92-125 cardio

112 111

CARDIOVASCULAR PROCEDURES CORONARY ARTERY DISEASES HEART FAILURE CARDIOMYOPATHY VALVULAR DISORDERS INFECTIVE HEART DISORDERS DYSRHYTHMIAS AND HEART BLOCKS HYPERTENSION ANEURYSM ARTERIAL AND VENOUS DISORDERSCARDIOVASCULAR PROCEDURES

1. A newly hired nurse is assigned to a status-post coronary artery bypass grafting client just 3 days ago. Being new in the area, you reviewed the clients chart and the surgical progress notes seeing that this type of surgery involves the revascularization of the coronary artery by harvesting available blood vessels in the body as the conduits. All but one is the most common sources of grafts

a. left internal mammary arteries.

b. great saphenous vein from the leg.

c. jugular veins from the neck.

d. left internal thoracic artery.

2. A client diagnosed with congestive heart failure is place on hemodynamic monitoring with the use of a Swan-Ganz catheter inserted via the antecubital vein. This monitoring technique will reflect which information of the clients heart?

a. Indirectly measures the left ventricular pressure

b. Directly measures oxygen-carbon dioxide interchange

c. Measures coronary artery perfusion

d. Analyzes the adequacy of pulmonary circulation.

3. After a diagnostic work up, Gem had her latest cholesterol level of 398 mg/dL. She was visited by a home health care nurse and asked what drug was prescribed to her due to hypercholesterolemia. Gem showed the nurse her latest pill of cholestyramine (Questran). After the nurse gave health teachings about the drug, which of the following statements, if made by Gem, indicates the need for further education?

a. I'll continue to watch my diet and reduce my fats.

b. I'll continue my nicotinic acid from the health food store.

c. Constipation and bloating might be a problem.

d. Walking a mile each day will help the whole process.

4. Helen, the neighbor of Gem also found out that she has high cholesterol level. She was prescribed with nicotic acid by her physician. The clinic nurse provided instructions to Helen about the medication. Among the following teachings of the nurse reflects the understanding of Helen about nicotic acid?

a. Nicotic acid should be taken on an empty stomach to decrease flushing.

b. I should take aspirin half an hour before taking nicotic acid to decrease flushing episodes.

c. Alcohol consumption should be limited when not taking the drug.

d. Large dose is necessary to achieve rapid decreased in cholesterol.

5. Pulsus paradoxus occurs to Jay who, 4 days ago, had coronary artery bypass graft surgery using the internal mammary artery. The nurse taking care of Jay is alerted by which complication of the surgery as evidenced by the pulsus paradoxus?

a. Pulmonic regurgitation.

b. Cor pulmonale

c. Mobitz I, a second degree AV block

d. Cardiac tamponade.

6. A client who has been experiencing syncope several times now, is advised to undergo 24-hour Holter monitoring. The client became anxious for not understanding clearly what the physician explained. The nurse will correctly reinforce what the physician explained to the client that Holter monitoring involves continuous ECG monitoring and it is necessary to

a. keep the lower extremities elevated while sitting.b. try to relax and limit exercise as much as possible.c. record the time and type of physical activities performed.d. take the radial pulse rate every hour during the next day.7. Asyong Salonga will undergo treadmill testing the next day. The physician asked the nurse to give teachings to the client regarding the preparations for the test. The nurse is incorrect if which of the following pre-procedural teaching she gave Asyong Salonga?

a. avoid smoking, coffee, and tea on the day of the test

b. wear rubber-soled comfortable shoes

c. eat a light meal 2 hours before the test

d. take the usual nitroglycerine dose 30 minutes before the test

8. Nino is in the telemetry unit for 24 hours under a Holter monitor. After the 24-hour continuous reading, the physician advised Nino for admission. During admission assessment, the nurse noted fast and irregular apical pulse on Nino and the nurse notifies the physician. The physician prepares to cardiovert Nino with the understanding that cardioversion involves

a. introduction of a contrast medium to outline the heart.

b. electrically recorded and amplified heart sounds.

c. administration of electrical shock through chest paddles.

d. delivery of electrical stimulation through an implanted device.

9. After initiation of four shocks on the client, the nurse must know that the best evidence of success of cardioversion is

a. pulse pressure of 30 mmHg.

b. pulse deficit of 0.

c. P and T wave normal, QRS 0.08 seconds.

d. client regains consciousness immediately.10. A client is lying on her bed while on the telemetry floor. A continuous cardiac monitor was placed in her chest 4 hours ago, which begins to sound its alarm. The nurse rushed to the room and looked at the monitor and saw no electrocardiographic complexes. The nurse will implement which next action?

a. report immediately to the physician since this means an arrest

b. initiate a code and bring the emergency drug

c. document the findings on the chart

d. view the lead placement and assess the client

CORONARY ARTERY DISEASES

11. The relatives of a client were waiting if myocardial infarction was ruled out as the possible diagnosis of the client. A 12-lead ECG was ordered and the nurse monitors for which of the following ECG pattern that indicates acute myocardial injury?

a. Prolonged QT interval

b. Pathologic U wave

c. ST segment elevation

d. Flat T wave

12. After acute myocardial infarction was confirmed, the physician ordered morphine sulfate, aspirin, and nitroglycerine as the clients medications. As a knowledgeable nurse, you know that which of the following reasons why these drugs were ordered?

a. morphine to decrease the pain, nitroglycerine to dilate the arteries, and aspirin to prevent clot formation

b. morphine to decrease the hearts oxygen demand, nitroglycerine to decrease the lumen of the aorta, and aspirin to dissolve the clot

c. morphine to sedate the client, nitroglycerine to decrease the pain, and aspirin to thin the blood

d. morphine to decrease the hearts oxygen demand, nitroglycerine for coronary artery dilation, and aspirin to prevent clot formation

13. A client in the emergency room is being asked by the nurse regarding the history of the acute myocardial attack. Which of the following questions would be most important for the nurse to ask?

a. "Did you experience numbness in your chest?"b. "Did the pain started while eating?"c. "Have you experienced a pounding headache?"d. At what time did the pain start?"14. Warfarin was prescribed to Wilma who was diagnosed of Acute Myocardial Infarction 5 days ago. The order revealed to take warfarin orally once a day in the evening. The nurse prepared a teaching plan for Wilma, specifically for the safe administration of Warfarin at home, taking into consideration the teachings about the action and effect of warfarin which is

a. prevents hepatic synthesis of Vitamin K dependent clotting factors.

b. prevents the replacement of prothrombin to thrombin.

c. as a tissue-plasminogen activator that dissolves existing clot.

d. prevents the coagulation of platelets.

15. Enteng was rushed in the emergency room 2 hours ago after an acute myocardial attack with chief complaints of shortness of breath, diaphoresis, trembling and slight confusion. The vital signs revealed heart rate of 118 beats/minute, blood pressure of 80/55 mmHg, and excess heart sounds S3 and S4. He was inserted with an indwelling catheter with only 33 ml of urine for the past 2 hours. After the emergency clearance and appropriate referral, Enteng was transferred to a nearby tertiary hospital specifically in the intensive care unit and with an outgoing order of insertion of pulmonary artery catheter. As the nurse that referred the client to the next hospital, you know that the client is experiencing

a. a cardiogenic shock.

b. aneurysm rupture.

c. cardiac tamponade.

d. mitral valve prolapse with heart failure.

16. Nitroglycerine is the drug of choice for clients with anginal pain. Julio, after being diagnosed of angina pectoris due to successive chest pain episodes, was given with nitroglycerine sublingual as an emergency drug for chest pain. The nurse should teach Julio to suspect that nitroglycerin sublingual tablets have lost their potency when:a. Onset of relief is delayed, but the duration of relief is unchanged.

b. Pain is more than 15 minutes after 2 doses.

c. The tablets in the cabinet are more than 4 months.

d. Tingling sensation in the mouth is experienced.

17. Presence of a thrombus is the most common cause of acute myocardial infarction that can lead to cardiogenic shock. If thrombolytic therapy is not effective, coronary perfusion can be achieved by what mechanical device that increases coronary perfusion and cardiac output while decreasing the workload of the heart and oxygen consumption?

a. Intra-aortic balloon pump

b. Cardioverter

c. Demand pacemaker

d. Coronary angiography

18. An elite business man is recovering from severe myocardial infarction. For the past 3 days, the patients hygiene and grooming needs have been met by the nursing staff. Which of the following activities should be implemented to achieve the goal of independence for Mr. Lozano?

a. Preparing a day-to-day activity list to be followed by the clientb. Involving family members in meeting clients personal needsc. Involving Mr. Lozano in his cared. Meeting his needs till he is ready to perform self-care19. Electrocardiography (ECG) is a graphical recording that evaluates the electrical activity of the heart. Clients who experienced myocardial infarction will have pertinent ECG wave patterns that are used to assess the severity of the attack. Which of the following ECG results would reveal that there is myocardial infarct?

a. ST segment elevation indicating cellular death and short T wave indicating cellular infarct

b. ST segment depression indicating cellular ischemia and peaked T wave indicating cellular injury

c. ST segment elevation indicating cellular injury and inverted T wave indicating cellular ischemia

d. ST segment depression indicating cellular death and peaked T wave indicating cellular infarct

20. The nurse is teaching a client diagnosed with myocardial infarction due to hypercholesterolemia, about dietary regimen. History reveals that the clients usual breakfast are bacon, hash browns, eggs, whole milk and cheese. The nurse will correctly teach about diet modification with the healthiest substitute food for this client which is

a. cereal for eggs.

b. sausage for bacon.

c. butter for cheese.

d. white bread for hash browns.

