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1. A nurse is providing instructions to a client who is A. Vitamin K (Mephyton).

receiving warfarin sodium (Coumadin). Which statement B. Deferoxamine (Desferal).

made by the client indicates the need for further C. Aminocaproic acid (Amicar).
instruction? D. Diphenhydramine (Benadryl).

A. “I will observe the color of my urine and stool“. 8. A nurse is providing health teachings regarding
B. “I will take Ecotrin (Enteric coated aspirin) for my antiplatelet medications. Which of the following is not
headaches”. true regarding the use of this medication?
C. “I will avoid drinking alcohol”.
D. “I will take the medicine daily at the same time”. A. Antiplatelet medication inhibits the aggregation of
platelets in the clotting process, thereby prolonging
2. A nurse is caring for a client receiving a heparin bleeding time.
intravenous (IV) infusion. The nurse expects that which of B. Antiplatelet medications cannot be used
the following laboratory will be prescribed to monitor with anticoagulants.
the therapeutic effect of heparin? C. Take the medication with food to prevent
gastrointestinal upset.
A. Prothrombin time (PT). D. A routine bleeding time is monitored during the
B. Activated partial thromboplastin time (aPTT). therapy.
C. Hematocrit (Hgb).
D. Hemoglobin (Hct). 9. A client is receiving Procainamide (Procanbid) for the
treatment of ventricular arrhythmia. The client suddenly
3. A client with atrial fibrillation is receiving a continuous complains of nausea and drowsiness. Which of the
heparin infusion at 1,000 units/hr. The nurse observes intervention should the nurse do first?
that the client is receiving the therapeutic effect based
on which of the following results? A. Check the blood pressure and heart rate.
B. Do a 12-lead electrocardiogram right away.
A. Activated partial thromboplastin time of 30 seconds. C. Measure the heart rate on the rhythm strip.
B. Activated partial thromboplastin time of 60 D. Give hydralazine (Apresoline) per orem.
C. Activated partial thromboplastin time of 120 seconds. 10. A client with myocardial infarction is receiving tissue
D. Activated partial thromboplastin time of 15 seconds. plasminogen activator, alteplase (Activase, tPA). While on
the therapy, the nurse plans to prioritize which of the
4. A client is receiving intravenous heparin therapy. The following?
nurse ensures the availability in which of the
following medication? A. Observe for neurological changes.
A. Acetylcysteine (Mucomyst). B. Monitor for any signs of renal failure.
B. Calcium gluconate. C. Check the food diary.
C. Vitamin K (Mephyton). D. Observe for signs of bleeding.
D. Protamine sulfate.
11. A nurse is caring a client who is
5. A client is receiving a continuous infusion of taking digoxin (Lanoxin) 0.25mcg tab once a day. The
streptokinase (Streptase). The client suddenly complaints client suddenly complaints of anorexia, nausea, vomiting,
of a difficulty of breathing, itchiness, and nausea. Which and diarrhea. The physician is ruling a digoxin toxicity. As
of the following should be the priority action of the a nurse, you know the therapeutic digoxin rate is?
A. 0.25-0.5 ng/ml.
A. Stop the infusion and notify the physician. B. 0.5-2 ng/ml.
B. Administer protamine sulfate and provide oxygen C. 1.5-3 ng/ml.
therapy. D. 3.5-4.5 ng/ml.
C. Administer antihistamine then continue the infusion.
D. Slow the infusion and administer oxygen. 12. A nurse is monitoring a client who is
taking Carvedilol (Coreg CR). Which of the following
6. A client with deep vein thrombosis is receiving assessment made by the nurse would warrant a possible
Streptokinase (Streptase). The nurse would notify the complication with the use of this medication?
physician if which of the following assessment is noted?
A. A temperature of 99.2° Fahrenheit. A. Baseline blood pressure of 160/100 mm hg followed
B. A pulse rate of 99 beats per minute. by a blood pressure of 120/70 mm hg after 3 doses.
C. A respiratory rate of 25 breaths per minute. B. Baseline heart rate of 97 bpm followed by a heart
D. A blood pressure of 185/110 mm Hg. rate of 62 bpm after 3 doses.
C. Complaints of nightmares and insomnia.
7. A client who is receiving streptokinase therapy D. Complaints of dyspnea.
suddenly had a nose bleeding. The nurse ensures the
availability in which of the following medication? 13. A nurse is interviewing a client who is about to
receive metoprolol. Upon the history taking, the client is
also taking insulin. Which of the following statements 18. A nurse is monitoring a client who is taking Digoxin
made by the nurse will correctly explain the possible (Lanoxin). All of which are the side effects associated
interaction of these medications? with the medication, except?

A. “This medication will maintain the blood sugar level A. Anorexia.

on a normal range”. B. Blurred vision.
B. “This medication will have no effect in the blood C. Diarrhea.
sugar level”. D. Tremors.
C. “This medication may mask some of the symptoms
of hypoglycemia such as tremor, palpitation, and rapid 19. A nurse is interviewing a patient who is about to
heartbeat. receive bumetanide (Bumex). Which of the following is a
D. “This medication may mask some of the symptoms concern related to the administration of the medication?
of hyperglycemia such as headache, increased thirst,
and blurred vision“. A. Penicillin allergy.
B. Sulfa allergy.
14. A client is about to receive Metolazone (Zaroxolyn). C. Soy containing allergy.
The nurse in charge understands that which of the D. Cephalosporin allergy.
following laboratory results are related to the
administration of the medication? 20. A client arrives in the emergency with complaints of
chest pain and is diagnosed with acute MI.
A. Hyperkalemia and hypocalcemia. A morphine 4mg IV was given 5 minutes ago. Which of
B. Hyperkalemia and hypoglycemia. the following assessment made by the nurse indicates a
C. Hypouricemia and hypoglycemia. further immediate action?
D. Hypokalemia and hyperglycemia.
A. Respiratory rate from 20 bpm to 12 bpm.
15. A client with congestive heart failure is being treated B. Blood pressure from 120/70 to 100/60 mmHg.
with Torsemide (Demadex). The nurse obtains the C. The client still complains of chest pain with a pain
following vital signs: Blood pressure of 100/65 mm hg; scale of 2/10.
pulse rate of 91 beats per minute; and respiration of 25 D. Cardiac rate of 103 bpm and a normal sinus rhythm
breaths per minute? Which of the following will be the of the ECG.
priority assessment of the nurse after the initiation of the
dose? 1. A nurse is assessing an electrocardiogram rhythm
strip. The P waves and QRS complexes are regular. The
A. Urine output. PR interval is 0.16 second, and QRS complexes measure
B. Serum potassium and calcium. 0.06 second. The overall heart rate is 64 beats per
C. Blood pressure. minute. The nurse assesses the cardiac rhythm as:
D. Weight.
1. Normal sinus rhythm
16. A nurse is giving instruction to a client who is 2. Sinus bradycardia
receiving Cholestyramine (Questran) for the treatment of 3. Sick sinus syndrome
hyperlipidemia. Which of the following statements made 4. First-degree heart block.
by the client indicates the need for further instructions?
2. A nurse notices frequent artifact on the ECG monitor
A. “This medication comes in a powder that must be for a client whose leads are connected by cable to a
mixed with juice or water before administration”. console at the bedside. The nurse examines the client to
B. “I will avoid eating foods rich in saturated fats”. determine the cause. Which of the following items is
C. “I will continue taking nicotinic acid as part of the unlikely to be responsible for the artifact?
D. “Constipation, belching and heartburn are some of 1. Frequent movement of the client
the side effects”. 2. Tightly secured cable connections
3. Leads applied over hairy areas
17. A nurse is providing instructions to a client who is on 4. Leads applied to the limbs
nicotinic acid for the treatment of hyperlipidemia. Which
statement made by the nurse indicates a comprehension 3. A nurse is watching the cardiac monitor and notices
of the instructions? that the rhythm suddenly changes. There are no P
waves, the QRS complexes are wide, and the ventricular
A. “I should take aspirin 30 minutes before nicotinic rate is regular but over 100. The nurse determines that
acid”. the client is experiencing:
B. “I will drink alcohol in moderation”.
C. “Yellowing of the skin is a common side effect”. 1. Premature ventricular contractions
D. “This medication is taken on an empty stomach“. 2. Ventricular tachycardia
3. Ventricular fibrillation
4. Sinus tachycardia
4. A nurse is viewing the cardiac monitor in a client’s 10. A nurse notes that a client with sinus rhythm has a
room and notes that the client has just gone into premature ventricular contraction that falls on the T
ventricular tachycardia. The client is awake and alert wave of the preceding beat. The client’s rhythm
and has good skin color. The nurse would prepare to do suddenly changes to one with no P waves or definable
which of the following? QRS complexes. Instead, there are coarse wavy lines of
varying amplitude. The nurse assesses this rhythm to
1. Immediately defibrillate be:
2. Prepare for pacemaker insertion
3. Administer amiodarone (Cordarone) intravenously 1. Ventricular tachycardia
4. Administer epinephrine (Adrenaline) intravenously 2. Ventricular fibrillation
3. Atrial fibrillation
5. A nurse is caring for a client with unstable ventricular 4. Asystole
tachycardia. The nurse instructs the client to do which
of the following, if prescribed, during an episode of 11. While caring for a client who has sustained an MI,
ventricular tachycardia? the nurse notes eight PVCs in one minute on the cardiac
monitor. The client is receiving an IV infusion
1. Breathe deeply, regularly, and easily. of D5W and oxygen at 2 L/minute. The nurse’s first
2. Inhale deeply and cough forcefully every 1 to 3 course of action should be to:
3. Lie down flat in bed 1. Increase the IV infusion rate
4. Remove any metal jewelry 2. Notify the physician promptly
3. Increase the oxygen concentration
6. A client is having frequent premature ventricular 4. Administer a prescribed analgesic
contractions. A nurse would place priority on
assessment of which of the following items? 12. The adaptations of a client with complete heart
block would most likely include:
1. Blood pressure and peripheral perfusion
1. Nausea and vertigo
2. Sensation of palpitations
2. Flushing and slurred speech
3. Causative factors such as caffeine
3. Cephalalgia and blurred vision
4. Precipitating factors such as infection
4. Syncope and slow ventricular rate
7. A client has developed atrial fibrillation, which a
13. A client with a bundle branch block is on a cardiac
ventricular rate of 150 beats per minute. A nurse
monitor. The nurse should expect to observe:
assesses the client for:
1. Sagging ST segments
1. Hypotension and dizziness 2. Absence of P wave configurations
2. Nausea and vomiting 3. Inverted T waves following each QRS complex
3. Hypertension and headache 4. Widening of QRS complexes to 0.12 second or
4. Flat neck veins greater.

