onco midterm reviewer

7/24/2019 Onco Midterm Reviewer

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NCLEX coronary artery disease

1. A client is scheduled for a cardiac catheterization using a radiopaquedye. Which of the following assessments is most critical efore theprocedure!1. Intake and output2. Baseline peripheral pulse rates

3. Height and weight4. Allergy to iodine or shellfish". A client with no history of cardio#ascular disease comes into theamulatory clinic with flu$li%e symptoms. &he client suddenly complainsof chest pain. Which of the following questions would est help a nurseto discriminate pain caused y a non$cardiac prolem!1. Have you ever had this pain before!2. "an you des#ribe the pain to $e!3. %oes the pain get worse when you breathe in!4. "an you rate the pain on a s#ale of 1&1'( with 1' being the worst!'. A client with myocardial infarction has een transferred from acoronary care unit to a general medical unit with cardiac monitoring #iatelemetry. A nurse plans to allow for which of the following clientacti#ities!1. )tri#t bed rest for 24 hours after transfer2. Bathroo$ privileges and selfare a#tivities3. *nsupervised hallway a$bulation with distan#es under 2'' feet4. Ad lib a#tivities be#ause the #lient is $onitored.(. A nurse notes ") ilateral edema in the lower e*tremities of a client

with myocardial infarction who was admitted " days ago. &he nursewould plan to do which of the following ne*t!1. +eview the intake and output re#ords for the last 2 days2. "hange the ti$e of diureti# ad$inistration fro$ $orning to evening3. +e,uest a sodiu$ restri#tion of 1 g-day fro$ the physi#ian.4. rder daily weights starting the following $orning.+. A client is wearing a continuous cardiac monitor, which egins tosound its alarm. A nurse sees no electrocardiogram comple*es on thescreen. &he first action of the nurse is to-1. "he#k the #lient status and lead pla#e$ent

2. /ress the re#order button on the ele#tro#ardiogra$ #onsole.3. "all the physi#ian4. "all a #ode blue. A nurse is assessing the lood pressure of a client diagnosed withprimary hypertension. &he nurse ensures accurate measurement ya#oiding which of the following!1. )eating the #lient with ar$ bared( supported( and at heart level.2. 0easuring the blood pressure after the #lient has been seated ,uietly for $inutes.


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3. *sing a #uff with a rubber bladder that en#ir#les at least ' of the li$b.4. aking a blood pressure within 1 $inutes after ni#otine or #affeine ingestion./. 0 heparin therapy is ordered for a client. While implementing thisorder, a nurse ensures that which of the following medications isa#ailale on the nursing unit!1. 5ita$in 62. A$ino#aproi# a#id

3. /otassiu$ #hloride4. /rota$ine sulfate2. A client is at ris% for pulmonary emolism and is on anticoagulanttherapy with warfarin 3Coumadin4. &he client5s prothromin time is "6seconds, with a control of 11 seconds. &he nurse assesses that this resultis-1. he sa$e as the #lient7s own baseline level2. 8ower than the needed therapeuti# level3. 9ithin the therapeuti# range4. Higher than the therapeuti# range7. A client who has een recei#ing heparin therapy also is started onwarfarin. &he client as%s a nurse why oth medications are eingadministered. 0n formulating a response, the nurse incorporates theunderstanding that warfarin-1. )ti$ulates the breakdown of spe#ifi# #lotting fa#tors by the liver( and it takes2&3 days for this to e:ert an anti#oagulant effe#t.2. Inhibits synthesis of spe#ifi# #lotting fa#tors in the liver( and it takes 3&4 daysfor this $edi#ation to e:ert an anti#oagulant effe#t.3. )ti$ulates produ#tion of the body7s own thro$bolyti# substan#es( but it takes

2&4 days for this to begin.4. Has the sa$e $e#hanis$ of a#tion as Heparin( and the #rossover ti$e isneeded for the seru$ level of warfarin to be therapeuti#.16. A 6$year$old male client comes into the emergency department withcomplaints of crushing chest pain that radiates to his shoulder and leftarm. &he admitting diagnosis is acute myocardial infarction. 0mmediateadmission orders include o*ygen y NC at (L8minute, lood wor%, chest*$ray, an EC9, and " mg of morphine gi#en intra#enously. &he nurseshould first-1. Ad$inister the $orphine

2. btain a 12&lead ;"ob #hange or early retire$ent3. 0ake a #o$$it$ent to long&ter$ therapy4. "ontrol high blood pressure1/. >ypertension is %nown as the silent %iller. &his phrase is associatedwith the fact that hypertension often goes undetected until symptoms ofother system failures occur. &his may occur in the form of-


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1. "erebrovas#ular a##ident2. 8iver disease3. 0yo#ardial infar#tion4. /ul$onary disease12. ?uring the pre#ious few months, a +$year$old woman felt rieftwinges of chest pain while wor%ing in her garden and has had frequentepisodes of indigestion. er e#aluation confirms adiagnosis of stale angina pectoris. After stailization and treatment, theclient is discharged from the hospital. At her follow$up appointment, sheis discouraged ecause she is e*periencing pain with increasingfrequency.


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'6. Which of the following types of pain is most characteristic of angina!1. 6nifelike2. )harp3. )hooting4. ightness'1. Which of the following parameters is the ma@or determinant ofdiastolic lood pressure!

1. Barore#eptors2. "ardia# output3. +enal fun#tion4. 5as#ular resistan#e'". Which of the following factors can cause lood pressure to drop tonormal le#els!1. 6idneys7 e:#retion of sodiu$ only2. 6idneys7 retention of sodiu$ and water3. 6idneys7 e:#retion of sodiu$ and water4. 6idneys7 retention of sodiu$ and e:#retion of water''. aroreceptors in the carotid artery walls and aorta respond to whichof the following conditions!1. "hanges in blood pressure2. "hanges in arterial o:ygen tension3. "hanges in arterial #arbon dio:ide tension4. "hanges in heart rate'(. Which of the following terms descries the force against which the#entricle must e*pel lood!1. Afterload

2. "ardia# output3. verload4. /reload'+. Which of the following terms is used to descrie the amount ofstretch on the myocardium at the end of diastole!1. Afterload2. "ardia# inde:3. "ardia# output4. /reload'. A +/$year$old client with a history of asthma is

prescried propranolol 30nderal4 to control hypertension.efore administered propranolol, which of the following actions shouldthe nurse ta%e first!1. 0onitor the api#al pulse rate2. Instru#t the #lient to take $edi#ation with food3. uestion the physi#ian about the order4. "aution the #lient to rise slowly when standing.'/. Bne hour after administering 0 furosemide 3Lasi*4 to a client withheart failure, a short urst of #entricular tachycardia appears on the


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cardiac monitor. Which of the following electrolyte imalances should thenurse suspect!1. Hypo#al#e$ia2. Hyper$agnese$ia3. Hypokale$ia4. Hypernatre$ia'2. A client is recei#ing spironolactone to treat hypertension. Which of

the following instructions should the nurse pro#ide!1. ;at foods high in potassiu$.!2. ake daily potassiu$ supple$ents.!3. %is#ontinue sodiu$ restri#tions.!4. Avoid salt substitutes.!'7. When assessing an EC9, the nurse %nows that the ;$= inter#alrepresents the time it ta%es for the-1. I$pulse to begin atrial #ontra#tion2. I$pulse to transverse the atria to the A5 node3. )A node to dis#harge the i$pulse to begin atrial depolari=ation4. I$pulse to travel to the ventri#les(6. ollowing a treadmill test and cardiac catheterization, the client isfound to ha#e coronary artery disease, which is inoperati#e. >e isreferred to the cardiac rehailitation unit. ?uring his first #isit to the unithe says that he doesn5t understand why he needs to e there ecausethere is nothing that can e done to ma%e him etter. &he est nursingresponse is-1. "ardia# rehabilitation is not a #ure but #an help restore you to $any of yourfor$er a#tivities.!

