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RPN Cardiac Practice Test:

1. During the acute phase following an MI, the PN should make the clients bed by:
a. Changing the top linen and only the necessary bottom linencomplete bed rest is
necessary
b. Changing the linen from top to bottom without lowering the HOB
c. Lifting rather than rolling the pt from side to side while changing the linen
d. Sliding the pt onto a stretcher, remaking the bed, then sliding the pt back to bed

2. A patient with CAD has a sudden episode of cyanosis & a change in respiration. The PN starts O2
administration immediately. In this situation:
a. O2 had not been ordered and therefore should not be administered
b. The nurses observation were sufficient to begin administration of O2 oxygen is an
emergency drug that can be given with prudence
c. The symptoms were too vague for the nurse to diagnose a need for O 2
d. The MD should have been called for an order before O2 was began

3. The PN attempts to allay the anxiety of a patient with heart failure because restlessness
a. Increase cardiac workload anxiety stimulates the adrenal glands to produce
cathecolamines that results to outpouring of epinephrine causing increased HR, directly
responsible for increased cardiac workload
b. Interferes with normal respirations
c. Produces an elevation in temperature
d. decreases the amount of O2 available

4. Modifiable risk factors in heart disease include:


a. Hyperlipidemia, cigarette smoking, and age.
b. Excess weight, diabetes, and hypertension.
c. Activity, diet, and age.
d. Hyperlipidemia, stress, and genetics.
Answer: B these are all modifiable risks factors.

5. A client admitted with fracture of the pelvis has a 10 mg MSO 4 q 4 hourly. Which assessment has
to be informed to the nurse-in charge immediately?
a. Urinary retention and restlessness.
b. Hypotension and bradycardia.
c. Bradypnea and lethargy Morphine is a CNS depressant
d. Tachypnea and irritability

6. Following, surgery for intestinal obstruction, the PN assesses Mr. Collins response to his
morphine. He states that he is feeling comfortable. The nurse notes that the following: blood
pressure 98/62 mmHg, PR 82, RR 12, drowsy but rouses easily. Base on this assessment, what
should the PN do?
a. Turn the PCA pump off
b. Decrease the morphine dose
c. Notify the physician of the clients vital signs
d. Continue routine assessment of the client Morphine causes vasodilation that may cause
drop in BP and the sedative effect of the drug causes drowsiness, however, the patient
should remain arousable

7. Stephen Finke, 50 years old, had angina attack. Which of the following statements made by the
PN reflects the precipitating factor of angina?
a. Describe to me your lifestyle, Mr. Finke?
b. What were you doing prior to the attack, Mr. Finke? activity requires extra usage in
oxygen that may precipitate chest pain to patient with heart problem
c. Are you taking your NTG, Mr. Finke?
d. Do you have a family history of heart disease, Mr. Finke?
Answer: B physical activities may precipitate angina as it requires more oxygen expenditure

8. A patient with Congestive Heart Failure has Lasix (Furosemide) prescribed for him. Which of the
following would be the BEST indicator that the drug is exerting its therapeutic effect:
a. Decrease in sacral and leg edema
b. Decrease in serum Potassium levels to 3.5meq/L or less
c. Increased urine output Lasix is a loop diuretic that results to increased urination
d. CVP (Central Venous Pressure) between 2-8 cm/H2O or 2-6mm/Hg

9. A 65- year - old patient with a history of Coronary Artery Disease (CAD) is admitted for cardiac
catheterization. Immediately following the procedure the BP is 140/86. When you check the patient
in 10 minutes BP 90/60, Pulse 100. Your first nursing action is to:
a. Notify the MD
b. Recheck the BP to make sure you auscultated it correctly
c. Check pulses in leg distal to insertion site
d. Check the dressing at insertion site for bleeding large arteries are used in cardiac cath
this can lead to bleeding; the patients BP is a manifestation of bleeding

10. Which medication should be given as MI is suspected?


a. Aspirin
b. Unfractionated heparin
c. Alteplase
d. Captopril
Answer: AASA has an antiplatelet effect

11. If the patient is receiving Aspirin therapy, the PN should:


a. Monitor vital signs every 4 hours.
b. Perform stool tests for occult blood.
c. Administer sublingual NTG as ordered.
d. Obtain a daily CXR.
Answer: Bbleeding is the side effects of these drugs.

