. P-Q or P-R interval
C. QRS complex
D. Q-T interval
E. T wave
10. Answer: E. T wave
E: The T wave represents the repolarization of the
ventricles, and the beginning of the T wave precedes
ventricular relaxation.
A: The P wave results from depolarization of the atrial
myocardium, and the beginning of the P wave precedes the
onset of atrial contraction.
B: The time between the beginning of the P wave and the
beginning of the QRS complex is the PQ interval,
commonly called the PR interval because the Q wave is very
small. During the PR interval, the atria contract and begin to
relax.
C: The QRS complex consists of three individual waves: the
Q, R, and S waves. The QRS complex results from
depolarization of the ventricles, and the beginning of the
QRS complex precedes ventricular contraction.
D: The QT interval extends from the beginning of the QRS
complex to the end of the T wave and represents the length
of time required for ventricular depolarization and
repolarization.
Answers and Rationale
1. Answer: 1. Normal sinus rhythm
measurements are normal, measuring 0.12 to 0.20 second
and 0.4 to 0.10 second, respectively.
2. Answer: 2. Tightly secured cable connections
Motion artifact, or “noise,” can be caused by frequent client
movement, electrode placement on limbs, and insufficient
adhesion to the skin, such as placing electrodes over hairy
areas of the skin. Electrode placement over bony
prominences also should be avoided. Signal interference can
also occur with electrode removal and cable disconnection.
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3. Answer: 2. Ventricular tachycardia
Ventricular tachycardia is characterized by the absence of P
waves, wide QRS complexes (usually greater than 0.14
second), and a rate between 100 and 250 impulses per
minute. The rhythm is usually regular.
4. Answer: 3. Administer amiodarone (Cordarone)
intravenously
First-line treatment of ventricular tachycardia in a client who
is hemodynamically stable is the use of antidysrhythmics
such as amiodarone (Cordarone), lidocaine (Xylocaine), and
procainamide (Pronestyl). Cardioversion also may be
needed to correct the rhythm (cardioversion is recommended
for stable ventricular tachycardia).
 Option A: Defibrillation is used with pulseless
ventricular tachycardia.
 Option D: Epinephrine would stimulate and already
excitable ventricle and is contraindicated.
5. Answer: 2. Inhale deeply and cough forcefully every 1
to 3 seconds.
Cough Cardiopulmonary Resuscitation (CPR) sometimes is
used in the client with unstable ventricular tachycardia. The
nurse tells the client to use cough CPR, if prescribed, by
inhaling deeply and coughing forcefully every 1 to 3
seconds. Cough CPR may terminate the dysrhythmia or
sustain the cerebral and coronary circulation for a short time
until other measures can be implemented.
6. Answer: 1. Blood pressure and peripheral perfusion
Premature ventricular contractions can cause hemodynamic
compromise. The shortened ventricular filling time with the
ectopic beats leads to decreased stroke volume and, if
frequent enough, to decreased cardiac output.
 Option B: The client may be asymptomatic or may
feel palpitations.
 Options C and D: PVCs can be caused by cardiac
disorders or by any number of physiological
stressors, such as infection, illness, surgery, or
trauma, and by the intake of caffeine, alcohol, or
nicotine.
7. Answer: 1. Hypotension and dizziness
The client with uncontrolled atrial fibrillation with a
ventricular rate more than 150 beats a minute is at risk for
low cardiac output because of loss of atrial kick. The nurse
assesses the client for palpitations, chest pain or discomfort,
hypotension, pulse deficit, fatigue, weakness, dizziness,
syncope, shortness of breath, and distended neck veins.
8. Answer: 2. Atrial fibrillation
Atrial fibrillation is characterized by a loss of P waves; an
undulating, wavy baseline; QRS duration that is often within
normal limits; and an irregular ventricular rate, which can
range from 60 to 100 beats per minute (when controlled with
medications) to 100 to 160 beats per minute (when
uncontrolled).
9. Answer: 1. Vagus nerve to slow the heart rate
Carotid sinus massage is one of the maneuvers used for
vagal stimulation to decrease a rapid heart rate and possibly