2. Here we tea#h you to gradually #hange your lifestyle to a##o$$odate yourheart disease.!3. ou are probably right but we #an gradually in#rease your a#tivities so thatyou #an live a $ore a#tive life.!4. %o you feel that you will have to $ake so$e #hanges in your life now!(1. &o e#aluate a client5s condition following cardiac catheterization, thenurse will palpate the pulse-1. In all e:tre$ities2. At the insertion site3. %istal to the #atheter insertion

4. Above the #atheter insertion(". A client5s physician orders nuclear cardiography and ma%es anappointment for a thallium scan. &he purpose of in@ecting radioisotopeinto the loodstream is to detect-1. Cor$al vs. abnor$al tissue2. %a$age in areas of the heart3. 5entri#ular fun#tion4. 0yo#ardial s#arring and perfusion


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('. A client enters the E= complaining of se#ere chest pain. A myocardialinfarction is suspected. A 1" lead EC9 appears normal, ut the doctoradmits the client for further testing until cardiac enzyme studies arereturned. All of the following will e included in the nursing care plan.Which acti#ity has the highest priority!1. 0onitoring vital signs2. "o$pleting a physi#al assess$ent

3. 0aintaining #ardia# $onitoring4. 0aintaining at least one I5 a##ess site((. A client is e*periencing tachycardia. &he nurse5s understanding of thephysiological asis for this symptom is e*plained y which of thefollowing statements!1. he de$and for o:ygen is de#reased be#ause of pleural involve$ent2. he infla$$atory pro#ess #auses the body to de$and $ore o:ygen to $eet itsneeds.3. he heart has to pu$p faster to $eet the de$and for o:ygen when there islowered arterial o:ygen tension.4. +espirations are labored.(+. A client enters the E= complaining of chest pressure and se#ereepigastric distress. >is < are 1+2876, 7(, "(, and 77D. &he doctororders cardiac enzymes. 0f the client were diagnosed with an :0, thenurse would e*pect which cardiac enzyme to rise within the ne*t ' to 2hours!1. "reatine kinase ?"6 or "/6@2. 8a#ti# dehydrogenase ?8%H@3. 8%H&1

4. 8%H&2(. A (+$year$old male client with leg ulcers and arterial insufficiency isadmitted to the hospital. &he nurse understands that leg ulcers of thisnature are usually caused y-1. %e#reased arterial blood flow se#ondary to vaso#onstri#tion2. %e#reased arterial blood flow leading to hypere$ia3. Atheros#leroti# obstru#tion of the arteries4. rau$a to the lower e:tre$ities(/. Which of the following instructions should e included in thedischarge teaching for a patient discharged with a transdermal

nitroglycerin patch!1. Apply the pat#h to a non hairy( nonfatty area of the upper torso or ar$s.!2. Apply the pat#h to the sa$e site ea#h day to $aintain #onsistent drugabsorption.!3. If you get a heada#he( re$ove the pat#h for 4 hours and then reapply.!4. If you get #hest pain( apply a se#ond pat#h right ne:t to the first pat#h.!(2. 0n order to pre#ent the de#elopment of tolerance, the nurse instructsthe patient to-


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1. Apply the nitrogly#erin pat#h every other day2. )wit#h to sublingual nitrogly#erin when the patient7s systoli# blood pressureelevates to D14' $$ Hg3. Apply the nitrogly#erin pat#h for 14 hours ea#h and re$ove for 1' hours atnight4. *se the nitrogly#erin pat#h for a#ute episodes of angina only(7. ?irect$acting #asodilators ha#e which of the following effects on the

heart rate!1. Heart rate de#reases2. Heart rate re$ains signifi#antly un#hanged3. Heart rate in#reases4. Heart rate be#o$es irregular+6. When teaching a patient why spironolactone 3Aldactone4 andfurosemide 3Lasi*4 are prescried together, the nurse ases teaching onthe %nowledge that-1. 0oderate doses of two different types of diureti#s are $ore effe#tive than alarge dose of one type2. his #o$bination pro$otes diuresis but de#reases the risk of hypokale$ia3. his #o$bination prevents dehydration and hypovole$ia4. *sing two drugs in#reases os$olality of plas$a and the glo$erular filtrationrate

Answers and Rationale

e#tion of a radiopa,ue dye into the blood vessel. he risk of allergi# rea#tionand possible anaphyla:is is serious and $ust be assessed before the pro#edure.2. AnswerE 3. "hest pain is assessed by using the standard pain assess$entpara$eters. ptions 1( 2( and 4 $ay or $ay not help dis#ri$inate the origin ofpain. /ain of pleuropul$onary origin usually worsens on inspiration.3. AnswerE 2. n transfer fro$ the ""*( the #lient is allowed selfare a#tivitiesand bathroo$ privileges. )upervised a$bulation for brief distan#es areen#ouraged( with distan#es gradually in#reased ?'( 1''( 2'' feet@.

4. AnswerE 1. ;de$a( the a##u$ulation of e:#ess fluid in the interstitial spa#es(#an be $easured by intake greater than output and by a sudden in#rease inweight. %iureti#s should be given in the $orning whenever possible to avoidno#turia. )tri#t sodiu$ restri#tions are reserved for #lients with severe sy$pto$s.. AnswerE 1. )udden loss of ele#tro#ardiogra$ #o$ple:es indi#ates ventri#ularasystole or possible ele#trode displa#e$ent. A##urate assess$ent of the #lientand e,uip$ent is ne#essary to deter$ine the #ause and identify the appropriateintervention.


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F. AnswerE 4. B/ should be taken with the #lient seated with the ar$ bared(positioned with support and at heart level. he #lient should sit with the legs onthe floor( feet un#rossed( and not speak during the re#ording. he #lient shouldnot have s$oked toba##o or taken in #affeine in the 3' $inutes pre#eding the$easure$ent. he #lient should rest ,uietly for $inutes before the reading istaken. he #uff bladder should en#ir#le at least ' of the li$b being $easured.


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undete#ted. "5A7s #an be related to long&ter$ hypertension. 8iver or pul$onarydisease is generally not asso#iated with hypertension. 0yo#ardial infar#tion isgenerally related to #oronary artery disease.1. AnswerE 3. Citrogly#erin $ay be used prophyla#ti#ally before stressfulphysi#al a#tivities su#h as stair #li$bing to help the #lient re$ain pain free.5isiting her friend early in the day would have no i$pa#t on de#reasing painepisodes. +esting before or after an a#tivity is not as likely to help prevent an

a#tivity&related pain episode.1. AnswerE 1. he #lient should report a #hange in the pattern of #hest pain. It$ay indi#ate in#reasing severity of "A%.2'. AnswerE 2. "ardia# #atheteri=ation is done in #lients with angina pri$arily toassess the e:tent and severity of the #oronary artery blo#kage( A de#ision about$edi#al $anage$ent( angioplasty( or #oronary artery bypass surgery will bebased on the #atheteri=ation results.21. AnswerE 3. Citrogly#erin produ#es peripheral vasodilation( whi#h redu#es$yo#ardial o:ygen #onsu$ption and de$and. 5asodilation in #oronary arteriesand #ollateral vessels $ay also in#rease blood flow to the is#he$i# areas of theheart. Citrogly#erin de#reases $yo#ardial o:ygen de$and. Citrogly#erin does nothave an effe#t on peri#ardial spasti#ity or #ondu#tivity in the $yo#ardiu$.22. AnswerE 1. Be#ause of the widespread vasodilating effe#ts( nitrogly#erin oftenprodu#es su#h side effe#ts as heada#he( hypotension( and di==iness. he #lientshould lie or sit down to avoid fainting. Citro does not #ause shortness of breathor sto$a#h #ra$ps.23. AnswerE 3. he #orre#t proto#ol for nitrogly#erin used involves i$$ediatead$inistration( with subse,uent doses taken at &$inute intervals as needed( fora total dose of 3 tablets. )ublingual nitrogly#erin appears in the bloodstrea$