12. Which treatment measures best relieve heart failure symptoms?


a. Medications and diet restrictions.
b. Weekly weights and strenuous activity.
c. Increased stress level.
d. Lifting weights greater than 10 pounds.
Adrugs (diuretics, inotropes) and low sodium diet are the cornerstone in treating CHF.

13. Mr. Pyzick is a 55-year-old male client with history of chest pain X30-minute-duration. His chest
pain is usually experienced after meals and has been persistent for about 3 months now. He had
angiogram done 2 months ago and the result revealed Left Anterior Descending and Right Coronary
Artery Disease. The clients chest pain was confirmed as true myocardial chest pain and it was
described as:
a. Usually radiates to the left side
b. It increases on exertion
c. It is not usually relieved by NTG
d. It occurs after heavy meals
Answer: C chest pain not relieved by NGT is the major differentiating factor between MI & angina.

14. Breath sounds associated with CHF?


a. Metallic tingling sound.
b. Wheezing sound.
c. Crackling or bubbling sound.
d. Inspiratory is more pronounced than expiratory phase.
Answer: Ccrackles are signs of fluids in the lungs.

15. Morphine Sulfate is the medication of choice in treating a client with chest pain because the drugs
desired effects would be
a. Morphines vasodilating properties will perfuse the heart muscles. the vasodilating effect of
Morphine improves oxygenation of the heart muscles
b. Morphines vasodilating effect will promote diuresis.
c. Morphine decreases cardiac contractility.
d. Morphine decreases cardiac output.

16. Enteric Coated Aspirin is an important drug during the following MI attack. The nurse would
question which of the following order with Aspirin?
a. Coumadin.potentiates aspirin
b. NTG SL
c. Digoxin
d. Lasix

17. In ER, treatment of Mr. Cruz, who was admitted with MI, would be in which of the following
sequence?
a. Oxygen, Morphine, Aspirin, Nitroglycerin.
b. Morphine, Oxygen, Nitroglycerin, Aspirin.
c. Nitroglycerin, Morphine, Oxygen, Aspirin.
d. Nitroglycerin, Morphine, Oxygen, Aspirin.
Answer: B - In emergency treatment, remember the acronym MONA (morphine, oxygen, nitroglycerin,
aspirin).

18. Characteristics of chest pain in MI are described as:


a. Heaviness on the chest, radiating to the right hand, indigestion-like, excruciating.
b. Oppressive, tightness, stabbing pain, radiating to the L hand.
c. Sharp pain that starts on the center of the chest, indigestion-like, radiating to the jaw and upper
shoulders.
d. Not usually relived by NTG, radiating, sharp and stabbing pain.
Answer: A These are the descriptions of chest pain in MI.

19. Signs and symptoms of R sided heart failure include:


a. Leg edema, abdominal distension, nocturnal dyspnea, moist rales.
b. Pitting edema, ascites, jugular neck vein distension.
c. Pink, frothy sputum, anxiety, moist rales, neck vein distension.
d. Parosxysmal nocturnal dyspnea, leg edema, orthopnea, ascites.
Answer: B These are signs of R sided heart failure.

20. Mary Ellen, 65 years old, came in with chronic congestive heart failure. She was placed on daily
Digoxin therapy. When evaluating the desired effect of the drug, the nurse will report a/an
a. diaphoresis and decreased urinary output.
b. increased heart and increased respiration rates.
c. ease in breathing and improved urinary output.
d. decreased chest pain and decreased blood pressure.
Answer: C - Digoxin, a cardiac glycoside, is used in patients with heart failure to slow and strengthen the
heartbeat. As cardiac output is improves, kidneys are perfused resulting to increased urinary output and
relief from pulmonary congestion (ease in breathing).

21. The PN teaches a client with heart failure to take oral furosemide in the morning. The primary
reason for this is to help
a. Prevent electrolyte imbalances.
b. Retard rapid drug absorption
c. Excrete excessive fluids accumulated during the night
d. Prevent sleep disturbances during the night from diuresis.
Answer: D Furosemide (Lasix) is a potent loop diuretic. It acts within less than an hour (if given by
mouth), therefore it must best given in the morning or during the day as it causes the patient to make
frequent trips to the washroom.