terminate a tachydysrhythmias. The others include inducing
the gag reflex and asking the client to strain or bear down.
Medication therapy often is needed as an adjunct to keep the
rate down or maintain the normal rhythm.
10. Answer: 2. Ventricular fibrillation
Ventricular fibrillation is characterized by irregular, chaotic
undulations of varying amplitudes. Ventricular fibrillation
has no measurable rate and no visible P waves or QRS
complexes and results from electrical chaos in the ventricles.
11. Answer: 2. Notify the physician promptly
PVCs are often a precursor of life-threatening dysrhythmias,
including ventricular tachycardia and ventricular fibrillation.
An occasional PVC is not considered dangerous, but if
PVCs occur at a rate greater than 5 or 6 per minute in the
post-MI client, the physician should be notified
immediately. More than 6 PVCs per minute is considered
serious and usually calls for decreasing ventricular
irritability by administering medications such as lidocaine.
 Option A: Increasing the IV infusion rate would not
decrease the number of PVCs.
 Option C: Increasing the oxygen concentration
should not be the nurse’s first course of action;
rather, the nurse should notify the physician
promptly.
 Option D: Administering a prescribed analgesic
would not decrease ventricular irritability.
12. Answer: 4. Syncope and slow ventricular rate
In complete atrioventricular block, the ventricles take over
the pacemaker function in the heart but at a much slower
rate than that of the SA node. As a result, there is decreased
cerebral circulation, causing syncope.
13. Answer: 4. Widening of QRS complexes to 0.12
second or greater.
Bundle branch block interferes with the conduction of
impulses from the AV node to the ventricle supplied by the
affected bundle. Conduction through the ventricles is
delayed, as evidenced by a widened QRS complex.
14. Answer: 2. Defibrillate the client
Ventricular fibrillation is a death-producing dysrhythmia
and, once identified, must be terminated immediately by
precordial shock (defibrillation). This is usually a standing
physician’s order in a CCU.
15. Answer: 1, 2.
The consistency of the RR interval indicates regular rhythm.
A normal P wave before each complex indicates the impulse
originated in the SA node.
 Option C: The number of complexes in a 6-second
strip is multiplied by 10 to approximate the heart
rate; normal sinus rhythm is 60 to 100.
 Option D: Elevation of the ST segment is a sign of
cardiac ischemia and is unrelated to the rhythm.
 Option E: The QRS duration should be less than
0.12 second; the PR interval should be 0.12 to 0.20
second.
16. Answer: 3. A continuous and totally unpredictable
irregularity
In atrial fibrillation, multiple ectopic foci stimulate the atria
to contract. The AV node is unable to transmit all of these
impulses to the ventricles, resulting in a pattern of highly
irregular ventricular contractions.
Answers and Rationale
1. Answer: 4. Allergy to iodine or shellfish
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: 3. “Does the pain get worse when you breathe
in?”
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Chest pain is assessed by using the standard pain assessment
parameters.
 Options 1, 2, and 4 may or may not help
discriminate the origin of pain. Pain of
pleuropulmonary origin usually worsens on
inspiration.
3. Answer: 2. Bathroom privileges and self-care activities
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: 1. Review the intake and output records for
the last 2 days
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.
 Option B: Diuretics should be given in the morning
whenever possible to avoid nocturia.
 Option C: Strict sodium restrictions are reserved
for clients with severe symptoms.
5. Answer: 1. Check the client status and lead placement
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: 4. Taking a blood pressure within 15 minutes
after nicotine or caffeine ingestion.
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.
 Option B: The client should rest quietly for 5
minutes before the reading is taken.
 Option C: The cuff bladder should encircle at least
80% of the limb being measured. Gauges other
than a mercury sphygmomanometer should be
calibrated every six (6) months to ensure accuracy.
7. Answer: 4. Protamine sulfate