8. A nurse is watching the cardiac monitor, and a client’s 14. When ventricular fibrillation occurs in a CCU, the
rhythm suddenly changes. There are no P waves; first person reaching the client should:
instead, there are wavy lines. The QRS complexes
measure 0.08 second, but they are irregular, with a rate 1. Administer oxygen
of 120 beats a minute. The nurse interprets this rhythm 2. Defibrillate the client
as: 3. Initiate CPR
4. Administer sodium bicarbonate intravenously
1. Sinus tachycardia
2. Atrial fibrillation 15. What criteria should the nurse use to determine
3. Ventricular tachycardia normal sinus rhythm for a client on a cardiac monitor?
4. Ventricular fibrillation Check all that apply.

9. A client with rapid rate atrial fibrillation asks a nurse 1. The RR intervals are relatively consistent
why the physician is going to perform carotid massage. 2. One P wave precedes each QRS complex
The nurse responds that this procedure may stimulate 3. Four to eight complexes occur in a 6-second strip
the: 4. The ST segment is higher than the PR interval
5. The QRS complex ranges from 0.12 to 0.20 second.
1. Vagus nerve to slow the heart rate
2. Vagus nerve to increase the heart rate; overdriving 16. When auscultating the apical pulse of a client who
the rhythm. has atrial fibrillation, the nurse would expect to hear a
3. Diaphragmatic nerve to slow the heart rate rhythm that is characterized by:
4. Diaphragmatic nerve to overdrive the rhythm
1. The presence of occasional coupled beats 1. Normal because of increased blood flow through the
2. Long pauses in an otherwise regular rhythm leg
3. A continuous and totally unpredictable irregularity 2. Slightly deteriorating and should be monitored for
4. Slow but strong and regular beats another hour
3. Moderately impaired, and the surgeon should be
1. Atherosclerosis impedes coronary blood flow by called
which of the following mechanisms? 4. Adequate from an arterial approach, but venous
complications are arising.
1. Plaques obstruct the vein
2. Plaques obstruct the artery 7. After open-heart surgery, a client develops a
3. Blood clots form outside the vessel wall temperature of 102*F. The nurse notifies the physician
4. Hardened vessels dilate to allow blood to flow because elevated temperatures:
1. Increase the cardiac output
2. A paradoxical pulse occurs in a client who had a 2. May indicate cerebral edema
coronary artery bypass graft (CABG) surgery two (2) 3. May be a forerunner of hemorrhage
days ago. Which of the following surgical complications 4. Are related to diaphoresis and possible chilling
should the nurse suspect?
8. During a cardiac catheterization blood samples from
1. Left-sided heart failure the right atrium, right ventricle, and pulmonary artery
2. Aortic regurgitation are analyzed for their oxygen content. Normally:
3. Complete heart block
4. Pericardial tamponade 1. All contain less CO2 than does pulmonary vein blood
2. All contain more oxygen than does pulmonary vein
3. After cardiac surgery, a client’s blood pressure blood
measures 126/80. The nurse determines that the mean 3. The samples of blood all contain about the same
arterial pressure (MAP) is which of the following? amount of oxygen
4. Pulmonary artery blood contains more oxygen than
1. 46 mm Hg the other samples
2. 80 mm Hg
3. 95 mm Hg 9. The nurse prepares the client for insertion of a
4. 90 mm Hg pulmonary artery catheter (Swan-Ganz catheter). The
nurse teaches the client that the catheter will be
4. A woman with severe mitral stenosis and mitral inserted to provide information about:
regurgitation has a pulmonary artery catheter inserted.
The physician orders pulmonary artery pressure 1. Stroke volume
monitoring, including pulmonary capillary wedge 2. Cardiac output
pressures. The purpose of this is to help assess the: 3. Venous pressure
4. Left ventricular functioning
1. Degree of coronary artery stenosis
2. Peripheral arterial pressure 10. When preparing a client for discharge after surgery
3. Pressure from fluid within the left ventricle for a CABG, the nurse should teach the client that there
4. Oxygen and carbon dioxide concentration is the will be:
1. No further drainage from the incisions after
5. For a client who excretes excessive amounts of hospitalizations
calcium during the postoperative period after open 2. A mild fever and extreme fatigue for several weeks
heart surgery, which of the following measures should after surgery
the nurse institute to help prevent complications 3. Little incisional pain and tenderness after 3 to 4
associated with excessive calcium excretion? weeks after surgery
4. Some increase in edema in the leg used for the
1. Ensure a liberal fluid intake donor graft when activity increases
2. Provide an alkaline ash diet
3. Prevent constipation 11. What is the most important nursing action when
4. Enrich the client’s diet with dairy products measuring a pulmonary capillary wedge pressure
6. A nurse is assessing the neurovascular of a client who
has returned to the surgical nursing unit 4 hours ago 1. Have the client bear down when measuring the
after undergoing aortoiliac bypass graft. The affected PCWP
leg is warm, and the nurse notes redness and edema. 2. Deflate the balloon as soon as the PCWP is
The pedal pulse is palpable and unchanged from measured
admission. The nurse interprets that the neurovascular 3. Place the client in a supine position before measuring
status is: the PCWP
4. Flush the catheter with heparin solution after the
PCWP is determined. 1. “Have you ever had this pain before?”
2. “Can you describe the pain to me?”
12. The most important assessment for the nurse to 3. “Does the pain get worse when you breathe in?”
make after a client has had a femoropopliteal bypass for 4. “Can you rate the pain on a scale of 1-10, with ten
peripheral vascular disease would be: (10) being the worst?”