22. You are driving to work when you come upon a motor vehicle accident. You performed CPR at the
scene. Under the Good Samaritan Act, the PN could be liable:
a. For gross negligence.
b. For assault and battery.
c. If she does not stop and offer care.
d. For nothing. Any action is covered.
Answer: D providing emergency resuscitation is covered by the Good Samaritan Act. This Act states that
the provider is not legally responsible for the outcome as long as she/he uses her/his hands and mouth when
performing CPR.

23. You are a PN working on the night shift. Four call bells go off at the same time. Which of the
following should you respond to first?
a. The client who has been given morphine.
b. The client who needs to go to the bathroom.
c. The client who is hard of hearing.
d. The client in a geriatric chair.
Answer: A morphine is a CNS depressant which can compromise the breathing.

24. Mrs. Harris is receiving a vasodilator .Which of the following clinical manifestations should the PN
report immediately?
a. Orthostatic hypotension the drug may decrease the BP through vasodilation; a
significant drop in BP must be reported to the MD
b. Blurred Vision this is not usually related to vasodilating drugs
c. Decreased appetite vasodilators do not usually affect the appetite
d. Dry mouth and constipation these are not related to vasodilators

25. Which action by the PN is the most appropriate before administering Digoxin (Lanoxin)?
a. Take the radial pulse for 30 seconds heart rate must taken for one full minute
b. Take the apical pulse for 1 minute bradycardia is a desired or side effect of Digoxin,
thus, heart rate must be monitored more accurately
c. Check the blood pressure Digoxin decreases heart rate
d. Check the vital signs heart rate is monitored prior to digoxin; BP and RR are not required

26. While assisting Mr. Fernandes, 82 years old, the PN finds his anti-embolic stockings are more
difficult to apply. He receives Digoxin and Lasix daily. Which one of the following interventions
would be most appropriate for the PN to take?
a. Weigh Mr. Fernandez daily and document the finding
b. Apply the stockings after the digoxin has been administered
c. Lower both of his legs prior to applying the stockings
d. Measure both of his calves and order new stockings TED stockings promote circulation
in deep veins, appropriate size provides adequate pressure to maintain and/or improve
circulation

27. Mr. Steven, a 31- year- old obese client has pericarditis. He is receiving an antibiotic by IM
injection. How should the injection be administered?
a. Needle length 1.5 inch with # 18 gauge administered in the vastus lateralis muscle
b. Needle length 1.5 inch with # 21 gauge administered in the deltoid muscle
c. Needle length 2 inch with # 18 gauge administered in the dorsogluteal muscle
d. Needle length 2 inch with # 21gauge administered in the ventrogluteal muscle in IM
injection, the medication is injected to the muscles, an obese patient will require the
longest needle available

28. Mr. Bean, 65 years old, has been diagnosed with hypertension and atherosclerosis. What suggestion
by the PN should encourage Mr. Bean to learn more about the disease?
a. Attend a hypertension support group the group usually provide emotional support
b. Participate in the jump rope for heart program this may help in decreasing the blood
pressure
c. Review an information sheet on his medication the effects and side effects of the
medications are good way of providing information about the patient medical problems
d. Check his blood pressure at a local pharmacy this is not the question

29. Mr. Dick Tracey improves. Hes now receiving Digoxin, 0.25 mg po daily and oxygen by nasal
cannula, 2 L/min. Which of the following signs indicates the Digoxin is working?
a. Increased urine output
b. Increased pulse rate
c. Decreased respiratory rate
d. Decreased blood pressure
Answer: ADigoxin increases the contraction of the heart muscles increasing cardiac output manifested
by increased urine output (kidneys are perfused).

30. D. Tracey complains of losing his appetite. Your response is based on the knowledge that
a. many patients dislike hospital food
b. some patients receiving oxygen are anorexic
c. Lasix can impair appetite
d. anorexia can indicate digitalis toxicity
D - poor appetite is a manifestation of digitalis toxicity.

31. Larry Holmes, 58 y/o , takes nitroglycerin for angina. He reports that sometimes he feels chest pains
during sexual intercourse with his wife. Significant nursing statement includes:
a. Have you thought of counseling with a sex therapist?
b. Youll have to limit your sexual activity.
c. You should understand that intercourse at your age may pose some problems.
d. Taking a nitroglycerin tablet just before intercourse may help.
Answer: DNTG can be used prophylactically to prevent chest pain during activity (sexual activity).