21. Nitroglycerine is the medication primarily ordered to clients with angina pectoris. Nitroglycerine could be used sublingually or in a form of patch. The primary nurse is giving drug instructions for discharge regarding the use of a nitrate patch. The nurse will correctly tell the client that the nitrate patch should be

a. worn for continuous 12 hours then 12 hours rest in between.

b. worn for continuous 8 hours then 4 hours rest in between.

c. worn for continuous 4 hours then 2 hours rest in between.

d. worn continuously for 24 hours.

22. A medical-surgical ward nurse is responsible in giving discharge health teachings about the nitroglycerine sublingual to Poli, with angina pectoris. Which of the following instructions does the nurse include in the teaching?

a. Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down.b. Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved.c. When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.d. Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.23. Dietary and lifestyle changes were proven not sufficient for Maria with a cholesterol level of 430 mg/dl and a history of chest pain episodes. Maria was ordered with lipid-lowering agents by her physician as adjunct treatment for hypercholesterolemia. Atorvastatin calcium (Lipitor) was ordered and the potential side effect according to the nurse during health teaching is

a. cachexia.

b. myalgia.

c. yellow halos.

d. irregular pulse.

24. Reynan will undergo cardiac catheterization and coronary arteriogram to determine the location of the clot that caused his myocardial attack. Being anxious, he was not able to understand completely what the physician told him before he sign the consent. As a knowledgeable nurse, you reinforced the teaching and which client statement indicates that he understands what will happen during the testing procedure?

a. Reynan says that when the dye is instilled, warmth will be felt.

b. Reynan says that he will be unconscious for the rest of the procedure.

c. Reynan says that even when anesthetized, he will experience a heavy sensation in his entire body.

d. Reynan says he will be able to hear his heart beating in his chest.

25. Following myocardial infarction, the physician ordered Streptokinase, a thrombolytic drug that dissolves the thrombus. When the client experiences gum bleeding, hematemesis, and melena, which medication that should be at hand or in the clients pocket?

a. Coumadin

b. Aquamephyton

c. Protamine Sulfate

d. Aminocaproic Acid

26. Monitoring for complication is a critical duty of a nurse especially to debilitating disorders like myocardial infarction. To which of the following assessments of a patient who had a recent myocardial infarction would the nurse give the highest priority?

a. Chest painb. Ventricular dysrhythmiasc. Bibasilar ralesd. Moderate levels of anxiety27. A male client with a history of chronic tobacco abuse was admitted with anginal pectoris. During coronary artery bypass graft (CABG) surgery, the client revealed an oxygen saturation of 88%. Subsequently, the client remains on a ventilator two days longer than anticipated. Which factor should the nurse consider when evaluating the client's progress?

a. Standard.b. Outcome.c. Variance.d. Goal.HEART FAILURE

28. Functional nursing is used in a hospital and a newly hired cardiovascular nurse is responsible to prepare and give medications to all patients diagnosed with heart failure. The most common drug in all the clients is Lanoxin, a cardiac glycoside. Being new in the Cardiac Unit, she reviewed her notes on Lanoxin and noted that the long standing hallmark in nursing intervention for clients taking Lanoxin is:

a. Palpate the radial pulse for one full minute.

b. Auscultate the apical pulse for one full minute.

c. Monitor potassium values every 2 days.

d. Get the blood pressure twice in the same arm before giving the drug.

29. Sydney is an experienced cardiovascular nurse in a tertiary hospital in town. She was assigned to a newly admitted client with a diagnosis of congestive heart failure. Sydney is reading the chart and notes which of the following data signifies that the client is developing a complication of heart failure?a.severe persistent diarrhea

b.increased SGPT value

c. increased circumference of the abdomend. verbalization of irritability

30. Regular assessment of a client with heart failure is necessary for the nurse to note for the effectivity of the medical regimen. The nurse determines that treatment of heart failure has been successful when the patient experiences a.alertness and no pain experienced.

b.normal heart rate and no adventitious breath sound.

c.heaves and bradycardia.

d.Easy fatigability and cyanosis.31. Congestive heart failure may lead to systemic backflow and fluid stasis in the different body parts. As a knowledgeable nurse, you know that edema is a classic sign of right-sided heart failure mainly due to what pressure change?

a. increased plasma hydrostatic pressure

b. decreased plasma hydrostatic pressure

c. increased plasma colloid oncotic pressure

d. decreased plasma colloid oncotic pressure

32. The nurse is caring for a 78-year-old Lola diagnosed with congestive heart failure. During the shift assessment, the nurse should keep in mind which clients complaint that necessitates the review of the latest digitalis level prior to the administration of the drug?

a. Constipation

b. Hypokalemia

c. Increased appetite

d. Body malaise

33. The nurse is admitting a client with right-sided ventricular heart failure with a complaint of pitting edema in both lower extremities. Further assessment of the nurse also revealed the presence of jugular vein distention. Which method is the most appropriate to assess or measure a clients jugular venous distention?

a. Recognize that a visible pulse at 2 cm below the sternal angle is recorded as distended.

b. Inspect external jugular vein for distention with the client in the supine position.

c. Observe for pulsations of the jugular vein that fluctuate with clients inspiration and expiration.

d. Place the client in a trendelenburg position for 5 minutes prior to assessment.

34. Due to pulmonary congestion, the nurse of Nora noted that her pulse is grade +2 but is becoming pale. The nurse reported this to the physician and the physician ordered supplemental oxygen therapy. The nurse is observing the clients response to the therapy and notes which assessment finding indicates that the oxygen therapy is effective?

a. the apical pulse is grade +3

b. the clients cheeks become blushed

c. the client wishes to increase the flow rate

d. the Blanch test reveals 3 seconds and above

35. The nurse is monitoring a client in the Intensive Care Unit with a diagnosis of congestive heart failure. Before giving the clients noontime diuretic, the nurse viewed the chart and notes that which of the following laboratory findings would warrant immediate attention?

a. Chloride 97 mEq/L

b. Bicarbonate 26 mEq/L

c. Potassium 2.8 mEq/L

d. Sodium 141 mEq/L

36. Discharge instructions in a client, after being admitted with congestive heart failure for 10 days, include the instructions about when to call the health care provider and to report which of these findings at home?

a. Appearance of non-pitting ankle edema

b. Weight gain of 1.5 pounds or more in 36-hour period

c. Decreased appetite and nausea

d. Filling the level of a cup 4 times each day

37. The client with congestive heart failure is for discharge. The nurse is giving health teaching regarding the intake of digoxin, an inotropic drug. It is essential for the nurse to discuss which of the following to be assessed periodically before giving digoxin?

a. blood pressure and sodium levels

b. heart sounds and radial pulse

c. apical pulse and potassium levels

d. blood pressure and radial pulse

38. After being diagnosed with left-sided heart failure, the client began to exhibit pink sputum and difficulty of breathing. Pulmonary edema is concluded by the physician as a complication. The nurse is making a nursing care plan and the primary goal of therapy for a client is

a. decrease leg edema.

b. improve respiratory status.

c. enhance comfort.

d. increase cardiac output.

CARDIOMYOPATHY

39. A 55-year-old client with end-stage cardiomyopathy is scheduled for a heart transplant at 9 in the morning the next day. Night before the surgery, the nurse reviews the surgical procedure with the client. The client is very anxious that is why there has been a problem about comprehending the surgical information. The next priority action of the nurse is to

a. sit beside the client and encourage verbalization of fears about the surgery.b. request an order of sedative from the physician.

c. provide a clip of the entire surgical procedure and do question and answer after.

d. discuss the surgery when husband and wife are together.40. Cardiomyopathy involves problems in the cardiac structures that make the cardiac muscles weak. This could be in a form of stiffened contraction, or enlarged ventricles, or dilated chambers and layers. Heart failure is a common complication, like left-sided heart failure, which is characterized by

a. Edema on both feet and pulmonary congestion.

b. Air hunger and tachycardia.

c. Hepatomegaly and neck vein distention.

d. Ascites and orthopnea.

41. Kingpin was diagnosed of hypertrophic cardiomyopathy a year ago and is now at the emergency room for developing the expected medical complication of cardiomyopathy which is

a. Cor pulmonale.

b. Cardiogenic shock.

c. Mitral valve stenosis.

d. Heart failure.

