1. A nurse is assessing a client with an abdominal aortic aneurysm (AAA).

Which of the
following assessment findings by the nurse is probably unrelated to the AAA?

a) pulsatile abdominal mass

b) hyperactive bowel sounds in the area
c) systolic bruit over the area of the mass
d) subjective sensation of "heart beating" in the abdomen

2. A 60 year old male client comes into the emergency department with complaints of
crushing substernal chest pain that radiates to his shoulder and left arm. The admitting
diagnosis is acute myocardial infarction (MI). Immediate admission orders include
oxygen by nasal cannula at 4 L/m, blood work, a chest radiograph, a 12-lead
electrocardiogram (ECG), and a 2 mg of morphine sulfate given intravenously. The nurse
should first:

3. If the client who was admitted for MI develops cardiogenic shock, which characteristic
sign should the nurse expect to observe?

a) oliguria
b) bradycardia
c) elevated blood pressure
d) fever

4. The physician orders continuous intravenous nitroglycerin infusion for the client with
MI. Essential nursing actions include which of the following?

a) obtaining an infusion pump for the medication

b) monitoring blood pressure every 4 hours
c) monitoring urine output hourly
d) obtaining serum potassium levels daily

5. When teaching the client with MI, the nurse explains that the pain associated with MI
is caused by:

a) left ventricular overload

b) impending circulatory collapse
c) extracellular electrolyte imbalances
d) insufficient oxygen reaching the heart muscle

6. Aspirin is administered to the client experiencing an MI because of its:

a) antipyretic action
b) antithrombolytic action
c) antiplatelet action
d) analgesic action
7. Which of the following is an expected outcome for a client on the second day of
hospitalization after an MI? The client:

a) has minimal chest pain

b) can identify risk factors for MI
c) agrees to participate in a cardiac rehabilitation program
d) can perform personal self-care activities without pain

8. After an MI, the hospitalized client is taught to move the legs about while resting in
bed. This type of exercise is recommended primarily to help:

a) prepare the client for ambulation

b) promote urinary and intestinal elimination
c) prevent thrombophlebitis and blood clot formation
d) decrease the likelihood of decubitus ulcer formation

9. Which of the following is an uncontrollable risk factors that has been linked to the
development of CAD?

a) exercise
b) obesity
c) stress
d) heredity

10. Crackles heard on lung auscultation indicate which of the following?

a) cyanosis
b) bronchospasm
c) airway narrowing
d) fluid filled alveoli

11. In which of the following positions should the nurse place a client with suspected
heart failure?

a) semi-sitting (low-fowler's position)

b) lying on the right side ( sim's position)
c) sitting almost upright ( high fowler's position)
d) lying on the back with the head lowered (trendelenburg position)

12. The nurse's discharge teaching plan for the client with congestive heart failure would
stress the significance of which of the following?

a) maintaining a high-fiber diet

b) walking 2 miles every day
c) obtaining daily weights at the same time each day
d) remaining sedentary for most of the day
13. Essential hypertension would be diagnosed in a 40 year-old man whose blood
pressure would be:

a) 120/90 mmHg
b) 130/85 mmHg
c) 140/90 mmHg
d) 160/80 mHg

14. The nurse understands that a priority nursing diagnosis for the client with
hypertension would be:

a) pain
b) deficient fluid volume
c) impaired skin integrity
d) ineffective health maintenance

15. The most important long-term goal for a client with hypertension would be to:

a) renal insufficiency and failure

b) valvular heart disease
c) endocarditis
d) peptic ulcer disease

16. Which of the following symptoms should the nurse teach the client with unstable
angina to report immediately to her physician?

a) a change in the pattern of her pain

b) pain during sexual activity
c) pain during an argument with her husband
d) pain during or after an activity such as lawn-mowing

17. The physician refers the client with unstable angina for a cardiac catheterization. The
nurse explains to the client that this procedure is being used in this specific case to:

a) open and dilate blocked coronary artery

b) assess the extent of arterial blockage
c) bypass obstructed vessels
d) assess the functional adequacy of the valves and heart muscle