1. Incisional pain 3. A client with myocardial infarction has been

2. Pedal pulse rate transferred from a coronary care unit to a general
3. Capillary refill time medical unit with cardiac monitoring via telemetry. A
4. Degree of hair growth nurse plans to allow for which of the following client
13. Which signs cause the nurse to suspect cardiac
tamponade after a client has cardiac surgery? Check all 1. Strict bed rest for 24 hours after transfer
that apply. 2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances
1. Tachycardia under 200 feet
2. Hypertension 4. Ad lib activities because the client is monitored.
3. Increased CVP
4. Increased urine output 4. A nurse notes 2+ bilateral edema in the lower
5. Jugular vein distention extremities of a client with myocardial infarction who
was admitted two (2) days ago. The nurse would plan to
14. A client has the diagnosis of left ventricular failure do which of the following next?
and a high pulmonary capillary wedge pressure (PCWP).
The physician orders dopamine to improve ventricular 1. Review the intake and output records for the last
function. The nurse will know the medication is working two (2) days
if the client’s: 2. Change the time of diuretic administration from
morning to evening
1. Blood pressure rises 3. Request a sodium restriction of one (1) g/day from
2. Blood pressure decreases the physician.
3. Cardiac index falls 4. Order daily weight starting the following morning.
4. PCWP rises
5. A client is wearing a continuous cardiac monitor,
15. A 35-year-old male was knifed in the street fight, which begins to sound its alarm. A nurse sees no
admitted through the ER, and is now in the ICU. An electrocardiogram complexes on the screen. The first
assessment of his condition reveals the following action of the nurse is to:
symptoms: respirations shallow and rapid, CVP 15 cm
H2O, BP 90 mm Hg systolic, skin cold and pale, urinary 1. Check the client status and lead placement
output 60-100 mL/hr for the last 2 hours. Analyzing 2. Press the recorder button on the electrocardiogram
these symptoms, the nurse will base a nursing diagnosis console.
on the conclusion that the client has which of the 3. Call the physician
following conditions? 4. Call a code blue

1. Hypovolemic shock 6. A nurse is assessing the blood pressure of a client

2. Cardiac tamponade diagnosed with primary hypertension. The nurse
3. Wound dehiscence ensures accurate measurement by avoiding which of
4. Atelectasis the following?

1. Seating the client with arm bared, supported, and at

1. A client is scheduled for a cardiac catheterization heart level.
using a radiopaque dye. Which of the following 2. Measuring the blood pressure after the client has
assessments is most critical before the procedure? been seated quietly for 5 minutes.
3. Using a cuff with a rubber bladder that encircles at
1. Intake and output least 80% of the limb.
2. Baseline peripheral pulse rates 4. Taking a blood pressure within 15 minutes after
3. Height and weight nicotine or caffeine ingestion.
4. Allergy to iodine or shellfish
7. IV heparin therapy is ordered for a client. While
2. A client with no history of cardiovascular disease implementing this order, a nurse ensures that which of
comes into the ambulatory clinic with flu-like the following medications is available on the nursing
symptoms. The client suddenly complains of chest pain. unit?
Which of the following questions would best help a
nurse to discriminate pain caused by a non-cardiac 1. Vitamin K
problem? 2. Aminocaproic acid
3. Potassium chloride 13. A client has driven himself to the ER. He is 50 years
4. Protamine sulfate old, has a history of hypertension, and informs the
nurse that his father died of a heart attack at 60 years
8. A client is at risk for pulmonary embolism and is on of age. The client is presently complaining of
anticoagulant therapy with warfarin (Coumadin). The indigestion. The nurse connects him to an ECG monitor
client’s prothrombin time is 20 seconds, with a control and begins administering oxygen at 2 L/minute per NC.
of 11 seconds. The nurse assesses that this result is: The nurse’s next action would be to:

1. The same as the client’s own baseline level 1. Call for the doctor
2. Lower than the needed therapeutic level 2. Start an intravenous line
3. Within the therapeutic range 3. Obtain a portable chest radiograph
4. Higher than the therapeutic range 4. Draw blood for laboratory studies

9. A client who has been receiving heparin therapy also 14. The nurse receives emergency laboratory results for
is started on warfarin. The client asks a nurse why both a client with chest pain and immediately informs the
medications are being administered. In formulating a physician. An increased myoglobin level suggests which
response, the nurse incorporates the understanding of the following?
that warfarin:
1. Cancer
1. Stimulates the breakdown of specific clotting factors 2. Hypertension
by the liver, and it takes two (2)- three (3) days for this 3. Liver disease
to exert an anticoagulant effect. 4. Myocardial infarction
2. Inhibits synthesis of specific clotting factors in the
liver, and it takes 3-4 days for this medication to exert 15. When teaching a client about propranolol
an anticoagulant effect. hydrochloride, the nurse should base the information
3. Stimulates production of the body’s own on the knowledge that propranolol hydrochloride:
thrombolytic substances, but it takes 2-4 days for this to
begin. 1. Blocks beta-adrenergic stimulation and thus causes
4. Has the same mechanism of action as Heparin, and decreased heart rate, myocardial contractility, and
the crossover time is needed for the serum level of conduction.
warfarin to be therapeutic. 2. Increases norepinephrine secretion and thus
decreases blood pressure and heart rate.
10. A 60-year-old male client comes into the emergency 3. Is a potent arterial and venous vasodilator that
department with complaints of crushing chest pain that reduces peripheral vascular resistance and lowers blood
radiates to his shoulder and left arm. The admitting pressure.
diagnosis is acute myocardial infarction. Immediate 4. Is an angiotensin-converting enzyme inhibitor that
admission orders include oxygen by NC at 4L/minute, reduces blood pressure by blocking the conversion of
blood work, chest x-ray, an ECG, and two (2) mg of angiotensin I to angiotensin II.
morphine given intravenously. The nurse should first:
16. The most important long-term goal for a client with
1. Administer the morphine hypertension would be to:
2. Obtain a 12-lead ECG
3. Obtain the lab work 1. Learn how to avoid stress
4. Order the chest x-ray 2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
11. When administered a thrombolytic drug to the 4. Control high blood pressure
client experiencing an MI, the nurse explains to him that
the purpose of this drug is to: 17. Hypertension is known as the silent killer. This
phrase is associated with the fact that hypertension
1. Help keep him well hydrated often goes undetected until symptoms of other system
2. Dissolve clots he may have failures occur. This may occur in the form of:
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias. 1. Cerebrovascular accident
2. Liver disease
12. When interpreting an ECG, the nurse would keep in 3. Myocardial infarction
mind which of the following about the P wave? Select 4. Pulmonary disease
all that apply.
18. During the previous few months, a 56-year-old
1. Reflects electrical impulse beginning at the SA node woman felt brief twinges of chest pain while working in
2. Indicated electrical impulse beginning at the AV node her garden and has had frequent episodes of
3. Reflects atrial muscle depolarization indigestion. She comes to the hospital after
4. Identifies ventricular muscle depolarization experiencing severe anterior chest pain while raking
5. Has a duration of normally 0.11 seconds or less. leaves. Her evaluation confirms a diagnosis of stable
angina pectoris. After stabilization and treatment, the
client is discharged from the hospital. At her follow-up 3. Take one (1) tablet, then an additional tablet every 5
appointment, she is discouraged because she is minutes for a total of three (3) tablets. Call the
experiencing pain with increasing frequency. She states physician if pain persists after three (3) tablets.
that she is visiting an invalid friend twice a week and 4. Take one (1) tablet. If pain persists after five (5)
now cannot walk up the second flight of steps to the minutes, take two (2) tablets. If pain persists five (5)
friend’s apartment without pain. Which of the following minutes later, call the physician.
measures that the nurse could suggest would most
likely help the client deal with this problem? 24. Which of the following arteries primarily feeds the
anterior wall of the heart?
1. Visit her friend earlier in the day.
2. Rest for at least an hour before climbing the stairs. 1. Circumflex artery
3. Take a nitroglycerin tablet before climbing the 2. Internal mammary artery
stairs. 3. Left anterior descending artery
4. Lie down once she reaches the friend’s apartment. 4. Right coronary artery

19. Which of the following symptoms should the nurse 25. When do coronary arteries primarily receive blood
teach the client with unstable angina to report flow?
immediately to her physician?
1. During inspiration
1. A change in the pattern of her pain 2. During diastolic
2. Pain during sex 3. During expiration
3. Pain during an argument with her husband 4. During systole
4. Pain during or after an activity such as lawn mowing
26. Prolonged occlusion of the right coronary artery
20. The physician refers the client with unstable angina produces an infarction in which of the following areas of
for a cardiac catheterization. The nurse explains to the the heart?
client that this procedure is being used in this specific
case to: 1. Anterior
2. Apical
1. Open and dilate the blocked coronary arteries 3. Inferior
2. Assess the extent of arterial blockage 4. Lateral
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and 27. A murmur is heard at the second left intercostal
heart muscle. space along the left sternal border. Which valve is this?

