CALAYAN EDUCATIONAL FOUNDATION INC Lucena City Medical-Surgical: Cardiovascular Donndulf T. Maningas, RN 1.

During a routine physical examination, a client reports recent occipital headaches, blurred vision, fatigue and increasing edema. The nurse reports these findings as indicative of : a. Endocarditis c. Hypertension b. Hypovolemic Shock d. Ventricular Tachycardia 2. A clients parents ask the nurse, What is the prognosis of myocarditis? The most appropriate response by the nurse is a. A heart transplant would be very promising b. Most often, a person will do well with coronary artery bypass surgery c. A coronary angioplasty would only involve a one to three day hospitalization d. Recovery usually happens without any special treatment 3. The nurse is planning the care for a client in the acute stage of bacterial endocarditis. Which of the following interventions should the nurse include 1. Rest 3. Vitamin K 5. Antibiotics 2. Fluid Restriction 4. Analgesics 6. Physical Therapy a. 1,2,3 b. 1,4,5 c. 1,5,6 d. 1,2,5

4. A client who has hypertension asks the nurse why a urine sample is needed. The nurse informs the client it is to check for a. Protein, which may indicate the kidneys are affected b. Illegal drugs, which may have caused the hypertension c. Infection, which may cause the blood pressure to rise d. The appropriate drug level of the antihypertensive medication 5. Which of the following orders should the nurse question in a client who has been admitted with a possible myocardial infarction and active peptic ulcer disease? a. Nitroglycerin SL c. Morphine IV b. Oxygen by nasal cannula d. Aspirin PO 6. The nurses client asks, How did I get rheumatic disease? The most appropriate response by the nurse is that rheumatic heart disease is frequently a result of a. Hypertension c. Genetic Tendency b. Streptococcal Infection d. Pregnancy 7. Which of the following interventions are a priority during exacerbation of left-sided heart failure? 1. Metered dose inhaler of Albuterol 4. IV fluids 2. High Fowlers position 5. Incentive Inspirometer 3. Oxygen 6. Diuretics a. 2,3,6 c. 1,3,5

b. 3,4,6

d. 1,2,3

8. The nurse is preparing a client to be discharged after a new diagnosis of heart failure. Which of the following statements by the client shows an appropriate understanding of the nurses teaching? a. I will do weekly finger stick monitoring of my glucose levels b. I will call my doctor if I gain more than two pounds in a day c. I will take my angiotensin-converting enzyme (ACE) inhibitor as needed for shortness of breath. d. I will not take my diuretic pill on weekends when I am travelling, in order to avoid incontinence 9. The nurse should monitor a client for after a coronary angioplasty for which of the following clinical manifestations indicating cardiac tamponade? 1. Muffled heart sounds 4. Vision changes 2. Headache 5. Cool, diaphoretic skin 3. Hypotension 6. Tachycardia a. 1,3,4,6 b. 1,2,3,6 c. 1,3,5,6 d. 1,4,5,6

10. The nurse is careing for a client who has allergy to penicillin. Immediately after receiving Cefazolin (Ancef) IV for prophylaxis for a pacemaker insertion, the client becomes restless, tachycardic, and hypertensive. Which of the following interventions should the nurse implement as the priority? a. Administer epinephrine (adrenaline) c. Administer thrombolytic therapy b. Obtain stat blood culture d. Administer atropine 11. After a myocardial infarction, a client has concers about when it is safe to resume sexual activity. The most appropriate response by the nurse is: a. You should really talk to your doctor about that b. Continue with the sexual practice which you are most comfortable c. You need to first undergo a cardiac stress test d. When youre able to climb two flights of stairs comfortably 12. In preparing a client for a transesophageal echocardiogram (TEE), the nurse should include which of the following in the client education? a. You will be able to eat only soft foods for the first day after the procedure b. You will need a designated driver to take you home c. The procedure involves a series of x-rays that require you to come back d. The procedure involves a balloon that will press plaque against the blocked walls of your coronary artery 13. After receiving a permanent pacemaker, the client asks the nurse if there are any activities to avoid during a vacation scheduled four months after discharge. Which of the following is the most appropriate response by the nurse? a. There are no restrictions on you activity b. You should avoid working over a running engine: c. Avoid standing in front of microwave ovens d. Swimming in the ocean should be avoided