32. The physician orders a bolus of Atropine Sulfate, 1 mg IV push, on Mrs. Collins who has heart
problem. The expected outcome of the Atropine is to:
a. Dry mucous membrane
b. Increase heart rate
c. Dilate the coronary vessels
d. Decrease the blood pressure
Answer: Batropine is an anticholinergic drug that increases the heart rate.

33. A priority of care for a client with excruciating chest pain due to acute MI:
a. Relieve pain
b. Oxygen therapy
c. Bed rest
d. Reduce stress
Answer: Arelieving chest pain is the priority; If chest pain remains untreated, increased oxygen
consumption persists

34. An MI patient complains of pain, became diaphoretic, dyspneic and cyanotic. What will be the first
action of the PN?
a. give nitroglycerin paste although this may promote relief to chest pain, its not the first drug of
choice
b. give oxygen this is the first drug of choice to treat chest pain
c. call the doctor this is important but oxygen must be administered first
d. document the observation treating the chest pain should be the priority

35. What do you expect to see after administration of Digoxin to a patient?


a. PR 68
b. RR increased
c. Bradycardia digoxin decreases heart rate
d. Weakness of the arm

36. Mary, 62 yrs old was having an angina pectoris and was brought to the ER by the paramedics. The
doctor ordered nitropaste 1 TID or QID. As a PN, where will you place the Nitropaste on the patients
body that will provide a good effect?
a. On the thighs.
b. At the back.
c. At the upper hands. the nitropaste is applied to the body part closer to the heart
d. On the same site where youve taken the nitropaste.

37. A patient with angina has rashes over his chest, back and arm. The physician ordered Nitro patch.
Where is the best site to apply?
a. Lower arm this can be a hairy part of the body
b. Abdomen the Nitro patch should be placed closest to the heart, in a less hairy part of the
body
c. Thigh this can be a hairy part of the body
d. Chest the patient has rashes in the chest

38. The PN will you monitor on the patient with a nitropaste in place?
a. BP - nitropaste is a vasodilating drug that decreases the BP
b. Heart rate.
c. RR
d. Temp.

39. Nancy, 55 yrs old has a history of myocardial infarction. She was on Coumadin 1 mg once a day.
Which of the following Coumadin toxicity that the nurse will instruct the patient to watch for at home?
a. Tinnitus
b. GI Bleeding Coumadin is an anticoagulant that may result to bleeding
c. Hypotension
d. Tachycardia
40. John has a congestive heart failure. He is on Lanoxin 0.125 mg tablet once a day. What is your best
nursing action?
a. Hold the drug if HR 60 100
b. Hold the drug if HR <60 and >100. Lanoxins (Digoxin) toxicity is manifested by
arrhythmia (bradycardia or tachycardia)
c. Give the drug if HR <60 and >100
d. Hold the drug if HR and BP is low.

41. During auscultation of the heart, the PN would expect the first heart sound (S 1) to be the loudest at the:
a. Apex of the heart.
b. Base of the heart.
c. Left lateral border.
d. Right lateral border.
Answer: A the first heart sound is produced by closure of the mitral and tricuspid valves; it is best heard
at the apex of the heart.
42. While caring for a client, PN Jones notices another PN giving a baby his dose of Digoxin (Lanoxin)
without taking the babys apical pulse. PN Jones is aware that the other PN has been reprimanded by
the nursing supervisor about unsafe practice. What is the most appropriate action for PN Jones to take?
a. report the incident to the physician
b. report the incident to the nursing supervisor
c. talk to the other nurse privately about what was observed
d. take the babys pulse after the other nurse leaves the room
Answer: B this is unsafe practice and the nursing supervisor must be inform for further disciplinary action

43. Digoxin is administered intravenously to a client with heart failure, primarily because the drug acts
to
a. dilate coronary arteries
b. increase myocardial contractility
c. decrease cardiac dysrrhythmias
d. decrease electrical conductivity in the heart
Answer: B Digoxin is a cardiac glycoside that improves the contraction of heart muscles, thus, its used
to treat heart failure

44. The PN teaches a client with heart failure to take oral Furosemide in the morning. The primary
reason for this is to help
a. Prevent electrolyte imbalances.
b. Retard rapid drug absorption
c. Excrete excessive fluids accumulated during the night
d. Prevent sleep disturbances during the night
Answer: D furosemide (Lasix) is a potent diuretic; its best to be given in the morning due to the patients
diuresis; if its given at night, the patient will suffer from disturbed sleep