Cardiac MI andHF 1) Which of the following actions is the first priority of care for a client exhibitin g signs and

symptoms of coronary artery disease? 1. Decrease anxiety 2. Enhance myocardial oxygenation 3. Administer sublingual nitroglycerin 4. Educate the client about his symptoms 2. Enhancing myocardial oxygenation is always the first priority when a client e xhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, t he myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn t the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priori ties when a client is compromised. 2) Medical treatment of coronary artery disease includes which of the following proced ures? 1. Cardiac catherization 2. Coronary artery bypass surgery 3. Oral medication therapy 4. Percutaneous transluminal coronary angioplasty 3. Oral medication administration is a noninvasive, medical treatment for corona ry artery disease. Cardiac catherization isn t a treatment, but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplas ty are invasive, surgical treatments. 3) Which of the following is the most common symptom of myocardial infarction (MI)? 1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations 1. 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 i ncrease in the metabolic needs of the body during an MI. Edema is a later sign o f heart failure, often seen after an MI. Palpitations may result from reduced ca rdiac output, producing arrhythmias. 4) Which of the following symptoms is the most likely origin of pain the client descri bed as knifelike chest pain that increases in intensity with inspiration? 1. Cardiac 2. Gastrointestinal 3. Musculoskeletal 4. Pulmonary 5) Which of the following blood tests is most indicative of cardiac damage? 1. Lactate dehydrogenase 2. Complete blood count (CBC) 3. Troponin I 4. Creatine kinase (CK) 6) What is the primary reason for administering morphine to a client with an MI? 1. To sedate the client 2. To decrease the client s pain 3. To decrease the client s anxiety 4. To decrease oxygen demand on the client s heart 7) Which of the following conditions is most commonly responsible for myocardial infar ction? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis

4. Renal failure 8) Which of the following complications is indicated by a third heart sound (S3)? 1. Ventricular dilation 2. Systemic hypertension 3. Aortic valve malfunction 4. Increased atrial contractions 9) After an anterior wall myocardial infarction, which of the following problems is in dicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricupsid valve malfunction 10) What is the first intervention for a client experiencing MI? 1. Administer morphine 2. Administer oxygen 3. Administer sublingual nitroglycerin 4. Obtain an ECG 11) Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Narcotics 4. Nitrates 12) What is the most common complication of an MI? 1. Cardiogenic shock 2. Heart failure 3. arrhythmias 4. Pericarditis 13) With which of the following disorders is jugular vein distention most prominen t? 1. Abdominal aortic aneurysm 2. Heart failure 3. MI 4. Pneumothorax 14) Toxicity from which of the following medications may cause a client to see a g reen-yellow halo around lights? 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec) 15) Which of the following symptoms is most commonly associated with left-sided he art failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension 16) In which of the following disorders would the nurse expect to assess sacral ed ema in a bedridden client? 1. Diabetes 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure 17) Which of the following symptoms might a client with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia 18) Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractibility?

