Coronary Artery Disease & Hypertension Practice Quiz (50 Questions)

Coronary Artery Disease & Hypertension.This is an NCLEX practice exam dedicated to Coronary Artery Disease and Hypertension. The purpose of this exam is to enable nurses and future nurses know how to care therapeutically for patients with or at risk for coronary artery disease (CAD) and hypertension. The activity below contains 50 items about the two diseases.

EXAM TIP: If the questions ask for an immediate action, all the options may be correct, so based your answer on identified priorities of action.

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Hypertension Topics

Included topics in this practice quiz are:

Guidelines

Follow the guidelines below to make the most out of this exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

Exam Mode

In Exam Mode: All questions are shown, but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 50 minutes for this exam.

Coronary Artery Disease & Hypertension Practice Quiz (50 Questions

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Question 1
When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:
A
Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
B
Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
C
Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
D
Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II
Question 1 Explanation:
Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
Question 2
IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?
A
Vitamin K
B
Aminocaproic acid
C
Potassium chloride
D
Protamine sulfate
Question 2 Explanation:
The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.
Question 3
The most important long-term goal for a client with hypertension would be to:
A
Learn how to avoid stress
B
Explore a job change or early retirement
C
Make a commitment to long-term therapy
D
Control high blood pressure
Question 3 Explanation:
Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.
Question 4
When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:
A
Impulse to begin atrial contraction
B
Impulse to transverse the atria to the AV node
C
SA node to discharge the impulse to begin atrial depolarization
D
Impulse to travel to the ventricles
Question 4 Explanation:
The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.
Question 5
The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
A
Headache
B
High blood pressure
C
Shortness of breath
D
Stomach cramps
Question 5 Explanation:
Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.
Question 6
To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:
A
In all extremities
B
At the insertion site
C
Distal to the catheter insertion
D
Above the catheter insertion
Question 6 Explanation:
Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.
Question 7
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 the blocked coronary arteries
B
Assess the extent of arterial blockage
C
Bypass obstructed vessels
D
Assess the functional adequacy of the valves and heart muscle
Question 7 Explanation:
Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.
Question 8
A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?
A
Strict bed rest for 24 hours after transfer
B
Bathroom privileges and self-care activities
C
Unsupervised hallway ambulation with distances under 200 feet
D
Ad lib activities because the client is monitored
Question 8 Explanation:
On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).
Question 9
Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?
A
Afterload
B
Cardiac index
C
Cardiac output
D
Preload
Question 9 Explanation:
Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload. Afterload is the force against which the ventricle must expel blood. Cardiac index is the individualized measurement of cardiac output, based on the client’s body surface area. Cardiac output is the amount of blood the heart is expelling per minute.
Question 10
A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:
A
Normal vs. abnormal tissue
B
Damage in areas of the heart
C
Ventricular function
D
Myocardial scarring and perfusion
Question 10 Explanation:
This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a more specific answer than (1) or (2). Specific ventricular function is tested by a gated cardiac blood pool scan.
Question 11
Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:
A
Cerebrovascular accident
B
Liver disease
C
Myocardial infarction
D
Pulmonary disease
Question 11 Explanation:
Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA’s can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.
Question 12
A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure?
A
Intake and output
B
Baseline peripheral pulse rates
C
Height and weight
D
Allergy to iodine or shellfish
Question 12 Explanation:
This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.
Question 13
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:
A
Check the client status and lead placement
B
Press the recorder button on the electrocardiogram console
C
Call the physician
D
Call a code blue
Question 13 Explanation:
Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.
Question 14
A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse should first:
A
Administer the morphine
B
Obtain a 12-lead ECG
C
Obtain the lab work
D
Order the chest x-ray
Question 14 Explanation:
Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain.
Question 15
A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?
A
Creatine kinase (CK or CPK)
B
Lactic dehydrogenase (LDH)
C
LDH-1
D
LDH-2
Question 15 Explanation:
Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream. Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.
Question 16
Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?
A
Take one tablet every 2 to 5 minutes until the pain stops.
B
Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes.
C
Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets.
D
Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.
Question 16 Explanation:
The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of 3 tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes.
Question 17
A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to:
A
Call for the doctor
B
Start an intravenous line
C
Obtain a portable chest radiograph
D
Draw blood for laboratory studies
Question 17 Explanation:
Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.
Question 18
A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom is explained by which of the following statements?
A
The demand for oxygen is decreased because of pleural involvement
B
The inflammatory process causes the body to demand more oxygen to meet its needs
C
The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension
D
Respirations are labored
Question 18 Explanation:
The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart’s having to beat faster to meet the body’s needs for oxygen.
Question 19
Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:
A
“Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
B
“Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
C
“You are probably right but we can gradually increase your activities so that you can live a more active life.”
D
“Do you feel that you will have to make some changes in your life now?”
Question 19 Explanation:
Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell upon his negativity about it.
Question 20
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:
A
Moderate doses of two different types of diuretics are more effective than a large dose of one type
B
This combination promotes diuresis but decreases the risk of hypokalemia
C
This combination prevents dehydration and hypovolemia
D
Using two drugs increases osmolality of plasma and the glomerular filtration rate
Question 20 Explanation:
Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
Question 21
When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:
A
Help keep him well hydrated
B
Dissolve clots he may have
C
Prevent kidney failure
D
Treat potential cardiac arrhythmias
Question 21 Explanation:
Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.
Question 22
A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?
A
“Have you ever had this pain before?”
B
“Can you describe the pain to me?”
C
“Does the pain get worse when you breathe in?”
D
“Can you rate the pain on a scale of 1-10, with 10 being the worst?”
Question 22 Explanation:
Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.
Question 23
Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?
A
Cardiac catheterization
B
Cardiac enzymes
C
Echocardiogram
D
Electrocardiogram (ECG)
Question 23 Explanation:
The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.
Question 24
A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?
A
Monitoring vital signs
B
Completing a physical assessment
C
Maintaining cardiac monitoring
D
Maintaining at least one IV access site
Question 24 Explanation:
Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished around the MI monitoring.
Question 25
A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:
A
Decreased arterial blood flow secondary to vasoconstriction
B
Decreased arterial blood flow leading to hyperemia
C
Atherosclerotic obstruction of the arteries
D
Trauma to the lower extremities
Question 25 Explanation:
Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.
Question 26
The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?
A
Cancer
B
Hypertension
C
Liver disease
D
Myocardial infarction
Question 26 Explanation:
Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Note: less than 90 mg/L is normal).
Question 27
When do coronary arteries primarily receive blood flow?
A
During inspiration
B
During diastolic
C
During expiration
D
During systole
Question 27 Explanation:
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow.
Question 28
Which of the following blood tests is most indicative of cardiac damage?
A
Lactate dehydrogenase
B
Complete blood count (CBC)
C
Troponin I
D
Creatine kinase (CK)
Question 28 Explanation:
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren’t detectable in people without cardiac injury.
Question 29
Which of the following factors can cause blood pressure to drop to normal levels?
A
Kidneys’ excretion of sodium only
B
Kidneys’ retention of sodium and water
C
Kidneys’ excretion of sodium and water
D
Kidneys’ retention of sodium and excretion of water
Question 29 Explanation:
The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.
Question 30
Which of the following terms describes the force against which the ventricle must expel blood?
A
Afterload
B
Cardiac output
C
Overload
D
Preload
Question 30 Explanation:
Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.
Question 31
As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug’s principal effects are produced by:
A
Antispasmodic effect on the pericardium
B
Causing an increased myocardial oxygen demand
C
Vasodilation of peripheral vasculature
D
Improved conductivity in the myocardium
Question 31 Explanation:
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
Question 32
A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:
A
Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect.
B
Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
C
Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
D
Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.
Question 32 Explanation:
Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited
Question 33
In order to prevent the development of tolerance, the nurse instructs the patient to:
A
Apply the nitroglycerin patch every other day
B
Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg
C
Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
D
Use the nitroglycerin patch for acute episodes of angina only
Question 33 Explanation:
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
Question 34
Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?
A
Changes in blood pressure
B
Changes in arterial oxygen tension
C
Changes in arterial carbon dioxide tension
D
Changes in heart rate
Question 34 Explanation:
Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.
Question 35
A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:
A
The same as the client’s own baseline level
B
Lower than the needed therapeutic level
C
Within the therapeutic range
D
Higher than the therapeutic range
Question 35 Explanation:
The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client’s control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.
Question 36
Which of the following arteries primarily feeds the anterior wall of the heart?
A
Circumflex artery
B
Internal mammary artery
C
Left anterior descending artery
D
Right coronary artery
Question 36 Explanation:
The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.
Question 37
A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following?
A
Seating the client with arm bared, supported, and at heart level.
B
Measuring the blood pressure after the client has been seated quietly for 5 minutes.
C
Using a cuff with a rubber bladder that encircles at least 80% of the limb.
D
Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
Question 37 Explanation:
BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.
Question 38
When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.
A
Reflects electrical impulse beginning at the SA node
B
Indicated electrical impulse beginning at the AV node
C
Reflects atrial muscle depolarization
D
Identifies ventricular muscle depolarization
E
Has duration of normally 0.11 seconds or less.
Question 38 Explanation:
In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
Question 39
Which of the following parameters is the major determinant of diastolic blood pressure?
A
Baroreceptors
B
Cardiac output
C
Renal function
D
Vascular resistance
Question 39 Explanation:
Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.
Question 40
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?
A
Monitor the apical pulse rate
B
Instruct the client to take medication with food
C
Question the physician about the order
D
Caution the client to rise slowly when standing
Question 40 Explanation:
Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.
Question 41
Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?
A
“Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”
B
“Apply the patch to the same site each day to maintain consistent drug absorption.”
C
“If you get a headache, remove the patch for 4 hours and then reapply.”
D
“If you get chest pain, apply a second patch right next to the first patch.”
Question 41 Explanation:
A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.
Question 42
During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion.
She comes to the hospital after experiencing severe anterior chest pain while raking 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 appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?
A
Visit her friend earlier in the day
B
Rest for at least an hour before climbing the stairs
C
Take a nitroglycerin tablet before climbing the stairs
D
Lie down once she reaches the friend’s apartment
Question 42 Explanation:
Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.
Question 43
A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?
A
Aortic
B
Mitral
C
Pulmonic
D
Tricuspid
Question 43 Explanation:
Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.
Question 44
Which of the following types of pain is most characteristic of angina?
A
Knifelike
B
Sharp
C
Shooting
D
Tightness
Question 44 Explanation:
The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.
Question 45
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?
A
Hypocalcemia
B
Hypermagnesemia
C
Hypokalemia
D
Hypernatremia
Question 45 Explanation:
Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.
Question 46
A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next?
A
Review the intake and output records for the last 2 days
B
Change the time of diuretic administration from morning to evening
C
Request a sodium restriction of 1 g/day from the physician
D
Order daily weights starting the following morning
Question 46 Explanation:
Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
Question 47
Direct-acting vasodilators have which of the following effects on the heart rate?
A
Heart rate decreases
B
Heart rate remains significantly unchanged
C
D
Heart rate becomes irregular
Question 47 Explanation:
Heart rate increases in response to decreased blood pressure caused by vasodilation.
Question 48
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 sex
C
Pain during an argument with her husband
D
Pain during or after an activity such as lawn mowing
Question 48 Explanation:
The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.
Question 49
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?
A
“Eat foods high in potassium.”
B
“Take daily potassium supplements.”
C
“Discontinue sodium restrictions.”
D
“Avoid salt substitutes.”
Question 49 Explanation:
Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.
Question 50
Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?
A
Anterior
B
Apical
C
Inferior
D
Lateral
Question 50 Explanation:
The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
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Coronary Artery Disease & Hypertension Practice Quiz (50 Questions)