18. The primary goal for the client with Buerger's disease is to prevent

a) embolus formation
b) fat embolus formation
c) thrombus formation
d) thrombophlebitis
19. A client with Buerger's disease smokes two packs of cigarettes a day. Smoking
cessation is critical or the client may lose the affected part. When helping a client change
behavior it is important to know the client's:

a) ability to attend support groups

b) goals of the treatment
c) perception of the behavior
d) motivation

20. Raynauld's disease is known as arteriospastic disease and is seen most often in:

a) young women
b) old women
c) old men
d) young men
21. The nurse has been assigned to a client with Raynauld's disease. The nurse realizes
that the underlying etiology of Raynauld's disease is unknown but that is characterized
by:

a) episodic vasospastic disorder of the small arteries

a) episodic vasospastic disorder of the small veins
a) episodic vasospastic disorder of the capillaries
a) episodic vasospastic disorder oof the aorta

22. The client with Raynauld's disease complains of cold and numbness in her fingers.
The nurse assesses the client for effects of vasoconstriction. Which of the following is an
early sign of vasoconstriction?

a) cyanosis
b) gangrene
c) pallor
d) rubor

23. The nurse should instruct a client who has been diagnosed with Raynauld's disease to:

a) immerse her hands in cold water during an episode

b) wear light garments when the temperature gets below 50F (10C)
c) wear gloves when handling ice or frozen foods
d) live in cold climate

24. Which of the following clients is at risk for varicose veins?

a) a client who has had a cerebral vascular accident

b) a client who has had anemia
c) a client who has had thrombophlebitis
d) a client who has had transient ischemia attack

25. The nurse assesses that a client's pulse pressure is decreasing. This would be
evaluated by calculating the:

a) force exerted against an arterial wall

b) difference between the apical and radial rates
c) difference between systolic and diastolic readings
d) degree of ventricular contraction in relation to output

26. The nurse should teach clients with peripheral vascular disease to stop smoking
because nicotine:

a) constricts the superficial vessels, dilating the deep vessels

b) constricts the peripheral vessels and increases the force of flow
c) dilates the superficial vessels but constricts the collateral circulation
d) dilates the peripheral vessels, causing a reflex constrictions of visceral vessels

27. When obtaining data from a client with thromboangitis obliterans (Burger's disease),
the nurse would expect the client to demonstrate or report:

a) easy fatigue of extremities, continuous claudification

b) general blanching of skin and intermittent claudification
c) intermittent claudification, burning pain after to cold
d) burning pain precipitated by cold exposure, fatigue, blanching of skin

28. Prolonged bed rest after surgery appears to promote hemostasis, particularly in th
deep veins of the calves. The most likely pathologic result of such hemostasis may be
thrombus formation and:

a) cerebral embolism
b) coronary occlusion
c) pulmonary embolism
d) dry gangrene of a limb

29. A client is being instructed of the use of elastic stockings. The nurse should teach the
client that the stockings should be:

a) alternately kept on 2 hours and off 2 hour

b) Worn only at night when activity is lessened
c) put on before getting out of bed in the morning
d) left in place until the physician advises otherwise

30. The nurse realizes that a pacemaker is used in some clients to serve the function
normally performed by the :
a) AV node
b) SA node
c) bundle of his
d) accelerator nerves to the heart

31. During a cardiac arrest, the nurse and the arrest team must keep in mind the:

a) age of the client

b) time the client is anoxic
c) emergency medications available
d) heart rate of the client before the arrest

32. Which of the following health measures need to be carried out in the care of patients
with hypertension?

1) refer to physician for proper management

2) encourage compliance to recommend schedule of blood pressure check up
3) follow-up patient to assure compliance to treatment
4) advise moderation in smoking and tobacco use

a. 1,2, and 3
b. 2 and 4
c. 1,2,3, and 4
d. 1 and 2

33. In teaching a patient to take his own blood pressure, a method of evaluation which
could be used to measure achievement is:

a. ask the patient how would he take his blood pressure

b. have the patient explain the importance of checking his blood pressure
c. observe the patient's ability to carry out procedure
d. have the patient explain why he should learn how to take his own blood pressure
33. To prevent re-programming of an artificial cardiac pacemaker, the client should be
instructed to avoid being near:

a. Chest X-ray machine

b. High-output electrical generators
c. Microwave ovens’
d. Metal detectors at airports