1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Diuretics 4. Inotropic agents 19) Stimulation of the sympathetic nervous system produces which of the following responses? 1. Bradycardia 2. Tachycardia 3. Hypotension 4. Decreased myocardial contractility 20) Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? 1. Angina pectoris 2. Cardiomyopathy 3. Left-sided heart failure 4. Right-sided heart failure 21) Which of the following heart muscle diseases is unrelated to other cardiovascu lar disease? 1. Cardiomyopathy 2. Coronary artery disease 3. Myocardial infarction 4. Pericardial effusion 22) Which of the following types of cardiomyopathy can be associated with childbir th? 1. Dilated 2. Hypertrophic 3. Myocarditis 4. Restrictive 23) Septal involvement occurs in which type of cardiomyopathy? 1. Congestive 2. Dilated 3. Hypertrophic 4. Restrictive 24) Which of the following recurring conditions most commonly occurs in clients wi th cardiomyopathy? 1. Heart failure 2. Diabetes 3. MI 4. Pericardial effusion 25) Dyspnea, cough, expectoration, weakness, and edema are classic signs and sympt oms of which of the following conditions? 1. Pericarditis 2. Hypertension 3. MI 4. Heart failure 26) In which of the following types of cardiomyopathy does cardiac output remain n ormal? 1. Dilated 2. Hypertrophic 3. Obliterative 4. Restrictive 27) Which of the following cardiac conditions does a fourth heart sound (S4) indic ate? 1. Dilated aorta 2. Normally functioning heart 3. Decreased myocardial contractility 4. Failure of the ventricle to eject all of the blood during systole 28) Which of the following classes of drugs is most widely used in the treatment o f cardiomyopathy? 1. Antihypertensives

2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Nitrates 29) If medical treatments fail, which of the following invasive procedures is nece ssary for treating cariomyopathy? 1. Cardiac catherization 2. Coronary artery bypass graft (CABG) 3. Heart transplantation 4. Intra-aortic balloon pump (IABP) 30) Which of the following conditions is associated with a predictable level of pa in that occurs as a result of physical or emotional stress? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina 31) Which of the following types of angina is most closely related with an impendi ng MI? 1. Angina decubitus 2. Chronic stable angina 3. Noctural angina 4. Unstable angina 32) Which of the following conditions is the predominant cause of angina? 1. Increased preload 2. Decreased afterload 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium 33) Which of the following tests is used most often to diagnose angina? 1. Chest x-ray 2. Echocardiogram 3. Cardiac catherization 4. 12-lead electrocardiogram (ECG) 34) Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress and anxiety 4. Reduction of associated risk factors 35) Which of the following interventions should be the first priority when treatin g a client experiencing chest pain while walking? 1. Sit the client down 2. Get the client back to bed 3. Obtain an ECG 4. Administer sublingual nitroglycerin 36) Myocardial oxygen consumption increases as which of the following parameters i ncrease? 1. Preload, afterload, and cerebral blood flow 2. Preload, afterload, and renal blood flow 3. Preload, afterload, contractility, and heart rate. 4. Preload, afterload, cerebral blood flow, and heart rate. 37) Which of the following positions would best aid breathing for a client with ac ute pulmonary edema? 1. Lying flat in bed 2. Left side-lying 3. In high Fowler s position 4. In semi-Fowler s position 38) Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia

39) Which of the following is a compensatory response to decreased cardiac output? 1. Decreased BP 2. Alteration in LOC 3. Decreased BP and diuresis 4. Increased BP and fluid retention 40) Which of the following actions is the appropriate initial response to a client coughing up pink, frothy sputum? 1. Call for help 2. Call the physician 3. Start an I.V. line 4. Suction the client 41) Which of the following terms describes the force against which the ventricle m ust expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload 42) Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle 43) An 18-year-old client who recently had an URI is admitted with suspected rheum atic fever. Which assessment findings confirm this diagnosis? 1. Erythema marginatum, subcutaneous nodules, and fever 2. Tachycardia, finger clubbing, and a load S3 3. Dyspnea, cough, and palpitations 4. Dyspnea, fatigue, and synocope 44) A client admitted with angina compains of severe chest pain and suddenly becom es unresponsive. After establishing unresponsiveness, which of the following act ions should the nurse take first? 1. Activate the resuscitation team 2. Open the client s airway 3. Check for breathing 4. Check for signs of circulation 45) A 55-year-old client is admitted with an acute inferior-wall myocardial infarc tion. During the admission interview, he says he stopped taking his metoprolol ( Lopressor) 5 days ago because he was feeling better. Which of the following nurs ing diagnoses takes priority for this client? 