The antidote to heparin is protamine sulfate and should be
readily available for use if excessive bleeding or hemorrhage
should occur.
 Option A: Vitamin K is an antidote for warfarin.
8. Answer: 3. Within the therapeutic range
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 the therapeutic range.
9. Answer: 2. Inhibits synthesis of specific clotting
factors in the liver, and it takes 3-4 days for this
medication to exert an anticoagulant effect.
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: 1. Administer the morphine
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: 2. Dissolve clots he may have
Thrombolytic drugs are administered within the first 6 hours
after onset of an MI to lyse clots and reduce the extent of
myocardial damage.
12. Answer: 1, 3, 5
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: 2. Start an intravenous line
Advanced cardiac life support recommends that at least one
or two intravenous lines be inserted in one or both of the
antecubital spaces.
 Options A, C, and D: Calling the physician,
obtaining a portable chest radiograph, and drawing
blood are important but secondary to starting the
intravenous line.
14. Answer: 4. Myocardial infarction
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 four (4) to six (6) hours after
infarction (Remember, less than 90 mg/L is normal).
15. Answer: 1. Blocks beta-adrenergic stimulation and
thus causes decreased heart rate, myocardial
contractility, and conduction.
Propranolol hydrochloride is a beta-adrenergic blocking
agent. Actions of propranolol hydrochloride include
reducing heart rate, decreasing myocardial contractility, and
slowing conduction.
16. Answer: 3. Make a commitment to long-term therapy
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: 1. Cerebrovascular accident
Hypertension is referred to as the silent killer for adults,
because until the adult has significant damage to other
systems, hypertension may go undetected. CVA’s can be
related to long-term hypertension.
 Option B and D: Liver or pulmonary disease is
generally not associated with hypertension.
 Option C: Myocardial infarction is generally
related to coronary artery disease.
18. Answer: 3. Take a nitroglycerin tablet before
climbing the stairs.
Nitroglycerin may be used prophylactically before stressful
physical activities such as stair climbing to help the client
remain pain-free.
 Option A: Visiting her friend early in the day
would have no impact on decreasing pain episodes.
 Option B: Resting before or after an activity is not
as likely to help prevent an activity-related pain
episode.
19. Answer: 1. A change in the pattern of her pain
The client should report a change in the pattern of chest
pain. It may indicate increasing severity of CAD.
20. Answer: 2. Assess the extent of arterial blockage
Cardiac catheterization 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 catheterization results.
21. Answer: 3. Vasodilation of peripheral vasculature
Nitroglycerin produces peripheral vasodilation, which
reduces myocardial oxygen consumption and demand.
Vasodilation in coronary arteries and collateral vessels may
also increase blood flow to the ischemic areas of the heart.
Nitroglycerin decreases myocardial oxygen demand.
Nitroglycerin does not have an effect on pericardial
spasticity or conductivity in the myocardium.
22. Answer: 1. Headache
Because of the widespread vasodilating effects,
nitroglycerin often produces such side effects as headache,
hypotension, and dizziness. The client should lie or sit down
to avoid fainting. Nitro does not cause shortness of breath or
stomach cramps.
23. Answer: 3. Take one (1) tablet, then an additional
tablet every five (5) minutes for a total of three (3)
tablets. Call the physician if pain persists after three
tablets.
The correct protocol for nitroglycerin used involves
immediate administration, with subsequent doses taken at 5-
minute intervals as needed, for a total dose of three (3)
tablets. Sublingual nitroglycerin appears in the bloodstream
within two (2) to three (3) minutes and is metabolized within
about 10 minutes.
24. Answer: 3. Left anterior descending artery
The left anterior descending artery is the primary source of
blood flow for the anterior wall of the heart.
 Options A, B, and D: The circumflex artery
supplies the lateral wall, the internal mammary