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Question 1
A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure?
A
Intake and output
B
Baseline peripheral pulse rates
C
Height and weight
D
Allergy to iodine or shellfish
Question 1 Explanation:
This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.
Question 2
A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?
A
“Have you ever had this pain before?”
B
“Can you describe the pain to me?”
C
“Does the pain get worse when you breathe in?”
D
“Can you rate the pain on a scale of 1-10, with 10 being the worst?”
Question 2 Explanation:
Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.
Question 3
A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?
A
Strict bed rest for 24 hours after transfer
B
Bathroom privileges and self-care activities
C
Unsupervised hallway ambulation with distances under 200 feet
D
Ad lib activities because the client is monitored
Question 3 Explanation:
On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).
Question 4
A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next?
A
Review the intake and output records for the last 2 days
B
Change the time of diuretic administration from morning to evening
C
Request a sodium restriction of 1 g/day from the physician
D
Order daily weights starting the following morning
Question 4 Explanation:
Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
Question 5
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:
A
Check the client status and lead placement
B
Press the recorder button on the electrocardiogram console
C
Call the physician
D
Call a code blue
Question 5 Explanation:
Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.
Question 6
A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following?
A
Seating the client with arm bared, supported, and at heart level.
B
Measuring the blood pressure after the client has been seated quietly for 5 minutes.
C
Using a cuff with a rubber bladder that encircles at least 80% of the limb.
D
Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
Question 6 Explanation:
BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.
Question 7
IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?
A
Vitamin K
B
Aminocaproic acid
C
Potassium chloride
D
Protamine sulfate
Question 7 Explanation:
The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.
Question 8
A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:
A
The same as the client’s own baseline level
B
Lower than the needed therapeutic level
C
Within the therapeutic range
D
Higher than the therapeutic range
Question 8 Explanation:
The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client’s control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.
Question 9
A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:
A
Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect.
B
Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
C
Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
D
Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.
Question 9 Explanation:
Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited
Question 10
A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse should first:
A
Administer the morphine
B
Obtain a 12-lead ECG
C
Obtain the lab work
D
Order the chest x-ray
Question 10 Explanation:
Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain.
Question 11
When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:
A
Help keep him well hydrated
B
Dissolve clots he may have
C
Prevent kidney failure
D
Treat potential cardiac arrhythmias
Question 11 Explanation:
Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial damage.
Question 12
When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.
A
Reflects electrical impulse beginning at the SA node
B
Indicated electrical impulse beginning at the AV node
C
Reflects atrial muscle depolarization
D
Identifies ventricular muscle depolarization
E
Has duration of normally 0.11 seconds or less.
Question 12 Explanation:
In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
Question 13
A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to:
A
Call for the doctor
B
Start an intravenous line
C
Obtain a portable chest radiograph
D
Draw blood for laboratory studies
Question 13 Explanation:
Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.
Question 14
The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?
A
Cancer
B
Hypertension
C
Liver disease
D
Myocardial infarction
Question 14 Explanation:
Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Note: less than 90 mg/L is normal).
Question 15
When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:
A
Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
B
Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
C
Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
D
Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II
Question 15 Explanation:
Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
Question 16
The most important long-term goal for a client with hypertension would be to:
A
Learn how to avoid stress
B
Explore a job change or early retirement
C
Make a commitment to long-term therapy
D
Control high blood pressure
Question 16 Explanation:
Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.
Question 17
Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:
A
Cerebrovascular accident
B
Liver disease
C
Myocardial infarction
D
Pulmonary disease
Question 17 Explanation:
Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA’s can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.
Question 18
During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion.
She comes to the hospital after experiencing severe anterior chest pain while raking 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 appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?
A
Visit her friend earlier in the day
B
Rest for at least an hour before climbing the stairs
C
Take a nitroglycerin tablet before climbing the stairs
D
Lie down once she reaches the friend’s apartment
Question 18 Explanation:
Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an activity-related pain episode.
Question 19
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 sex
C
Pain during an argument with her husband
D
Pain during or after an activity such as lawn mowing
Question 19 Explanation:
The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.
Question 20
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 the blocked coronary arteries
B
Assess the extent of arterial blockage
C
Bypass obstructed vessels
D
Assess the functional adequacy of the valves and heart muscle
Question 20 Explanation:
Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.
Question 21
As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug’s principal effects are produced by:
A
Antispasmodic effect on the pericardium
B
Causing an increased myocardial oxygen demand
C
Vasodilation of peripheral vasculature
D
Improved conductivity in the myocardium
Question 21 Explanation:
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
Question 22
The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
A
Headache
B
High blood pressure
C
Shortness of breath
D
Stomach cramps
Question 22 Explanation:
Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.
Question 23
Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?
A
Take one tablet every 2 to 5 minutes until the pain stops.
B
Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes.
C
Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets.
D
Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.
Question 23 Explanation:
The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of 3 tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes.
Question 24
Which of the following arteries primarily feeds the anterior wall of the heart?
A
Circumflex artery
B
Internal mammary artery
C
Left anterior descending artery
D
Right coronary artery
Question 24 Explanation:
The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.
Question 25
When do coronary arteries primarily receive blood flow?
A
During inspiration
B
During diastolic
C
During expiration
D
During systole
Question 25 Explanation:
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow.
Question 26
Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?
A
Anterior
B
Apical
C
Inferior
D
Lateral
Question 26 Explanation:
The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
Question 27
A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?
A
Aortic
B
Mitral
C
Pulmonic
D
Tricuspid
Question 27 Explanation:
Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.
Question 28
Which of the following blood tests is most indicative of cardiac damage?
A
Lactate dehydrogenase
B
Complete blood count (CBC)
C
Troponin I
D
Creatine kinase (CK)
Question 28 Explanation:
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren’t detectable in people without cardiac injury.
Question 29
Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?
A
Cardiac catheterization
B
Cardiac enzymes
C
Echocardiogram
D
Electrocardiogram (ECG)
Question 29 Explanation:
The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.
Question 30
Which of the following types of pain is most characteristic of angina?
A
Knifelike
B
Sharp
C
Shooting
D
Tightness
Question 30 Explanation:
The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.
Question 31
Which of the following parameters is the major determinant of diastolic blood pressure?
A
Baroreceptors
B
Cardiac output
C
Renal function
D
Vascular resistance
Question 31 Explanation:
Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.
Question 32
Which of the following factors can cause blood pressure to drop to normal levels?
A
Kidneys’ excretion of sodium only
B
Kidneys’ retention of sodium and water
C
Kidneys’ excretion of sodium and water
D
Kidneys’ retention of sodium and excretion of water
Question 32 Explanation:
The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.
Question 33
Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?
A
Changes in blood pressure
B
Changes in arterial oxygen tension
C
Changes in arterial carbon dioxide tension
D
Changes in heart rate
Question 33 Explanation:
Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.
Question 34
Which of the following terms describes the force against which the ventricle must expel blood?
A
Afterload
B
Cardiac output
C
Overload
D
Preload
Question 34 Explanation:
Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.
Question 35
Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?
A
Afterload
B
Cardiac index
C
Cardiac output
D
Preload
Question 35 Explanation:
Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload. Afterload is the force against which the ventricle must expel blood. Cardiac index is the individualized measurement of cardiac output, based on the client’s body surface area. Cardiac output is the amount of blood the heart is expelling per minute.
Question 36
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?
A
Monitor the apical pulse rate
B
Instruct the client to take medication with food
C
Question the physician about the order
D
Caution the client to rise slowly when standing
Question 36 Explanation:
Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.
Question 37
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?
A
Hypocalcemia
B
Hypermagnesemia
C
Hypokalemia
D
Hypernatremia
Question 37 Explanation:
Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.
Question 38
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?
A
“Eat foods high in potassium.”
B
“Take daily potassium supplements.”
C
“Discontinue sodium restrictions.”
D
“Avoid salt substitutes.”
Question 38 Explanation:
Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.
Question 39
When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:
A
Impulse to begin atrial contraction
B
Impulse to transverse the atria to the AV node
C
SA node to discharge the impulse to begin atrial depolarization
D
Impulse to travel to the ventricles
Question 39 Explanation:
The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.
Question 40
Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:
A
“Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
B
“Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
C
“You are probably right but we can gradually increase your activities so that you can live a more active life.”
D
“Do you feel that you will have to make some changes in your life now?”
Question 40 Explanation:
Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell upon his negativity about it.
Question 41
To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:
A
In all extremities
B
At the insertion site
C
Distal to the catheter insertion
D
Above the catheter insertion
Question 41 Explanation:
Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.
Question 42
A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:
A
Normal vs. abnormal tissue
B
Damage in areas of the heart
C
Ventricular function
D
Myocardial scarring and perfusion
Question 42 Explanation:
This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a more specific answer than (1) or (2). Specific ventricular function is tested by a gated cardiac blood pool scan.
Question 43
A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?
A
Monitoring vital signs
B
Completing a physical assessment
C
Maintaining cardiac monitoring
D
Maintaining at least one IV access site
Question 43 Explanation:
Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished around the MI monitoring.
Question 44
A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom is explained by which of the following statements?
A
The demand for oxygen is decreased because of pleural involvement
B
The inflammatory process causes the body to demand more oxygen to meet its needs
C
The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension
D
Respirations are labored
Question 44 Explanation:
The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart’s having to beat faster to meet the body’s needs for oxygen.
Question 45
A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?
A
Creatine kinase (CK or CPK)
B
Lactic dehydrogenase (LDH)
C
LDH-1
D
LDH-2
Question 45 Explanation:
Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream. Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.
Question 46
A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:
A
Decreased arterial blood flow secondary to vasoconstriction
B
Decreased arterial blood flow leading to hyperemia
C
Atherosclerotic obstruction of the arteries
D
Trauma to the lower extremities
Question 46 Explanation:
Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.
Question 47
Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?
A
“Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”
B
“Apply the patch to the same site each day to maintain consistent drug absorption.”
C
“If you get a headache, remove the patch for 4 hours and then reapply.”
D
“If you get chest pain, apply a second patch right next to the first patch.”
Question 47 Explanation:
A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.
Question 48
In order to prevent the development of tolerance, the nurse instructs the patient to:
A
Apply the nitroglycerin patch every other day
B
Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg
C
Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
D
Use the nitroglycerin patch for acute episodes of angina only
Question 48 Explanation:
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
Question 49
Direct-acting vasodilators have which of the following effects on the heart rate?
A
Heart rate decreases
B
Heart rate remains significantly unchanged
C
Heart rate increases
D
Heart rate becomes irregular
Question 49 Explanation:
Heart rate increases in response to decreased blood pressure caused by vasodilation.
Question 50
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:
A
Moderate doses of two different types of diuretics are more effective than a large dose of one type
B
This combination promotes diuresis but decreases the risk of hypokalemia
C
This combination prevents dehydration and hypovolemia
D
Using two drugs increases osmolality of plasma and the glomerular filtration rate
Question 50 Explanation:
Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
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1. A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure?