42. As a knowledgeable nurse assigned to a client admitted due to dilated cardiomyopathy, you would expect the physician to order which of the following, as the best treatment modality for this disorder?

a. Verapamil twice daily for 2 years.

b. Maintain client on a left lateral recumbent position.

c. Heart transplant, with heart-lung machine for continuous circulation.

d. Coronary artery bypass grafting using the great saphenous vein.

43. CJ is a new nurse in the cardiac unit. He asked Jun about cardiomyopathy and its mechanism. Jun will correctly discuss cardiomyopathy if he explained to CJ that

a. Restrictive cardiomyopathy is treated with ethanol injection.

b. In hypertrophic cardiomyopathy, cardiac output remains normal.

c. Dilated cardiomyopathy can tolerate strenuous exercise.

d. Restrictive and dilated cardiomyopathies are due to lung infections.

VALVULAR DISORDERS

44. A client with unstable ventricular dysrhythmias had undergone surgical procedure and has now an implantable cardioverter defibrillator (ICD). Upon discharge, the nurse has correct understanding of the risk of this implant when she instruct the client

a. The use of appliances at home is not permitted.

b. Carry the cell phone opposite the implant.c. Lifetime restriction in driving.d. Do not lift heavy objects.45. A 25-year-old teacher was given an employment visa abroad and is now scheduled to undergo physical examination. The result of one of the cardiac tests is the presence of a heart murmur. History reveals that it is related to a childhood infection that affected one of the valves of the heart. The nurse taking the clients history will most likely hear from the client that the childhood infection is

a. Lyssa also known as Rabies.

b. Singles, the second attack of varicella.

c. Rheumatic fever due to Group A beta hemolytic streptococcus.

d. Intrauterine rubella infection.

46. Aortic stenosis is the narrowing of the opening of the aortic semilunar valve. Which of the following is an assessment finding for a client with aortic stenosis?

a. Crescendo-decrescendo murmur

b. Loud, rough systolic murmur

c. Regurgitant murmur

d. Diastolic murmur

47. After undergoing echocardiography, Juan Paulo was informed that he has mitral valve stenosis. The most accurate explanation of the nurse to Juan Paulo that the location of the mitral valve is between the

a. left ventricle and the aortab. right atrium and right ventriclec. left atrium and left ventricled. right ventricle and the pulmonary artery48. Juan Paulo asked the nurse that he would like to hear the sound of his mitral valve to know the sound that the defect creates. The nurse will correctly instruct Juan Paulo that auscultation of the mitral valve will be best heard at

a. at the second intercostal space to the left of the sternumb. at the second intercostal space to the right of the sternumc. at the fifth intercostal space in the left midclavicular lined. at the fourth intercostal space to the left of the sternum49. The physician arrived at Juan Paulos unit and prescribed him with 250 mg nafcillin sodium (Unipen) by mouth once a day. Juan Paulo asked the nurse about the indication of the drug for him with mitral stenosis. The nurse will give correct explanation when she tells Juan Paulo that nafcillin sodium may

a. hinder potential bacterial infections.b. kill the viral agent that caused the stenosis.c. prevent scarring of the valve.d. avoid coagulation of the blood.50. Diagnosed a decade now with mitral valve stenosis, the client was prescribed and is taking for this long period Lasix, a loop diuretic, and Lanoxin, a cardiac glycoside. Now, he is at the emergency room for severe shortness of breath, loud machinery murmur and possible heart failure. The physician recommended mitral valve replacement surgery. Which statement indicates that the client understands the surgical procedure involving mitral valve replacement?

a. The client says a piece of his leg vein will be used to replace his valve.b. The client says his blood will be circulated through a heart-lung machine.c. The client says the surgeon will enlarge his valve by inserting his finger.d. The client says his chest will be opened during surgery but his heart will not.51. The client is status post mitral valve replacement and is now transferred on a private room. The physician ordered the client to sit up in the chair as tolerated. The client has minimal shortness of breath but can do moderate activity. Which nursing intervention is best to add to the care plan to reduce the client's energy expenditure?

a. Restrict visitors to brief periods of time.b. Provide analgesic medications when necessary.c. Administer oxygen when the client is dyspneic.d. Distribute routine care over several hours.INFECTIVE HEART DISORDERS

52. Bimbo was brought by his mother in the emergency department due to intermittent high fever. History reveals that Bimbo was not regularly brushing his teeth. Nurse Belinda told the mother of Bimbo the necessity of good oral hygiene and that good dental care is an important measure in reducing the risk of endocarditis. Health teaching of Nurse Belinda should include the promotion of good dental care and a demonstration of the proper use of

a. mouth swab.

b. manual toothbrush.

c. electric toothbrush.

d. dental floss.

53. Following cardiac surgery, the client was inserted with a pulmonary artery catheter to monitor pressure within the heart. Several hours later, the client is suspected of having bacterial endocarditis. The nurse in the surgical ward verifies the possibility of bacterial infection with which of the following data?

a. The client has blood-tinged vomitus.

b. The client reported dull chest pain.

c. The client has murmur.

d. The client has temperature of 101.3F.

54. A 24-year old female has the following medical history: Thalassemia, Diabetes Mellitus Type I, Rheumatic fever, status-post mitral valve replacement surgery and also undergone appendectomy a year ago. She now plans to have tooth extraction. Based on the clients history, which of the following will predispose the development of bacterial endocarditis?

a. Thalassemia

b. Appendectomy

c. Mitral valve replacement

d. Diabetes mellitus type I

55. After being admitted due to a systemic viral infection, the laboratory findings of Klide reveals elevated C-reactive protein. The client also experiences chest pain depending on his activities. Pericarditis, as a complication, was concluded by the physician. The nurse is aware the pericarditis pain typically varies based on the clients activities and is often aggravated by

a. eating heavy meal, brushing, laughing.

b. deep breathing, turning, leaning.

c. coughing, jogging, walking.

d. inspiration, coughing, lying down.

56. A client is frequently rushed to the hospital due to repeated acute pericarditis. During assessment, the nurse asked the client to do one forced expiration so that the nurse will best auscultate which heart sound common among clients with pericarditis?

a. A pericardial friction rub

b. A machinery-like murmur

c. A muffled heart sound

d. A weak, thready S1

57. Lolo was diagnosed to have cancer of the lungs 3 years ago and now was admitted with pericarditis. While performing the shift assessment, which of the following findings will alert the nurse about the development of complication of pericarditis, which is cardiac tamponade?

a. systolic murmur and tachycardia

b. jugular vein distention and hypotension

c. difficulty of breathing and pink sputum

d. tachypnea and narrowed pulse pressure

58. A newly hired nurse is reviewing the chart of a client with an admitting diagnosis of pericarditis. History reveals myocardial infarction 2 weeks ago. As a knowledgeable nurse, you will question which medication prescribed to the client that is good for myocardial infarction but is contraindicated for pericarditis? a. Streptokinase, a thrombolytic

b. Penicillin, an antibiotic

c. Demerol, an opioid analgesic

d. Ibuprofen, an NSAID

DYSRHYTHMIAS AND HEART BLOCKS

59. An ICU nurse is assigned to a client who apparently showed premature ventricular contractions (PVC) that is greater than 8 per minute in the ECG monitor. Being knowledgeable about ventricular dysrhythmias, the nurse knows that more than 6 PVCs in a minute is life-threatening and will prepare in giving which prescribed drug to the client?

a. Sodium bicarbonate

b. Lidocaine drip in D5W or IV push

c. Amniodarone IV push

d. Verapamil continuous IV drip

60. A client is in atrial fibrillation and the newly hired nurse is assisting in giving synchronized cardioversion. After initiating the first shock, the machine paused. What action should the nurse do in this case?

a. Turn off the machine and report to the physician.

b. Get the clients carotid pulse right away.

c. Increase the joules and redischarge.

d. Wait until the machine discharges.

61. After a brain attack, the client is placed in the ICU. The nurse is completing the history to verify the cause of stroke, whether if it is hemorrhagic or embolic in nature. What predisposing factor in the clients history that the nurse will suspect of emboli as the origin?

a. Atrial fibrillation

b. Ventricular fibrillation

c. Alternating sinus tachycardia and bradycardia

d. Ventricular bigemy

62. A clients optimism is reduced after knowing that her once diagnosis of second-degree AV block becomes a complete heart block now. Since the diagnosis is new, the nurse will contact which new medication ordered by the physician?

a. Mix 10cc of 1: 5000 solution of isoproterenol (Isuprel) in 500 cc D5W for sustained bradycardia below 30.

b. Administer Lidocaine (Xylocaine) 50mg IV push for PVCs in excess of 6 per minute.

c. Anticipate scheduling client for a temporary pacemaker if pulse continues to decrease.

d. Administer atropine sulfate (Atropine) .05 mg IV for symptomatic bradycardia.