1. Anxiety 2. Ineffective tissue perfusion; cardiopulmonary 3. Acute pain 4. Ineffective therapeutic regimen management 46) A client comes into the E.R. with acute shortness of breath and a cough that p roduces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client s medical history included DM, HTN, and heart failure. Which of the follow ing disorders should the nurse suspect? 1. Pulmonary edema 2. Pneumothorax 3. Cardiac tamponade 4. Pulmonary embolus 47) The nurse coming on duty receives the report from the nurse going off duty. Wh ich of the following clients should the on-duty nurse assess first? 1. The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a respiratory rate of 21 breaths a minute. 2. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order. 3. The 62-year-old client who was admitted one day ago with thrombophlebitis and

receiving IV heparin. 4. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibril lation and is receiving IV diltiazem (Cardizem). 48) When developing a teaching plan for a client with endocarditis, which of the f ollowing points is most essential for the nurse to include? 1. Report fever, anorexia, and night sweats to the physician. 2. Take prophylactic antibiotics after dental work and invasive procedures. 3. Include potassium rich foods in your diet. 4. Monitor your pulse regularly. 49) A nurse is conducting a health history with a client with a primary diagnosis of heart failure. Which of the following disorders reported by the client is unl ikely to play a role in exacerbating the heart failure? 1. Recent URI 2. Nutritional anemia 3. Peptic ulcer disease 4. A-Fib 50) A nurse is preparing for the admission of a client with heart failure who is b eing sent directly to the hospital from the physician s office. The nurse would pl an on having which of the following medications readily available for use? 1. Diltiazem (Cardizem) 2. Digoxin (Lanoxin) 3. Propranolol (Inderal) 4. Metoprolol (Lopressor) 51) A nurse caring for a client in one room is told by another nurse that a second client has developed severe pulmonary edema. On entering the 2ndclient s room, the nurse would expect the client to be: 1. Slightly anxious 2. Mildly anxious 3. Moderately anxious 4. Extremely anxious 52) A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also will be started on Digoxin (Lanoxin), a nurse checks the cl ient s most recent: 1. Digoxin level 2. Sodium level 3. Potassium level 4. Creatinine level 53) A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Uri ne output for the subsequent hour was 25 ml. Daily laboratory results indicate t he blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurs e interprets the client is at risk for: 1. Hypovolemia 2. UTI 3. Glomerulonephritis 4. Acute renal failure 54) A nurse is preparing to ambulate a client on the 3rdday after cardiac surgery. The nurse would plan to do which of the following to enable the client to best t olerate the ambulation? 1. Encourage the client to cough and deep breathe 2. Premedicate the client with an analgesic 3. Provide the client with a walker 4. Remove telemetry equipment because it weighs down the hospital gown. 55) A client s electrocardiogram strip shows atrial and ventricular rates of 80 comp lexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0 .08 second. The nurse interprets this rhythm is: 1. Normal sinus rhythm 2. Sinus bradycardia 3. Sinus tachycardia

4. Sinus dysrhythmia 56) A client has frequent bursts of ventricular tachycardia on the cardiac monitor . A nurse is most concerned with this dysrhythmia because: 1. It is uncomfortable for the client, giving a sense of impending doom. 2. It produces a high cardiac output that quickly leads to cerebral and myocardi al ischemia. 3. It is almost impossible to convert to a normal sinus rhythm. 4. It can develop into ventricular fibrillation at any time. 57) A home care nurse is making a routine visit to a client receiving digoxin (Lan oxin) in the treatment of heart failure. The nurse would particularly assess the client for: 1. Thrombocytopenia and weight gain 2. Anorexia, nausea, and visual disturbances 3. Diarrhea and hypotension 4. Fatigue and muscle twitching 58) A client with angina complains that the angina pain is prolonged and severe an d occurs at the same time each day, most often in the morning, On further assess ment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as: 1. Stable angina 2. Unstable angina 3. Variant angina 4. Nonanginal pain 59) The physician orders continuous intravenous nitroglycerin infusion for the cli ent with MI. Essential nursing actions include which of the following? 