NCA Atanacio

Carina D. AtanacioBSN4A

1. Which of the following arteries primarily feeds the anterior wall of the heart?a. Circumflex arteryb. Internal mammary arteryc. Left anterior descending arteryd. Right coronary artery

2. When do coronary arteries primarily receive blood flow?a. During inspirationb. During diastolec. During expirationd. During systole

3. Which of the following illnesses is the leading cause of death in the US?a. Cancerb. Coronary artery diseasec. Liver failured. Renal failure

4. Which of the following conditions most commonly results in CAD?a. Atherosclerosisb. DMc. MId. Renal failure

5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?a. Plaques obstruct the veinb. Plaques obstruct the arteryc. Blood clots form outside the vessel walld. Hardened vessels dilate to allow the blood to flow through

6. Which of the following risk factors for coronary artery disease cannot be corrected?a. Cigarette smokingb. DMc. Heredityd. HPN

Carina AtanacioBSN 4A

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7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease?a. 100 mg/dlb. 150 mg/dlc. 175 mg/dld. 200 mg/dl

8. Which of the following actions is the first priority care for a client exhibitingsigns and symptoms of coronary artery disease?a. Decrease anxietyb. Enhance myocardial oxygenationc. Administer sublingual nitroglycerind. Educate the client about his symptoms

9. Medical treatment of coronary artery disease includes which of the following procedures?a. Cardiac catheterizationb. Coronary artery bypass surgeryc. Oral medication administrationd. Percutaneous transluminal coronary angioplasty

10. Prolonged occlusion of the right coronary artery produces an infarction in which of he following areas of the heart?a. Anteriorb. Apicalc. Inferiord. Lateral

11. Which of the following is the most common symptom of myocardial infarction?a. Chest painb. Dyspneac. Edemad. Palpitations

12. Which of the following landmarks is the correct one for obtaining an apical pulse?a. Left intercostal space, midaxillary lineb. Left fifth intercostal space, midclavicular linec. Left second intercostal space, midclavicular lined. Left seventh intercostal space, midclavicular line


13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration?a. Cardiacb. Gastrointestinalc. Musculoskeletald. Pulmonary

14. A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this?a. Aorticb. Mitralc. Pulmonicd. Tricuspid

15. Which of the following blood tests is most indicative of cardiac damage?a. Lactate dehydrogenaseb. Complete blood countc. Troponin Id. Creatine kinase

16. What is the primary reason for administering morphine to a client with myocardial infarction?a. To sedate the clientb. To decrease the client’s painc. To decrease the client’s anxietyd. To decrease oxygen demand on the client’s heart

17. Which of the following conditions is most commonly responsible for myocardial infarction?a. Aneurysmb. Heart failurec. Coronary artery thrombosisd. Renal failure

18. What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?a. Chlorideb. Digoxinc. Potassiumd. Sodium


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19. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes are these?a. Electrophysiologicb. Hematologicc. Mechanicald. Metabolic

20. Which of the following complications is indicated by a third heart sound (S3)?a. Ventricular dilationb. Systemic hypertensionc. Aortic valve malfunctiond. Increased atrial contractions

21. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?a. Left-sided heart failureb. Pulmonic valve malfunctionc. Right-sided heart failured. Tricuspid valve malfunction

22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?a. Cardiac catheterizationb. Cardiac enzymesc. Echocardiogramd. Electrocardiogram

23. What is the first intervention for a client experiencing myocardial infarction?a. Administer morphineb. Administer oxygenc. Administer sublingual nitroglycerind. Obtain an electrocardiogram

24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?a. “Tell me about your feeling right now.”b. “When the doctor arrives, everything will be fine.”c. “This is a bad situation, but you’ll feel better soon.”d. “Please be assured we’re doing everything we can to make you feel better.”


25. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamine and sympathetic nerve stimulation?a. Beta-adrenergic blockersb. Calcium channel blockersc. Narcoticsd. Nitrates

26. What is the most common complication of a myocardial infarction?a. Cardiogenic shockb. Heart failurec. Arrhythmiasd. Pericarditis

27. Which of the following disorders is jugular vein distention most prominent?a. Abdominal aortic aneurysmb. Heart failurec. Myocardial infarctiond. Pneumothorax

28. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention?a. High-fowler’sb. Raised 10 degreesc. Raised 30 degreesd. Supine position

29. Which of the following parameters should be checked before administering digoxin?a. Apical pulseb. Blood pressurec. Radial pulsed. Respiratory rate

30. Toxicity from which of the following medications may cause a client to see a green halo around lights?a. Digoxinb. Furosemidec. Metoprolold. Enalapril

31. Which ofthe following symptoms is most commonly associated with left-sided heart failure?


a. Cracklesb. Arrhythmiasc. Hepatic engorgementd. Hypotension

32. In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?a. DMb. Pulmonary embolic. Renal failured. Right-sided heart failure

33. Which of the following symptoms might a client with right-sided heart failure exhibit?a. Adequate urine outputb. Polyuriac. Oliguriad. Polydipsia

34. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by increasing ventricular contractility?a. Beta-adrenergic blockersb. Calcium channel blockersc. Diureticsd. Inotropic agents

35. Stimulation of the sympathetic nervous system produces which of the following responses?a. Bradycardiab. Tachycardiac. Hypotensiond. Decreased myocardial contractility

36. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output?a. Angina pectorisb. Cardiomyopathyc. Left-sided heart failured. Right-sided heart failure

37. What is the most common cause of abdominal aortic aneurysm?a. Atherosclerosis


b. DMc. HPNd. Syphilis

38. In which of the following areas is an abdominal aortic aneurysm most commonly located?a. Distal to the iliac arteriesb. Distal to the renal arteriesc. Adjacent to the aortic branchd. Proximal to the renal arteries

39. A pulsating abdominal mass usually indicates which of the following conditions?a. Abdominal aortic aneurysmb. Enlarged spleenc. Gastic distentiond. Gastritis

40. What is the most common symptom in a client with abdominal aorticaneurysm?a. Abdominal painb. Diaphoresisc. Headached. Upper back pain

41. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?a. Abdominal painb. Absent pedal pulsesc. Anginad. Lower back pain

42. What is the definitive test used to diagnose an abdominal aorticaneurysm?a. Abdominal X-rayb. Arteriogramc. CT scand. Ultrasound

43. Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?a. HPNb. Aneurysm rupture


c. Cardiac arrhythmiasd. Diminished pedal pulses

44. Which of the following blood vessel layers may be damaged in a client with an aneurysm?a. Externab. Internac. Mediad. Interna and Media

45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?a. Right upper quadrantb. Directly over the umbilicusc. Middle lower abdomen to the left of the midlined. Midline lower abdomen to the right of the midline

46. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?a. DMb. HPNc. PVDd. Syphilis

47. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?a. Bruitb. Cracklesc. Dullnessd. Friction rubs

48. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?a. Lower back pain, increased BP, decreased RBC, increased WBCb. Severe lower back pain, decreased BP, decreased RBC, increased WBCc. Severe lower back pain, decreased BP, decreased RBC, decreased WBCd. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC

49. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?a. Herniab. Stage 1 pressure ulcerc. Retroperitoneal rupture at the repair site


d. Rapid expansion of the aneurysm

50. Which hereditary disease is most closely linked to aneurysm?a. Cystic fibrosisb. Lupus erythematosusc. Marfan’s syndromed. Myocardial infarction

51. Which of the following treatments is the definitive one for a ruptured aneurysm?a. Antihypertensive medication administrationb. Aortogramc. Beta-adrenergic blocker administrationd. Surgical intervention

52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease?a. Cardiomyopathyb. Coronary artery diseasec. Myocardial infarctiond. Pericardial Effusion

53. Which of the following types of cardiomyopathy can be associated with childbirth?a. Dilatedb. Hypertrophicc. Myocarditisd. Restrictive

54. Septal involvement occurs in which type of cardiomyopathy?a. Congestiveb. Dilatedc. Hypertrophicd. Restrictive

55. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?a. Heart failureb. DMc. MId. Pericardial effusion