14. After a client with coronary artery disease develops heavy, substernal chest pain, which of the following interventions should the nurse do first? a. Administer 2 puffs of albuterol (Preventil) by mouth b. Administer 1 tablet of nitroglycerin under the tongue every 5 minutes; call 911 if no relief after 15 minutes c. Administer 0.04 mg IV push nitroglycerin slowly over 1 to 2 minutes d. Administer immediate synchronized cardioversion 15. The nurse assists the client with coronary artery disease to select which of the following menu choices? 1. Mozzarella cheese 4. Peanut-butter sandwich 2. Grilled cheddar cheese sandwich 5. 2% Milk 3. Tomato juice 6. Tortilla a. 1,6 b. 2,5 c. 3,4 d. 3,6

16. In caring for a client with cardiac history the client has a temperature of 39.4C, becomes tachycardic, hypotensive and short of breath while exhibiting cool, clammy skin and a decreased urine output. The client also has positive blood cultures. The nurse should plan of care for this client? a. Assistance with pericardiocentesis c. Administration of vasopressors b. Administration of antihypertensives d. Assistance with defibrillation 17. Which of the following should the nurse include in the perioperative teaching for a client scheduled for coronary artery bypass graft (CABG) surgery? a. A liquid diet will be ordered for the first four to five days post operatively b. Coughing is to be avoided in order to protect the sterna incision c. The hospital stay in generally about the 10 days d. High calorie supplements are encouraged in the first few weeks postoperative 18. The nurse assesses the left foot of a client with known coronary artery disease that has become suddenly cold, painful, and pulseless. Which of the following would be priority intervention for this client? a. Notify the physician b. Provide education to the client about probable bypass surgery for the clients leg the following week c. Instruct the client on importance of daily doses of warfarin (Coumadin) d. Instruct the client to restrict activity, keeping it warm and elevated until it heals 19. Plans for nursing interventions for a client in the acute stage of bacterial endocarditis should include which of the following interventions? a. Daily ECGs c. Strict fluid restriction b. Administer of analgesics as needed d. Aggressive physical activity 20. Which of the following is a priority for the nurse to report when obtaining a history from a client scheduled for a coronary angiogram? a. A history of rheumatic heart disease b. A history of allergy to shellfish c. A recent diagnosis of hyperlipidemia

d. A previous coronary angioplasty to the right coronary artery 21. Which of the following should the nurse include in the plan of care for a client following a coronary angiogram? a. Vigorous leg exercise c. Encourage fluids b. Immediate cardiac stress test d. Activity restriction for four to six weeks 22. The nurse is teaching a class to student nurses on rheumatic fever. Which of the following should the nurse include in the class? Which of the following should the nurse include in the class? Rheumatic fever a. Occurs mainly in the elderly b. Is more likely to develop after a varicella zoster infection c. Is easy to be diagnosed with a throat culture and serum antistreptolysin titer d. May be diagnosed by a series of two-step blood cultures 23. Which of the following should the nurse include in the plan of care for the client experiencing pain from a deep vein thrombosis (DVT) of the left who is receiving heparin and warfarin (Coumadin)? Administration of a. Aspirin 325 mg PO every 4 hours b. Patient-controlled analgesic of IV morphine c. Meperidine (Demerol) 50 mg IV every 3 hours d. Ibuprofen (Motrin) 400 mg PO every 6 hours PRN 24. The client with a recent diagnosis of cardiomyopathy asks the nurse, What contributed to my getting this illness? The most appropriate response is to say that the majority of clients with cardiomyopathy also have a. Hypertension c. A genetic trait b. A viral infection d. An unknown cause 25. The nurse is teaching the client what to expect after coronary artery bypass graft surgery (CABG), Which of the following client statements demonstrate that the client correctly understood the teaching? a. I will be given a pen and paper to communicate, because I will still have a breathing tube in my throat b. I will be fed with a tube into my stomach until I can eat again c. Pain medicine is generally not needed after this surgery d. The nurses will be checking one me every four hours 26. The nurse should include which of the following in the plan of care of a client after a pacemaker is inserted? a. Instruct the client to avoid lifting the arm on the pacemaker above shoulder height. b. Encourage the client to exercise the shoulder and arm on the side of the pacemaker four times a day. c. Encourage the client to wash the pacemaker incision with warm soapy water twice a day. d. Instruct the client to avoid the use of microwave ovens. 27. In caring for a client with atrial flutter, which of the following goals would have priority? a. Reduce the ventricular rate to below 100 beats per minute b. Identify and treat the underlying cause c. Control the heart rate and maintain cardiac output