within 2 to 3 $inutes and is $etaboli=ed within about 1' $inutes.24. AnswerE 3. he left anterior des#ending artery is the pri$ary sour#e of bloodflow for the anterior wall of the heart. he #ir#u$fle: artery supplies the lateralwall( the internal $a$$ary supplies the $a$$ary( and the right #oronary arterysupplies the inferior wall of the heart.2. AnswerE 2. Although the #oronary arteries $ay re#eive a $inute portion ofblood during systole( $ost of the blood flow to #oronary arteries is suppliedduring diastole. Breathing patterns are irrelevant to blood flow.2F. AnswerE 3. he right #oronary artery supplies the right ventri#le( or theinferior portion of the heart. herefore( prolonged o##lusion #ould produ#e an

infar#tion in that area. he right #oronary artery doesn7t supply the anteriorportion ?left ventri#le@( lateral portion ?so$e of the left ventri#le and the leftatriu$@( or the api#al portion ?left ventri#le@ of the heart.2G. AnswerE 3. Abnor$alities of the pul$oni# valve are aus#ultated at the se#ondleft inter#ostal spa#e along the left sternal border. Aorti# valve abnor$alities areheard at the se#ond inter#ostal spa#e( to the right of the sternu$. 0itral valveabnor$alities are heard at the fifth inter#ostal spa#e in the $id#lavi#ular line.ri#upsid valve abnor$alities are heard at the 3rd and 4th inter#ostal spa#esalong the sternal border.


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2. AnswerE 3. roponin I levels rise rapidly and are dete#table within 1 hour of$yo#ardial in>ury. roponin levels aren7t dete#table in people without #ardia#in>ury.2. AnswerE 4. he ;"< is the ,ui#kest( $ost a##urate( and $ost widely used toolto deter$ine the lo#ation of $yo#ardial infar#tion. "ardia# en=y$es are used todiagnose 0I but #an7t deter$ine the lo#ation. An e#ho#ardiogra$ is used $ostwidely to view $yo#ardial wall fun#tion after an 0I has been diagnosed. "ardia#

#atheteri=ation is an invasive study for deter$ining #oronary artery disease and$ay also indi#ate the lo#ation of $yo#ardial da$age( but the study $ay not beperfor$ed i$$ediately.3'. AnswerE 4. he pain of angina usually ranges fro$ a vague feeling oftightness to heavy( intense pain. /ain i$pulses originate in the $ost vis#eral$us#les and $ay $ove to su#h areas as the #hest( ne#k( and ar$s.31. AnswerE 4. 5as#ular resistan#e is the i$pedan#e of blood flow by thearterioles that $ost predo$inantly affe#ts the diastoli# pressure. "ardia# outputdeter$ines systoli# blood pressure.32. AnswerE 3. he kidneys respond to a rise in blood pressure by e:#retingsodiu$ and e:#ess water. his response ulti$ately affe#ts systoli# pressure byregulating blood volu$e.33. AnswerE 1. Barore#eptors lo#ated in the #arotid arteries and aorta sensepulsatile pressure. %e#reases in pulsatile pressure #ause a refle: in#rease in heartrate. "he$ore#eptors in the $edulla are pri$arily sti$ulated by #arbon dio:ide./eripheral #he$ore#eptors in the aorta and #arotid arteries are pri$arilysti$ulated by o:ygen.34. AnswerE 1. Afterload refers to the resistan#e nor$ally $aintained by theaorti# and pul$oni# valves( the #ondition and tone of the aorta( and the

resistan#e offered by the syste$i# and pul$onary arterioles. "ardia# output is thea$ount of blood e:pelled fro$ the heart per $inute. verload refers to anabundan#e of #ir#ulating volu$e. /reload is the volu$e of blood in the ventri#le atthe end of diastole.3. AnswerE 4. /reload is the a$ount of stret#h of the #ardia# $us#le fibers atthe end of diastole. he volu$e of blood in the ventri#le at the end of diastoledeter$ines the preload. Afterload is the for#e against whi#h the ventri#le $uste:pel blood. "ardia# inde: is the individuali=ed $easure$ent of #ardia# output(based on the #lient7s body surfa#e area. "ardia# output is the a$ount of blood theheart is e:pelling per $inute.

3F. AnswerE 3. /ropranolol and other beta&adrenergi# blo#kers are#ontraindi#ated in a #lient with asth$a( so the nurse should ,uestion thephysi#ian before giving the dose. he other responses are appropriate a#tions fora #lient re#eiving propranolol( but ,uestioning the physi#ian takes priority. he#lient7s api#al pulse should always be #he#ked before giving propranololJ if thepulse rate is e:tre$ely low( the nurse should withhold the drug and notify thephysi#ian.


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3G. AnswerE 3. Kurose$ide is a potassiu$&depleting diureti# than #an #ausehypokale$ia. In turn( hypokale$ia in#reases $yo#ardial e:#itability( leading toventri#ular ta#hy#ardia.3. AnswerE 4. Be#ause spironola#tone is a potassiu$&sparing diureti#( the #lientshould avoid salt substitutes be#ause of their high potassiu$ #ontent. he #lientshould also avoid potassiu$&ri#h foods and potassiu$ supple$ents. o redu#efluid&volu$e overload( sodiu$ restri#tions should #ontinue.

3. AnswerE 4. he /&+ interval is $easured on the ;"< strip fro$ the beginningof the / wave to the beginning of the +) #o$ple:. It is the ti$e it takes for thei$pulse to travel to the ventri#le.4'. AnswerE 1. )u#h a response does not have false hope to the #lient but ispositive and realisti#. he answer tells the #lient what #ardia# rehabilitation is anddoes not dwell upon his negativity about it.41. AnswerE 3. /alpating pulses distal to the insertion site is i$portant toevaluate for thro$bophlebitis and vessel o##lusion. hey should be bilateral andstrong.42. AnswerE 4. his s#an dete#ts $yo#ardial da$age and perfusion( an a#ute or#hroni# 0I. It is a $ore spe#ifi# answer than ?1@ or ?2@. )pe#ifi# ventri#ularfun#tion is tested by a gated #ardia# blood pool s#an.43. AnswerE 3. ;ven though initial tests see$ to be within nor$al range( it takesat least 3 hours for the #ardia# en=y$e studies to register. In the $eanti$e( the#lient needs to be wat#hed for brady#ardia( heart blo#k( ventri#ular irritability( andother arrhyth$ias. ther a#tivities #an be a##o$plished around the 0I$onitoring.44. AnswerE 3. he arterial o:ygen supply is lowered and the de$and for o:ygenis in#reased( whi#h results in the heart7s having to beat faster to $eet the body7s

needs for o:ygen.4. AnswerE 1. "reatine kinase ?"6( for$ally known as "/6@ rises in 3& hours ifan 0I is present. 9hen the $yo#ardiu$ is da$aged( "/6 leaks out of the #ell$e$branes and into the bloodstrea$. 8a#ti# dehydrogenase rises in 24&4 hours(and 8%H&1 and 8%H&2 rises in &24 hours.4F. AnswerE 1. %e#reased arterial flow is a result of vasospas$. he etiology isunknown. It is $ore proble$ati# in #older #li$ates or when the person is understress. Hypere$ia o##urs when the vasospas$ is relieved.4G. AnswerE 1. A nitrogly#erin pat#h should be applied to a non hairy( nonfattyarea for the best and $ost #onsistent absorption rates. )ites should be rotated to

prevent skin irritation( and the drug should be #ontinued if heada#he o##ursbe#ause toleran#e will develop. )ublingual nitrogly#erin should be used to treat#hest pain.4. AnswerE 3. oleran#e #an be prevented by $aintaining an & to 12&hournitrate&free period ea#h day.4. AnswerE 3. Heart rate in#reases in response to de#reased blood pressure#aused by vasodilation.'. AnswerE 2. )pironola#tone is a potassiu$&sparing diureti#J furose$ide is apotassiu$&losing diureti#.