1. Intake and output
2. Baseline peripheral pulse rates
3. Height and weight
4. Allergy to iodine or shellfish

2. A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?

1. “Have you ever had this pain before?”
2. “Can you describe the pain to me?”
3. “Does the pain get worse when you breathe in?”
4. “Can you rate the pain on a scale of 1-10, with ten (10) being the worst?”

3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?

1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances under 200 feet
4. Ad lib activities because the client is monitored.

4. A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted two (2) days ago. The nurse would plan to do which of the following next?

1. Review the intake and output records for the last two (2) days
2. Change the time of diuretic administration from morning to evening
3. Request a sodium restriction of one (1) g/day from the physician.
4. Order daily weight starting the following morning.

5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:

1. Check the client status and lead placement
2. Press the recorder button on the electrocardiogram console.
3. Call the physician
4. Call a code blue

6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following?

1. Seating the client with arm bared, supported, and at heart level.
2. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
3. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

7. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?

1. Vitamin K
2. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate

8. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:

1. The same as the client’s own baseline level
2. Lower than the needed therapeutic level
3. Within the therapeutic range
4. Higher than the therapeutic range

9. A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:

1. Stimulates the breakdown of specific clotting factors by the liver, and it takes two (2)- three (3) days for this to exert an anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
3. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
4. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

10. A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and two (2) mg of morphine given intravenously. The nurse should first:

1. Administer the morphine
2. Obtain a 12-lead ECG
3. Obtain the lab work
4. Order the chest x-ray

11. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:

1. Help keep him well hydrated
2. Dissolve clots he may have
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias.

12. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.

1. Reflects electrical impulse beginning at the SA node
2. Indicated electrical impulse beginning at the AV node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has a duration of normally 0.11 seconds or less.

13. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to:

1. Call for the doctor
2. Start an intravenous line
3. Obtain a portable chest radiograph
4. Draw blood for laboratory studies

14. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

1. Cancer
2. Hypertension
3. Liver disease
4. Myocardial infarction

15. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:

1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
2. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
3. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

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

1. Learn how to avoid stress
2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
4. Control high blood pressure

17. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:

1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction
4. Pulmonary disease

18. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking 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 appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?

1. Visit her friend earlier in the day.
2. Rest for at least an hour before climbing the stairs.
3. Take a nitroglycerin tablet before climbing the stairs.
4. Lie down once she reaches the friend’s apartment.