56. What is the term used to describe an enlargement of the heart muscle?a. Cardiomegalyb. Cardiomyopathyc. Myocarditisd. Pericarditis

57. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions?a. Pericarditisb. Hypertensionc. Obliteratived. Restrictive

59. Which of the following cardiac conditions does a fourth heart sound (S4) indicate?a. Dilated aortab. Normally functioning heartc. Decreased myocardial contractilityd. Failure of the ventricle to eject all the blood during systole

60. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?a. Antihypertensiveb. Beta-adrenergic blockersc. Calcium channel blockersd. Nitrates

61. The client's lab results show a high-density lipoprotein of 65 mg/dl and a low-density lipoprotein level of 90 mg/dl. What is the likely course of action?A. Doctor's order for a statin B. No specific course is indicated C. Education about diet modification D. Test kidney function62. The client's PT test starts showing signs of an overdose of Warfarin sodium (Coumadin). What is a likely intervention?A. Administer Plavix B. Assess for bruit C. Administer Vitamin K D. Assess for fibrillation

63. The client shows dyspnea, hemoptysis as well as pulmonary edema and irregular cardiac rhythm. Additionally, there is an apical diastolic murmur. The nurse suspects a diagnosis of:


A. Mitral valve stenosis B. Extreme hyperkalemia C. Endocarditis D. Dowager's syndrome64. The sinoatrial node generates how much many electrical signals per minute?A. 20-60 B. 40-80 C. 60-100D. 80-120

65. The nurse is educating a client about an upcoming cardiac catheterization. What statement by the client shows the need for further education?A. The procedure involves sticking a catheter into the heart and nearby vasculature B. I won't be able to eat or drink 2-3 hours before the procedure C. It is a common procedure that is generally safe D. My weight and height determine how much dye is used

66. An angioplasty is being performed on a client for atherosclerosis. What complication may occur after the procedure?A. Improved blood flow B. Graft occlusionC. Dressler's syndromeD. Neointimal hyperplasia

67. A client is experiencing significant sinus bradycardia. Atropine sulfate has been administered. The client starts to show signs of shock. The nurse should be ready to:A. Administer anticoagulants B. Administer atenolol C. Assess arterial blood gas D. Apply a transcutaneous pacemaker

68. What is the key difference between cardio version and defibrillation?A. Defibrillation applies an electric shock B. Cardio version is synchronized shocks C. Defibrillation tends to be elective D. Cardio version allows holding of the bed

69. What is special about a synchronous pacemaker?A. It's a device used to temporarily treat diabetic arrhythmias B. It senses when to activate


C. It forces a preset rhythm D. It treats long QT syndrome

70. A client is instructed to be very careful in cleaning their mouth. This might be because of the risk of:A. Endocarditis B. Prinzmetal angina C. Type 2 hypertension D. PVST arrhythmia

71. A client with peripheral arterial disease has received instructions from the nurse about how to limit the progression of the disease. The nurse determines that the client needs further instructions if which statement was made by the client?a. I need to eat balanced dietb. a heating pad on my leg will help soothe the leg painc. I need to take special care of my feet to prevent injuryd. I should walk daily to increase the circulation to my legs

72. The nurse is teaching a client with hypertension about items that contain sodium and reviews a written list of items sent from the cardiac rehabilitation department. The nurse tells the client that which of the following items is lowest in sodium content?a. antacidsb. laxativesc. toothpasted. demineralized water

73. A client with congestive heart failure and secondary hyperaldosteronism is started on spironolactone (Aldactone) to manage this disorder. The nurse informs the client that the need for dosage adjustment may be necessary if which of the following medications is also being taken?a. potassium chlorideb. alprazolam (Xanax)c. warfarin sodium (Coumadin)d. verapamil hydrochloride (Calan)

74. A client seeks treatment in an ambulatory care center for symptoms of Raynaud's disease.


The nurse instructs the client to:a decrease cigarette smoking by one halfb. alternate exposures to both heat and coldc. continue activity during vasospasm for quicker relief of symptomsd. wear protective items, such as gloves and warm socks, as necessary