63. When the intrinsic heart rate of a client is nearing 70 beats/min and below, the pacemaker then creates a pacer spike before each QRS complex. The nurse will interpret this as a. Expected, because the demand pacemaker is responding to the heart rate drop at the preset level.b. Expected, because the asynchronous pacemaker is responding to the heart rate change as designed.

c. Needs further evaluation, because the demand pacemaker is not effectively pacing both the atria and ventricle.d. Needs further evaluation, because the asynchronous pacemaker is not functioning as designed.64. An implantable permanent pacemaker has its own battery to be able to deliver direct stimulation to the heart causing electrical depolarization. During routine assessment of the battery, the nurse will inspect which area of implantation?

a. above the sternum

b. at the fifth ICS anterior axillary line

c. below the left nippled. beneath the right clavicle65. A client with persistent third degree block was implanted with a permanent demand pacemaker. The nurse taking care of the client is knowledgeable that this type of pacemaker delivers conduction based on a set heart rate like for example on the client the set heart rate is 68 beats/minute. Which findings noted by the nurse indicates dysfunction of the pacemaker?

a. Blood pressure of 110/88, pulse at 78

b. Tenderness at site of pacemaker implant

c. Pulse rate of 88 and irregular

d. Apical pulse rate regular at 62

66. A client continues to have irregular and slow heart rate with varying waves. The physician concluded complete heart block as the clients diagnosis and scheduled the insertion of an artificial pacemaker in replace to the natural pacemaker of the heart, which is the sinoatrial node. As a knowledgeable nurse, you will make sure that after implantation of the artificial pacemaker it is important to

a. make all equipments in the clients unit are grounded.

b. maintain a positive body image.

c. monitor vital signs only.

d. practice clean technique during dressing change.

67. Four days after the insertion of the pacemaker, the client is for discharge. It is important for the nurse to instructs the client with an artificial pacemaker that a sign of pacemaker malfunction is

a. pain radiating to the arm.b. tenderness under the skin.c. numbness of the insertion site.d. dizziness during activity.68. A client was brought to the ICU for having episodes of unstable ventricular tachycardia. During acute episodes of this type of dysrhythmia, if ordered by the physician, the nurse instructs the client to do which of the following?

a. Inhale deeply and cough forcefully every 1 to 3 seconds

b. Pursed lip breathing

c. Remove any constrictive clothing

d. Lower the head than the feet

HYPERTENSION

69. The blood pressure is a very important parameter in assessing the condition of a client. Accurate results are necessary for precise diagnosis especially when the client has hypertension. The nurse should consider that when taking the blood pressure of a client who weighs 115 kg, it is necessary to

a. assist the client to a lying down position and take the blood pressure.

b. inflate the blood pressure cuff up to 220 mm Hg.

c. get an extra-large cuff for proper fit.

d. position client by raising his thigh and get the thigh blood pressure.

70. Pedring was diagnosed with essential hypertension seven years ago. During his quarterly check up at the clinic, the nurse noted that his blood pressure is 180/100. The client also reported that there are times he feels dizzy and has blurred vision. The clinic nurse knows that the noted increased diastolic pressure reflects which of the following?

a. Increased workload of the atriums and increased peripheral resistance

b. The diameter of the arteries are widened

c. Peripheral vasodilation

d. Decreased elasticity of the arteries like the aorta

71. A patient suddenly collapse and rushed to Puting Uling Emergency. Upon assessment, the physician made a medical diagnosis of hypertensive emergency. Hypertensive emergency is characterized by

a.a sudden rise in BP accompanied by neurologic impairment. b. symptoms of a stroke with an elevated BP.c. a severe elevation of BP that occurs over several days or weeks.d. a systolic BP >200 mm Hg and a diastolic BP >120 mm Hg.72. A nurse is observing the response of a client who took propanolol (Inderal) as one of her morning pill. The nurse should be watching out for which potential serious complication associated with propanolol?

a.Apical pulse rate of 75 beats/min at rest followed by another resting heart rate of 68 beats/min

b. Blood pressure of 139/89 mmHg and 105/75 30 minutes apart

c. Complaints of gastric upset and difficulty of falling asleepd. An audible expiratory wheezes

73. Gregor was diagnosed with hypertension due to diabetes mellitus. He has been taking anti-hypertensive medications for the last 6 months. For over a week, he experiences persistent hacking cough. As a knowledgeable nurse, you know that which of the following anti-hypertensive drug may be the cause of Gregors manifestations?

a. Angiotensin-II blockers

b. ACE inhibitors

c. Beta blockers

d. Alpha-adrenergic agents

74. Gregor was prescribed with another anti-hypertensive drug while admitted in the hospital. The nurse is preparing the new drug, furosemide (Lasix) by withdrawing from the ampule. The best technique for the nurse to do to withdraw the medication is to

a. roll the ampule gently between the palms of the hands.

b. hold the ampule upside down, then flip it right side up.

c. tap the ampule stem with the fingernail a few times.

d. allow the ampule to stand undisturbed for a few minutes.

75. A client diagnosed with hypertension 2 days ago was prescribed with isosorbide dinitrate to relax the vascular smooth muscles. After 3 doses, the client verbalized which of the following manifestations that will warrant an adjustment in the dose of the medication?

a. The client says he feels the room is revolving.

b. The client says he wants to vomit.

c. The client says he wants to go to sleep most of the time.

d. The client says he has no appetite.

76. Mr. Ambo Ato was diabetic for 10 years now, and just a week ago, he was rushed to the hospital with an admitting diagnosis of secondary hypertension. The physician advised Mr. Ambo Ato that he needs diet modification to improve his health status giving attention to both diabetes and hypertension. He was referred to a

a. Enterostomal Therapy Nurse.

b. Pathologist.

c. Nutritionist.

d. Dietician.

77. Enalapril was prescribed by the health-care provider to a client diagnosed with essential hypertension. The client asked the nurse what is the action of this anti-hypertensive drug compared to the other drugs he is also taking for hypertension. The nurse will correctly answer the client with which of the following responses?

a. Enalapril decreases blood pressure by relaxing vascular smooth muscle.

b. Enalapril decreases blood pressure by preventing vasoconstriction.

c. Enalapril decreases blood pressure by inhibiting the beta-receptor stimulation in the heart.

d. Enalapril decreases blood pressure by blocking the alpha-receptors in the vascular smooth muscle.

78. In the emergency department, if the client was rushed due to complaints of headache and diagnosed with hypertension, it is very vital to ask which of the following questions in the history of the client?

a. Describe your familys cardiovascular history.

b. What over-the-counter medications do you take?

c. Tell me about your usual diet.

d. Describe your usual exercise and activity patterns.

ANEURYSM

79. At home, the client suddenly complained of chest pain to his wife. He was rushed immediately to the emergency department and has a specific chief complaint of severe right-sided chest pain that radiates to the back. After having electrocardiography and computed tomography, myocardial infarction was ruled out but thoracic aortic aneurysm was confirmed. The nurse is getting the history of the client and will most likely hear what disorder that predisposed the development of the clients diagnosis?

a. Hepatic portal hypertension

b. Atherosclerosis

c. Type I diabetes mellitus

d. Pyloric stenosis

80. While monitoring the client diagnosed with thoracic aortic aneurysm, it is most important for the nurse to keep in mind that the most common complication of this type of aneurysm is

a. Mitral valve prolapse

b. Coarctation of the aorta

c. Secondary hypertension

d. Aortic wall distention

81. Which of the following assessment findings of Josefa, who was diagnosed of having abdominal aortic aneurysm, is not expected?

a. Feeling of heart beat in the abdomen

b. Pulsating abdominal mass

c. Hyperactive bowel sounds

d. Auscultated bruit over the mass

82. A nurse is having a continuing program seminar about aneurysm. During the lecture, she was asked by the speaker to differentiate aortic dissection types A and B. Which of the following is the correct differentiation of the nurse?

a. Aortic dissection type A is a dissection of the ascending aorta while type B is a dissection of the descending aorta.

b. Aortic dissection type A is a dissection of the descending aorta while type B is a dissection of the ascending aorta.

c. Aortic dissection type A is a tear in the tunica intima while type B is characterized by hemorrhage in the tunica media.

d. Aortic dissection type A is treated with medications while type B is treated using open surgical techniques.

83. A client is in the post anesthesia care unit after an abdominal aortic aneurysm repair. The nurse assessed the client and got the following findings: pulse rate 125 beats/minute, respiratory rate 28, blood pressure 104/74, urine output in the drainage bad 35 cc for the past 2 hours, central venous pressure negative 2 cm H2O. The next action of the nurse is

a. do nothing, all findings are normal.

b. obtain an ECG to monitor the cardiac conduction.

c. keep the client supine and notify the physician.

d. regulate the IV fluid to KVO.

84. The nurse is caring for a client after abdominal aortic aneurysm repair. The nurse correctly understands that this kind of procedure will most likely lead to the development of which impending complication?

a. Risk of altered renal perfusion

b. Risk of gastrointestinal adhesion

c. Risk of wound infection

d. Risk of hypoalbuminemia

ARTERIAL AND VENOUS DISORDERS

85. From the heart, the peripheral blood flow varies and is based on which of the following factors?

a. Force of contraction of the heart and resistance of vessels.

b. Pressure differences in the arterial and venous systems and resistance.

c. Blood viscosity and diameter of vessels.

d. Diameter and resistance of vessels.