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

1. A change in the pattern of her pain
2. Pain during sex
3. Pain during an argument with her husband
4. Pain during or after an activity such as lawn mowing

20. 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:

1. Open and dilate the blocked coronary arteries
2. Assess the extent of arterial blockage
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and heart muscle.

21. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug’s principal effects are produced by:

1. Antispasmodic effect on the pericardium
2. Causing an increased myocardial oxygen demand
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium

22. The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:

1. Headache
2. High blood pressure
3. Shortness of breath
4. Stomach cramps

23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?

1. Take one (1) tablet every two (2) to five (5) minutes until the pain stops.
2. Take one (1) tablet and rest for ten (10) minutes. Call the physician if pain persists after ten (10) minutes.

3. Take one (1) tablet, then an additional tablet every 5 minutes for a total of three (3) tablets. Call the physician if pain persists after three (3) tablets.

4. Take one (1) tablet. If pain persists after five (5) minutes, take two (2) tablets. If pain persists five (5) minutes later, call the physician.

24. Which of the following arteries primarily feeds the anterior wall of the heart?

1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery

25. When do coronary arteries primarily receive blood flow?

1. During inspiration
2. During diastolic
3. During expiration
4. During systole

26. Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?

1. Anterior
2. Apical
3. Inferior
4. Lateral

27. A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?

1. Aortic
2. Mitral
3. Pulmonic
4. Tricuspid

28. Which of the following blood tests is most indicative of cardiac damage?

1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)

29. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

1. Cardiac catheterization
2. Cardiac enzymes
3. Echocardiogram
4. Electrocardiogram (ECG)

30. Which of the following types of pain is most characteristic of angina?

1. Knifelike
2. Sharp
3. Shooting
4. Tightness

31. Which of the following parameters is the major determinant of diastolic blood pressure?

1. Baroreceptors
2. Cardiac output
3. Renal function
4. Vascular resistance

32. Which of the following factors can cause blood pressure to drop to normal levels?

1. Kidneys’ excretion of sodium only
2. Kidneys’ retention of sodium and water
3. Kidneys’ excretion of sodium and water
4. Kidneys’ retention of sodium and excretion of water

33. Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?

1. Changes in blood pressure
2. Changes in arterial oxygen tension
3. Changes in arterial carbon dioxide tension
4. Changes in heart rate

34. Which of the following terms describes the force against which the ventricle must expel blood?

1. Afterload
2. Cardiac output
3. Overload
4. Preload

35. Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?

1. Afterload
2. Cardiac index
3. Cardiac output
4. Preload

36. A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?

1. Monitor the apical pulse rate
2. Instruct the client to take medication with food
3. Question the physician about the order
4. Caution the client to rise slowly when standing.

37. One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?

1. Hypocalcemia
2. Hypermagnesemia
3. Hypokalemia
4. Hypernatremia

38. A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?

1. “Eat foods high in potassium.”
2. “Take daily potassium supplements.”
3. “Discontinue sodium restrictions.”
4. “Avoid salt substitutes.”

39. When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:

1. Impulse to begin atrial contraction
2. Impulse to transverse the atria to the AV node
3. SA node to discharge the impulse to begin atrial depolarization
4. Impulse to travel to the ventricles

40. Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:

1. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
2. “Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
3. “You are probably right but we can gradually increase your activities so that you can live a more active life.”
4. “Do you feel that you will have to make some changes in your life now?”

41. To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:

1. In all extremities
2. At the insertion site
3. Distal to the catheter insertion
4. Above the catheter insertion

42. A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:

1. Normal vs. abnormal tissue
2. Damage in areas of the heart
3. Ventricular function
4. Myocardial scarring and perfusion

43. A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?

1. Monitoring vital signs
2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site

44. A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom is explained by which of the following statements?

1. The demand for oxygen is decreased because of pleural involvement
2. The inflammatory process causes the body to demand more oxygen to meet its needs.
3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.
4. Respirations are labored.

45. A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?

1. Creatine kinase (CK or CPK)
2. Lactic dehydrogenase (LDH)
3. LDH-1
4. LDH-2

46. A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:

1. Decreased arterial blood flow secondary to vasoconstriction
2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries
4. Trauma to the lower extremities

47. Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

1. “Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”
2. “Apply the patch to the same site each day to maintain consistent drug absorption.”
3. “If you get a headache, remove the patch for 4 hours and then reapply.”
4. “If you get chest pain, apply a second patch right next to the first patch.”

48. In order to prevent the development of tolerance, the nurse instructs the patient to:

1. Apply the nitroglycerin patch every other day
2. Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg
3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
4. Use the nitroglycerin patch for acute episodes of angina only

49. Direct-acting vasodilators have which of the following effects on the heart rate?

1. Heart rate decreases
2. Heart rate remains significantly unchanged
3. Heart rate increases
4. Heart rate becomes irregular

50. When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:

1. Moderate doses of two different types of diuretics are more effective than a large dose of one type
2. This combination promotes diuresis but decreases the risk of hypokalemia
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration rate

Answers and Rationale

1. Answer: 4. Allergy to iodine or shellfish

This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.

2. Answer: 3. “Does the pain get worse when you breathe in?”

Chest pain is assessed by using the standard pain assessment parameters.

  • Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.

3. Answer: 2. Bathroom privileges and self-care activities

On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).

4. Answer: 1. Review the intake and output records for the last 2 days

Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight.

  • Option B: Diuretics should be given in the morning whenever possible to avoid nocturia.
  • Option C: Strict sodium restrictions are reserved for clients with severe symptoms.

5. Answer: 1. Check the client status and lead placement

Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.

6. Answer: 4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement.

  • Option B: The client should rest quietly for 5 minutes before the reading is taken.
  • Option C: The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every six (6) months to ensure accuracy.

7. Answer: 4. Protamine sulfate

The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur.

  • Option A: Vitamin K is an antidote for warfarin.

8. Answer: 3. Within the therapeutic range

The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client’s control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within the therapeutic range.

9. Answer: 2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.

Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.

10. Answer: 1. Administer the morphine

Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain.

11. Answer: 2. Dissolve clots he may have

Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.

12. Answer: 1, 3, 5

In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

13. Answer: 2. Start an intravenous line

Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.

  • Options A, C, and D: Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.