34. A client with a history of chronic arterial occlusive disease complains of pain in the
legs while walking. Which would be the best action for the nurse to implement?

a. Continue the exercise

b. Give the client a break and then resume the exercise
c. Stop the exercise and administer a narcotic
d. Place the client on bedrest and notify the physician

35. Two days following a myocardial infraction, a client’s temperature is elevated. This
indicates:

a. Pneumonia
b. Tissue necrosis
c. Possible infection
d. Pulmonary infarction

36. During the early postoperative period following open heart surgery, adequate
oxygenation is essential because:

a. All clients have a chest tube in place

b. Hypoxia can precipitate respiratory alkalosis
c. Hypoxia can stimulate dangerous dysrhythmias
d. An increased respiratory rate adds to postoperative pain

37. It is an important responsibility of the nurse to educate clients on reducing risk factors
for coronary artery disease. Risk factors to include in the nurse’s teaching plan are:

a. A diet rich in saturated fats

b. Regular exercise program of walking
c. Reduce smoking to one-half or one pack a day
d. Maintain stress levels

38. When assessing a client with a diagnosis of possible myocardial infarction for pain,
the nurse would expect the client to describe it as:

a. Severe, intense chest pain

b. A burning sensation of short duration
c. Mild chest pain, radiating down to the fingers
d. A squeezing chest pain, relieved by nitroglycerin

39. A client with congestive heart failure is placed on digoxin and asks the nurse why this
is necessary. The nurse bases the answer on the fact that digoxin:

a. Increases ventricular contractions

b. Reduces edema in extracellular spaces
c. Slows and strengthens cardiac contractions
d. Lengthens the refractory phase of the cardiac cycle

40. A central venous pressure (CVP) reading of 3 cm H20 indicates to the nurse that the
client is experiencing:

a. Congestive heart failure

b. Pulmonary edema
c. Dehydration
d. Cardiac decompression
ANSWERS AND RATIONALE

33) B
- the clients needs to avoid sources of strong electromagnetic fields, such as magnets,
telecommunications transmitters, and electrical generators. Clients with pacemaker can
have chest x-rays when necessary. Microwave ovens will not interfere with the
pacemaker. Metal detectors are safe.

34) B
- progressive exercise needs to be initiated to develop collateral circulation. Pain is due to
ischemic muscle and is relieved by resting.

35) B
- the body’s general inflammatory response to myocardial necrosis causes an elevation of
temperature as well as leukocytosis within 24 to 48 hours.

36) C
- inadequate oxygenation can cause premature ventricular beats

37) B
- regular exercise, (for example, walking) is suggested. This strengthens and conditions
the heart muscles and other muscles of the body. Exercise can help with weight and stress
reduction. The client should be advised to stop smoking, since this puts him at risk for
CAD. The client should be advised about how to manage stress, but regular exercise is
most important.

38) A
- blockage of myocardial blood supply causes accumulation of unoxidized metabolites
that affect nerve endings and cause pain.

39) C
- digoxin increase the strength of myocardial contractions (positive inotropic effect) and,
by altering the electrophysiologic properties of the heart, slows the heart rate (negative
chronotropic effect).

40) C
- this low value reflects a drop in circulating fluid volume. The CVP will be elevated in
CHF, pulmonary edema and cardiac decompression.

ANSWERS:

21) a ..... 22) c ..... 23) c ..... 24) c ..... 25) c

26) b ..... 27) c ..... 28) c ..... 29) c ..... 30) b

31) b..... 32) a ..... 33)) c

ANSWERS:

1) b ..... 2) a ..... 3) a ..... 4) a ..... 5) d

6) b ..... 7) d ..... 8) c ..... 9) d ..... 10) d

11) c ...12) c .... 13) c .... 14) d ..... 15) b

16) a .... 17) b .... 18) c .... 19) c .... 20) b