86. Buergers disease is a vascular condition that affects the arteries, veins, and capillaries. Meloy was diagnosed a year ago with Buergers disease. As a competent nurse, you know that upon assessment of Meloy, you will see changes in what anatomic areas most often affected by this vascular condition?

a. neck veins and back

b. fingers and palms

c. groin and knees

d. legs and feet

87. Mang Rogelio was admitted with Buergers disease due to history of smoking. The nurse will include in the teaching about smoking cessation as a critical strategy to prevent the aggravation of the disorder. Smoking cessation needs careful technique to attain compliance. The nurse anticipates that Mang Rogelio will go home with a prescription of which of the following medications?

a. Acetaminophen

b. Isosorbide dinitrate

c. Nicotine

d. Hydrochlorothiazide

88. Buergers disease is the inflammation of the intermediate and small arteries and veins of the extremities, most specifically the lower than the upper ones. All of the following are manifestations of Buergers disease except:

a. Cyanosis and paresthesia

b. Ulcers in ankles and burning pain

c. intermittent claudication and ulcers in toes

d. grade 3 pulse and tortuous vessels

89. Susan, with a history of thrombophlebitis was asked by her son to visit them in the province. The province is 3-hour drive from Susans home. To prevent the aggravation of Susans diagnosis, the physician advised her before that what activities she could do to prevent venous stasis?

a. rotate the foot and perform ankle pumps

b. raise both arms while riding in the car

c. gluteal setting can be performed

d. press the legs against the car seat

90. Manay complains of right calf pain when the right foot is dorsiflexed, two days after undergoing a total abdominal hysterectomy. Diagnostic finding through venography reveals deep vein thrombosis. Other than the complaint of pain, the nurse will most likely detect

a. left calf circumference 2.5cm larger than the right.b. swelling and redness of the right leg.c. a decrease in the right pedal pulse. d. loss of hair on the lower portion of the left leg.91. Venous disorders are characterized by incomplete return of blood from the lower extremities to the heart. A client presents with peripheral venous disease will probably complain of which of the following upon assessment of the nurse

a. lower extremity is pale when raised and red when dangled.

b. edematous foot and redness.

c. itchiness and hair loss.

d. cold foot and pain during walking.

92. Anti embolic stockings are indicated for thrombophlebitis and deep vein thrombosis by promoting venous return from the legs. As a knowledgeable nurse, you will teach your client, that the most appropriate position in applying anti-embolic stockings is

a. while on a low fowler position.

b. while putting her shoes.

c. while sitting in an elevated seat.

d. while reclining.

93. Pulselessness is a classic sign of arterial occlusive disease. This is due to an obstruction of the blood flow from the heart to the extremities. If the nurse is unable to palpate the right pedal pulses of a client, which will be the next action of the nurse to take?

a. palpate for a thrill

b. use a Doppler ultrasound device

c. inspect the entire right extremity

d. report immediately

94. History plays a major role in the assessment to be able to relate the existing condition with the possible precipitating factors in the past. Which of the following history will lead to peripheral edema and is a priority to be evaluated?

a. Junior, 55 years old, with essential hypertension, taking furosemide for 3 years

b. Julia, 37 years old, gravida 3, and is now in the third trimester of pregnancy

c. Junny, 33 years old, with type 2 diabetes, a typist

d. Junpyo, 49 years old, with cardiomyopathy, taking digoxin

95. Arterial insufficiency is the diagnosis of Carlos mother. Carlo is asking the nurse about the treatment regimen of her mother and how to take care of the affected extremity. Which of the following would the nurse include in the teaching plan of Carlos mother, regarding conservative manner of foot care?

a. Vigilant inspection and lubrication of the feet

b. Wearing firm, supportive casual shoes.

c. Daily bath using luke warm water

b. Applying anti-embolism stockings before getting out of bed

96. A patient was admitted to confirm the diagnosis of arterial occlusive disease. Arteriogram was ordered by the physician. The patient is anxious and is frequently asking the nurse the purpose of the procedure. The nurse should explain to the patient that the arteriogram will confirm the diagnosis of occlusive arterial disease by

a. tracing the different waves that the heart can generate.

b. showing the location of the obstruction and the collateral circulation.

c. scanning the legs and find the areas of blood stasis.

d. using ultrasound to estimate the velocity changes in the blood vessels.

97. Rosanna has severe arterial occlusive disease and now developed ulcers toes and gangrene of the left great toe. Among the listed manifestations, which will the nurse most likely assess on Rosannas left lower extremity as additional symptoms of arterial occlusive disease?

a. Thick toenails and decreased sensation

b. Brown ankle pigmentation and pulselessness

c. Hair loss and redness on dependency

d. Late afternoon edema and paresthesia

98. Kingpin with peripheral vascular disorder undergone aortofemoral-popliteal bypass graft and is now recovering. The nurse is developing a postoperative education plan and will ask which of the following questions that is of outmost importance related to the condition?

a. Before surgery, how far could you walk until pain is experienced?

b. Before admission, what are the ways you utilize in managing your health?

c. Before surgery, do you have problems in your urine output?

d. What is your home environment like?

99. A nurse discusses the ideal use of the ordered anti-embolic stockings to a hospitalized client, identified to be at risk for thromboembolic disease. Which teaching should the nurse include in the client?

a. Avoid crossing the legs unless you are seated with the stockings applied.

b. If ambulating early morning and late night, necessity in wearing the stockings is not vital.c. The important technique is to elevate the leg 15 minutes prior to application before getting out of bed.d. If the hose becomes painful to the skin underneath, notify the nurse and request pain medication.100. The right leg of a client is swollen due to peripheral edema. Which of the following is the most appropriate technique in applying a bandage around the affected extremity?a. Assessing the skin integrity carefully before reapplying each new bandageb. Increasing tension with each successive turn when applying the bandagec. Encouraging peripheral blood flow by beginning bandaging at the proximal end and working to the distal aread. Placing clips and tape over the area with the most swelling to prevent slippage

ANSWERS AND CONCEPT ILLUMINATIONS1. ANSWER: C.

CONCEPT ILLUMINATION

Coronary artery bypass grafting is a surgical procedure wherein available blood vessels in the body are used as conduits to produce vascularity to the affected part of the heart. The most common donor blood vessels are the internal mammary arteries, great saphenous veins of the legs, and the internal thoracic artery.

2. ANSWER: A.


Swan-ganz catheter is inserted via the antecubital vein into the right side of the heart, floated to the pulmonary artery. It indirectly reflects the left side pressure of the heart and used as a hemodynamic monitoring device.

3. ANSWER: B.


Nicotinic acid should be avoided because it is hepatotoxic plus the combination of cholestyramine, another lipid-lowering agent, which is another hepatotoxic drug that can both may cause liver failure. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

4. ANSWER: B.


Flushing and itchiness are classic side effects of nicotic acid. Any NSAID like aspirin should be taken 30 minutes before taking nicotic acid to decrease flushing. Taking the drug with meals will decrease gastrointestinal upset and flushing, therefore it should not be taken on an empty stomach. Alcohol consumption needs to be avoided during the drug therapy since it will add stress to the liver, because nicotic acid is hepatotoxic. Small doses are necessary when starting the therapy to prevent severe flushing.

5. ANSWER: D.


Pulsus paradoxus, also known as paradoxical pulse, is characterized by systolic blood pressure that is markedly lower during inhalation and this is a classic complication of coronary artery bypass graft surgery.

6. ANSWER: C.


A Holter monitor is a continuous ECG monitoring technique, usually for 24 to 48 hours. The aim of this diagnostic procedure is to collect data on a person's heart rhythm patterns during normal daily activity that is why it is of great importance for the client to record the physical activities done. The abnormal result of the test will be patterned on the activities being done. Instructing the client to keep a log is a good way to do this.

7. ANSWER: D.


Treadmill testing or stress test is used to evaluate chest pain, effectiveness of therapy and identify ischemic heart disease. Pre-procedural teachings include: avoid all stimulants and depressants to prevent inaccurate results, wear rubber-soled shoes for safety and loose-fitting clothes for comfort, eat a light meal 2 hours before the test, and nitroglycerine and other vasodilators should be taken 2 hours before the test.

8. ANSWER: C.


Cardioversion involves administering electric shock to the heart using smaller Joules compared to defibrillation. Angiography is the introduction of a contrast medium to outline the heart and blood vessels. Phenocardiography uses electrically recorded and amplified heart sounds. Pacemaker is a device that involves the delivery of electrical stimulation through an implantation.

9. ANSWER: C.


Cardioversion is done to convert cardiac dysrhythmia into a more hemodynamic, stable and normal sinus rhythm, wherein the P and T wave are normal and the QRS complex falls on the normal range of 0.05 to 0.10 seconds. The pulse pressure and pulse deficit in the choices are normal but they do not reflect the success of cardioversion. The client remains awake but usually has no memory of the experience.