supplies the mammary, and the right coronary
artery supplies the inferior wall of the heart.
25. Answer: 2. During diastolic
Although the coronary arteries may receive a minute portion
of blood during systole, most of the blood flow to coronary
arteries is supplied during diastole. Breathing patterns are
irrelevant to blood flow.
26. Answer: 3. Inferior
The right coronary artery supplies the right ventricle or the
inferior portion of the heart. Therefore, prolonged occlusion
could produce an infarction in that area. The right coronary
artery doesn’t supply the anterior portion (left ventricle),
 Options A, B, and D: The right coronary artery
doesn’t supply the anterior portion (left ventricle),
lateral portion (some of the left ventricle and the
left atrium), or the apical portion (left ventricle) of
the heart.
27. Answer: 3. Pulmonic
Abnormalities of the pulmonic valve are auscultated at the
second left intercostal space along the left sternal border.
 Option A: Aortic valve abnormalities are heard at
the second intercostal space, to the right of the
sternum.
 Option B: Mitral valve abnormalities are heard at
the fifth intercostal space in the midclavicular line.
 Option D: Tricuspid valve abnormalities are heard
at the 3rd and 4th intercostal spaces along the
sternal border.
28. Answer: 3. Troponin I
Troponin I levels rise rapidly and are detectable within 1
hour of myocardial injury. Troponin levels aren’t detectable
in people without cardiac injury.
29. Answer: 4. Electrocardiogram (ECG)
The ECG is the quickest, most accurate, and most widely
used tool to determine the location of myocardial infarction.
 Option A: Cardiac catheterization is an invasive
study for determining coronary artery disease and
may also indicate the location of myocardial
damage, but the study may not be performed
immediately.
 Option B: Cardiac enzymes are used to diagnose
MI but can’t determine the location.
 Option C: An echocardiogram is used most widely
to view myocardial wall function after an MI has
been diagnosed.
30. Answer: 4. Tightness
The pain of angina usually ranges from a vague feeling of
tightness to heavy, intense pain. Pain impulses originate in
the most visceral muscles and may move to such areas as the
chest, neck, and arms.
31. Answer: 4. Vascular resistance
Vascular resistance is the impedance of blood flow by the
arterioles that most predominantly affects the diastolic
pressure.
 Option B: Cardiac output determines systolic blood
pressure.
32. Answer: 3. Kidneys’ excretion of sodium and water
The kidneys respond to a rise in blood pressure by excreting
sodium and excess water. This response ultimately affects
systolic pressure by regulating blood volume.
33. Answer: 1. Changes in blood pressure
Baroreceptors located in the carotid arteries and aorta sense
pulsatile pressure. Decreases in pulsatile pressure cause a
reflex increase in heart rate. Chemoreceptors in the medulla
are primarily stimulated by carbon dioxide. Peripheral
chemoreceptors in the aorta and carotid arteries are
primarily stimulated by oxygen.
34. Answer: 1. Afterload
Afterload refers to the resistance normally maintained by the
aortic and pulmonic valves, the condition and tone of the
aorta, and the resistance offered by the systemic and
pulmonary arterioles.
 Option B: Cardiac output is the amount of blood
expelled from the heart per minute.
 Option C: Overload refers to an abundance of
circulating volume.
 Option D: Preload is the volume of blood in the
ventricle at the end of diastole.
35. Answer: 4. Preload
Preload is the amount of stretch of the cardiac muscle fibers
at the end of diastole. The volume of blood in the ventricle
at the end of diastole determines the preload.
 Option A: Afterload is the force against which the
ventricle must expel blood.
 Option B: Cardiac index is the individualized
measurement of cardiac output, based on the
client’s body surface area.
 Option C: Cardiac output is the amount of blood
the heart is expelling per minute.
36. Answer: 3. Question the physician about the order
Propranolol and other beta-adrenergic blockers are
contraindicated in a client with asthma, so the nurse should
question the physician before giving the dose. The other
responses are appropriate actions for a client receiving