14. Answer: 4. Myocardial infarction

Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction (Remember, less than 90 mg/L is normal).

15. Answer: 1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

16. Answer: 3. Make a commitment to long-term therapy

Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.

17. Answer: 1. Cerebrovascular accident

Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, hypertension may go undetected. CVA’s can be related to long-term hypertension.

  • Option B and D: Liver or pulmonary disease is generally not associated with hypertension.
  • Option C: Myocardial infarction is generally related to coronary artery disease.

18. Answer: 3. Take a nitroglycerin tablet before climbing the stairs.

Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain-free.

  • Option A: Visiting her friend early in the day would have no impact on decreasing pain episodes.
  • Option B: Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

19. Answer: 1. A change in the pattern of her pain

The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

20. Answer: 2. Assess the extent of arterial blockage

Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.

21. Answer: 3. Vasodilation of peripheral vasculature

Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

22. Answer: 1. Headache

Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.

23. Answer: 3. Take one (1) tablet, then an additional tablet every five (5) minutes for a total of three (3) tablets. Call the physician if pain persists after three tablets.

The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of three (3) tablets. Sublingual nitroglycerin appears in the bloodstream within two (2) to three (3) minutes and is metabolized within about 10 minutes.

24. Answer: 3. Left anterior descending artery

The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart.

  • Options A, B, and D: The circumflex artery supplies the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.

25. Answer: 2. During diastolic

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

26. Answer: 3. Inferior

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

  • Options A, B, and D: The right coronary artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.

27. Answer: 3. Pulmonic

Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border.

  • Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum.
  • Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line.
  • Option D: Tricuspid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.

28. Answer: 3. Troponin I

Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren’t detectable in people without cardiac injury.

29. Answer: 4. Electrocardiogram (ECG)

The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction.

  • Option A: Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.
  • Option B: Cardiac enzymes are used to diagnose MI but can’t determine the location.
  • Option C: An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed.

30. Answer: 4. Tightness

The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.

31. Answer: 4. Vascular resistance

Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure.

  • Option B: Cardiac output determines systolic blood pressure.

32. Answer: 3. Kidneys’ excretion of sodium and water

The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.

33. Answer: 1. Changes in blood pressure

Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.

34. Answer: 1. Afterload

Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles.

  • Option B: Cardiac output is the amount of blood expelled from the heart per minute.
  • Option C: Overload refers to an abundance of circulating volume.
  • Option D: Preload is the volume of blood in the ventricle at the end of diastole.

35. Answer: 4. Preload

Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload.

  • Option A: Afterload is the force against which the ventricle must expel blood.
  • Option B: Cardiac index is the individualized measurement of cardiac output, based on the client’s body surface area.
  • Option C: Cardiac output is the amount of blood the heart is expelling per minute.

36. Answer: 3. Question the physician about the order

Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

  • Options A, B, and D: The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

37. Answer: 3. Hypokalemia

Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

38. Answer: 4. “Avoid salt substitutes.”

Because Spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content.

  • Options A, B, and C: The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue.

39. Answer: 4. Impulse to travel to the ventricles

The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

40. Answer: 1. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”

Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell on his negativity about it.

41. Answer: 3. Distal to the catheter insertion

Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

42. Answer: 4. Myocardial scarring and perfusion

This scan detects myocardial damage and perfusion, an acute or chronic MI.

  • Option D: Specific ventricular function is tested by a gated cardiac blood pool scan.

43. Answer: 3. Maintaining cardiac monitoring

Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished by the MI monitoring.

44. Answer: 3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.

The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart’s having to beat faster to meet the body’s needs for oxygen.

45. Answer: 1. Creatine kinase (CK or CPK)

Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream.

  • Options B, C, and D: Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.

46. Answer: 1. Decreased arterial blood flow secondary to vasoconstriction

Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.

47. Answer: 1. “Apply the patch to a nonhairy, nonfatty area of the upper torso or arms.”

A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates.

  • Option B: Sites should be rotated to prevent skin irritation.
  • Option C: The drug should be continued if headache occurs because tolerance will develop.
  • Option D: Sublingual nitroglycerin should be used to treat chest pain.

48. Answer: 3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night

Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.

49. Answer: 3. Heart rate increases

Heart rate increases in response to decreased blood pressure caused by vasodilation.

50. Answer: 2. This combination promotes diuresis but decreases the risk of hypokalemia

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

You may also like these other quizzes and exam tip articles:

Study Guides

Cardiovascular System

Respiratory System

Nervous System

Digestive and Gastrointestinal System

Endocrine System

Urinary System

Homeostasis: Fluids and Electrolytes

Cancer and Oncology Nursing

Burns and Burn Injury Management

Emergency Nursing

Miscellaneous

This is an NCLEX practice exam dedicated to Coronary Artery Disease and Hypertension. The purpose of this exam is to enable nurses and future nurses know how to care therapeutically for patients with or at risk for coronary artery disease (CAD) and hypertension. The activity below contains 50 items about the two diseases.

EXAM TIP: If the questions ask for an immediate action, all the options may be correct, so based your answer on identified priorities of action.

So be sure when you step, Step with care and great tact. And remember that life’s A Great Balancing Act. And will you succeed? Yes! You will, indeed! (98 and ¾ percent guaranteed) Kid, you’ll move mountains.
~ Dr. Seuss

Topics

Included topics in this practice quiz are:

  • Coronary Artery Disease
  • Hypertension

Guidelines

Follow the guidelines below to make the most out of this exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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In Exam Mode: All questions are shown, but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 50 minutes for this exam.

Coronary Artery Disease & Hypertension Practice Quiz (50 Questions

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Coronary Artery Disease & Hypertension Practice Quiz (50 Questions)

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1. A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following assessments is most critical before the procedure?

1. Intake and output
2. Baseline peripheral pulse rates
3. Height and weight
4. Allergy to iodine or shellfish

2. A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?

1. “Have you ever had this pain before?”
2. “Can you describe the pain to me?”
3. “Does the pain get worse when you breathe in?”
4. “Can you rate the pain on a scale of 1-10, with ten (10) being the worst?”

3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?

1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances under 200 feet
4. Ad lib activities because the client is monitored.

4. A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted two (2) days ago. The nurse would plan to do which of the following next?