10. ANSWER: D.


The cardiac monitor will alarm due to two possible conditions: ventricular asystole or possible electrode displacement. Checking the status of the client as well as the lead placement should be the next action to verify the cause of the alarm. After confirmation, if the client is really on asystole, call a code and report the scenario immediately to the physician. Documentation of lead displacement is not necessary.

11. ANSWER: C.


ST elevation indicates immediate myocardial injury. Prolonged QT interval is not present in tissue injury. There is the development of pathologic Q wave and not U wave. Flat T wave is present in hypokalemia.12. ANSWER: D.


Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it is not primarily given for those reasons. Nitroglycerine is a vasodilator and aspirin is an anti-platelet aggregate that prevent clot formation.

13. ANSWER: D.


Treatment of the acute myocardial infarction is geared in quickly dissolving the thrombus in the coronary artery and re-perfusing the myocardium before cellular death occurs. It takes approximately four to six hours for the entire thickness of the muscle to become necrosed in the majority of patients. To be of benefit, thrombolytic must be given as soon as possible, preferably within the first six hours after the onset of pain.

14. ANSWER: A.


Warfarin is an anti-coagulant that interferes with the synthesis of vitamin K-dependent clotting factors II, VII, IX and X. It does not prevent formation of thrombin from prothrombin. Thrombolytics such as streptokinase are the ones that dissolve clots. Aspirin is an example of a drug that prevents aggregation and coagulation of platelets.

15. ANSWER: A.


The clients findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impending blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as lactic acid accumulates from poor blood flow, preventing waste removal.

16. ANSWER: C.


Health teachings regarding the medication are very important since the drug is an emergency drug for chest pain. Nitroglycerine is a photosensitive drug and is inactivated by heat, moisture, and air. With these, the drugs should be replaced every 3 months. Four months exceeds the guideline for its potency. Tingling sensation means that the drug is potent. Pain more that 15 minutes means that the condition is worsening and the drug after 2 doses were not relieving the chest pain.

17. ANSWER: A.


Counterpulsation with an intra-aortic balloon pump may be indicated for temporary circulatory assistance in clients with cardiogenic shock. A cardioverter is commonly used for termination of life-threatening ventricular rhythms in a conscious client. Demand pacemakers are used to maintain the heartbeat at a predetermined rate. Coronary angiography is a diagnostic procedure to monitor the location of the thrombus.

18. ANSWER: C.


Involving the client in his treatment regimen even to the simplest care, which is self-care, is very vital to promote independence. This is called an active-assistive care.

19. ANSWER: C.


Myocardial infarction will be reflected in the ECG reading of a client with the following waves:

Inverted T wave indicating cellular ischemia

Elevated ST segment indicating cellular injury

Pathologic Q wave indicating cellular infarct

20. ANSWER: A.


Among the choices, the healthiest choice for a low-cholesterol diet is to eat cereal rather than eggs for breakfast. Egg yolk is a rich source of cholesterol. Sausage and bacon, butter and cheese are all high fat. White bread is not also healthy compared to wheat bread exchange for hash brown.

21. ANSWER: A.


To help prevent tolerance, clients need a 12-hour no-nitrate time, sometimes referred to as a pharmacological vacation away from the medication.

22. ANSWER: B.


Angina pectoris is also known as myocardial ischemia due to decreased coronary blood supply leading to anaerobic metabolism of the cells. Nitroglycerine is a coronary artery vasodilator that improves the coronary blood flow in 3 5 mins. If the chest pain is unrelieved, after three tablets, there is a possibility of acute coronary occlusion that requires immediate medical attention.

23. ANSWER: B.


Atorvastatin calcium (Lipitor) lowers low density lipoproteins and total triglycerides and increases the amount of high density lipoproteins. In doses large enough to lower blood fat components, Lipitor may cause back pain and muscle pain (myalgia). The nurse must assess for muscle pain, tenderness, or weakness and also monitor the client's cholesterol levels. The other options are not side effect of the drug.

24. ANSWER: A.


The contrast dye used during the coronary arteriogram causes vasodilation and is experienced as a brief flush or warmth that spreads over the skin surface. It is possible to feel fluttering or what some describe as butterflies as the catheter is passed into the heart, disturbing its rhythm. Heaviness or chest pain, if experienced, is generally treated with nitroglycerin. The client receives sedation but will not be completely unconscious during the entire procedure.25. ANSWER: D.


The major complication of thromboembolytic therapy is hemorrhage, and the antidote for this is Amicar, which aids in the stoppage of bleeding by inhibiting plasminogen, which inhibits thrombolysis. This drug should be available for any patient on this type of thromboembolytic therapy. Protamine Sulfate and Vitamin K are the antidotes for Heparin and Coumadin, respectively. Coumadin is not correct, as it is an anticoagulant.

26. ANSWER: B.


Ventricular dysrhythmia is one of the most life-threatening complications of myocardial infarction. The nurse needs to intervene quickly since ventricular dysrhythmias, if left untreated, can lead to cardiac arrest. Chest pain is the most common distressing complaint of MI clients. Bibasilar rales indicates congestive heart failure which can put additional workload to the heart but it is not directly life-threatening when experienced. Moderate levels of anxiety in a patient with a myocardial infarction need to be addressed and treated also but secondary only to ventricular dysrhytmias.

27. ANSWER: C.


A variance is the occurrence of an unexpected event that hinders the good prognosis of a client, such as in the situation, remaining on a ventilator for an additional two days. In the nursing care plan, the goal is included as well as the outcome, therefore they are what the nurse is attaining for. The nurse should use standard to provide guidance in implementing and evaluating procedural processes.

28. ANSWER: B.


Lanoxin is a brand name of digoxin, also known as Digitalis, a cardiac glycoside. Digoxin has therapeutic effect for clients with heart failure by increasing the force of myocardial contraction to release blood from the heart while decreasing the speed of contraction to lessen hearts workload. Because of its effect in decreasing the speed of contraction, bradycardia is the usual warning sign that digoxin should be withheld. Do not give this drug if the apical pulse is less than 60 minutes.

29. ANSWER: B.


Congestive heart failure can lead to right side shunt to the systemic circulation. This could lead to liver congestion, which is reflected by the increased levels of liver enzyme, more specifically SGPT. Diarrhea is not related to heart failure. Increased circumference of the abdomen, which is ascites, is related to right sided heart failure. Irritability is related to hypoxia due to pulmonary congestion.

30. ANSWER: B.


One of the measures in assessing the effectivity of treatment for clients with heart failure is the lungs sound that evaluates if pulmonary edema is resolved. Another is the pulse rate, wherein in clients with congestion, tachycardia is experienced as the bodys compensatory mechanism for hypoxia. Alertness could be a sign of success, but there is no pain in clients with heart failure. Heaves is characterized by the visible apical pulse when the chest is seen, therefore it means that tachycardia is not resolved, as well as bradycardia. Easy fatigability and cyanosis reflects hypoxia and unresolved pulmonary congestion.

31. ANSWER: A.


Hydrostatic pressure is the pushing pressure inside the blood vessels that allows fluid to move from the intravascular to the interstitial and intracellular. Clients with congestion heart failure, with right-sided affectation, blood volume in the intravascular space is increased leading now to increased hydrostatic pressure which pushes blood outside the blood vessels leading now to edema. Decreased hydrostatic pressure is the goal in congestive heart failure. On the other hand, colloid oncotic pressure is the pulling pressure that when increased, will not lead to edema. Decreased oncotic pressure is related to low albumin level, not heart failure.

32. ANSWER: D.


Body malaise is a psychological interpretation that the body is having extreme fatigue and weakness. This is an initial sign of digoxin toxicity. Diarrhea is another manifestation and not constipation, and having good and increased appetite is desirable for the client because anorexia is another sign of toxicity. Hypokalemia is also a sign of toxicity but the client cannot complain of hypokalemia but instead body weakness as a sign of decreased potassium levels.

33. ANSWER: C.


Jugular vein distention is due to the backflow of blood from the right side of the heart to the systemic circulation. Due to congestion and increased blood volume, the jugular vein is distended. In measuring the jugular vein, the nurse should note the pulsations that fluctuate with clients breathing pattern.

34. ANSWER: B.


The supplemental oxygen was ordered because the client is manifesting pallor as an initial sign of decreased oxygen. Also, the supplemental oxygen was used to decrease the workload of the heart. Blushing indicates flushing which means proper oxygenation. Grade +3 pulse means rapid and bounding pulse, which reflects unresolved hypoxia. Blanch test measures capillary refill and the normal is less than 3 seconds. Verbalization of the clients wish to increase the flow rate means that the clients in unrelieved.

35. ANSWER: C.


Most of the types of diuretics are potassium-depleting, which means they allow potassium excretion that can lead to hypokalemia. Therefore, it is important for the nurse to report the noted potassium level in the chart because the normal potassium is between 3.5 and 5.0 mEq/L. Giving the diuretic may aggravate hypokalemia and may lead to critical complications. Other results are normal chloride 90 to110 mEq/L, bicarbonate 22 to 26 mEq/L, and sodium 135 to 145 mEq/L.