75. The nurse determines that the client with atherosclerosis understands dietary modifications to lower the risk of heart disease if which of the following food selections is made?a. roast beefb. fresh cantaloupec. broiled cheeseburgerd. mashed potato with gravy

76. Left-sided congestive heart failure is most often associated with which of the following manifestations?a. dyspneab. distended neck veinc. hepatomegalyd. pedal edema

77. A client with chest pain is admitted to the emergency department. He states that his chest pain was not relieved after taking 3 nitroglycerine tablets at home. Which of the following is the best initial nursing action?a. administer the prescribed analgesicb. give nitroglycerine sublinguallyc. monitor blood pressured. monitor ECG

78. After cardiac catheterization, which of the following findings should the nurse report to the physician?a. pain on the groin when changing positionsb. the client denies tingling sensation in the extremityc. the client verbalizes that she experienced flushing sensation during the procedured. the toenail blanches on compression and pinkish color returns after 1 to 3 seconds

79. After cardiac catheterization that involves femoral artery, which of the following actions by the RN needs intervention by the charge nurse?a. the RN monitors the client's vital signsb. the RN applies small ice pack over the puncture sitec. the RN elevates the head of the bed to sitting position as requested by the clientd. the RN immobilizes the affected extremity in extension


80. An elderly client who had suffered a severe heart attack says to the nurse, "I have a living will and my children do not agree with what I have decided. I hope you nurses and doctors will abide by my wishes." Which of these responses by the nurse is best?a. your wishes are the most importantb. do you expect your children to be here when you have to make decisions?c. you and your children should really decide togetherd. it's always best to reconsider your decisions

81. The following are manifestations of left-sided congestive heart failure. Select all that applya. hypertensionb. dependent edemac. hypokalemiad. paroxysmal nocturnal dyspneae. non-productive coughf. pink-tinged, frothy sputumg. ascites

82. Which of the following health teachings should be included when caring for a client with angina pectoris?a limit cigarette smokingb. do not go out during cold weatherc. take sublingual nitroglycerine every 5 minutes until chest pain subsidesd. keep nitroglycerine in a clear plastic container

83. A client has dual chamber pacemaker, which of the following is true about the pacemaker?a. it provides atrial firingb. it provides ventricular firingc. it provides both atrial and ventricular firingd. it provides alternate atrial and ventricular firing

84.. Which of the following is a characteristic manifestation of the patient with cardiac tamponade?a.Increased pulse rateb. rapid respirationc. increased body temperatured. distended neck vein

85. Which of the following findings in a client who had undergone cardiac catheterization needs


immediate follow-up?a. Bleeding on dressingb. capillary refill of more than 3 secondsc. feeling of warmth and thirstd. drowsiness

86. The nurse is completing the admission assessment on the client with chest pain. Which of the following statements by the client indicates the priority modifiable risk factor for coronary artery disease?a. I have been told that I have a high cholesterol levelb. my father died of a heart attack at age 48c. I have been under a lot of stress at work latelyd. I know I am overweight and have to do something about it

87. The client with chest pain was diagnosed with myocardial infarction and is now ready to be discharged. The nurse is reviewing discharge instructions. Which statement if made by the client indicates the highest priority teaching need?a. I am going to try and cut down on smokingb. from now on I am going to eat mainly fruits and vegetablesc. I plan to take up jogging when I go homed. I plan to work half days for a while

88. A nurse is providing care to a client immediately after the insertion of a cardiac pacemaker. Which action is most important for the nurse to do first?a. observe the incision site for signs of local infectionb arrange for the client to have a post-insertion x-rayc. monitor vital signs every 15 minutes until stabled. encourage client to get out of bed with assistance

89. The home care nurse calls the wife of the client with chronic heart disease who is coughing frothy, white secretions and became confused during the night. Which question is most important for the nurse to ask?a. Did your husband eat breakfast this morning?b. What did your husband do yesterday?c. Where did your husband sleep last night?d. Are your husband's ankles swollen?