1. Review the intake and output records for the last two (2) days
2. Change the time of diuretic administration from morning to evening
3. Request a sodium restriction of one (1) g/day from the physician.
4. Order daily weight starting the following morning.

5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:

1. Check the client status and lead placement
2. Press the recorder button on the electrocardiogram console.
3. Call the physician
4. Call a code blue

6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following?

1. Seating the client with arm bared, supported, and at heart level.
2. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
3. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

7. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?

1. Vitamin K
2. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate

8. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:

1. The same as the client’s own baseline level
2. Lower than the needed therapeutic level
3. Within the therapeutic range
4. Higher than the therapeutic range

9. A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:

1. Stimulates the breakdown of specific clotting factors by the liver, and it takes two (2)- three (3) days for this to exert an anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
3. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
4. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

10. A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and two (2) mg of morphine given intravenously. The nurse should first:

1. Administer the morphine
2. Obtain a 12-lead ECG
3. Obtain the lab work
4. Order the chest x-ray

11. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:

1. Help keep him well hydrated
2. Dissolve clots he may have
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias.

12. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.

1. Reflects electrical impulse beginning at the SA node
2. Indicated electrical impulse beginning at the AV node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has a duration of normally 0.11 seconds or less.

13. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to:

1. Call for the doctor
2. Start an intravenous line
3. Obtain a portable chest radiograph
4. Draw blood for laboratory studies

14. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

1. Cancer
2. Hypertension
3. Liver disease
4. Myocardial infarction

15. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:

1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
2. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
3. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

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

1. Learn how to avoid stress
2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
4. Control high blood pressure

17. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:

1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction
4. Pulmonary disease

18. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking 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 appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?

1. Visit her friend earlier in the day.
2. Rest for at least an hour before climbing the stairs.
3. Take a nitroglycerin tablet before climbing the stairs.
4. Lie down once she reaches the friend’s apartment.

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

1. A change in the pattern of her pain
2. Pain during sex
3. Pain during an argument with her husband
4. Pain during or after an activity such as lawn mowing

20. 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:

1. Open and dilate the blocked coronary arteries
2. Assess the extent of arterial blockage
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and heart muscle.

21. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug’s principal effects are produced by:

1. Antispasmodic effect on the pericardium
2. Causing an increased myocardial oxygen demand
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium

22. The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:

1. Headache
2. High blood pressure
3. Shortness of breath
4. Stomach cramps

23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs?

1. Take one (1) tablet every two (2) to five (5) minutes until the pain stops.
2. Take one (1) tablet and rest for ten (10) minutes. Call the physician if pain persists after ten (10) minutes.

3. Take one (1) tablet, then an additional tablet every 5 minutes for a total of three (3) tablets. Call the physician if pain persists after three (3) tablets.

4. Take one (1) tablet. If pain persists after five (5) minutes, take two (2) tablets. If pain persists five (5) minutes later, call the physician.

24. Which of the following arteries primarily feeds the anterior wall of the heart?

1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery

25. When do coronary arteries primarily receive blood flow?

1. During inspiration
2. During diastolic
3. During expiration
4. During systole

26. Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?

1. Anterior
2. Apical
3. Inferior
4. Lateral

27. A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?

1. Aortic
2. Mitral
3. Pulmonic
4. Tricuspid

28. Which of the following blood tests is most indicative of cardiac damage?

1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)

29. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

1. Cardiac catheterization
2. Cardiac enzymes
3. Echocardiogram
4. Electrocardiogram (ECG)

30. Which of the following types of pain is most characteristic of angina?

1. Knifelike
2. Sharp
3. Shooting
4. Tightness

31. Which of the following parameters is the major determinant of diastolic blood pressure?

1. Baroreceptors
2. Cardiac output
3. Renal function
4. Vascular resistance

32. Which of the following factors can cause blood pressure to drop to normal levels?

1. Kidneys’ excretion of sodium only
2. Kidneys’ retention of sodium and water
3. Kidneys’ excretion of sodium and water
4. Kidneys’ retention of sodium and excretion of water

33. Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?

1. Changes in blood pressure
2. Changes in arterial oxygen tension
3. Changes in arterial carbon dioxide tension
4. Changes in heart rate

34. Which of the following terms describes the force against which the ventricle must expel blood?

1. Afterload
2. Cardiac output
3. Overload
4. Preload

35. Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?

1. Afterload
2. Cardiac index
3. Cardiac output
4. Preload

36. A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first?

1. Monitor the apical pulse rate
2. Instruct the client to take medication with food
3. Question the physician about the order
4. Caution the client to rise slowly when standing.

37. One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?

1. Hypocalcemia
2. Hypermagnesemia
3. Hypokalemia
4. Hypernatremia

38. A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?

1. “Eat foods high in potassium.”
2. “Take daily potassium supplements.”
3. “Discontinue sodium restrictions.”
4. “Avoid salt substitutes.”

39. When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:

1. Impulse to begin atrial contraction
2. Impulse to transverse the atria to the AV node
3. SA node to discharge the impulse to begin atrial depolarization
4. Impulse to travel to the ventricles

40. Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:

1. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
2. “Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
3. “You are probably right but we can gradually increase your activities so that you can live a more active life.”
4. “Do you feel that you will have to make some changes in your life now?”

41. To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:

1. In all extremities
2. At the insertion site
3. Distal to the catheter insertion
4. Above the catheter insertion

42. A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:

1. Normal vs. abnormal tissue
2. Damage in areas of the heart
3. Ventricular function
4. Myocardial scarring and perfusion

43. A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?

1. Monitoring vital signs
2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site

44. A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom is explained by which of the following statements?

1. The demand for oxygen is decreased because of pleural involvement
2. The inflammatory process causes the body to demand more oxygen to meet its needs.
3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.
4. Respirations are labored.

45. A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?

1. Creatine kinase (CK or CPK)
2. Lactic dehydrogenase (LDH)
3. LDH-1
4. LDH-2

46. A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:

1. Decreased arterial blood flow secondary to vasoconstriction
2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries
4. Trauma to the lower extremities

47. Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

1. “Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”
2. “Apply the patch to the same site each day to maintain consistent drug absorption.”
3. “If you get a headache, remove the patch for 4 hours and then reapply.”
4. “If you get chest pain, apply a second patch right next to the first patch.”