21. As an initial step in treating a client with angina, the 1. Aortic

physician prescribes nitroglycerin tablets, 0.3mg given 2. Mitral
sublingually. This drug’s principal effects are produced 3. Pulmonic
by: 4. Tricuspid

1. Antispasmodic effect on the pericardium 28. Which of the following blood tests is most indicative
2. Causing an increased myocardial oxygen demand of cardiac damage?
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium 1. Lactate dehydrogenase
2. Complete blood count (CBC)
22. The nurse teaches the client with angina about the 3. Troponin I
common expected side effects of nitroglycerin, 4. Creatine kinase (CK)
29. Which of the following diagnostic tools is most
1. Headache commonly used to determine the location of myocardial
2. High blood pressure damage?
3. Shortness of breath
4. Stomach cramps 1. Cardiac catheterization
2. Cardiac enzymes
23. Sublingual nitroglycerin tablets begin to work within 3. Echocardiogram
1 to 2 minutes. How should the nurse instruct the client 4. Electrocardiogram (ECG)
to use the drug when chest pain occurs?
30. Which of the following types of pain is most
1. Take one (1) tablet every two (2) to five (5) minutes characteristic of angina?
until the pain stops.
2. Take one (1) tablet and rest for ten (10) minutes. Call 1. Knifelike
the physician if pain persists after ten (10) minutes. 2. Sharp
3. Shooting
4. Tightness
38. A client is receiving spironolactone to treat
31. Which of the following parameters is the major hypertension. Which of the following instructions
determinant of diastolic blood pressure? should the nurse provide?

1. Baroreceptors 1. “Eat foods high in potassium.”

2. Cardiac output 2. “Take daily potassium supplements.”
3. Renal function 3. “Discontinue sodium restrictions.”
4. Vascular resistance 4. “Avoid salt substitutes.”

32. Which of the following factors can cause blood 39. When assessing an ECG, the nurse knows that the P-
pressure to drop to normal levels? R interval represents the time it takes for the:

1. Kidneys’ excretion of sodium only 1. Impulse to begin atrial contraction

2. Kidneys’ retention of sodium and water 2. Impulse to transverse the atria to the AV node
3. Kidneys’ excretion of sodium and water 3. SA node to discharge the impulse to begin atrial
4. Kidneys’ retention of sodium and excretion of water depolarization
4. Impulse to travel to the ventricles
33. Baroreceptors in the carotid artery walls and aorta
respond to which of the following conditions? 40. Following a treadmill test and cardiac
catheterization, the client is found to have coronary
1. Changes in blood pressure artery disease, which is inoperative. He is referred to
2. Changes in arterial oxygen tension the cardiac rehabilitation unit. During his first visit to
3. Changes in arterial carbon dioxide tension the unit he says that he doesn’t understand why he
4. Changes in heart rate needs to be there because there is nothing that can be
done to make him better. The best nursing response is:
34. Which of the following terms describes the force
against which the ventricle must expel blood? 1. “Cardiac rehabilitation is not a cure but can help
restore you to many of your former activities.”
1. Afterload 2. “Here we teach you to gradually change your lifestyle
2. Cardiac output to accommodate your heart disease.”
3. Overload 3. “You are probably right but we can gradually increase
4. Preload your activities so that you can live a more active life.”
4. “Do you feel that you will have to make some
35. Which of the following terms is used to describe the changes in your life now?”
amount of stretch on the myocardium at the end of
diastole? 41. To evaluate a client’s condition following cardiac
catheterization, the nurse will palpate the pulse:
1. Afterload
2. Cardiac index 1. In all extremities
3. Cardiac output 2. At the insertion site
4. Preload 3. Distal to the catheter insertion
4. Above the catheter insertion
36. A 57-year-old client with a history of asthma is
prescribed propranolol (Inderal) to control 42. A client’s physician orders nuclear cardiography and
hypertension. Before administered propranolol, which makes an appointment for a thallium scan. The purpose
of the following actions should the nurse take first? of injecting radioisotope into the bloodstream is to
1. Monitor the apical pulse rate
2. Instruct the client to take medication with food 1. Normal vs. abnormal tissue
3. Question the physician about the order 2. Damage in areas of the heart
4. Caution the client to rise slowly when standing. 3. Ventricular function
4. Myocardial scarring and perfusion
37. One hour after administering IV furosemide (Lasix)
to a client with heart failure, a short burst of ventricular 43. A client enters the ER complaining of severe chest
tachycardia appears on the cardiac monitor. Which of pain. A myocardial infarction is suspected. A 12 lead
the following electrolyte imbalances should the nurse ECG appears normal, but the doctor admits the client
suspect? for further testing until cardiac enzyme studies are
returned. All of the following will be included in the
1. Hypocalcemia nursing care plan. Which activity has the highest
2. Hypermagnesemia priority?
3. Hypokalemia
4. Hypernatremia 1. Monitoring vital signs
2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site 49. Direct-acting vasodilators have which of the
following effects on the heart rate?
44. A client is experiencing tachycardia. The nurse’s
understanding of the physiological basis for this 1. Heart rate decreases
symptom is explained by which of the following 2. Heart rate remains significantly unchanged
statements? 3. Heart rate increases
4. Heart rate becomes irregular
1. The demand for oxygen is decreased because of
pleural involvement 50. When teaching a patient why spironolactone
2. The inflammatory process causes the body to (Aldactone) and furosemide (Lasix) are prescribed
demand more oxygen to meet its needs. together, the nurse bases teaching on the knowledge
3. The heart has to pump faster to meet the demand that:
for oxygen when there is lowered arterial oxygen
tension. 1. Moderate doses of two different types of diuretics
4. Respirations are labored. are more effective than a large dose of one type
2. This combination promotes diuresis but decreases
45. A client enters the ER complaining of chest pressure the risk of hypokalemia
and severe epigastric distress. His VS are 158/90, 94, 24, 3. This combination prevents dehydration and
and 99*F. The doctor orders cardiac enzymes. If the hypovolemia
client were diagnosed with an MI, the nurse would 4. Using two drugs increases osmolality of plasma and
expect which cardiac enzyme to rise within the next 3 to the glomerular filtration rate
8 hours?
1. The nurse is preparing to teach a client with
1. Creatine kinase (CK or CPK) microcytic hypochromic anemia about the diet to follow
2. Lactic dehydrogenase (LDH) after discharge. Which of the following foods should be
3. LDH-1 included in the diet?
4. LDH-2
A. Eggs
46. A 45-year-old male client with leg ulcers and arterial B. Lettuce
insufficiency is admitted to the hospital. The nurse C. Citrus fruits
understands that leg ulcers of this nature are usually D. Cheese
caused by:
2. The nurse would instruct the client to eat which of
1. Decreased arterial blood flow secondary to the following foods to obtain the best supply of vitamin
vasoconstriction B12?
2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries A. Whole grains
4. Trauma to the lower extremities B. Green leafy vegetables
C. Meats and dairy products
47. Which of the following instructions should be D. Broccoli and Brussels sprouts
included in the discharge teaching for a patient
discharged with a transdermal nitroglycerin patch? 3. The nurse has just admitted a 35-year-old female
client who has a serum B12 concentration of 800 pg/ml.
1. “Apply the patch to a non hairy, nonfatty area of the Which of the following laboratory findings would cue
upper torso or arms.” the nurse to focus the client history on specific drug or
2. “Apply the patch to the same site each day to alcohol abuse?
maintain consistent drug absorption.”
3. “If you get a headache, remove the patch for 4 hours A. Total bilirubin, 0.3 mg/dL
and then reapply.” B. Serum creatinine, 0.5 mg/dL
4. “If you get chest pain, apply a second patch right next C. Hemoglobin, 16 g/dL
to the first patch.” D. Folate, 1.5 ng/mL

48. In order to prevent the development of tolerance, 4. The nurse understands that the client with pernicious
the nurse instructs the patient to: anemia will have which distinguishing laboratory
1. Apply the nitroglycerin patch every other day
2. Switch to sublingual nitroglycerin when the patient’s A. Schilling’s test elevated
systolic blood pressure elevates to >140 mm Hg B. Intrinsic factor, absent.
3. Apply the nitroglycerin patch for 14 hours each and C. Sedimentation rate, 16 mm/hour
remove for 10 hours at night D. RBCs 5.0 million
4. Use the nitroglycerin patch for acute episodes of
angina only 5. The nurse devises a teaching plan for the patient with
aplastic anemia. Which of the following is the most
important concept to teach for health maintenance?
A. “The reason for your vitamin deficiency is an inability
A. Eat animal protein and dark leafy vegetables each to absorb the vitamin because the stomach is not
day producing sufficient acid.”
B. Avoid exposure to others with acute infection B. “The reason for your vitamin deficiency is an
C. Practice yoga and meditation to decrease stress and inability to absorb the vitamin because the stomach is
anxiety not producing sufficient intrinsic factor.”
D. Get 8 hours of sleep at night and take naps during C. “The reason for your vitamin deficiency is an
the day excessive excretion of the vitamin because of kidney
6. A client comes into the health clinic 3 years after D. “The reason for your vitamin deficiency is an
undergoing a resection of the terminal ileum increased requirement for the vitamin because of rapid
complaining of weakness, shortness of breath, and a red blood cell production.”
sore tongue. Which client statement indicates a need
for intervention and client teaching? 12. The nurse is assessing a client’s activity intolerance
by having the client walk on a treadmill for 5 minutes.
A. “I have been drinking plenty of fluids.” Which of the following indicates an abnormal response?
B. “I have been gargling with warm salt water for my
sore tongue.” A. Pulse rate increased by 20 bpm immediately after the
C. “I have 3 to 4 loose stools per day.” activity
D. “I take a vitamin B12 tablet every day.” B. Respiratory rate decreased by 5 breaths/minute
C. Diastolic blood pressure increased by 7 mm Hg
7. A vegetarian client was referred to a dietitian for D. Pulse rate within 6 bpm of resting phase after 3
nutritional counseling for anemia. Which client outcome minutes of rest.
indicates that the client does not understand nutritional
counseling? The client: 13. When comparing the hematocrit levels of a post-op
client, the nurse notes that the hematocrit decreased
A. Adds dried fruit to cereal and baked goods from 36% to 34% on the third day even though the RBC
B. Cooks tomato-based foods in iron pots and hemoglobin values remained stable at 4.5 million
C. Drinks coffee or tea with meals and 11.9 g/dL, respectively. Which nursing intervention
D. Adds vitamin C to all meals is most appropriate?