d. Increase the heart rate 28. Which of the following should the nurse include in the plan of care with sinus tachycardia a. Administer lidocaine b. Assess the client c. Administer atropine d. Cardioversion 29. On the duty in the emergency room, the nurse is concerned when a client continues to bleed from severe lacerations even after applying direct pressure. The next action is to a. Apply the ice to lower the body temperature b. Monitor closely for signs of shock c. Elevate the upper extremities and apply blankets to raise body temperature. d. Maintain a patent airway and prevent vomiting 30. A 54 year old client was put on quinidine (a drug that decreases myocardial excitability) to prevent atrial fibrillation. He also has kidney disease. The nurse is aware that this drug, when given to a client with kidney disease, may a. Cause cardiac arrest c. Produce mild bradycardia b. Cause hypotension d. Be very toxic even inn small doses 31. Thrombolytic therapy would be appropriate for which of the following conditions a. Continual blood pressure above 200/120 c. History of significant kidney disease b. History of diabetic retinopathy d. Myocardial Infarction 32. When assessing an ECG, the nurse knows that the PR interval represents the time it takes for the a. Impulse to begin atrial contraction b. Impulse to traverse the atria to the AV node c. SA node to discharge the impulse to begin atrial depolarization d. Impulse to travel to the ventricles 33. Monitoring a central venous pressure (CVP), the nurse understands that a normal reading is between a. 5 and 15 cm c. 5 and 10 cm b. 10 and 15 cm d. 10 and 20 cm 34. Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease. After discharge from coronary care unit with a significant MI, the client is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesnt understand why he needs to be there because there is nothing that can be done and the damage is done. The best nursing response is a. Cardiac rehabilitation is not a cure but can help restore you to many of your former activities b. Here we teach you gradually change your lifestyle to accommodate your heart disease c. You are probably right but can gradually increases your activities so that you can live a more active life d. Do you feel that you will have to make some changes in your life now?

35. A client admitted with the diagnosis of cardiac disease tells the nurse he is afraid of dying from a heart attack. The most therapeutic response is a. Perhaps you should discuss this with you physician b. Of course you arent going to die c. What makes you think you will die d. Tell me more about these fears of dying from a heart attack 36. To evaluate a clients condition following cardiac catheterization, the priority intervention is to palpate the pulse a. In all extremities b. At the insertion site c. Distal to the catheter insertion d. Above the catheter insertion 37. While admitting a client scheduled for a cardiac catheterization the client states to the nurse, I always get a rash when I eat shellfish. The following safety protocol, the most appropriate initial nursing intervention is to a. Notify the physician b. Place a note on the chart regarding this reaction c. Ask this client if there are any other foods that cause such a reaction d. Notify the dietitian of the reaction and request a no shellfish diet 38. A clients physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting a radioscope into the blood stream is to detect. a. Normal versus abnormal tissue c. Ventricular function b. Damage in areas of the heart d. Myocardial scarring and perfusion 39. A client enters the emergency department complaining of severe chest pain. A myocardial infarction is suspected. A 12-lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has highest priority. a. Monitor vital signs c. Maintaining cardiac monitoring b. Completing a physical assessment d. Maintaining at least one IV access site 40. A client is experiencing tachycardia. The nurses understanding of the physiological basis for this symptom is explained by which of the following statements? a. The demand for oxygen is decreased because of pleural involvement b. The inflammatory process causes the body to demand more oxygen to meet its needs c. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension d. Respirations are labored 41. A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure (PWCP). The physician orders dopamine to improve ventricular function. The nurse will know the medication is working if the clients a. Blood pressure rises c. Cardiac index falls b. Blood pressure decreases d. PWCP rises 42. The nurse knows that the most informative measurement for determining cardiogenic shock is