90. The nurse is completing the admission assessment form on the client with chronic heart


disease. Which of the following, if noted by the nurse, indicates a priority symptom of left-sided heart failure?a.Distended neck veinb. edema of the lower extremitiesc. weight gain of 10 pounds in the last monthd. crackles in the lung

91. The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present?a.Weight lossb. flat neck and hand veinsc.an increase in blood pressured. a decreased central venous pressure (CVP)

92. A nurse is caring for a client with acute congestive heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in this client if hyponatremia were present?a. dry skinb. decreased urinary outputc. hyperactive bowel soundsd. increased specific gravity of the urine

93. A client arrives in the emergency room complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.6 ng/mL. The nurse interprets that this result indicates a:a. normal levelb. low value that indicates possible gastritisc. level that indicates a myocardial infarctiond. level that indicates the presence of possible angina

94.. A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium


(Coumadin) has a prothrombin time of 35 seconds. Based on the prothrombin time, the nurse anticipates which of the following orders?a. adding a dose of heparin sodiumb. holding the next dose of warfarinc. increasing the next dose of warfarind. administering the next dose of warfarin

95. A client recently diagnosed with a myocardial infarction and impaired renal function is recuperating on the step-down cardiac unit. The client's blood pressure has been borderline low and intravenous (IV) fluids have been infusing at 100 ml/hr via a central line catheter in the right internal jugular for approximately 24 hours to increase renal output and maintain blood pressure. On entering the client's room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is most likelya. hematomab. systemic infectionc. electrolyte overloadd. circulatory overload

96. A clinic nurse has provided home care instructions o the client with a history of cardiac disease who has just been told that she is pregnant. Which statement, if made by the client, indicates a need for further instructions?a. it is best that I rest lying on my side to promote blood return to the heartb. I need to avoid excessive weight gain to prevent increased demands on my heartc. I need to try to avoid stressful situations because stress increases the workload of the heartd. During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection

97. A nurse is providing instructions to a maternity client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse?a. I should drink adequate fluids and increase my intake of high-fiber foodsb. I should maintain a low-calorie diet to prevent any weight gainc. I should lower my blood volume by limiting fluidsd. I should increase my sodium intake during pregnancy

98. A clinic nurse reviews the record of a child just seen by a physician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?


a. pallorb. hyperactivityc. exercise intoleranced. gastrointestinal disturbances

99. A nurse has provided home care instructions to the mother of a child who is being discharged following cardiac surgery. Which statement made by the mother indicates a need for further instructions?a. a balance of rest and exercise is importantb. I can apply lotion or powder to the incision if it is itchyc. activities in which my child could fall need to be avoided for 2 to 4 weeksd. large crowds of people need to avoided for at least 2 weeks following surgery

100. A nurse provides home care instructions to the parents of a child with congestive heart failure (CHF) regarding the procedure for the administration of digoxin (Lanoxin). Which statement, if made by the parent, indicates the need for further instructions?a. I will not mix the medication with foodb. If more than one dose is missed, I will call the physicianc. I will take the child's pulse before administering the medicationd. if the child vomits after medication administration, I will repeat the dose


ANSWERS:1. C. The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.

2. B. Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow

3. B. Coronary artery disease accounts for over 50% of all deaths in the US. Cancer accounts for approximately 20%. Liver failure and renal failure account for less than 10% of all deaths in the US.

4. A. Atherosclerosis, or plaque formation, is the leading cause of CAD. DM is a risk factor for CAD but isn’t the most common cause. Renal failure doesn’t cause CAD, but the two conditions are related. Myocardial infarction is commonly a result of CAD.

5. B. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can’t dilate properly and, therefore, constrict blood flow.

6. C. Because “heredity” refers to our genetic makeup, it can’t be changed. Cigarette smoking cessation is a lifestyle change that involves behavior modification. Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Altering one’s diet, exercise, and medication can correct hypertension.


7. D. Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD.

8. B. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but its administration isn’t the first priority. Although educating the client and decreasing anxiety are important in care delivery, nether are priorities when a client is compromised.

9. C. Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catheterization isn’t a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

10. C. The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.

11. A. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

12. B. The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. Normally, heart sounds aren’t heard in the midaxillary line or the seventh intercostal space in the midclavicular line.

13. D. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increase with movement. Cardiac and GI pains don’t change with respiration.