8. A client was admitted with iron deficiency anemia A. Check the dressing and drains for frank bleeding
and blood-streaked emesis. Which question is most B. Call the physician
appropriate for the nurse to ask in determining the C. Continue to monitor vital signs
extent of the client’s activity intolerance? D. Start oxygen at 2L/min per NC

A. “What activities were you able to do 6 months ago 14. A client is to receive epoetin (Epogen) injections.
compared to the present?” What laboratory value should the nurse assess before
B. “How long have you had this problem?” giving the injection?
C. “Have you been able to keep up with all your usual
activities?” A. Hematocrit
D. “Are you more tired now than you used to be?” B. Partial thromboplastin time
C. Hemoglobin concentration
9. The primary purpose of the Schilling test is to D. Prothrombin time
measure the client’s ability to:
15. A client states that she is afraid of receiving vitamin
A. Store vitamin B12 B12 injections because of the potential toxic reactions.
B. Digest vitamin B12 What is the nurse’s best response to relieve these
C. Absorb vitamin B12 fears?
D. Produce vitamin B12
A. “Vitamin B12 will cause ringing in the eats before a
10. The nurse implements which of the following for toxic level is reached.”
the client who is starting a Schilling test? B. “Vitamin B12 may cause a very mild skin rash
A. Administering methylcellulose (Citrucel) C. “Vitamin B12 may cause mild nausea but nothing
B. Starting a 24- to 48 hour urine specimen collection toxic.”
C. Maintaining NPO status D. “Vitamin B12 is generally free of toxicity because it
D. Starting a 72 hour stool specimen collection is water soluble.”

11. A client with pernicious anemia asks why she must 16. A client with microcytic anemia is having trouble
take vitamin B12 injections for the rest of her life. What selecting food items from the hospital menu. Which
is the nurse’s best response? food is best for the nurse to suggest for satisfying the
client’s nutritional needs and personal preferences?
A. Egg yolks B. Macrophage
B. Brown rice C. Stem cell
C. Vegetables D. T cell
D. Tea
24. Which of the following symptoms is expected with
17. A client with macrocytic anemia has a burn on her hemoglobin of 10 g/dl?
foot and states that she had been watching television
while lying on a heating pad. What is the nurse’s first A. None
response? B. Pallor
C. Palpitations
A. Assess for potential abuse D. Shortness of breath
B. Check for diminished sensations
C. Document the findings 25. Which of the following diagnostic findings are most
D. Clean and dress the area likely for a client with aplastic anemia?

18. Which of the following nursing assessments is a late A. Decreased production of T-helper cells
symptom of polycythemia vera? B. Decreased levels of white blood cells, red blood
cells, and platelets
A. Headache C. Increased levels of WBCs, RBCs, and platelets
B. Dizziness D. Reed-Sternberg cells and lymph node enlargement
C. Pruritus
D. Shortness of breath 26. A client with iron deficiency anemia is scheduled for
discharge. Which instruction about prescribed ferrous
19. The nurse is teaching a client with polycythemia gluconate therapy should the nurse include in the
vera about potential complications from this disease. teaching plan?
Which manifestations would the nurse include in the
client’s teaching plan? Select all that apply. A. “Take the medication with an antacid.”
B. “Take the medication with a glass of milk.”
A. Hearing loss C. “Take the medication with cereal.”
B. Visual disturbance D. “Take the medication on an empty stomach.”
C. Headache
D. Orthopnea 27. Which of the following disorders results from a
E. Gout deficiency of factor VIII?
F. Weight loss
A. Sickle cell disease
20. When a client is diagnosed with aplastic anemia, B. Christmas disease
the nurse monitors for changes in which of the C. Hemophilia A
following physiological functions? D. Hemophilia B

A. Bleeding tendencies 28. The nurse explains to the parents of a 1-year-old

B. Intake and output child admitted to the hospital in a sickle cell crisis that
C. Peripheral sensation the local tissue damage the child has on admission is
D. Bowel function caused by which of the following?

21. Which of the following blood components is A. Autoimmune reaction complicated by hypoxia
decreased in anemia? B. Lack of oxygen in the red blood cells
C. Obstruction to circulation
A. Erythrocytes D. Elevated serum bilirubin concentration.
B. Granulocytes
C. Leukocytes 29. The mothers asks the nurse why her child’s
D. Platelets hemoglobin was normal at birth but now the child has S
hemoglobin. Which of the following responses by the
22. A client with anemia may be tired due to a tissue nurse is most appropriate?
deficiency of which of the following substances?
A. “The placenta bars passage of the hemoglobin S from
A. Carbon dioxide the mother to the fetus.”
B. Factor VIII B. “The red bone marrow does not begin to produce
C. Oxygen hemoglobin S until several months after birth.”
D. T-cell antibodies C. “Antibodies transmitted from you to the fetus
provide the newborn with temporary immunity.”
23. Which of the following cells is the precursor to the D. “The newborn has a high concentration of fetal
red blood cell (RBC)? hemoglobin in the blood for some time after birth.”

A. B cell
30. Which of the following would the nurse identify as C. Ecchymosis formation around a joint
the priority nursing diagnosis during a toddler’s vaso- D. Instability of a long bone in passive movement
occlusive sickle cell crisis?
36. Because of the risks associated with administration
A. Ineffective coping related to the presence of a life- of factor VIII concentrate, the nurse would teach the
threatening disease client’s family to recognize and report which of the
B. Decreased cardiac output related to abnormal following?
hemoglobin formation
C. Pain related to tissue anoxia A. Yellowing of the skin
D. Excess fluid volume related to infection B. Constipation
C. Abdominal distention
31. A mother asks the nurse if her child’s iron D. Puffiness around the eyes
deficiency anemia is related to the child’s frequent
infections. The nurse responds based on the 37. A child suspected of having sickle cell disease is
understanding of which of the following? seen in a clinic, and laboratory studies are performed. A
nurse checks the lab results, knowing that which of the
A. Little is known about iron-deficiency anemia and its following would be increased in this disease?
relationship to infection in children.
B. Children with iron deficiency anemia are more A. Platelet count
susceptible to infection than are other children. B. Hematocrit level
C. Children with iron-deficiency anemia are less C. Reticulocyte count
susceptible to infection than are other children. D. Hemoglobin level
D. Children with iron-deficient anemia are equally as
susceptible to infection as are other children. 38. A clinic nurse instructs the mother of a child with
sickle cell disease about the precipitating factors related
32. Which statements by the mother of a toddler would to pain crisis. Which of the following, if identified by the
lead the nurse to suspect that the child has iron- mother as a precipitating factor, indicates the need for
deficiency anemia? Select all that apply. further instructions?