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1. A client is scheduled for a cardiac catherization using a radiopaque

dye. Which of the following assessments is most critical before the

procedure?

a. Intake and outputb. Baseline peripheral pulse rates

c. Height and weight

d. Allergy to iodine or shellfish

2. A client with no history of cardiovascular disease comes into the

ambulatory clinic with ulie symptoms. !he 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. an you describe the pain to !e?

c. "oes the pain get worse when you breathe in?

d. an you rate the pain on a scale of #$#%& with #% being the worst?

#. 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. 'trict bed rest for () hours after transfer

b. Bathroo! privileges and self$care activities

c. *nsupervised hallway a!bulation with distances under (%% feet

d. Ad lib activities because the client is !onitored.

$. A nurse notes 2% bilateral edema in the lower e&tremities of a client

with myocardial infarction who was admitted 2 days ago. !he nurse

would plan to do which of the following ne&t?

a. Review the intake and output records for the last ( days

b. hange the ti!e of diuretic ad!inistration fro! !orning to evening

c. Re+uest a sodiu! restriction of # g,day fro! the physician.

d. -rder daily weights starting the following !orning.


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'. A client is wearing a continuous cardiac monitor( which begins to

sound its alarm. A nurse sees no electrocardiogram comple&es on the

screen. !he )rst action of the nurse is to*

a. heck the client status and lead place!ent

b. ress the recorder button on the electrocardiogra! console.

c. all the physician

d. all a code blue

+. A nurse is assessing the blood pressure of a client diagnosed with

primary hypertension. !he nurse ensures accurate measurement by

avoiding which of the following?

a. 'eating the client with ar! bared& supported& and at heart level.

b. /easuring the blood pressure after the client has been seated +uietly for 0 !inutes.

c. *sing a cuff with a rubber bladder that encircles at least 1%2 of the li!b.

d. 3aking a blood pressure within #0 !inutes after nicotine or caffeine ingestion.

,. - 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. 4ita!in 5

b. A!inocaporic acid

c. otassiu! chloride

d. rota!ine sulfate

/. A client is at ris for pulmonary embolism and is on anticoagulant

therapy with warfarin 0oumadin. !he client3s prothrombin time is 24

seconds( with a control of 11 seconds. !he nurse assesses that this

result is*

a. 3he sa!e as the client6s own baseline level

b. 7ower than the needed therapeutic level

c. 8ithin the therapeutic ranged. Higher than the therapeutic range

5. A client who has been receiving heparin therapy also is started on

warfarin. !he client ass a nurse why both medications are being

administered. -n formulating a response( the nurse incorporates the

understanding that warfarin*


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a. 'ti!ulates the breakdown of specific clotting factors by the liver& and it takes ($9 days for

this to e:ert an anticoagulant effect.

b. Inhibits synthesis of specific clotting factors in the liver& and it takes 9$) days for this

!edication to e:ert an anticoagulant effect.

c. 'ti!ulates production of the body6s own thro!bolytic substances& but it takes ($) days for

this to begin.

d. Has the sa!e !echanis! of action as Heparin& and the crossover ti!e is needed for theseru! level of warfarin to be therapeutic.

14. A +4"year"old male client comes into the emergency department with

complaints of crushing chest pain that radiates to his shoulder and left

arm. !he admitting diagnosis is acute myocardial infarction. -mmediate

admission orders include o&ygen by 6 at $78minute( blood wor( chest

&"ray( an 9:( and 2mg of morphine given intravenously. !he nurse

should )rst*

a. Ad!inister the !orphine

b. -btain a #($lead ; .-n transfer fro! the *& the client is allowed self$care activities and

bathroo! privileges. 'upervised a!bulation for brief distances are encouraged& with

distances gradually increased 0%& #%%& (%% feet@.

$. A6=W9> A.;de!a& the accu!ulation of e:cess fluid in the interstitial spaces& can be

!easured by intake greater than output and by a sudden increase in weight. "iuretics should

be given in the !orning whenever possible to avoid nocturia. 'trict sodiu! restrictions are

reserved for clients with severe sy!pto!s.

'. A6=W9> A.'udden loss of electrocardiogra! co!ple:es indicates ventricular asystole

or possible electrode displace!ent. Accurate assess!ent of the client and e+uip!ent is

necessary to deter!ine the cause and identify the appropriate intervention.

+. A6=W9> @.B should be taken with the client seated with the ar! bared& positioned

with support and at heart level. 3he client should sit with the legs on the floor& feet uncrossed&

and not speak during the recording. 3he client should not have s!oked tobacco or taken in

caffeine in the 9% !inutes preceding the !easure!ent. 3he client should rest +uietly for 0

!inutes before the reading is taken. 3he cuff bladder should encircle at least 1%2 of the li!bbeing !easured. @.3he antidote to heparin is prota!ine sulfate and should be readily available

for use if e:cessive bleeding or he!orrhage should occur. 4ita!in 5 is an antidote for

warfarin.

/. A6=W9> .3he therapeutic range for prothro!bin ti!e is #.0 to ( ti!es the control for

clients at risk for thro!bus. Based on the client6s control value& the therapeutic range for thisindividual would be #.0 to (( seconds. 3herefore the result is within therapeutic range.

5. A6=W9> .8arfarin works in the liver and inhibits synthesis of four vita!in 5$

dependent clotting factors & I& 4II& and II@& but it takes 9 to ) days before the therapeutic

effect of warfarin is e:hibited.

14. A6=W9> A.Although obtaining the ;


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11. A6=W9> .3hro!bolytic drugs are ad!inistered within the first hours after onset of

a /I to lyse clots and reduce the e:tent of !yocardial da!age.

12. A6=W9>= A( ( 9.In a client who has had an ; A.ropranolol hydrochloride is a beta$adrenergic blocking agent. Actions of

propranolol hydrochloride include reducing heart rate& decreasing !yocardial contractility& and

slowing conduction.

1+. A6=W9> .o!pliance is the !ost critical ele!ent of hypertensive therapy. In !ost

cases& hypertensive clients re+uire lifelong treat!ent and their hypertension cannot be

!anaged successfully without drug therapy. 'tress !anage!ent and weight !anage!entare i!portant co!ponents of hypertension therapy& but the priority goal is related to

co!pliance.

1,. A6=W9> A.Hypertension is referred to as the silent killer for adults& because until the

adult has significant da!age to other syste!s& the hypertension !ay go undetected. 4A6s

can be related to long$ter! hypertension. 7iver or pul!onary disease is generally not

associated with hypertension. /yocardial infarction is generally related to coronary artery

disease.

1/. A6=W9> .Ditroglycerin !ay be used prophylactically before stressful physical

activities such as stair cli!bing to help the client re!ain pain free. 4isiting her friend early in

the day would have no i!pact on decreasing pain episodes. Resting before or after an activity

is not as likely to help prevent an activity$related pain episode.

15. A6=W9> A.3he client should report a change in the pattern of chest pain. It !ay

indicate increasing severity of A".


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24. A6=W9> .ardiac catheri=ation is done in clients with angina pri!arily to assess the

e:tent and severity of the coronary artery blockage& A decision about !edical !anage!ent&

angioplasty& or coronary artery bypass surgery will be based on the catheri=ation results.

NCLEX myocardial infarction

1. Which of the following actions is the first priority of care for a client

e*hiiting signs and symptoms of coronary artery disease!

1. %e#rease an:iety

2. ;nhan#e $yo#ardial o:ygenation

3. Ad$inister sublingual nitrogly#erin

4. ;du#ate the #lient about his sy$pto$s

". :edical treatment of coronary artery disease includes which of thefollowing procedures!