14. C. Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border.

15. C. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren’t detectable in people without cardiac injury. Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in


diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

16. D. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but isn’t primarily given for those reasons.

17. C. Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. An aneurysm is an out pouching of a vessel and doesn’t cause an MI. Renal failure can be associated with MI but isn’t a direct cause. Heart failure is usually the result of an MI.

18. C. Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Chloride and sodium aren’t loss during diuresis. Digoxin acts to increase contractility but isn’t given routinely with furosemide.

19. D. Both glucose and fatty acids are metabolites whose levels increase after amyocardial infarction. Mechanical changes are those that affect the pumping action of the heart, and electro physiologic changes affect conduction. Hematologic changes would affect the blood.

20. A. Rapid filling of the ventricles causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result is a fourth heart sound. Aortic valve malfunction is heard as a murmur.

21. A. The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn’t function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.

22. D. The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.

23. B. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublingual nitroglycerin are also used to treat MI, but they’re more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.


24. A. Validation of the client’s feelings is the most appropriate response. It gives the client a feeling of comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing MI will feel or get better and therefore, these responses are inappropriate.

25. A. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decreased anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

26. C. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial of viral infection but may occur after MI.27. B. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein distention isn’t a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention.

28. C. Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Inclined pressure can’t be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). In high Fowler’s position, the veins would be barely discernible above the clavicle.

29. A. An apical pulse is essential or accurately assessing the client’s heart rate before administering digoxin. The apical pulse is the most accurate point in the body. Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and therefore, won’t always accurately depict the heart rate. Digoxin has no effect on respiratory function.

30. A. One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other medications aren’t associated with such an effect.

31. A. Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right


and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

32. D. The most accurate area on the body to assed dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and renal disease aren’t directly linked to sacral edema.

33. C. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren’t associated with right-sided heart failure.

34. D. Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.

35. B. Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.

36. D. Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn’t cause weight gain, nausea, or a decrease in urine output.

37. A. Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are related to the development of an aneurysm, none is a direct cause.38. B. The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn’t surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.

39. A. The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic distention cause pulsation.

40. A. Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Lower back pain, not upper, is a common


symptom, usually signifying expansion and impending rupture of the aneurysm. Headache and diaphoresis aren’t associated with abdominal aortic aneurysm.

41. D. Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries.

42. B. An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound don’t give a direct view of the vessels and don’t yield as accurate a diagnosis as the arteriogram.

43. B. Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but isn’t life threatening. Cardiac arrhythmias aren’t directly linked to an aneurysm.

44. C. The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so it’s more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.

45. C. The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.

46. B. Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn’t as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesn’t have direct link to aneurysm.

47. A. A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface.

48. B. Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not increase. The WBC count increases as cells migrate to the site of injury.


49. C. Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesn’t cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma won’t form.

50. C. Marfan’s syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasn’t been linked to aneurysms. Lupus erythematosus isn’t hereditary. Myocardial infarction is neither hereditary nor a disease.

51. D. When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.

52. A. Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. Coronary artery disease and myocardial infarction are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure.

53. A. Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn’t specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial.

54. C. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers – is apparent. This abnormality isn’t seen in other types of cardiomyopathy.

55. A. Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Pericardial effusion is most predominant in clients with percarditis. Diabetes mellitus is unrelated to cardiomyopathy.

56. A. Cardiomegaly denotes an enlarged heart muscle. Cardiomyopathy is a heart muscle disease of unknown origin. Myocarditis refers to inflammation of heart muscle. Pericarditis is an inflammation of the pericardium, the sac surrounding the heart.

57. D. These are the classic symptoms of heart failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances and a flushed face. Myocardial infarction causes


heart failure but isn’t related to these symptoms.58. B. Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Dilated cardiomyopathy, and restrictive cardomyopathy all decrease cardiac output.59. D. An S4 occurs as a result of increased resistance to ventricular filling adterl atrial contraction. This increased resistance is related to decrease compliance of the ventricle. A dilated aorta doesn’t cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An s4 isn’t heard in a normally functioning heart.