A. “He drinks over 3 cups of milk per day.” A. Infection

B. “I can’t keep enough apple juice in the house; he B. Trauma
must drink over 10 ounces per day.” C. Fluid overload
C. “He refuses to eat more than 2 different kinds of D. Stress
D. “He doesn’t like meat, but he will eat small amounts 39. Laboratory studies are performed for a child
of it.” suspected of having iron deficiency anemia. The nurse
5. “He sleeps 12 hours every night and take a 2-hour reviews the laboratory results, knowing that which of
nap.” the following results would indicate this type of
33. Which of the following foods would the nurse
encourage the mother to offer to her child with iron A. An elevated hemoglobin level
deficiency anemia? B. A decreased reticulocyte count
C. An elevated RBC count
A. Rice cereal, whole milk, and yellow vegetables D. Red blood cells that are microcytic and hypochromic
B. Potato, peas, and chicken
C. Macaroni, cheese, and ham 40. A pediatric nurse health educator provides a
D. Pudding, green vegetables, and rice teaching session to the nursing staff regarding
hemophilia. Which of the following information
34. The physician has ordered several laboratory tests regarding this disorder would the nurse plan to include
to help diagnose an infant’s bleeding disorder. Which of in the discussion?
the following tests, if abnormal, would the nurse
interpret as most likely to indicate hemophilia? A. Hemophilia is a Y linked hereditary disorder
B. Males inherit hemophilia from their fathers
A. Bleeding time C. Females inherit hemophilia from their mothers
B. Tourniquet test D. Hemophilia A results from a deficiency of factor VIII
C. Clot retraction test
D. Partial thromboplastin time (PTT) 1. Which of the following actions is the first priority of
care for a client exhibiting signs and symptoms of
35. Which of the following assessments in a child with coronary artery disease?
hemophilia would lead the nurse to suspect early
hemarthrosis? 1. Decrease anxiety
2. Enhance myocardial oxygenation
A. Child’s reluctance to move a body part 3. Administer sublingual nitroglycerin
B. Cool, pale, clammy extremity 4. Educate the client about his symptoms
3. Right-sided heart failure
2. Medical treatment of coronary artery disease 4. Tricupsid valve malfunction
includes which of the following procedures?
10. What is the first intervention for a client
1. Cardiac catheterization experiencing MI?
2. Coronary artery bypass surgery
3. Oral medication therapy 1. Administer morphine
4. Percutaneous transluminal coronary angioplasty 2. Administer oxygen
3. Administer sublingual nitroglycerin
3. Which of the following is the most common symptom 4. Obtain an ECG
of myocardial infarction (MI)?
11. Which of the following classes of medications
1. Chest pain protects the ischemic myocardium by blocking
2. Dyspnea catecholamines and sympathetic nerve stimulation?
3. Edema
4. Palpitations 1. Beta-adrenergic blockers
2. Calcium channel blockers
4. Which of the following symptoms is the most likely 3. Narcotics
origin of pain the client described as knifelike chest pain 4. Nitrates
that increases in intensity with inspiration?
12. What is the most common complication of an MI?
1. Cardiac
2. Gastrointestinal 1. Cardiogenic shock
3. Musculoskeletal 2. Heart failure
4. Pulmonary 3. Arrhythmias
4. Pericarditis
5. Which of the following blood tests is most indicative
of cardiac damage? 13. With which of the following disorders is jugular vein
distention most prominent?
1. Lactate dehydrogenase
2. Complete blood count (CBC) 1. Abdominal aortic aneurysm
3. Troponin I 2. Heart failure
4. Creatine kinase (CK) 3. MI
4. Pneumothorax
6. What is the primary reason for administering
morphine to a client with an MI? 14. Toxicity from which of the following medications
may cause a client to see a green-yellow halo around
1. To sedate the client lights?
2. To decrease the client’s pain
3. To decrease the client’s anxiety 1. Digoxin
4. To decrease oxygen demand on the client’s heart 2. Furosemide (Lasix)
3. Metoprolol (Lopressor)
7. Which of the following conditions is most commonly 4. Enalapril (Vasotec)
responsible for myocardial infarction?
15. Which of the following symptoms is most commonly
1. Aneurysm associated with left-sided heart failure?
2. Heart failure
3. Coronary artery thrombosis 1. Crackles
4. Renal failure 2. Arrhythmias
3. Hepatic engorgement
8. Which of the following complications is indicated by a 4. Hypotension
third heart sound (S3)?
16. In which of the following disorders would the nurse
1. Ventricular dilation expect to assess sacral edema in a bedridden client?
2. Systemic hypertension
3. Aortic valve malfunction 1. Diabetes
4. Increased atrial contractions 2. Pulmonary emboli
3. Renal failure
9. After an anterior wall myocardial infarction, which of 4. Right-sided heart failure
the following problems is indicated by auscultation of
crackles in the lungs? 17. Which of the following symptoms might a client
with right-sided heart failure exhibit?
1. Left-sided heart failure
2. Pulmonic valve malfunction 1. Adequate urine output
2. Polyuria 25. Dyspnea, cough, expectoration, weakness, and
3. Oliguria edema are classic signs and symptoms of which of the
4. Polydipsia following conditions?

18. Which of the following classes of medications 1. Pericarditis

maximizes cardiac performance in clients with heart 2. Hypertension
failure by increasing ventricular contractility? 3. MI
4. Heart failure
1. Beta-adrenergic blockers
2. Calcium channel blockers 26. In which of the following types of cardiomyopathy
3. Diuretics does cardiac output remain normal?
4. Inotropic agents
1. Dilated
19. Stimulation of the sympathetic nervous system 2. Hypertrophic
produces which of the following responses? 3. Obliterative
4. Restrictive
1. Bradycardia
2. Tachycardia 27. Which of the following cardiac conditions does a
3. Hypotension fourth heart sound (S4) indicate?
4. Decreased myocardial contractility
1. Dilated aorta
20. Which of the following conditions is most closely 2. Normally functioning heart
associated with weight gain, nausea, and a decrease in 3. Decreased myocardial contractility
urine output? 4. Failure of the ventricle to eject all of the blood
during systole
1. Angina pectoris
2. Cardiomyopathy 28. Which of the following classes of drugs is most
3. Left-sided heart failure widely used in the treatment of cardiomyopathy?
4. Right-sided heart failure
1. Antihypertensives
21. Which of the following heart muscle diseases is 2. Beta-adrenergic blockers
unrelated to other cardiovascular disease? 3. Calcium channel blockers
4. Nitrates
1. Cardiomyopathy
2. Coronary artery disease 29. If medical treatments fail, which of the following
3. Myocardial infarction invasive procedures is necessary for treating
4. Pericardial effusion cardiomyopathy?

22. Which of the following types of cardiomyopathy can 1. Cardiac catheterization

be associated with childbirth? 2. Coronary artery bypass graft (CABG)
3. Heart transplantation
1. Dilated 4. Intra-aortic balloon pump (IABP)
2. Hypertrophic
3. Myocarditis 30. Which of the following conditions is associated with
4. Restrictive a predictable level of pain that occurs as a result of
physical or emotional stress?
23. Septal involvement occurs in which type of
cardiomyopathy? 1. Anxiety
2. Stable angina
1. Congestive 3. Unstable angina
2. Dilated 4. Variant angina
3. Hypertrophic
4. Restrictive 31. Which of the following types of angina is most
closely related with an impending MI?
24. Which of the following recurring conditions most
commonly occurs in clients with cardiomyopathy? 1. Angina decubitus
2. Chronic stable angina
1. Heart failure 3. Nocturnal angina
2. Diabetes 4. Unstable angina
3. MI
4. Pericardial effusion 32. Which of the following conditions is the
predominant cause of angina?

1. Increased preload
2. Decreased afterload 40. Which of the following actions is the appropriate
3. Coronary artery spasm initial response to a client coughing up pink, frothy
4. Inadequate oxygen supply to the myocardium sputum?

33. Which of the following tests is used most often to 1. Call for help
diagnose angina? 2. Call the physician
3. Start an I.V. line
1. Chest x-ray 4. Suction the client
2. Echocardiogram
3. Cardiac catheterization 41. Which of the following terms describes the force
4. 12-lead electrocardiogram (ECG) against which the ventricle must expel blood?

34. Which of the following results is the primary 1. Afterload

treatment goal for angina? 2. Cardiac output
3. Overload
1. Reversal of ischemia 4. Preload
2. Reversal of infarction
3. Reduction of stress and anxiety 42. Acute pulmonary edema caused by heart failure is
4. Reduction of associated risk factors usually a result of damage to which of the following
areas of the heart?
35. Which of the following interventions should be the
first priority when treating a client experiencing chest 1. Left atrium
pain while walking? 2. Right atrium
3. Left ventricle
1. Sit the client down 4. Right ventricle
2. Get the client back to bed
3. Obtain an ECG 43. An 18-year-old client who recently had an URI is
4. Administer sublingual nitroglycerin admitted with suspected rheumatic fever. Which
assessment findings confirm this diagnosis?
36. Myocardial oxygen consumption increases as which
of the following parameters increase? 1. Erythema marginatum, subcutaneous nodules, and
1. Preload, afterload, and cerebral blood flow 2. Tachycardia, finger clubbing, and a load S3
2. Preload, afterload, and renal blood flow 3. Dyspnea, cough, and palpitations
3. Preload, afterload, contractility, and heart rate. 4. Dyspnea, fatigue, and syncope
4. Preload, afterload, cerebral blood flow, and heart
rate. 44. A client admitted with angina complains of severe
chest pain and suddenly becomes unresponsive. After
37. Which of the following positions would best aid establishing unresponsiveness, which of the following
breathing for a client with acute pulmonary edema? actions should the nurse take first?