1. "ardia# #atheteri=ation

2. "oronary artery bypass surgery

3. ral $edi#ation therapy

4. /er#utaneous translu$inal #oronary angioplasty

'. Which of the following is the most common symptom of myocardial

infarction 3:04!

1. "hest pain

2. %yspnea

3. ;de$a

4. /alpitations

(. Which of the following symptoms is the most li%ely origin of pain the

client descried as %nifeli%e chest pain that increases in intensity with

inspiration!

1. "ardia#

2.


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+. Which of the following lood tests is most indicati#e of cardiac

damage!

1. 8a#tate dehydrogenase

2. "o$plete blood #ount ?"B"@

3. roponin I

4. "reatine kinase ?"6@

. What is the primary reason for administering morphine to a client with

an :0!

1. o sedate the #lient

2. o de#rease the #lient7s pain

3. o de#rease the #lient7s an:iety

4. o de#rease o:ygen de$and on the #lient7s heart

/. Which of the following conditions is most commonly responsile for

myocardial infarction!

1. Aneurys$

2. Heart failure

3. "oronary artery thro$bosis

4. +enal failure

2. Which of the following complications is indicated y a third heartsound 3


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1. Ad$inister $orphine

2. Ad$inister o:ygen

3. Ad$inister sublingual nitrogly#erin

4. btain an ;"ui#es( su#h as to$ato >ui#e( are typi#ally high

in sodiu$ and should be avoided in a sodiu$&restri#ted diet.

F. AnswerE 2. A nor$al api#al i$pulse is found under over the ape: of the heart

and is typi#ally lo#ated and aus#ultated in the left fifth inter#ostal spa#e in the

$id#lavi#ular line. An api#al i$pulse lo#ated or aus#ultated below the fifth


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inter#ostal spa#e or lateral to the $id#lavi#ular line $ay indi#ate left ventri#ular

enlarge$ent.

G'. AnswerE 3. 8eft anterior des#ending artery

he left anterior des#ending artery is the pri$ary sour#e of blood for the anterior

wall of the heart. he #ir#u$fle: artery supplies the lateral wall( the internal

$a$$ary artery supplies the $a$$ary( and the right #oronary artery suppliesthe inferior wall of the heart.

1. Which of the following actions is the first priority of care for a cliente*hiiting signs and symptoms of coronary artery disease!

1. %e#rease an:iety2. ;nhan#e $yo#ardial o:ygenation3. Ad$inister sublingual nitrogly#erin

4. ;du#ate the #lient about his sy$pto$s

". :edical treatment of coronary artery disease includes which of thefollowing procedures!

1. "ardia# #atheteri=ation2. "oronary artery bypass surgery3. ral $edi#ation therapy4. /er#utaneous translu$inal #oronary angioplasty

'. Which of the following is the most common symptom of myocardialinfarction 3:04!

1. "hest pain2. %yspnea3. ;de$a4. /alpitations

(. Which of the following symptoms is the most li%ely origin of pain theclient descried as %nifeli%e chest pain that increases in intensity withinspiration!

1. "ardia#2.


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+. Which of the following lood tests is most indicati#e of cardiacdamage!

1. 8a#tate dehydrogenase2. "o$plete blood #ount ?"B"@3. roponin I

4. "reatine kinase ?"6@

. What is the primary reason for administering morphine to a client withan :0!

1. o sedate the #lient2. o de#rease the #lient7s pain3. o de#rease the #lient7s an:iety4. o de#rease o:ygen de$and on the #lient7s heart

/. Which of the following conditions is most commonly responsile formyocardial infarction!

1. Aneurys$2. Heart failure3. "oronary artery thro$bosis4. +enal failure

2. Which of the following complications is indicated y a third heartsound 3


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16. What is the first inter#ention for a client e*periencing :0!

1. Ad$inister $orphine2. Ad$inister o:ygen3. Ad$inister sublingual nitrogly#erin4. btain an ;"= of 1"" ;:, and a respiratoryrate of '2 reaths8minute. &he client5s medical history included ?:, >&N,and heart failure. Which of the following disorders should the nursesuspect!

1. /ul$onary ede$a2. /neu$othora:3. "ardia# ta$ponade

4. /ul$onary e$bolus

(/. &he nurse coming on duty recei#es the report from the nurse goingoff duty. Which of the following clients should the on$duty nurse assessfirst!

1. he &year&old #lient who was ad$itted 2 days ago with heart failure( B/ of12F-GF( and a respiratory rate of 21 breaths a $inute.2. he &year&old #lient with end&stage right&sided heart failure( B/ of G-'(

and a %C+ order.3. he F2&year&old #lient who was ad$itted one day ago with thro$bophlebitisand re#eiving I5 heparin.4. A GF&year&old #lient who was ad$itted 1 hour ago with new&onset atrialfibrillation and is re#eiving I5 diltia=e$ ?"ardi=e$@.

(2. When de#eloping a teaching plan for a client with endocarditis, whichof the following points is most essential for the nurse to include!


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1. +eport fever( anore:ia( and night sweats to the physi#ian.!2. ake prophyla#ti# antibioti#s after dental work and invasive pro#edures.!3. In#lude potassiu$ ri#h foods in your diet.!4. 0onitor your pulse regularly.!

(7. A nurse is conducting a health history with a client with a primary

diagnosis of heart failure. Which of the following disorders reported ythe client is unli%ely to play a role in e*acerating the heart failure!

1. +e#ent *+I2. Cutritional ane$ia3. /epti# ul#er disease4. A&Kib

+6. A nurse is preparing for the admission of a client with heart failure

who is eing sent directly to the hospital from the physician5s office. &henurse would plan on ha#ing which of the following medications readilya#ailale for use!

1. %iltia=e$ ?"ardi=e$@2. %igo:in ?8ano:in@3. /ropranolol ?Inderal@4. 0etoprolol ?8opressor@

+1. A nurse caring for a client in one room is told y another nurse that asecond client has de#eloped se#ere pulmonary edema. Bn entering the"nd client5s room, the nurse would e*pect the client to e-

1. )lightly an:ious2. 0ildly an:ious3. 0oderately an:ious4. ;:tre$ely an:ious

+". A client with pulmonary edema has een on diuretic therapy. &heclient has an order for additional furosemide 3Lasi*4 in the amount of (6mg 0 push. Fnowing that the client also will e started on ?igo*in3Lano*in4, a nurse chec%s the client5s most recent-

1. %igo:in level2. )odiu$ level


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3. /otassiu$ level4. "reatinine level

+'. A client who had cardiac surgery "( hours ago has a urine outputa#eraging 17 ml8hr for " hours. &he client recei#ed a single olus of +66ml of 0 fluid. rine output for the susequent hour was "+ ml. ?aily

laoratory results indicate the lood urea nitrogen is (+ mg8dL and theserum creatinine is "." mg8dL. A nurse interprets the client is at ris% for-

1. Hypovole$ia2. *I3.


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+/. A home care nurse is ma%ing a routine #isit to a client recei#ingdigo*in 3Lano*in4 in the treatment of heart failure. &he nurse wouldparticularly assess the client for-

1. hro$bo#ytopenia and weight gain2. Anore:ia( nausea( and visual disturban#es

3. %iarrhea and hypotension4. Katigue and $us#le twit#hing

+2. A client with angina complains that the angina pain is prolonged andse#ere and occurs at the same time each day, most often in the morning,Bn further assessment a nurse notes that the pain occurs in the asenceof precipitating factors. &his type of anginal pain is est descried as-

1. )table angina

2. *nstable angina3. 5ariant angina4. Conanginal pain

+7. &he physician orders continuous intra#enous nitroglycerin infusionfor the client with :0. Essential nursing actions include which of thefollowing!