a. Arterial blood pressure b. Central venous pressure

c. Pulmonary artery pressure d. Cardiac output index

43. A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. The complication that the nurse will constantly observe for is a. Presence of a heart murmur c. Fever b. Systemic emboli d. Congestive heart failure 44. A 35 year old male was knifed in a street fight admitted through the emergency room, and is now in the ICU. An assessment of his condition reveals the following symptom: respiration shallow and rapid, paradoxical pulse, CVP 15 cm H20, BP 90 mm Hg systolic, skin cold and pale, urinary output 60-100ml/hr for the last 2 hours. Analyzing these symptoms, the nurse will base a nursing diagnosis on the conclusion that the client has which one of the following conditions. a. Hypovolemic shock c. Wound Dehiscence b. Cardiac Tamponade d. Atelectasis 45. Throbophlebitis is common complication following vascular surgery. Which of the following signs indicates that a possible thrombus has occurred. a. Kernigs sign c. Dull, aching calf pain b. Homans sign d. Soft, pliable calf muscle 46. In preparation for discharge of a client with arterial insuffiency and Raynauds Disease, client teaching instructions should include a. Walking several times each day as part of an exercise routine b. Keeping the heat up so that the environment is warm c. Wearing hose during the day d. Using hydrotherapy for increasing oxygenation 47. A 45 year old male client with leg ulcers and arterial insuffiency is admitted to the hospital. The nurse understand that the leg ulcers of this nature are usually caused by a. Decreased arterial blood flow secondary to vasoconstriction b. Decreased arterial blood flow leading to hyperemia c. Atherosclerotic obstruction of arteries d. Trauma to the lower extremities 48. A client comes into the clinic and tells the nurse that he has leg pains that begin when he walks but cease when he stops walking. Which of the following conditions would the nurse assess for? a. An acute obstruction in the vessels of the legs b. Peripheral vascular problems in both legs c. Diabetes d. Calcium deficiency 49. A client who recently started taking a daily dose of the drug methyldopa (Aldomet) for hypertension complains of drowsiness and lethargy when the nurse makes a home visit. The nursing intervention would be to a. Notify the physician of the negative side effects so the dose can be reduced b. Ask the physician to prescribe another antihypertensive c. Suggest that the client take the medication in the evening and reevaluate on the next visit

d. Explain what these are expected side effects and he will have to live with them 50. Dyspnea associated with congestive heart failure is primarily due to a. Blockage of a pulmonary artery by an embolus b. Accumulation of fluid in the interstitial spaces and alveoli of the lungs c. Blockage of bronchi by mucous secretions d. Compression of lungs by the dilated lungs 51. The client returns to the clinic a week after discharge following a leg fracture. The fracture was complicated by a clot in the left leg. The orders were to remain on Coumadin. The client has a prothrombin time drawn. The results indicate that it is 24 seconds. The follow up care plan for the client is based on the knowledge that these results are a. Above normal and in the therapeutic range b. Below normal and in the therapeutic range c. Normal within acceptable limits d. Abnormal and test should be repeated 52. Before administering digoxin (Lanoxin) what is the most important action for the nurse to take? a. Provide foods high in potassium. (K+) c. Take an apical pulse b. Take the clients blood pressure d. Weigh the client daily 53. The client is complaining of a headache after administration of nitroglycerine. What should be the nurse instruct the client to do? a. Decrease the nitroglycerine dose b. Do not take the next scheduled dose of nitroglycerine c. Lie down in a cool environment and rest d. Tell a healthcare worker immediately 54. The client is diagnosed with angina. What should the nurse teach the client about taking Nitroglycerine SL? a. After taking one SL NTG without a relief of symptoms, the client should call his doctor b. Carry NTG in your pocket when you leave the house c. Replace the NTG every year d. Take NTG before exercising to prevent angina from occurring 55. What should the nurse have available if the patient receives an overdose of heparin? a. Iron c. Protamine Sulfate b. Platelets d. Vitamin K 56. A client has just returned from a cardiac catheterization. Nursing care for this client would include which of the following options? a. Check the extremity, distal to catheterization site for color, temperature, pulse and capillary refill b. Keep the extremity bent at 45 angle immediately postoperative c. Keep the head of the bed elevated to 45 d. Place a loose dressing over the catheterization site 57. Modifiable risks factors for atherosclerosis include which of the following? 1. Age 4. Hypertension 6. Smoking

2. Diet 3. Hypercholesterolemia a. 1,2,3,4 b. 2,3,4,5,6,7

5. Obesity c. 2,4,6 d. 3,5,7

7. Weight loss

58. Dyspnea, edema, fatigue and tachycardia are clinical manifestations of which of the following? a. Asthma c. Heart failure b. Aortic valve regurgitation d. Pneumonia 59. Which of the following is a manifestation of chronic venous insuffiency? a. Dry, necrotic ulcers in the feet c. Hair loss b. Edema d. Thick, deformed toenails 60. Which of the following contribute to deep vein thrombosis? a. Dehydration, immobility and oral contraceptives b. Dehydration, oral contraceptives, and high intake of calcium c. Hypertension, immobility, and dehydration d. Immobility, diabetes and digoxin (Lanoxin) 61. When auscultating a clients heart sounds, the nurse hears turbulence occurring between this findings as indicative of which of the following? a. Cardiac murmurs c. Normal heart sounds b. Fourth heart sound (S4) d. Third heart sound (S3) 62. In P wave on an ECG represents an impulse that begins in which of the following? a. In the AV node and depolarizes the atria b. In the AV node and repolarizes the atria c. In the SA node and depolarizes the atria d. In the SA node and repolarized the atria 63. Unmodifiable risk factors for a client with coronary artery disease include which of the following? a. Age c. Hypertension b. Cigarette smoking d. Physical Inactivity 64. A client in the hospital with angina tells his nurse that he is having chest pain. What does the nurse understand this to mean a. The clients symptoms are associated with irreversible cardiac muscle damage b. The client is experiencing a heart attack c. The client will have pain relief with rest, nitroglycerine, or both d. The client will have ST changes on the ECG 65. Antiplatelet aggregation therapy is a first line of treatment for which of the following? a. Angina c. Pulmonary embolus b. Arrhythmia d. Valve disease 66. A client in the CCU is complaining of chest pain. He categorizes his chest pain as a 6 (on a 1 to 10 scale). His BP is 108/72. The nurse gives the client NTG 1/150 sublingual. After 5 minutes, the client states that his chest pain is now a 2. What should the nurse do next?