1. Lying flat in bed 1. Activate the resuscitation team

2. Left side-lying 2. Open the client’s airway
3. In high Fowler’s position 3. Check for breathing
4. In semi-Fowler’s position 4. Check for signs of circulation

38. Which of the following blood gas abnormalities is 45. A 55-year-old client is admitted with an acute
initially most suggestive of pulmonary edema? inferior-wall myocardial infarction. During the
admission interview, he says he stopped taking his
1. Anoxia metoprolol (Lopressor) 5 days ago because he was
2. Hypercapnia feeling better. Which of the following nursing diagnoses
3. Hyperoxygenation takes priority for this client?
4. Hypocapnia
1. Anxiety
39. Which of the following is a compensatory response 2. Ineffective tissue perfusion; cardiopulmonary
to decreased cardiac output? 3. Acute pain
4. Ineffective therapeutic regimen management
1. Decreased BP
2. Alteration in LOC 46. A client comes into the E.R. with acute shortness of
3. Decreased BP and diuresis breath and a cough that produces pink, frothy sputum.
4. Increased BP and fluid retention 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 following
disorders should the nurse suspect? 52. A client with pulmonary edema has been on diuretic
therapy. The client has an order for additional
1. Pulmonary edema furosemide (Lasix) in the amount of 40 mg IV push.
2. Pneumothorax Knowing that the client also will be started on Digoxin
3. Cardiac tamponade (Lanoxin), a nurse checks the client’s most recent:
4. Pulmonary embolus
1. Digoxin level
47. The nurse coming on duty receives the report from 2. Sodium level
the nurse going off duty. Which of the following clients 3. Potassium level
should the on-duty nurse assess first? 4. Creatinine level

1. The 58-year-old client who was admitted 2 days ago 53. A client who had cardiac surgery 24 hours ago has a
with heart failure, BP of 126/76, and a respiratory rate urine output averaging 19 ml/hr for 2 hours. The client
of 21 breaths a minute. received a single bolus of 500 ml of IV fluid. Urine
2. The 88-year-old client with end-stage right-sided output for the subsequent hour was 25 ml. Daily
heart failure, BP of 78/50, and a DNR order. laboratory results indicate the blood urea nitrogen is 45
3. The 62-year-old client who was admitted one day ago mg/dL and the serum creatinine is 2.2 mg/dL. A nurse
with thrombophlebitis and receiving IV heparin. interprets the client is at risk for:
4. A 76-year-old client who was admitted 1 hour ago
with new-onset atrial fibrillation and is receiving IV 1. Hypovolemia
diltiazem (Cardizem). 2. UTI
3. Glomerulonephritis
48. When developing a teaching plan for a client with 4. Acute renal failure
endocarditis, which of the following points is most
essential for the nurse to include? 54. A nurse is preparing to ambulate a client on the 3rd
day after cardiac surgery. The nurse would plan to do
1. “Report fever, anorexia, and night sweats to the which of the following to enable the client to best
physician.” tolerate the ambulation?
2. “Take prophylactic antibiotics after dental work and
invasive procedures.” 1. Encourage the client to cough and deep breathe
3. “Include potassium rich foods in your diet.” 2. Premedicate the client with an analgesic
4. “Monitor your pulse regularly.” 3. Provide the client with a walker
4. Remove telemetry equipment because it weighs
49. A nurse is conducting a health history with a client down the hospital gown.
with a primary diagnosis of heart failure. Which of the
following disorders reported by the client is unlikely to 55. A client’s electrocardiogram strip shows atrial and
play a role in exacerbating the heart failure? ventricular rates of 80 complexes per minute. The PR
interval is 0.14 second, and the QRS complex measures
1. Recent URI 0.08 second. The nurse interprets this rhythm is:
2. Nutritional anemia
3. Peptic ulcer disease 1. Normal sinus rhythm
4. A-Fib 2. Sinus bradycardia
3. Sinus tachycardia
50. A nurse is preparing for the admission of a client 4. Sinus dysrhythmia
with heart failure who is being sent directly to the
hospital from the physician’s office. The nurse would 56. A client has frequent bursts of ventricular
plan on having which of the following medications tachycardia on the cardiac monitor. A nurse is most
readily available for use? concerned with this dysrhythmia because:

1. Diltiazem (Cardizem) 1. It is uncomfortable for the client, giving a sense of

2. Digoxin (Lanoxin) impending doom.
3. Propranolol (Inderal) 2. It produces a high cardiac output that quickly leads to
4. Metoprolol (Lopressor) cerebral and myocardial ischemia.
3. It is almost impossible to convert to a normal sinus
51. A nurse caring for a client in one room is told by rhythm.
another nurse that a second client has developed 4. It can develop into ventricular fibrillation at any
severe pulmonary edema. On entering the 2nd client’s time.
room, the nurse would expect the client to be:
57. A home care nurse is making a routine visit to a
1. Slightly anxious client receiving digoxin (Lanoxin) in the treatment of
2. Mildly anxious heart failure. The nurse would particularly assess the
3. Moderately anxious client for:
4. Extremely anxious
1. Thrombocytopenia and weight gain 64. Which of the following nursing diagnoses would be
2. Anorexia, nausea, and visual disturbances appropriate for a client with heart failure? Select all that
3. Diarrhea and hypotension apply.
4. Fatigue and muscle twitching
1. Ineffective tissue perfusion related to decreased
58. A client with angina complains that the angina pain peripheral blood flow secondary to decreased cardiac
is prolonged and severe and occurs at the same time output.
each day, most often in the morning, On further 2. Activity intolerance related to increased cardiac
assessment a nurse notes that the pain occurs in the output.
absence of precipitating factors. This type of anginal 3. Decreased cardiac output related to structural and
pain is best described as: functional changes.
4. Impaired gas exchange related to decreased
1. Stable angina sympathetic nervous system activity.
2. Unstable angina
3. Variant angina 65. Which of the following would be a priority nursing
4. Nonanginal pain diagnosis for the client with heart failure and pulmonary
59. The physician orders continuous intravenous
nitroglycerin infusion for the client with MI. Essential 1. Risk for infection related to stasis of alveolar
nursing actions include which of the following? secretions
2. Impaired skin integrity related to pressure
1. Obtaining an infusion pump for the medication 3. Activity intolerance related to pump failure
2. Monitoring BP q4h 4. Constipation related to immobility
3. Monitoring urine output hourly
4. Obtaining serum potassium levels daily 66. Captopril may be administered to a client with HF
because it acts as a:
60. Aspirin is administered to the client experiencing an
MI because of its: 1. Vasopressor
2. Volume expander
1. Antipyretic action 3. Vasodilator
2. Antithrombotic action 4. Potassium-sparing diuretic
3. Antiplatelet action
4. Analgesic action 67. Furosemide is administered intravenously to a client
with HF. How soon after administration should the
61. Which of the following is an expected outcome for a nurse begin to see evidence of the drugs desired effect?
client on the second day of hospitalization after an MI?
1. 5 to 10 minutes
1. Has severe chest pain 2. 30 to 60 minutes
2. Can identify risks factors for MI 3. 2 to 4 hours
3. Agrees to participate in a cardiac rehabilitation 4. 6 to 8 hours
walking program
4. Can perform personal self-care activities without 68. Which of the following foods should the nurse teach
pain a client with heart failure to avoid or limit when
following a 2-gram sodium diet?
62. Which of the following reflects the principle on
which a client’s diet will most likely be based during the 1. Apples
acute phase of MI? 2. Tomato juice
3. Whole wheat bread
1. Liquids as ordered 4. Beef tenderloin
2. Small, easily digested meals
3. Three regular meals per day 69. The nurse finds the apical pulse below the 5th
4. NPO intercostal space. The nurse suspects:

63. An older, sedentary adult may not respond to 1. Left atrial enlargement
emotional or physical stress as well as a younger 2. Left ventricular enlargement
individual because of: 3. Right atrial enlargement
4. Right ventricular enlargement
1. Left ventricular atrophy
2. Irregular heartbeats 70. Which of the following arteries primarily feeds the
3. Peripheral vascular occlusion anterior wall of the heart?
4. Pacemaker placement
1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery nurse also notes superficial thrombophlebitis of the
lower leg. The nurse would next assess the client for:
1. The most important factor in regulating the caliber of
blood vessels, which determines resistance to flow, is: 1. Familial tendency toward peripheral vascular disease
2. Smoking history
1. Hormonal secretion 3. Recent exposures to allergens
2. Independent arterial wall activity. 4. History of insect bites
3. The influence of circulating chemicals
4. The sympathetic nervous system 8. Intravenous heparin therapy is ordered for a client.
While implementing this order, a nurse ensures that
2. With peripheral arterial insufficiency, leg pain during which of the following medications is available on the
rest can be reduced by: nursing unit?