36. ANSWER: B.


Congestive heart failure leads to pulmonary and systemic congestion as reflected by rapid weight gain. Daily weight monitoring is vital for the client. A sudden increase in weight should be reported immediately as this reflects fluid stasis. It is more serious if it is pitting, instead of non-pitting edema. Decreased appetite and nausea are not serious findings. Having a client urinate 4 times with cup per urination still signifies the ability of the kidneys to filter urine and adequate fluid status is maintained.

37. ANSWER: C.


Digoxin is a cardiac glycoside that has the following properties positive inotropic which strengthens the force of the hearts contraction, negative chronotropic which decreases the conduction in the heart, and negative dromotropic effect which decreases the speed of contraction. It is necessary to assess the apical pulse, as the most reliable pulse rate, before giving the drug since it may cause bradycardia. Digoxin also decreases the potassium levels which may cause hypokalemia.

38. ANSWER: D.


The main goal in treating the client with pulmonary edema secondary to left-sided heart failure is to increase the cardiac output. This is attained with the use of its drug of choice which is digoxin. When the blood is pump efficiently and effectively towards the systemic circulation, known as cardiac output, congestion and backflow to the lungs will then be decreased, thus decreasing pulmonary edema.

39. ANSWER: A.


Increased anxiety among clients candidate for organ transplant is the fear of death. Offering self and exploring the fears about death or other concerns like length of rehabilitation, financial matters, and immunosuppressant therapy helps decrease anxiety so that learning can take place. If verbalization of feelings becomes ineffective and the anxiety increased further, sedatives could be given to the client. Providing a video is not appropriate and the client might not understand, therefore learning did not take place. Support mechanism could lessen the anxiety but indirect only.

40. ANSWER: B.


The client with left-sided heart failure usually manifests signs and symptoms of pulmonary congestion due to backflow of blood to the lungs. The characteristics of left-sided heart failure are dyspnea, air hunger, orthopnea, hemoptysis and coughing. The other choices above, edema, hepatomegaly, neck vein distention, and ascites are due to right-sided heart failure.

41. ANSWER: D.


Clients with hypertrophic cardiomyopathy will most likely develop heart failure. This is due to inadequate contraction leading to the incomplete emptying of the chamber causing congestion. Cor pulmonale is a complication of right-sided congestive heart failure due to lung infection. Cardiogenic shock occurs following myocardial infarction. Mitral valve stenosis can be due to rheumatic fever or bacterial endocarditis.

42. ANSWER: C.


The definitive treatment for a client with dilated cardiomyopathy is heart transplant with heart-lung machine for circulation. This could prevent end-stage heart failure. Diuretics are the usual drug and calcium channel blockers are usually given in hypertrophic type. Maintaining left lateral position will further promote venous return and increased workload to the heart. Coronary artery bypass grafting is for patients with occlusion in the coronary artery like in myocardial infarction.

43. ANSWER: B.


Hypertrophic cardiomyopathy does not affect the cardiac output because the size of the ventricle remains relatively unchanged. Ethanol injection is for hypertrophic type not restrictive. Strenuous activities should be avoided in dilated cardiomyopathy. Lung infections like amyloidosis and sarcoidosis can cause restrictive cardiomyopathy not the two types mentioned in option D.

44. ANSWER: B.


Any gadgets and machines that have magnets should not be operated directly by the client. Option A is incorrect since it is not specific to what appliance. Driving is not permitted only when the client feels dizzy due to the ICD. Lifting heavy objects is permitted as long as it is tolerated by the client.

45. ANSWER: C.


Rheumatic fever affects the endocardium or the innermost layer of the heart where the valves are located. This type of infection often causes permanent damage to the heart and valves specifically mitral valve stenosis. Rabies and varicella are not known to cause damage to the valves while intrauterine rubella infection can cause congenital heart defects but not specifically affecting the valves.

46. ANSWER: B.


Aortic stenosis causes a murmur that is heard during systole when blood enters the aortic valve when the left ventricle contracts. It is characterized as loud and rough. Crescendo-decrescendo murmur can be heard in a client with pulmonic stenosis. Regurgitant murmur is for mitral valve prolapse and diastolic murmur can be heard on clients with mitral and tricuspid stenosis.

47. ANSWER: C.


The mitral valve (or bicuspid valve) is an atrioventricular valve. It is located between the left atrium and left ventricle. The aortic valve is located between the left ventricle and the aorta in option A. The tricuspid valve is between the right atrium and right ventricle in option B. The pulmonic valve is between the right ventricle and the pulmonary artery in option D.

48. ANSWER: C.


The mitral valve is located at the fifth intercostal space in the left midclavicular line which is at the apex of the heart. The sound that this valve produces will be best heard at the same location of the point of maximal index. At the second intercostal space to the left of the sternum, the pulmonic valve will be best heard while the aortic valve is at the right of the sternum also second intercostal space. Finally, the tricuspid valve is best heard at the fourth intercostal space to the left of the sternum where it is also located.

49. ANSWER: A.


Nafcillin sodium is a type of penicillin that is given to clients with valvular disorders to prevent potential streptococcal infections especially for people with history of rheumatic heart disease. If not prevented, this type of infection will further damage the valve furthermore the heart. The other indications on the choices are not under the therapeutic effect of nafcillin sodium.50. ANSWER: B.


During an open-heart surgery, blood is oxygenated and circulated by cardiopulmonary bypass using a heart-lung machine to prevent hypoxia. Porcine (pork) valves and mechanical valves are used for replacing diseased valvular tissue.

51. ANSWER: D.


Scheduling rest between activities is necessary to help the client adapt to activity intolerance. Visitor restriction is not the first intervention to use to reduce energy expenditure. Analgesic medications do relieve pain, but they do not relieve shortness of breath. Oxygen administration is suitable to prevent hypoxemia, but it does not decrease the use of energy.

52. ANSWER: B.


Dental hygiene is a very effective way to prevent the entry of microorganism through the oral cavity. The use of mouth swab will not be as effective as the use of manual toothbrush. The use of electric toothbrush and dental floss may cause gum bleeding and break in the skin integrity, which may be an entry point for bacteria to enter mucous membranes, then eventually the blood stream to the heart leading to the risk of developing endocarditis.

53. ANSWER: D.


Being on a febrile state is one of the bodys responses to infection. The clients temperature is 101.3F which is equivalent to 38.5C. Chemicals present in white blood cells, which fight infection, trigger a heat-producing response in the hypothalamus named as endogenous pyrogens. Blood-tinged sputum is seen on clients with tuberculosis. Dull chest pain is usually is caused by inadequate blood supply to the myocardium and not infection. The presence of murmur is usually from defects in the valves but not necessarily the presence of bacterial infection.

54. ANSWER: C.


Valves are located in the endocardium, the innermost layer of the heart. When valves are replaced, inflammatory reaction develops in the site. Fibrin and platelets aggregate on the valve tissue and engulfs circulating bacteria leading to a bacterial infection.

55. ANSWER: D.


Pericarditis is the inflammation of the membranous sac that borders the heart. The pain experienced by clients is usually located beneath the clavicle or left scapula. When the patient deep breaths, turns and lie down, pain is experienced. Coughing may also lead to pain. Leaning forward or assuming a sitting position relieves pain.

56. ANSWER: A.


A pericardial friction rub is a classic symptom of pericarditis. It is characterized by a grating sound when the heart moves and is auscultated best during forced expiration, when the patient is leaning forward. This is caused by two layers of tissue moving roughly over each another. A machinery-like murmur is auscultated in clients with patent ductus arteriosus. A muffled heart sound is reflected in a client with cardiac tamponade. While a weak, thready S1 signifies a problem in the atrioventricular valves.

57. ANSWER: B.


Cardiac tamponade is the primary complication of pericarditis. Since the visceral and parietal pericardiums are affected, there will be rapid fluid shifting to the pericardial space leading to cardiac tamponade. This leads to restricted myocardial contraction thus the ventricles are not completely emptied, which then yields to decreased cardiac output and backflow of the remaining blood to the jugular vein leading to its distention. Decreased cardiac output is manifested by hypotension. Systolic murmur and tachycardia in option A is seen on clients with semilunar valve stenosis. Difficulty of breathing and pink sputum in option C is seen on clients with pulmonary congestion. Clients experiencing hypovolemic shock manifests tachypnea and narrowed pulse pressure in option D.

58. ANSWER: A.


When the client developed pericarditis, the nurse should watch out for its complication which is cardiac tamponade. The client should not be given with a thrombolytic agent since this will further predispose the development of cardiac tamponade even if it is a drug used to dissolve the clot in myocardial infarction. Penicillin is the antibiotic of choice for pericarditis. Demerol could be used to relieve pericardial pain as well as ibuprofen.

59. ANSWER: B.


Premature Ventricular Contraction is a dysrhythmia that produces ectopic beats from the ventricles. More than 6 PVC per minute is life-threatening and can lead to ventricular tachycardia. The drug of choice is Lidocaine given either IV push or drip diluted in D5W. Sodium bicarbonate and amniodarone are given in ventricular tachycardia. Verapamil is a calcium-channel blocker that is given in atrial flutter.