1. btaining an infusion pu$p for the $edi#ation2. 0onitoring B/ ,4h3. 0onitoring urine output hourly4. btaining seru$ potassiu$ levels daily

6. Aspirin is administered to the client e*periencing an :0 ecause ofits-

1. Antipyreti# a#tion

2. Antithro$boti# a#tion3. Antiplatelet a#tion4. Analgesi# a#tion

1. Which of the following is an e*pected outcome for a client on thesecond day of hospitalization after an :0!


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1. Has severe #hest pain2. "an identify risks fa#tors for 0I3. Agrees to parti#ipate in a #ardia# rehabilitation walking progra$4. "an perfor$ personal selfare a#tivities without pain

". Which of the following reflects the principle on which a client5s diet

will most li%ely e ased during the acute phase of :0!

1. 8i,uids as ordered2. )$all( easily digested $eals3. hree regular $eals per day4. C/

'. An older, sedentary adult may not respond to emotional or physicalstress as well as a younger indi#idual ecause of-

1. 8eft ventri#ular atrophy2. Irregular heartbeats3. /eripheral vas#ular o##lusion4. /a#e$aker pla#e$ent

(. Which of the following nursing diagnoses would e appropriate for aclient with heart failure!


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. Captopril may e administered to a client with > ecause it acts asa-

1. 5asopressor2. 5olu$e e:pander3. 5asodilator

4. /otassiu$&sparing diureti#

/. urosemide is administered intra#enously to a client with >. >owsoon after administration should the nurse egin to see e#idence of thedrugs desired effect!

1. to 1' $inutes2. 3' to F' $inutes3. 2 to 4 hours

4. F to hours

2. Which of the following foods should the nurse teach a client withheart failure to a#oid or limit when following a "$gram sodium diet!

1. Apples2. o$ato >ui#e3. 9hole wheat bread4. Beef tenderloin

7. &he nurse finds the apical pulse elow the +th intercostal space. &henurse suspects-

1. 8eft atrial enlarge$ent2. 8eft ventri#ular enlarge$ent3. +ight atrial enlarge$ent4. +ight ventri#ular enlarge$ent

/6. Which of the following arteries primarily feeds the anterior wall ofthe heart!

1. "ir#u$fle: artery2. Internal $a$$ary artery3. 8eft anterior des#ending artery4. +ight #oronary artery


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Answers and Rationale

ury( "6isoen=y$es are re,uired to dete#t #ardia# in>ury.

F. AnswerE 4. 0orphine is ad$inistered be#ause it de#reases $yo#ardial o:ygende$and. 0orphine will also de#rease pain and an:iety while #ausing sedation( butit isn7t pri$arily given for those reasons.


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G. AnswerE 3. "oronary artery thro$bosis #auses an in#lusion of the artery(leading to $yo#ardial death. An aneurys$ is an outpou#hing of a vessel anddoesn7t #ause an 0I. +enal failure #an be asso#iated with 0I but isn7t a dire#t#ause. Heart failure is usually a result fro$ an 0I.

. AnswerE 1. +apid filling of the ventri#le #auses vasodilation that is aus#ultated

as )3. In#reased atrial #ontra#tion or syste$i# hypertension #an result in a fourthheart sound. Aorti# valve $alfun#tion is heard as a $ur$ur.

. AnswerE 1. he left ventri#le is responsible for $ost of the #ardia# output. Ananterior wall 0I $ay result in a de#rease in left ventri#ular fun#tion. 9hen the leftventri#le doesn7t fun#tion properly( resulting in left&sided heart failure( fluida##u$ulates in the interstitial and alveolar spa#es in the lungs and #auses#ra#kles. /ul$oni# and tri#uspid valve $alfun#tion #auses right sided heartfailure.

1'. AnswerE 2. Ad$inistering supple$ental o:ygen to the #lient is the firstpriority of #are. he $yo#ardiu$ is deprived of o:ygen during an infar#tion( soadditional o:ygen is ad$inistered to assist in o:ygenation and prevent furtherda$age. 0orphine and nitro are also used to treat 0I( but they7re $ore#o$$only ad$inistered after the o:ygen. An ;"< is the $ost #o$$on diagnosti#tool used to evaluate 0I.

11. AnswerE 1. Beta&adrenergi# blo#kers work by blo#king beta re#eptors in the

$yo#ardiu$( redu#ing the response to #ate#hola$ines and sy$patheti# nervesti$ulation. hey prote#t the $yo#ardiu$( helping to redu#e the risk of anotherinfar#tion by de#reasing $yo#ardial o:ygen de$and. "al#iu$ #hannel blo#kersredu#e the workload of the heart by de#reasing the heart rate. Car#oti#s redu#e$yo#ardial o:ygen de$and( pro$ote vasodilation( and de#rease an:iety. Citratesredu#e $yo#ardial o:ygen #onsu$ption by de#reasing left ventri#ular end&diastoli# pressure ?preload@ and syste$i# vas#ular resistan#e ?afterload@.

12. AnswerE 3. Arrhyth$ias( #aused by o:ygen deprivation to the $yo#ardiu$(

are the $ost #o$$on #o$pli#ation of an 0I. "ardiogeni# sho#k( another#o$pli#ation of an 0I( is defined as the end stage of left ventri#ular dysfun#tion.his #ondition o##urs in appro:i$ately 1 of #lients with 0I. Be#ause thepu$ping fun#tion of the heart is #o$pro$ised by an 0I( heart failure is these#ond $ost #o$$on #o$pli#ation. /eri#arditis $ost #o$$only results fro$ aba#terial or viral infe#tion but $ay o##ur after the 0I.

13. AnswerE 2. ;levated venous pressure( e:hibited as >ugular vein distention(indi#ates a failure of the heart to pu$p. L5% isn7t a sy$pto$ of abdo$inal aorti#


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aneurys$ or pneu$othora:. An 0I( if severe enough( #an progress to heartfailure( however( in and of itself( an 0I doesn7t #ause L5%.

14. AnswerE 1. ne of the $ost #o$$on signs of digo:in to:i#ity is the visualdisturban#e known as the green&yellow halo sign.! he other $edi#ations aren7tasso#iated with su#h an effe#t.

1. AnswerE 1. "ra#kles in the lungs are a #lassi# sign of left&sided heart failure.hese sounds are #aused by fluid ba#king up into the pul$onary syste$.Arrhyth$ias #an be asso#iated with both right& and left&sided heart failure. 8eft&sided heart failure #auses hypertension se#ondary to an in#reased workload onthe syste$.

1F. AnswerE 4. he $ost a##urate area on the body to assess dependent ede$ain a bed&ridden #lient is the sa#ral area. )a#ral( or dependent( ede$a is

se#ondary to right&sided heart failure.

1G. AnswerE 3. Inade,uate dea#tivation of aldosterone by the liver after right&sided heart failure leads to fluid retention( whi#h #auses oliguria.

1. AnswerE 4. Inotropi# agents are ad$inistered to in#rease the for#e of theheart7s #ontra#tions( thereby in#reasing ventri#ular #ontra#tility and ulti$atelyin#reasing #ardia# output.

1. AnswerE 2. )ti$ulation of the sy$patheti# nervous syste$ #auses ta#hy#ardiaand in#reased #ontra#tility. he other sy$pto$s listed are related to theparasy$patheti# nervous syste$( whi#h is responsible for slowing the heart rate.

2'. AnswerE 4. 9eight gain( nausea( and a de#rease in urine output arese#ondary effe#ts of right&sided heart failure. "ardio$yopathy is usually identifiedas a sy$pto$ of left&sided heart failure. 8eft&sided heart failure #auses pri$arilypul$onary sy$pto$s rather than syste$i# ones. Angina pe#toris doesn7t #ause

weight gain( nausea( or a de#rease in urine output.

21. AnswerE 1. "ardio$yopathy isn7t usually related to an underlying heartdisease su#h as atheros#lerosis. he etiology in $ost #ases is unknown. "A% and0I are dire#tly related to atheros#lerosis. /eri#ardial effusion is the es#ape of fluidinto the peri#ardial sa#( a #ondition asso#iated with /eri#arditis and advan#edheart failure.