1. Elevating the limb above heart level 1. Vitamin K

2. Lowering the limb so it is dependent 2. Aminocaproic acid
3. Massaging the limb after application of cold 3. Potassium chloride
compresses 4. Protamine sulfate
4. Placing the limb in a plane horizontal to the body
9. A client who has been receiving heparin therapy also
3. Buerger’s disease is characterized by all of the is started on warfarin sodium (coumadin). The client
following except: asks the nurse why both medications are being
administered. In formulating a response, the nurse
1. Arterial thrombosis formation and occlusion incorporates the understanding that warfarin sodium:
2. Lipid deposits in the arteries
3. Redness or cyanosis in the limb when it is dependent 1. Stimulates the breakdown of specific clotting factors
4. Venous inflammation and occlusion by the liver, and it takes 2-3 days for this is exhibit an
anticoagulant effect.
4. A significant cause of venous thrombosis is: 2. Inhibits synthesis of specific clotting factors in the
liver, and it takes 3 to 4 days for this medication to
1. Altered blood coagulation exert an anticoagulation effect.
2. Stasis of blood 3. Stimulates production of the body’s own
3. Vessel wall injury thrombolytic substances, but it takes 2-4 days for it to
4. All of the above begin.
4. Has the same mechanism action of heparin, and the
5. When caring for a patient who has started crossover time is needed for the serum level of warfarin
anticoagulant therapy with warfarin (Coumadin), the sodium to be therapeutic.
nurse knows not to expect therapeutic benefits for:
10. A nurse has the order to begin administering
1. At least 12 hours warfarin sodium (Coumadin) to a client. While
2. The first 24 hours implementing this order, the nurse ensures that which
3. 2-3 days of the following medications is available on the nursing
4. 1 week unit as the antidote for Coumadin?

6. Mike, a 43-year old construction worker, has a history 1. Vitamin K

of hypertension. He smokes two packs of cigarettes a 2. Aminocaproic acid
day, is nervous about the possibility of being 3. Potassium chloride
unemployed, and has difficulty coping with stress. His 4. Protamine sulfate
current concern is calf pain during minimal exercise that
decreased with rest. The nurse assesses Mike’s 11. A nurse is assessing the neurovascular status of a
symptoms as being associated with peripheral arterial client who returned to the surgical nursing unit 4 hours
occlusive disease. The nursing diagnosis is probably: ago after undergoing aortoiliac bypass graft. The
affected leg is warm, and the nurse notes redness and
1. Alteration in tissue perfusion related to edema. The pedal pulse is palpable and unchanged
compromised circulation from admission. The nurse interprets that the
2. Dysfunctional use of extremities related to muscle neurovascular status is:
3. Impaired mobility related to stress associated with 1. Normal because of the increased blood flow through
pain the leg
4. Impairment in muscle use associated with pain on 2. Slightly deteriorating and should be monitored for
exertion. another hour
3. Moderately impaired, and the surgeon should be
7. A 24-year old man seeks medical attention for called.
complaints of claudication in the arch of the foot. A 4. Adequate from the arterial approach, but venous
complications are arising.
19. A nurse is assessing a client with an abdominal
12. A client is admitted with a venous stasis leg ulcer. A aortic aneurysm. Which of the following assessment
nurse assesses the ulcer, expecting to note that the findings by the nurse is probably unrelated to an
ulcer: aneurysm?

1. Has a pale colored base 1. Pulsatile abdominal mass

2. Is deep, with even edges 2. Hyperactive bowel sounds in that area
3. Has little granulation tissue 3. Systolic bruit over the area of the mass
4. Has brown pigmentation around it. 4. Subjective sensation of “heart beating” in the
13. In preparation for the discharge of a client with
arterial insufficiency and Raynaud’s disease, client 20. A nurse is caring for a client who had a
teaching instructions should include: percutaneous insertion of an inferior vena cava filter
and was on heparin therapy before surgery. The nurse
1. Walking several times each day as an exercise would inspect the surgical site most closely for signs of:
2. Keeping the heat up so that the environment is 1. Thrombosis and infection
warm 2. Bleeding and infection
3. Wearing TED hose during the day 3. Bleeding and wound dehiscence.
4. Using hydrotherapy for increasing oxygenation 4. Wound dehiscence and evisceration.

14. A client comes to the outpatient clinic and tells the 1. A 68-year-old woman is scheduled to undergo mitral
nurse that he has had legs pains that began when he valve replacement for severe mitral stenosis and mitral
walks but cease when he stops walking. Which of the regurgitation. Although the diagnosis was made during
following conditions would the nurse assess for? childhood, she did not have any symptoms until 4 years
ago. Recently, she noticed increased symptoms, despite
1. An acute obstruction in the vessels of the legs daily doses of digoxin and furosemide. During the initial
2. Peripheral vascular problems in both legs interview with the nice lady, the nurse would most
3. Diabetes likely learn that the client’s childhood health history
4. Calcium deficiency included:

15. Which of the following characteristics is typical of 1. Chicken pox

the pain associated with DVT? 2. Poliomyelitis
3. Rheumatic fever
1. Dull ache 4. Meningitis
2. No pain
3. Sudden onset 2. Which of the following signs and symptoms would
4. Tingling most likely be found in a client with mitral
16. Cancer can cause changes in what component of
Virchow’s triad? 1. Exertional dyspnea
2. Confusion
1. Blood coagulability 3. Elevated creatine phosphokinase concentration
2. Vessel walls 4. Chest pain
3. Blood flow
4. Blood viscosity 3. The nurse expects that a client with mitral stenosis
would demonstrate symptoms associated with
17. Varicose veins can cause changes in what congestion in the:
component of Virchow’s triad?
1. Aorta
1. Blood coagulability 2. Right atrium
2. Vessel walls 3. Superior vena cava
3. Blood flow 4. Pulmonary circulation
4. Blood viscosity
4. Because a client has mitral stenosis and is a
18. Which technique is considered the gold standard for prospective valve recipient, the nurse preoperatively
diagnosing DVT? assesses the client’s past compliance with medical
regimens. Lack of compliance with which of the
1. Ultrasound imaging following regimens would pose the greatest health
2. Venography hazard to this client?
3. MRI
4. Doppler flow study 1. Medication therapy
2. Diet modification
3. Activity restrictions
4. Dental care 4. The ST segment is higher than the PR interval
5. The QRS complex ranges from 0.12 to 0.2 seconds
5. Good dental care is an important measure in
reducing the risk of endocarditis. A teaching plan to
promote good dental care in a client with mitral
stenosis should include demonstration of the proper
use of:

1. A manual toothbrush
2. An electric toothbrush
3. An irrigation device
4. Dental floss

6. A client has been admitted to the hospital with a

diagnosis of suspected bacterial endocarditis. The
complication the nurse will constantly observe for is:

1. Presence of heart murmur

2. Systemic emboli
3. Fever
4. Congestive heart failure

7. Cholesterol, frequently discussed in relation to

atherosclerosis, is a substance that:

1. May be controlled by eliminating food sources

2. Is found in many foods, both plant and animal
3. All persons would be better off without because it
causes the disease process
4. Circulates in the blood, the level of which usually
decreases when unsaturated fats are substituted for
saturated fats.

8. When teaching a client with a cardiac problem, who

is on a high-unsaturated fatty-acid diet, the nurse
should stress the importance of increasing the intake of:

1. Enriched whole milk

2. Red meats, such as beef
3. Vegetables and whole grains
4. Liver and other glandular organ meats

9. A 2-gram sodium diet is prescribed for a client with

severe hypertension. The client does not like the diet,
and the nurse hears the client request that the spouse
“Bring in some good home-cooked food.” It would be
most effective for the nurse to plan to:

1. Call in the dietician for client teaching

2. Wait for the client’s family and discuss the diet with
the client and family
3. Tell the client that the use of salt is forbidden,
because it will raise BP
4. Catch the family members before they go into the
client’s room and tell them about the diet.

10. What criteria should the nurse use to determine

normal sinus rhythm for a client on a cardiac monitor?
Check all that apply.

1. The RR intervals are relatively consistent

2. One P wave precedes each QRS complex
3. Four to eight complexes occur in a 6-second strip