1. Obtaining an infusion pump for the medication 2. Monitoring BP q4h 3. Monitoring urine output hourly 4. Obtaining serum potassium levels daily 60) Aspirin is administered to the client experiencing an MI because of its: 1. Antipyrectic action 2. Antithrombotic action 3. Antiplatelet action 4. Analgesic action 61) Which of the following is an expected outcome for a client on the second day o f hospitalization after an MI? 1. Has severe chest pain 2. Can identify risks factors for MI 3. Agrees to participate in a cardiac rehabilitation walking program 4. Can perform personal self-care activities without pain 62) Which of the following reflects the principle on which a client s diet will most likely be based during the acute phase of MI? 1. Liquids as ordered 2. Small, easily digested meals 3. Three regular meals per day 4. NPO 63) An older, sedentary adult may not respond to emotional or physical stress as w ell as a younger individual because of: 1. Left ventricular atrophy 2. Irregular heartbeats 3. peripheral vascular occlusion 4. Pacemaker placement 64) Which of the following nursing diagnoses would be appropriate for a client wit h heart failure? Select all that apply. 1. Ineffective tissue perfusionrelated todecreased peripheral blood flow secondary to decreased cardiac output. 2. Activity intolerancerelated toincreased cardiac output. 3. Decreased cardiac outputrelated tostructural and functional changes. 4. Impaired gas exchangerelated todecreased sympathetic nervous system activity. 65) Which of the following would be a priority nursing diagnosis for the client wi

th heart failure and pulmonary edema? 1. Risk for infection related to stasis of alveolar secretions 2. Impaired skin integrity related to pressure 3. Activity intolerance related to pump failure 4. Constipation related to immobility 66) Captopril may be administered to a client with HF because it acts as a: 1. Vasopressor 2. Volume expander 3. Vasodilator 4. Potassium-sparing diuretic 67) Furosemide is administered intravenously to a client with HF. How soon after a dministration should the nurse begin to see evidence of the drugs desired effect ? 1. 5 to 10 minutes 2. 30 to 60 minutes 3. 2 to 4 hours 4. 6 to 8 hours 68) Which of the following foods should the nurse teach a client with heart failur e to avoid or limit when following a 2-gram sodium diet? 1. Apples 2. Tomato juice 3. Whole wheat bread 4. Beef tenderloin 69) The nurse finds the apical pulse below the 5thintercostal space. The nurse susp ects: 1. Left atrial enlargement 2. Left ventricular enlargement 3. Right atrial enlargement 4. Right ventricular enlargement ANSWERS 1. 2. Enhancing myocardial oxygenation is always the first priority when a clien t exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation , the myocardium suffers damage. Sublingual nitroglycerin is administered to tre at acute angina, but administration isn t the first priority. Although educating t he client and decreasing anxiety are important in care delivery, neither are pri orities when a client is compromised. 2. 3. Oral medication administration is a noninvasive, medical treatment for cor onary artery disease. Cardiac catherization isn t a treatment, but a diagnostic to ol. Coronary artery bypass surgery and percutaneous transluminal coronary angiop lasty are invasive, surgical treatments. 3. 1. 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 a n increase in the metabolic needs of the body during an MI. Edema is a later sig n of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias. 4. 4. Pulmonary pain is generally described by these symptoms. Musculoskeletal p ain only increases with movement. Cardiac and GI pains don t change with respirati on. 5. 3. Troponin I levels rise rapidly and are detectable within 1 hour of myocard ial injury. Troponin I levels aren t detectable in people without cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not specif ic 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 revi ew electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoe nzymes are required to detect cardiac injury. 6. 4. Morphine is administered because it decreases myocardial oxygen demand. Mo rphine will also decrease pain and anxiety while causing sedation, but it isn t pr imarily given for those reasons. 7. 3. Coronary artery thrombosis causes an inclusion of the artery, leading to m yocardial death. An aneurysm is an outpouching 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 a result from an MI. 8. 1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3.Increased atrial contraction or systemic hypertension can result in a fourth h eart sound. Aortic valve malfunction is heard as a murmur. 9. 1. The left ventricle is responsible for most of the cardiac output. An anter ior 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 cra ckles. Pulmonic and tricuspid valve malfunction causes right sided heart failure . 10. 2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional o xygen is administered to assist in oxygenation and prevent further damage. Morph ine and nitro are also used to treat MI, but they re more commonly administered af ter the oxygen. An ECG is the most common diagnostic tool used to evaluate MI. 11. 1. Beta-adrenergic blockers work by blocking beta receptors in the myocardiu m, reducing the response to catecholamines and sympathetic nerve stimulation. Th ey protect the myocardium, helping to reduce the risk of another infarction by d ecreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen d emand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial ox ygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload). 12. 3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occ urs 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 complica tion. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI. 13. 2. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. JVD 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 JVD. 14. 1. One of the most common signs of digoxin toxicity is the visual disturbanc e known as the green-yellow halo sign. The other medications aren t associated with such an effect. 15. 1. Crackles in the lungs are a classic sign of left-sided heart failure. The se 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 hear t failure causes hypertension secondary to an increased workload on the system. 16. 4. The most accurate area on the body to assess dependent edema in a bed-rid den client is the sacral area. Sacral, or dependent, edema is secondary to right -sided heart failure. 17. 3. Inadequate deactivation of aldosterone by the liver after right-sided hea rt failure leads to fluid retention, which causes oliguria. 18. 4. Inotropic agents are administered to increase the force of the heart s cont ractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. 19. 2. Stimulation of the sympathetic nervous system causes tachycardia and incr eased contractility. The other symptoms listed are related to the parasympatheti c nervous system, which is responsible for slowing the heart rate. 20. 4. 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 pulmonar y symptoms rather than systemic ones. Angina pectoris doesn t cause weight gain, n ausea, or a decrease in urine output. 21. 1. Cardiomyopathy isn t usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. CAD and MI are directly

related to atherosclerosis. Pericardial effusion is the escape of fluid into th e pericardial sac, a condition associated with Pericarditis and advanced heart f ailure. 22. 1. Although the cause isn t entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after bi rth. The condition may result from a preexisting cardiomyopathy not apparent pri or to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the vent ricles that has an unknown etiology but a strong familial tendency. Myocarditis isn t specifically associated with childbirth. Restrictive cardiomyopathy indicate s constrictive pericarditis; the underlying cause is usually myocardial. 23. 3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum not t he ventricle chambers is apparent. This abnormality isn t seen in other types of car diomyopathy. 24. 1. Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. MI results from pr olonged myocardial ischemia due to reduced blood flow through one of the coronar y arteries. Pericardial effusion is most predominant in clients with pericarditi s. 25. 4. These are the classic signs of failure. Pericarditis is exhibited by a fe eling of fullness in the chest and auscultation of a pericardial friction rub. H ypertension is usually exhibited by headaches, visual disturbances, and a flushe d face. MI causes heart failure but isn t related to these symptoms. 26. 2. Cardiac output isn t affected by hypertrophic cardiomyopathy because the si ze of the ventricle remains relatively unchanged. All of the rest decrease cardi ac output. 27. 4. An S4occurs as a result of increased resistance to ventricular filling aft er atrial contraction. The increased resistance is related to decreased complian ce 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 hea rt sound. An S4isn t heard in a normally functioning heart. 28. 2. By decreasing the heart rate and contractility, beta-blockers improve myo cardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren t usually indicated because they would decr ease cardiac output in clients who are already hypotensive. Calcium channel bloc kers are sometimes used for the same reasons as beta-blockers; however, they are n t as effective as beta-blockers and cause increased hypotension. Nitrates aren t u sed because of their dilating effects, which would further compromise the myocar dium. 29. 3. The only definitive treatment for cardiomyopathy that can t be controlled m edically is a heart transplant because the damage to the heart muscle is irrever sible. 30. 2. The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Unstable angina doesn t always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually oc curs at rest not as a result of exercise or stress. 31. 4. Unstable angina progressively increases in frequency, intensity, and dura tion and is related to an increased risk of MI within 3 to 18 months. 32. 4. Inadequate oxygen supply to the myocardium is responsible for the pain ac companying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery sp asm is responsible for variant angina. 33. 4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addi tion, with variant angina, the ECG shows ST-segment elevation. A chest x-ray wil l show heart enlargement or signs of heart failure, but isn t used to diagnose ang ina. 34. 1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can t be reversed. 35. 1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is