60. ANSWER: D.


Synchronized cardioversion involves the delivery of a timed electrical current. The machine discharges during ventricular depolarization or in the R wave therefore the delay or pause is expected. The nurse should wait until discharges.

61. ANSWER: A.


Atrial fibrillation causes 200 to 400 atrial beats which leads to incomplete emptying of the atria that causes blood to clot. The thrombus that was formed could dislodge and becomes embolus. This could exit the heart due to rapid atrial beats. When the embolus enters the brain, stroke embolic in origin could develop.

62. ANSWER: B.


In complete heart block, the AV node blocks all impulses from the SA node so the atria and ventricles beat independently. Because Lidocaine suppresses ventricular irritability, it may diminish the existing ventricular response. All cardiac depressants are contraindicated in presence of complete heart block. The other options are appropriate treatment.

63. ANSWER: A.


A demand pacemaker, also known as synchronous, is preset by the physician, wherein it will begin firing when there is the development of the lowest acceptable intrinsic heart rate. On the other hand, a fixed or asynchronous pacemaker delivers a pacing stimulus at a set rate and does not respond to the client's intrinsic heart rate. The pacer spike shows up before the QRS interval on an ECG strip.

64. ANSWER: D.


Beneath the right clavicle is the most common site of implantation of the battery of a permanent pacemaker. In contrast to a temporary pacemaker which uses a wire that is inserted through a peripheral vein then threaded into the right atrium and the right ventricle. The area below the nipple is too low for the pacemaker and most pacemakers are not located in the sternal area. The 5th chest lead in an ECG machine is the one placed at the fifth IC anterior axillary line.

65. ANSWER: D.


Demand pacemaker triggers electrical firings only when the heart rate nears the set rate for conduction. The pacer is said to be malfunctioning if pulse rate drops below the preset rate. The pulse should be maintained at a minimal rate set on the pacemaker.

66. ANSWER: A.


After the insertion of an artificial pacemaker, it is necessary to make all the equipments ground like the appliances in the clients surrounding to prevent ventricular fibrillation. Maintaining a positive self-image is also important but is not the immediate concern. Monitor vital signs and more importantly the ECG of the client after the implantation. Sterile technique, not clean, is needed during dressing change to prevent wound infection.

67. ANSWER: D.


The classic signs that signals that the artificial pacemaker is having incompatibility in terms of supporting adequate cardiac output are dizziness, faintness, lightheadedness, and shortness of breath. Pain that radiates to the arm is a symptom of angina pectoris or myocardial infarction. Tenderness may be caused by an infectious process. Numbness of the insertion site is unrelated to the malfunctioning pacemaker.

68. ANSWER: A.


Client with unstable ventricular tachycardia are sometimes instructed to do cough cardiopulmonary resuscitation (cough CPR). 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 sustain the cerebral and coronary circulation for a short time or terminate the dysrhythmia until other measures can be implemented.

69. ANSWER: C.


The guideline in taking the blood pressure is for the cuff to be properly fitted to the client. Too snugly could lead to false low result, while too fit narrow leads to false high reading. The bladder of the cuff should encircle at least two-thirds of the limb at its midpoint and is as wide as 40% of the mid-limb circumference. In addition, the client is obese therefore the cuff will not fit around the client's thigh. Also, the guideline in inflating the cuff should be approximately 30 mm Hg above the baseline blood pressure or the systolic palpatory blood pressure.

70. ANSWER: D.


When the layers of the arteries loss their elasticity, it will be difficult for the heart to pump blood to the systemic circulation. This will lead to increased diastolic reading. The diastolic pressure is the pressure when the heart is at rest, and the heart will not achieved the maximum rest when it is having increased workload. The chambers that are measured with the diastole are the ventricles, not the atrium. Peripheral vasodilation, wherein the lumen of the arteries are widened, causes decreased blood pressure, both systole and diastole.

71. ANSWER: A.


Hypertensive emergency is a type of hypertensive crisis, wherein the blood pressure is severely elevated for days and with evidence of acute-organ damage, especially to the central nervous system (CNS). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or laterizing symptoms of stroke. 72. ANSWER: D.


Propanolol, a beta-blocker, could block the beta respiratory receptors in the bronchial area, which may lead to bronchospasm and exits of air through a narrowed space leading to wheezes. The therapeutic side effects of propanolol are decrease in blood pressure and heart rate, while gastric upset and insomnia are also side effects but do not pose a serious threat to the client.

73. ANSWER: B.


ACE (angiotensin-converting enzyme) increases the sensitivity of the cough reflex leading to the common adverse effect sometimes referred to as an ACE cough.

74. ANSWER: C.


When withdrawing a medication from an ampule, the competent technique is to tap the stem several times with a fingernail. Allowing the ampule to stand, flipping the ampule back and forth, or rolling the ampule does not bring medication trapped in the ampule stem into the base of the container.

75. ANSWER: A.


Lightheadedness, dizziness, and vertigo are side effect of nitrate drugs due to vasodilation. Nitrates have a direct relaxing effect on the smooth muscle of blood vessels. This results to vasodilation to the brain causing the above mentioned side effects. Vertigo or the feeling that the room is revolving may compromise the safety of the client that is why adjustment in the dosage is necessary.

76. ANSWER: C.


Mr. Ambo Ato who needs to modify his diet must be referred to a nutritionist. Nutritionist is an expert in terms of improving health status of a patient such as change in the diet and lifestyle modification. An enterostomal therapy nurse is an expert in ostomy care. A pathologist is a person who studies and investigates diseases. A dietician provides information regarding diet and mealtime planning but it does not include lifestyle modification.77. ANSWER: B.


Enalapril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor, and in turn prevents the release of aldosterone in the adrenal cortex thus preventing sodium and water retention alleviating the high blood volume and pressure. Option A pertains to vasodilators, option C refers to beta-blockers while option D to alpha-adrenergic blocking agents.

78. ANSWER: B.


Over-the-counter (OTC) medications may have an affectation to the clients blood pressure. Specific OTC drugs include cold preparation and bronchodilators which could stimulate the beta 1 receptors in the heart leading to the point of hypertension.79. ANSWER: B.


The most common cause of thoracic aortic aneurysms is atherosclerosis, which weakens the aortic wall and gradually distends the vessel lumen. Hepatic portal hypertension could backflow to the different systemic large veins but not the arteries like the aorta. Diabetes mellitus may contribute to the development atherosclerosis but does not cause it. Pyloric stenosis is a disorder of the gastric area and does not cause aneurysm.

80. ANSWER: D.


Thoracic aortic aneurysm may predispose the development of aortic wall distention as the blood backflows to the heart due to severe increase in pressure. Mitral valve prolapse may cause heart failure and damage to other valves. Coarctation of the aorta is characterized by a narrowed part in one of the parts of the aorta causing increased pressure to the upper part of the body and decreased in the lower part therefore it does not cause aneurysm or can be a complication of an aneurysm. Hypertension may contribute in the development of an aneurysm.

81. ANSWER: C.


Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Hyperactive bowel sound could be due to pyloric stenosis on the proximal part or due to any intestinal obstruction that causes increased peristalsis before the obstruction. The other choices are expected findings on a client with abdominal aortic aneurysm. Since it is an artery, heart beat, pulse and bruit could be assessed.

82. ANSWER: A.


Aortic dissection type A is a dissection of the ascending aorta, is treated using open surgical techniques. Aortic dissection type B is a dissection of the descending aorta and is treated with the use of medications. Both types are characterized by a tear or partial tear in the tunica and allow seepage of blood in the layers causing hemorrhage.

83. ANSWER: C.


The findings of the nurse suggest hypovolemic shock and the physician should be notified immediately. The CVP and vital signs of the clients reflect hypovolemia and should be given intervention. ECG monitoring is not an immediate concern at this point. The IV fluid of the client should be increased not decreased to a KVO regulation.

84. ANSWER: A.


During and after surgery, there is an increased risk of hypovolemia, hypotension, and prolonged aortic cross-clamping. All of these may lead to the decreased blood supply to the kidneys. Gastrointestinal adhesion is uncommon since repair of an abdominal aneurysm does not enter the gastrointestinal wall. Wound infection could be expected but it is only secondary. Hypoalbuminemia could develop if the kidneys will be damaged, leading to the excretion of albumin in the urine.85. ANSWER: B.


The two factors that influence blood flow within this closed system are the pressure differences and the resistance to blood flow throughout the system. Blood flows in a unidirectional manner, and the blood flow involves the differences in pressure between the arterial and venous systems. The greater the resistance, the greater the driving force needed, which results in an increase in the force of the contraction of the heart.

86. ANSWER: D.


Buergers disease, also known as thromboangitis obliterans, is the inflammation of the arteries, veins, and capillaries that leads to swollen blood vessels and intermittent claudication. The primary risk factor is cigarette smoking. The most common affected parts are the legs a

92-125 cardio

Documents

Transcript of 92-125 cardio