60. B. By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren’t usually indicated because they would decrease cardiac output in clients who are often already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren’t as effective as beta-adrenergic blockers and cause increase hypotension. Nitrates aren’t’ used because of their dilating effects, which would further compromise the myocardium.

61. B. From these lab results alone, no further course is indicated. A HDL above 60 mg/dl is considered good, as well as an LDL level below 100 mg/dl.

62. C. Vitamin K is an antagonist to Warfarin (Coumadin).

63. A. The symptoms combined with the diastolic murmur point to mitral valve stenosis. Dowager's is a term associated with a hump and osteoporosis.

64. C. The sinoatrial node generates 60-100 electrical impulses per minute.

65. B. Though the procedure protocol can vary depending on where it is done, typically cardiac catheterization requires fasting for a longer period beforehand.

66. D. The term neointimal hyperplasia refers to the regrowth of tissue after a procedure due to aggravation. In angioplasties, this can result in the vessel being blocked again despite initial success in clearing space.

67. D. A transcutaneous pacemaker can be used to temporarily control sinus bradycardia that presents with shock that doesn't respond to atropine.

68. B. In cardioversion, the heart still has a rhythm and so the shocks are synchronized. Defibrillation is done when there is no pulse such as ventricular fibrillation and is generally asynchronous.

69. B. A synchronous pacemaker is designed to activate "on-need." It helps the heart while attempting to interfere as little as possible.This approach does not work in all cases, of course. Sometimes constant stimulation is needed.


70. A. Endocarditis can be caused by bacteria migrating from the mouth. Good dental hygiene can lower the risk.

71. B. The long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). The application of heat directly to the extremity is contraindicated. The limb may have decreased sensitivity and be more at risk for burns. Additionally, the direct application of heat raises the oxygen and nutritional requirements of the tissue even further.

72. D. Sodium intake can be increased with the use of several types of products, including toothpaste and mouthwashes; over-the-counter medications such as analgesics, antacids, cough remedies, laxatives, and sedatives; and softened water as well as some mineral waters. Water that is bottled, distilled, deionized, or demineralized may be used for drinking and cooking. Clients are advised to read labels for sodium content.

73. A. Spironolactone (Aldactone) is a potassium-sparing diuretic. If the client is also taking potassium chloride or another potassium supplement, the risk for hyperkalemia exists. Potassium doses would need to be adjusted while the client is taking this medication. A dosage adjustment would not be necessary if the client was taking the medications identified in options B, C, and D.

74. D. Treatment for Raynaud's disease includes the avoidance of precipitating factors such as cold or damp weather, stress, and cigarettes. The client should get sufficient rest and sleep, protect the extremities by wearing protective clothing, and stop activity during vasospasm.

75. B. To lower the risk of heart disease, the diet should be low in saturated fat with the appropriate number of total calories. The diet should include less red meat and more white meat with the skin removed. Dairy products used should be low in fat, and foods with high amounts of empty calories should be avoided.

76. A. left-sided congestive heart failure is characterized by signs and symptoms due to: a. pulmonary edema ("left" - "lung"), b. cellular hypoxia, c. RAAS activation --> hypertension and hypokalemia.Choices B, C, D are signs and symptoms of right-sided CHF.

77. A. Relief of chest pain is a priority in myocardial infarction. Pain increases cardiac workload and may lead to shock. Morphine sulfate is the drug of choice.

78. A. Pain in the groin after cardiac catheterization may indicate hematoma at the site. This


indicates bleeding at the site and compression of blood vessels by the hematoma may occur. His in turn, may cause circulatory impairment in the area.

79. C. Avoid acute hip flexion after cardiac catheterization involving the femoral artery to prevent circulatory impairment. HOB may be elevated only up to 30 degree for the first 6 to 8 hours

80. A. The client's wishes are primary considerations in living will.

81. A, C, D, E, F. These are signs and symptoms of left-sided CHF. Signs and symptoms of left-sided CHF are due to pulmonary edema, cellular hypoxia and activation of renin-angiotensin- aldosterone system (RAAS).

82. B. precipitating events to chest pain in angina pectoris include exposure to cold, exertion, eating a large meal, and strong emotions.