sitting down. After the ECGm sublingual nitro would be administered. When the c lient s condition is stabilized, he can be returned to bed. 36. 3. Myocardial oxygen consumption increases as preload, afterload, renal cont ractility, and heart rate increase. Cerebral blood flow doesn t directly affect my ocardial oxygen consumption. 37. 3. A high Fowler s position promotes ventilation and facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen the breathing and increase workload of the heart. Semi-Fowler s position won t reduce the workloa d of the heart as well as the Fowler s position will. 38. 4. In an attempt to compensate for increased work of breathing due to hyperv entilation, carbon dioxide decreases, causing hypocapnea. If the condition persi sts, CO2retention occurs and hypercapnia results. 39. 4. The body compensates for a decrease in cardiac output with a rise in BP, due to the stimulation of the sympathetic NS and an increase in blood volume as the kidneys retain sodium and water. Blood pressure doesn t initially drop in resp onse to the compensatory mechanism of the body. Alteration in LOC will occur onl y if the decreased cardiac output persists. 40. 1. Production of pink, frothy sputum is a classic sign of acute pulmonary ed ema. Because the client is at high risk for decompensation, the nurse should cal l for help but not leave the room. The other three interventions would immediate ly follow. 41. 1. Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulatin g volume. Preload is the volume of blood in the ventricle at the end of diastole . 42. 3. The left ventricle is responsible for the majority of force for the cardi ac output. If the left ventricle is damaged, the output decreases and fluid accu mulates in the interstitial and alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn t affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium and righ t ventricle were damaged, right-sided heart failure would result. 43. 1. Diagnosis of rheumatic fever requires that the client have either two maj or Jones criteria or one minor criterion plus evidence of a previous streptococc al infection. Major criteria include carditis, polyarthritis, Sydenham s chorea, s ubcutaneous nodules, and erythema maginatum (transient, nonprurtic macules on th e trunk or inner aspects of the upper arms or thighs). Minor criteria include fe ver, arthralgia, elevated levels of acute phase reactants, and a prolonged PR-in terval on ECG. 44. 1. Immediately after establishing unresponsiveness, the nurse should activat e the resuscitation team. The next step is to open the airway using the head-til t, chin-lift maneuver and check for breathing (looking, listening, and feeling f or no more than 10-seconds). If the client isn t breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpati ng the carotid pulse. 45. 2. MI results from prolonged myocardial ischemia caused by reduced blood flo w through the coronary arteries. Therefore, the priority nursing diagnosis for t his client isIneffective tissue perfusion (cardiopulmonary). Anxiety, acute pain , and ineffective therapeutic regimen management are appropriate but don t take pr iority. 46. 1. SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink , frothy sputum are late signs of pulmonary edema. 47. 4. The client with A-fib has the greatest potential to become unstable and i s on IV medication that requires close monitoring. After assessing this client, the nurse should assess the client with thrombophlebitis who is receiving a hepa rin infusion, and then go to the 58-year-old client admitted 2-days ago with hea rt failure (her s/s are resolving and don t require immediate attention). The lowe st priority is the 89-year-old with end stage right-sided heart failure, who req uires time consuming supportive measures.

48. 1. The most essential teaching point is to report signs of relapse, such as fever, anorexia, and night sweats, to the physician. To prevent further endocard itis episodes, prophylactic antibiotics are taken before and sometimes after den tal work, childbirth, or GU, GI, or gynecologic procedures. A potassium-rich die t and daily pulse monitoring aren t necessary for a client with endocarditis. 49. 3. Heart failure is precipitated or exacerbated by physical or emotional str ess, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget s disea se, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, and hype rvolemia. 50. 2. Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the medication of choi ce to treat heart failure. Diltiazem (calcium channel blocker) and propranolol a nd metoprolol (beta blockers) have a negative inotropic effect and would worsen the failing heart. 51. 4. Pulmonary edema causes the client to be extremely agitated and anxious. T he client may complain of a sense of drowning, suffocation, or smothering. 52. 3. The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digitalis effect leading to digoxin toxicity can occur i n the client with hypokalemia. Hypokalemia also predisposes the client to ventri cular dysrhythmias. 53. 4. The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therap y. Renal insult is signaled by decreased urine output, and increased BUN and cre atinine levels. The client may need medications such as dopamine (Intropin) to i ncrease renal perfusion and possibly could need peritoneal dialysis or hemodialy sis. 54. 