propranolol, but questioning the physician takes priority.
The client’s apical pulse should always be checked before
giving propranolol; if the pulse rate is extremely low, the
nurse should withhold the drug and notify the physician.
 Options A, B, and D: The other responses are
appropriate actions for a client receiving
propranolol, but questioning the physician takes
priority. The client’s apical pulse should always be
checked before giving propranolol; if the pulse rate
is extremely low, the nurse should withhold the
drug and notify the physician.
37. Answer: 3. Hypokalemia
Furosemide is a potassium-depleting diuretic than can cause
hypokalemia. In turn, hypokalemia increases myocardial
excitability, leading to ventricular tachycardia.
38. Answer: 4. “Avoid salt substitutes.”
Because Spironolactone is a potassium-sparing diuretic, the
client should avoid salt substitutes because of their high
potassium content.
 Options A, B, and C: The client should also avoid
potassium-rich foods and potassium supplements.
To reduce fluid volume overload, sodium
restrictions should continue.
39. Answer: 4. Impulse to travel to the ventricles
The P-R interval is measured on the ECG strip from the
beginning of the P wave to the beginning of the QRS
complex. It is the time it takes for the impulse to travel to
the ventricle.
40. Answer: 1. “Cardiac rehabilitation is not a cure but
can help restore you to many of your former activities.”
Such a response does not have false hope to the client but is
positive and realistic. The answer tells the client what
cardiac rehabilitation is and does not dwell on his negativity
about it.
41. Answer: 3. Distal to the catheter insertion
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Palpating pulses distal to the insertion site is important to
evaluate for thrombophlebitis and vessel occlusion. They
should be bilateral and strong.
42. Answer: 4. Myocardial scarring and perfusion
This scan detects myocardial damage and perfusion, an
acute or chronic MI.
 Option D: Specific ventricular function is tested by
a gated cardiac blood pool scan.
43. Answer: 3. Maintaining cardiac monitoring
Even though initial tests seem to be within normal range, it
takes at least 3 hours for the cardiac enzyme studies to
register. In the meantime, the client needs to be watched for
bradycardia, heart block, ventricular irritability, and other
arrhythmias. Other activities can be accomplished by the MI
monitoring.
44. Answer: 3. The heart has to pump faster to meet the
demand for oxygen when there is lowered arterial
oxygen tension.
The arterial oxygen supply is lowered and the demand for
oxygen is increased, which results in the heart’s having to
beat faster to meet the body’s needs for oxygen.
45. Answer: 1. Creatine kinase (CK or CPK)
Creatine kinase (CK, formally known as CPK) rises in 3-8
hours if an MI is present. When the myocardium is
damaged, CPK leaks out of the cell membranes and into the
bloodstream.
 Options B, C, and D: Lactic dehydrogenase rises in
24-48 hours, and LDH-1 and LDH-2 rises in 8-24
hours.
46. Answer: 1. Decreased arterial blood flow secondary
to vasoconstriction
Decreased arterial flow is a result of vasospasm. The
etiology is unknown. It is more problematic in colder
climates or when the person is under stress. Hyperemia
occurs when the vasospasm is relieved.
47. Answer: 1. “Apply the patch to a nonhairy, nonfatty
area of the upper torso or arms.”
A nitroglycerin patch should be applied to a nonhairy,
nonfatty area for the best and most consistent absorption
rates.
 Option B: Sites should be rotated to prevent skin
irritation.
  Option C: The drug should be continued if
headache occurs because tolerance will develop.
 Option D: Sublingual nitroglycerin should be used
to treat chest pain.

48. Answer: 3. Apply the nitroglycerin patch for 14

hours each and remove for 10 hours at night

Tolerance can be prevented by maintaining an 8- to 12-hour

nitrate-free period each day.

49. Answer: 3. Heart rate increases

Heart rate increases in response to decreased blood pressure

caused by vasodilation.

50. Answer: 2. This combination promotes diuresis but

decreases the risk of hypokalemia

Spironolactone is a potassium-sparing diuretic; furosemide

is a potassium-losing diuretic. Giving these together
minimizes electrolyte imbalance.