83. C. a dual chamber pacemaker provides both atrial and ventricular firing.

84. D. cardiac tamponade, an accumulation of blood in the pericardial sac is characterized by Beck's triad signs and symptoms which are as follows: distended neck vein, muffled heart sounds and diminished or absent pulse.

85. B. capillary refill of more than 3 seconds indicates circulatory impairment, and needs immediate follow-up. Normal capillary refill time is 1 to 2 seconds.

86. A. High serum cholesterol level is one of the most common modifiable risk factor for coronary artery disease.

87. C. walking is the best exercise for post-MI clients undergoing cardiac rehabilitation. Jogging may not be well-tolerated by the client. Therefore, choice C indicates knowledge deficit of the client and these requires further teaching.

88. C. close monitoring of the client after insertion of cardiac pacemaker especially the vital signs is very essential. Changes in the vital signs indicate occurrence of complications.

89. C. orthopnea, like sleeping in a couch indicates progressive heart failure like CHF (congestive heart failure) and pulmonary edema.


90. D. left-sided congestive heart failure may lead to pulmonary edema. Signs and symptoms pertaining to the lungs are characteristic of left-sided congestive heart failure.Choices A, B, and C are due to venous back-up which characterize right-sided congestive heart failure.

91. C. assessment findings associated with excess fluid volume include cough, dyspnea, crackles, tachypnea, tachycardia, an elevated blood pressure and a bounding pulse, an elevated CVP, weight gain, edema, neck and hand vein distention, altered level of consciousness, and a decreased hematocrit. Options A, B and D identify signs noted in deficient fluid volume.

92. C. hyperactive bowel sounds indicate hyponatremia. Options A, B and D are signs of hypernatremia. Inhyponatremia, increased urinary output and decreased specific gravity of the urinEditPostse would be noted. Dry skin occurs in deficient fluid volume.

93. C. troponin is a regulatory protein found in striated muscle. The troponins function together in the contractile apparatus for striated muscle in skeletal muscle and in the myocardium. Increased amounts of troponins T are released to the bloodstream when an infarction causes damage to the myocardium. A troponin T value that is higher than 0.1 to 0.2 ng/mL is consistent with a myocardial infarction.

94. B. the normal prothrombin time (PT) is 9.6 to 11.8 seconds (male adult) or 9.5 to 11.3 seconds (female adult). A therapeutic PT level is 1.5 to 2.0 times higher than the normal level. Because the value of 35 seconds is high (and perhaps near the critical range), the nurse should anticipate that the client would not receive further doses at this time.

95. D. circulatory (fluid overload) is a complication of intravenous therapy. Signs include rapid breathing, dyspnea, a moist cough, and crackles. When circulatory overload is present, the client's blood pressure would also increase. Hematoma is characterized by ecchymosis, swelling and leakage at the IV insertion site, and hard and painful lumps at the site. Systemic infection is characterized by chills, fever, malaise, headache, nausea, vomiting, backaches, and tachycardia. Signs of electrolyte imbalance depend on the specific electrolyte.

96. D. to avoid infections, visitors with active infections should not be allowed to visit the client; otherwise, restrictions are not required. Stress causes increased heart workload, and the client should be instructed to avoid stress. Too much weight gain can place further demands on the heart. Resting should be done by lying on the side to promote blood return.

97. A. constipation can cause the client to use Valsalva's maneuver. This maneuver can cause blood to rush to the heart and overload the cardiac system. Therefore, high-fiber foods are important. A low-calorie diet is not recommended during pregnancy and could be harmful to the fetus. Diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of


nutrients, so adequate fluid intake and high-fiber foods are important. Sodium should be restricted somewhat, as prescribed by the physician, because excess sodium will cause an overload to the circulating blood volume and contribute to cardiac complications.

98. C. The child with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods of time. Pallor may be noted but is not specific to this type of disorder alone. Options B and D are not related to this disorder.

99. B. The mother should be instructed that lotions and powders should not be applied to the incision site. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site. Options A, C and D are accurate instructions regarding home care after cardiac surgery.

100. D. The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. Options A, B and C are accurate instructions regarding the administration of this medication. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 hours later, the dose should not be administered.


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