2. The nurse should encourage regular use of pain medication for the first 4 8 to 72 hours after cardiac surgery because analgesia will promote rest, decreas e myocardial oxygen consumption resulting from pain, and allow better participat ion in activities such as coughing, deep breathing, and ambulation. Options 1 an d 3 will not help in tolerating ambulation. Removal of telemetry equipment is co ntraindicated unless prescribed. 55. 1. 56. 4. Ventricular tachycardia is a life-threatening dysrhythmia that results fr om an irritable ectopic focus that takes over as the pacemaker for the heart. Th e low cardiac output that results can lead quickly to cerebral and myocardial is chemia. Client s frequently experience a feeling of impending death. Ventricular t achycardia is treated with antidysrhythmic medications or magnesium sulfate, car dioversion (client awake), or defibrillation (loss of consciousness), Ventricula r tachycardia can deteriorate into ventricular defibrillation at any time. 57. 2. The first signs and symptoms of digoxin toxicity in adults include abdomi nal pain, N/V, visual disturbances (blurred, yellow, or green vision, halos arou nd lights), bradycardia, and other dysrhythmias. 58. 3. Stable angina is induced by exercise and is relieved by rest or nitroglyc erin tablets. Unstable angina occurs at lower and lower levels of activity and r est, is less predictable, and is often a precursor of myocardial infarction. Var iant angina, or Prinzmetal s angina, is prolonged and severe and occurs at the sam e time each day, most often in the morning. 59. 1. IV nitro infusion requires an infusion pump for precise control of the me dication. BP monitoring would be done with a continuous system, and more frequen tly than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion. 60. 2. Aspirin does have antipyretic, antiplatelet, and analgesic actions, but t he primary reason ASA is administered to the client experiencing an MI is its an tithrombotic action. 61. 4. By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Day 2 hospitalization may be too so on for clients to be able to identify risk factors for MI or begin a walking pro gram; however, the client may be sitting up in a chair as part of the cardiac re habilitation program. Severe chest pain should not be present.

62. 2. Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are b etter tolerated. Fluids are given according to the client s needs, and sodium rest rictions may be prescribed, especially for clients with manifestations of heart failure. Cholesterol restrictions may be ordered as well. Clients are not prescr ibed a diet of liquids only or NPO unless their condition is very unstable. 63. 1. In older adults who are less active and do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in th e myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle. 64. 1 and 3. HF is a result of structural and functional abnormalities of the he art tissue muscle. The heart muscle becomes weak and does not adequately pump th e blood out of the chambers. As a result, blood pools in the left ventricle and backs up into the left atrium, and eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing c ardiac output. In addition, this pooling leads to thrombus formation and ineffec tive tissue perfusion because of the decrease in blood flow to the other organs and tissues of the body. Typically, these clients have an ejection fraction of l ess than 50% and poorly tolerate activity. Activity intolerance is related to a decrease, not increase, in cardiac output. Gas exchange is impaired. However, th e decrease in cardiac output triggers compensatory mechanisms, such as an increa se in sympathetic nervous system activity. 65. 3. Activity intolerance is a primary problem for clients with heart failure and pulmonary edema. The decreased cardiac output associated with heart failure leads to reduced oxygen and fatigue. Clients frequently complain of dyspnea and fatigue. The client could be at risk for infection related to stasis of secretio ns or impaired skin integrity related to pressure. However, these are not the pr iority nursing diagnoses for the client with HF and pulmonary edema, nor is cons tipation related to immobility. 66. 3. ACE inhibitors have become the vasodilators of choice in the client with mild to severe HF. Vasodilator drugs are the only class of drugs clearly shown t o improve survival in overt heart failure. 67. 1.After IV injectionof furosemide, diuresis normally begins in about 5 minutes and reaches its peak within about 30 minutes. Medication effects last 2 to 4 ho urs. 68. 2. Canned foods and juices, such as tomato juice, are typically high in sodi um and should be avoided in a sodium-restricted diet. BRING ON THE STEAK! 69. 2. A normal apical impulse is found under over the apex of the heart and is typically located and auscultated in the left fifth intercostal space in the mid clavicular line. An apical impulse located or auscultated below the fifth interc ostal space or lateral to the midclavicular line may indicate left ventricular e nlargement