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22. AnswerE 1. Although the #ause isn7t entirely known( #ardia# dilation and heartfailure $ay develop during the last $onth of pregnan#y or the first few $onthsafter birth. he #ondition $ay result fro$ a pree:isting #ardio$yopathy notapparent prior to pregnan#y. Hypertrophi# #ardio$yopathy is an abnor$alsy$$etry of the ventri#les that has an unknown etiology but a strong fa$ilialtenden#y. 0yo#arditis isn7t spe#ifi#ally asso#iated with #hildbirth. +estri#tive#ardio$yopathy indi#ates #onstri#tive peri#arditisJ the underlying #ause is usually

$yo#ardial.

23. AnswerE 3. In hypertrophi# #ardio$yopathy( hypertrophy of the ventri#ularseptu$Mnot the ventri#le #ha$bersMis apparent. his abnor$ality isn7t seen inother types of #ardio$yopathy.

24. AnswerE 1. Be#ause the stru#ture and fun#tion of the heart $us#le is affe#ted(heart failure $ost #o$$only o##urs in #lients with #ardio$yopathy. 0I resultsfro$ prolonged $yo#ardial is#he$ia due to redu#ed blood flow through one of the#oronary arteries. /eri#ardial effusion is $ost predo$inant in #lients withperi#arditis.

2. AnswerE 4. hese are the #lassi# signs of failure. /eri#arditis is e:hibited by afeeling of fullness in the #hest and aus#ultation of a peri#ardial fri#tion rub.Hypertension is usually e:hibited by heada#hes( visual disturban#es( and aflushed fa#e. 0I #auses heart failure but isn7t related to these sy$pto$s.

2F. AnswerE 2. "ardia# output isn7t affe#ted by hypertrophi# #ardio$yopathybe#ause the si=e of the ventri#le re$ains relatively un#hanged. All of the restde#rease #ardia# output.

2G. AnswerE 4. An )4 o##urs as a result of in#reased resistan#e to ventri#ularfilling after atrial #ontra#tion. he in#reased resistan#e is related to de#reased#o$plian#e of the ventri#le. A dilated aorta doesn7t #ause an e:tra heart sound(though it does #ause a $ur$ur. %e#reased $yo#ardial #ontra#tility is heard as athird heart sound. An )4 isn7t heard in a nor$ally fun#tioning heart.

2. AnswerE 2. By de#reasing the heart rate and #ontra#tility( beta&blo#kersi$prove $yo#ardial filling and #ardia# output( whi#h are pri$ary goals in thetreat$ent of #ardio$yopathy. Antihypertensives aren7t usually indi#ated be#ausethey would de#rease #ardia# output in #lients who are already hypotensive."al#iu$ #hannel blo#kers are so$eti$es used for the sa$e reasons as beta&blo#kersJ however( they aren7t as effe#tive as beta&blo#kers and #ause in#reasedhypotension. Citrates aren7t used be#ause of their dilating effe#ts( whi#h wouldfurther #o$pro$ise the $yo#ardiu$.


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2. AnswerE 3. he only definitive treat$ent for #ardio$yopathy that #an7t be#ontrolled $edi#ally is a heart transplant be#ause the da$age to the heart$us#le is irreversible.

3'. AnswerE 2. he pain of stable angina is predi#table in nature( builds gradually(and ,ui#kly rea#hes $a:i$u$ intensity. *nstable angina doesn7t always need a

trigger( is $ore intense( and lasts longer than stable angina. 5ariant anginausually o##urs at restMnot as a result of e:er#ise or stress.

31. AnswerE 4. *nstable angina progressively in#reases in fre,uen#y( intensity(and duration and is related to an in#reased risk of 0I within 3 to 1 $onths.

32. AnswerE 4. Inade,uate o:ygen supply to the $yo#ardiu$ is responsible forthe pain a##o$panying angina. In#reased preload would be responsible for right&sided heart failure. %e#reased afterload #auses in#reased #ardia# output.

"oronary artery spas$ is responsible for variant angina.

33. AnswerE 4. he 12&lead ;"< will indi#ate is#he$ia( showing &wave inversion.In addition( with variant angina( the ;"< shows )&seg$ent elevation. A #hest :&ray will show heart enlarge$ent or signs of heart failure( but isn7t used todiagnose angina.

34. AnswerE 1. +eversal of the is#he$ia is the pri$ary goal( a#hieved by redu#ingo:ygen #onsu$ption and in#reasing o:ygen supply. An infar#tion is per$anentand #an7t be reversed.

3. AnswerE 1. he initial priority is to de#rease the o:ygen #onsu$ptionJ thiswould be a#hieved by sitting the #lient down. An ;"< #an be obtained after the#lient is sitting down. After the ;"


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3. AnswerE 4. In an atte$pt to #o$pensate for in#reased work of breathing dueto hyperventilation( #arbon dio:ide de#reases( #ausing hypo#apnea. If the#ondition persists( "2 retention o##urs and hyper#apnia results.

3. AnswerE 4. he body #o$pensates for a de#rease in #ardia# output with a risein B/( due to the sti$ulation of the sy$patheti# C) and an in#rease in blood

volu$e as the kidneys retain sodiu$ and water. Blood pressure doesn7t initiallydrop in response to the #o$pensatory $e#hanis$ of the body. Alteration in 8"will o##ur only if the de#reased #ardia# output persists.

4'. AnswerE 1. /rodu#tion of pink( frothy sputu$ is a #lassi# sign of a#utepul$onary ede$a. Be#ause the #lient is at high risk for de#o$pensation( thenurse should #all for help but not leave the roo$. he other three interventionswould i$$ediately follow.

41. AnswerE 1. Afterload refers to the resistan#e nor$ally $aintained by theaorti# and pul$oni# valves( the #ondition and tone of the aorta( and theresistan#e offered by the syste$i# and pul$onary arterioles. "ardia# output is thea$ount of blood e:pelled by the heart per $inute. verload refers to anabundan#e of #ir#ulating volu$e. /reload is the volu$e of blood in the ventri#le atthe end of diastole.

42. AnswerE 3. he left ventri#le is responsible for the $a>ority of for#e for the#ardia# output. If the left ventri#le is da$aged( the output de#reases and fluid

a##u$ulates in the interstitial and alveolar spa#es( #ausing pul$onary ede$a.%a$age to the left atriu$ would #ontribute to heart failure but wouldn7t affe#t#ardia# output or( therefore( the onset of pul$onary ede$a. If the right atriu$and right ventri#le were da$aged( right&sided heart failure would result.

43. AnswerE 1. %iagnosis of rheu$ati# fever re,uires that the #lient have eithertwo $a>or Lones #riteria or one $inor #riterion plus eviden#e of a previousstrepto#o##al infe#tion. 0a>or #riteria in#lude #arditis( polyarthritis( )ydenha$7s#horea( sub#utaneous nodules( and erythe$a $arginatu$ ?transient( non pruriti#

$a#ules on the trunk or inner aspe#ts of the upper ar$s or thighs@. 0inor #riteriain#lude fever( arthralgia( elevated levels of a#ute phase rea#tants( and aprolonged /+&interval on ;"


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breaths using a bag $ask or po#ket $ask. Ce:t( #he#k for signs of #ir#ulation bypalpating the #arotid pulse.

4. AnswerE 2. 0I results fro$ prolonged $yo#ardial is#he$ia #aused by redu#edblood flow through the #oronary arteries. herefore( the priority nursing diagnosisfor this #lient is Ineffe#tive tissue perfusion ?#ardiopul$onary@. An:iety( a#ute

pain( and ineffe#tive therapeuti# regi$en $anage$ent are appropriate but don7ttake priority.

4F. AnswerE 1. )B( ta#hypnea( low B/( ta#hy#ardia( #ra#kles( and a #oughprodu#ing pink( frothy sputu$ are late signs of pul$onary ede$a.