48. In order to prevent the development of tolerance, the nurse instructs the patient to:

1. Apply the nitroglycerin patch every other day
2. Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg
3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
4. Use the nitroglycerin patch for acute episodes of angina only

49. Direct-acting vasodilators have which of the following effects on the heart rate?

1. Heart rate decreases
2. Heart rate remains significantly unchanged
3. Heart rate increases
4. Heart rate becomes irregular

50. When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:

1. Moderate doses of two different types of diuretics are more effective than a large dose of one type
2. This combination promotes diuresis but decreases the risk of hypokalemia
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration rate

Answers and Rationale

1. Answer: 4. Allergy to iodine or shellfish

This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and must be assessed before the procedure.

2. Answer: 3. “Does the pain get worse when you breathe in?”

Chest pain is assessed by using the standard pain assessment parameters.

  • Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.

3. Answer: 2. Bathroom privileges and self-care activities

On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).

4. Answer: 1. Review the intake and output records for the last 2 days

Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight.

  • Option B: Diuretics should be given in the morning whenever possible to avoid nocturia.
  • Option C: Strict sodium restrictions are reserved for clients with severe symptoms.

5. Answer: 1. Check the client status and lead placement

Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.

6. Answer: 4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement.

  • Option B: The client should rest quietly for 5 minutes before the reading is taken.
  • Option C: The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every six (6) months to ensure accuracy.

7. Answer: 4. Protamine sulfate

The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur.

  • Option A: Vitamin K is an antidote for warfarin.

8. Answer: 3. Within the therapeutic range

The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client’s control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within the therapeutic range.

9. Answer: 2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.

Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.

10. Answer: 1. Administer the morphine

Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain.

11. Answer: 2. Dissolve clots he may have

Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.

12. Answer: 1, 3, 5

In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

13. Answer: 2. Start an intravenous line

Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.

  • Options A, C, and D: Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.

14. Answer: 4. Myocardial infarction

Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction (Remember, less than 90 mg/L is normal).

15. Answer: 1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

16. Answer: 3. Make a commitment to long-term therapy

Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.

17. Answer: 1. Cerebrovascular accident

Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, hypertension may go undetected. CVA’s can be related to long-term hypertension.

  • Option B and D: Liver or pulmonary disease is generally not associated with hypertension.
  • Option C: Myocardial infarction is generally related to coronary artery disease.

18. Answer: 3. Take a nitroglycerin tablet before climbing the stairs.

Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain-free.

  • Option A: Visiting her friend early in the day would have no impact on decreasing pain episodes.
  • Option B: Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

19. Answer: 1. A change in the pattern of her pain

The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

20. Answer: 2. Assess the extent of arterial blockage

Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.

21. Answer: 3. Vasodilation of peripheral vasculature

Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

22. Answer: 1. Headache

Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.

23. Answer: 3. Take one (1) tablet, then an additional tablet every five (5) minutes for a total of three (3) tablets. Call the physician if pain persists after three tablets.

The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as needed, for a total dose of three (3) tablets. Sublingual nitroglycerin appears in the bloodstream within two (2) to three (3) minutes and is metabolized within about 10 minutes.

24. Answer: 3. Left anterior descending artery

The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart.

  • Options A, B, and D: The circumflex artery supplies the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.

25. Answer: 2. During diastolic

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

26. Answer: 3. Inferior

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

  • Options A, B, and D: The right coronary artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.

27. Answer: 3. Pulmonic

Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border.

  • Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum.
  • Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line.
  • Option D: Tricuspid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the sternal border.

28. Answer: 3. Troponin I

Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels aren’t detectable in people without cardiac injury.

29. Answer: 4. Electrocardiogram (ECG)

The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction.

  • Option A: Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.
  • Option B: Cardiac enzymes are used to diagnose MI but can’t determine the location.
  • Option C: An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed.

30. Answer: 4. Tightness

The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms.

31. Answer: 4. Vascular resistance

Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure.

  • Option B: Cardiac output determines systolic blood pressure.

32. Answer: 3. Kidneys’ excretion of sodium and water

The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic pressure by regulating blood volume.

33. Answer: 1. Changes in blood pressure

Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are primarily stimulated by oxygen.

34. Answer: 1. Afterload

Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles.

  • Option B: Cardiac output is the amount of blood expelled from the heart per minute.
  • Option C: Overload refers to an abundance of circulating volume.
  • Option D: Preload is the volume of blood in the ventricle at the end of diastole.

35. Answer: 4. Preload

Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of diastole determines the preload.

  • Option A: Afterload is the force against which the ventricle must expel blood.
  • Option B: Cardiac index is the individualized measurement of cardiac output, based on the client’s body surface area.
  • Option C: Cardiac output is the amount of blood the heart is expelling per minute.

36. Answer: 3. Question the physician about the order

Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

  • Options A, B, and D: The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

37. Answer: 3. Hypokalemia

Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

38. Answer: 4. “Avoid salt substitutes.”

Because Spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content.

  • Options A, B, and C: The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue.

39. Answer: 4. Impulse to travel to the ventricles

The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

40. Answer: 1. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”

Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell on his negativity about it.

41. Answer: 3. Distal to the catheter insertion

Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

42. Answer: 4. Myocardial scarring and perfusion

This scan detects myocardial damage and perfusion, an acute or chronic MI.

  • Option D: Specific ventricular function is tested by a gated cardiac blood pool scan.

43. Answer: 3. Maintaining cardiac monitoring

Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished by the MI monitoring.

44. Answer: 3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.

The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart’s having to beat faster to meet the body’s needs for oxygen.

45. Answer: 1. Creatine kinase (CK or CPK)

Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream.

  • Options B, C, and D: Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.

46. Answer: 1. Decreased arterial blood flow secondary to vasoconstriction

Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.

47. Answer: 1. “Apply the patch to a nonhairy, nonfatty area of the upper torso or arms.”

A nitroglycerin patch should be applied to a nonhairy, nonfatty area for the best and most consistent absorption rates.

  • Option B: Sites should be rotated to prevent skin irritation.
  • Option C: The drug should be continued if headache occurs because tolerance will develop.
  • Option D: Sublingual nitroglycerin should be used to treat chest pain.

48. Answer: 3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night

Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.

49. Answer: 3. Heart rate increases

Heart rate increases in response to decreased blood pressure caused by vasodilation.

50. Answer: 2. This combination promotes diuresis but decreases the risk of hypokalemia

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

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