a. Administer another NTG b. Check the blood pressure

c. Check the pulse rate d. Obtain an EKG

67. A client is experiencing shortness of breath in the supine position, fatigue, jugular vein distention, and a third heart sounds (S3). The name concludes that these are signs and symptoms of which of the following? a. Coronary artery disease c. Hypertension b. Heart failure d. Valvular heart disease 68. Which diuretic is a potassium sparing diuretics? a. Furosemide (Lasix) c. Mannitol (Osmitrol) b. Hydrochlorothiazide (Esidrix) d. Spironolactone (Aldactone) 69. Which is the antidote for a severe warfarin (Coumadin) overdose? a. Protamine zinc c. Vitamin E b. Protamine sulfate d. Vitamin K 70. Nursing consideration when administering digoxin (Lanoxin) to an adult include which of the following? a. Holding the medication if the heart rate is above 100 beats per minutes b. Instructing the client to eat foods that are low in potassium c. Taking an apical pulse for 15 seconds before administrations d. Understanding the signs and symptoms of nausea, vomiting, and anorexia need to be reported to the physician. 71. A client comes to the ER and states that she had chest pain lasting for 10 minutes after walking up the steps. After resting, her pain subsided. Which of the following is the client experiencing? a. Acute myocardial infarction c. Heart failure b. Angina d. Pneumothorax 72. Which of the following assessment findings by the nurse indicates right ventricular failure? a. A dry hacking cough c. Nocturia b. Jugular vein distention d. Pulmonary edema 73. When checking capillary refill on a client, the color returns to normal in 10 seconds. The nurse understands that this finding is indicative of which of the following? a. Impaired arterial blood flow to the extremities b. Impaired venous blood flow to the extremities c. Normal capillary refill time d. Thrombus formation in the vein 74. The nurse is giving warfarin (Coumadin) to a client with atrial fibrillation. What does the nurse understand the implications of this medication to be? a. Coumadin is helpful in converting atrial fibrillation to sinus rhythm b. Coumadin is used to dissolve clots c. Coumadin is used to prevent heart attacks in the clients with atrial fibrillation d. Coumadin is used to prevent strokes in clients with atrial fibrillation.

75. The client is being discharged after his treatment for atrial fibrillation. He will take warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of Coumadin? a. I will begin an exercise program b. I will get routine PTT levels drawn c. I will take aspirin instead of Tylenol for my headaches d. I will use my electric razor for shaving instead of using my razor blades 76. Which of the following is important to teach the client who has receives an implantable cardiac defibrillator? a. The client will no longer be allowed to travel by air due to security screening b. Family members should learn CPR c. Routine ICD checks are needed every year d. The ICD is small enough to fit into the clients pockets 77. The client who is risk for infective endocarditis must understand the significance of prophylactic antibiotic therapy before which of the following occurs? a. All chest X-rays c. All dental procedures b. Beginning an exercise program d. Becoming pregnant 78. The nurse suspects the presence of a deep vein thrombosis (DVT) based on which of the following findings? a. Coolness of the leg c. Pain in the ankle and foot b. Decreased pedal pulses d. Unilateral leg edema 79. A client is preparing for an exercise stress test. The nurse understands that the client needs additional teaching if he makes which of the following comments? a. I will not smoke prior to my test b. I will take my medications the morning of my test c. I will allow for eight hours of sleep the night prior to the test d. I will only have coffee the morning of exam 80. An adult client is experiencing cardiac arrest and the nurse is performing CPR. Which of the following is the correct hand position on the clients chest? a. The middle of the sternum b. Over the upper half of the clients chest c. Over the xyphoid process d. Two finger widths above the xyphoid process