4G. AnswerE 4. he #lient with A&fib has the greatest potential to be#o$e unstableand is on I5 $edi#ation that re,uires #lose $onitoring. After assessing this #lient(the nurse should assess the #lient with thro$bophlebitis who is re#eiving a

heparin infusion( and then go to the &year&old #lient ad$itted 2&days ago withheart failure ?her s-s are resolving and don7t re,uire i$$ediate attention@. helowest priority is the &year&old with end stage right&sided heart failure( whore,uires ti$e #onsu$ing supportive $easures.

4. AnswerE 1. he $ost essential tea#hing point is to report signs of relapse(su#h as fever( anore:ia( and night sweats( to the physi#ian. o prevent furtherendo#arditis episodes( prophyla#ti# antibioti#s are taken before and so$eti$esafter dental work( #hildbirth( or


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2. AnswerE 3. he seru$ potassiu$ level is $easured in the #lient re#eivingdigo:in and furose$ide. Heightened digitalis effe#t leading to digo:in to:i#ity #ano##ur in the #lient with hypokale$ia. Hypokale$ia also predisposes the #lient toventri#ular dysrhyth$ias.

3. AnswerE 4. he #lient who undergoes #ardia# surgery is at risk for renal in>ury

fro$ poor perfusion( he$olysis( low #ardia# output( or vasopressor $edi#ationtherapy. +enal insult is signaled by de#reased urine output( and in#reased B*Cand #reatinine levels. he #lient $ay need $edi#ations su#h as dopa$ine?Intropin@ to in#rease renal perfusion and possibly #ould need peritoneal dialysisor he$odialysis.

4. AnswerE 2. he nurse should en#ourage regular use of pain $edi#ation for thefirst 4 to G2 hours after #ardia# surgery be#ause analgesia will pro$ote rest(de#rease $yo#ardial o:ygen #onsu$ption resulting fro$ pain( and allow betterparti#ipation in a#tivities su#h as #oughing( deep breathing( and a$bulation.ptions 1 and 3 will not help in tolerating a$bulation. +e$oval of tele$etrye,uip$ent is #ontraindi#ated unless pres#ribed.

. AnswerE 1

F. AnswerE 4. 5entri#ular ta#hy#ardia is a life&threatening dysrhyth$ia thatresults fro$ an irritable e#topi# fo#us that takes over as the pa#e$aker for theheart. he low #ardia# output that results #an lead ,ui#kly to #erebral and

$yo#ardial is#he$ia. "lient7s fre,uently e:perien#e a feeling of i$pending death.5entri#ular ta#hy#ardia is treated with antiarrhyth$i# $edi#ations or $agnesiu$sulfate( #ardioversion ?#lient awake@( or defibrillation ?loss of #ons#iousness@(5entri#ular ta#hy#ardia #an deteriorate into ventri#ular fibrillation at any ti$e.

G. AnswerE 2. he first signs and sy$pto$s of digo:in to:i#ity in adults in#ludeabdo$inal pain( C-5( visual disturban#es ?blurred( yellow( or green vision( halosaround lights@( brady#ardia( and other dysrhyth$ias.

. AnswerE 3. )table angina is indu#ed by e:er#ise and is relieved by rest ornitrogly#erin tablets. *nstable angina o##urs at lower and lower levels of a#tivityand rest( is less predi#table( and is often a pre#ursor of $yo#ardial infar#tion.5ariant angina( or /rin=$etal7s angina( is prolonged and severe and o##urs at thesa$e ti$e ea#h day( $ost often in the $orning.

. AnswerE 1. I5 nitro infusion re,uires an infusion pu$p for pre#ise #ontrol ofthe $edi#ation. B/ $onitoring would be done with a #ontinuous syste$( and


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$ore fre,uently than every 4 hours. Hourly urine outputs are not alwaysre,uired. btaining seru$ potassiu$ levels is not asso#iated with nitrogly#erininfusion.

F'. AnswerE 2. Aspirin does have antipyreti#( antiplatelet( and analgesi# a#tions(but the pri$ary reason A)A is ad$inistered to the #lient e:perien#ing an 0I is its

antithro$boti# a#tion.

F1. AnswerE 4. By day 2 of hospitali=ation after an 0I( #lients are e:pe#ted to beable to perfor$ personal #are without #hest pain. %ay 2 hospitali=ation $ay betoo soon for #lients to be able to identify risk fa#tors for 0I or begin a walkingprogra$J however( the #lient $ay be sitting up in a #hair as part of the #ardia#rehabilitation progra$. )evere #hest pain should not be present.

F2. AnswerE 2. +e#o$$ended dietary prin#iples in the a#ute phase of 0I in#lude

avoiding large $eals be#ause s$all( easily digested foods are better digestedfoods are better tolerated. Kluids are given a##ording to the #lient7s needs( andsodiu$ restri#tions $ay be pres#ribed( espe#ially for #lients with $anifestationsof heart failure. "holesterol restri#tions $ay be ordered as well. "lients are notpres#ribed a diet of li,uids only or C/ unless their #ondition is very unstable.

F3. AnswerE 1. In older adults who are less a#tive and do not e:er#ise the heart$us#le( atrophy #an result. %isuse or de#onditioning #an lead to abnor$al#hanges in the $yo#ardiu$ of the older adult. As a result( under sudden

e$otional or physi#al stress( the left ventri#le is less able to respond to thein#reased de$ands on the $yo#ardial $us#le.

F4. AnswerE 1 and 3. HK is a result of stru#tural and fun#tional abnor$alities ofthe heart tissue $us#le. he heart $us#le be#o$es weak and does notade,uately pu$p the blood out of the #ha$bers. As a result( blood pools in theleft ventri#le and ba#ks up into the left atriu$( and eventually into the lungs.herefore( greater a$ounts of blood re$ain in the ventri#le after #ontra#tionthereby de#reasing #ardia# output. In addition( this pooling leads to thro$bus

for$ation and ineffe#tive tissue perfusion be#ause of the de#rease in blood flowto the other organs and tissues of the body. ypi#ally( these #lients have ane>e#tion fra#tion of less than ' and poorly tolerate a#tivity. A#tivity intoleran#eis related to a de#rease( not in#rease( in #ardia# output.


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failure leads to redu#ed o:ygen and fatigue. "lients fre,uently #o$plain ofdyspnea and fatigue. he #lient #ould be at risk for infe#tion related to stasis ofse#retions or i$paired skin integrity related to pressure. However( these are notthe priority nursing diagnoses for the #lient with HK and pul$onary ede$a( nor is#onstipation related to i$$obility.

FF. AnswerE 3. A"; inhibitors have be#o$e the vasodilators of #hoi#e in the #lientwith $ild to severe HK. 5asodilator drugs are the only #lass of drugs #learly shownto i$prove survival in overt heart failure.

FG. AnswerE 1. After I5 in>e#tion of furose$ide( diuresis nor$ally begins in about $inutes and rea#hes its peak within about 3' $inutes. 0edi#ation effe#ts last 2to 4 hours.

F. AnswerE 2. "anned foods and >ui#es( su#h as to$ato >ui#e( are typi#ally high

in sodiu$ and should be avoided in a sodiu$&restri#ted diet.

F. AnswerE 2. A nor$al api#al i$pulse is found under over the ape: of the heartand is typi#ally lo#ated and aus#ultated in the left fifth inter#ostal spa#e in the$id#lavi#ular line. An api#al i$pulse lo#ated or aus#ultated below the fifthinter#ostal spa#e or lateral to the $id#lavi#ular line $ay indi#ate left ventri#ularenlarge$ent.

G'. AnswerE 3. 8eft anterior des#ending arteryhe left anterior des#ending artery is the pri$ary sour#e of blood for the anteriorwall of the heart. he #ir#u$fle: artery supplies the lateral wall( the internal$a$$ary artery supplies the $a$$ary( and the right #oronary artery suppliesthe inferior wall of the heart.

onco midterm reviewer

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