Cardiac Arrhythmias Practice Quiz (16 Questions)

nl

1. A nurse is assessing an electrocardiogram rhythm strip.

The P waves and QRS complexes are regular. The PR interval 6. A client is having frequent premature ventricular
is 0.16 second, and QRS complexes measure 0.06 second. contractions. A nurse would place priority on assessment of
The overall heart rate is 64 beats per minute. The nurse which of the following items?
assesses the cardiac rhythm as:
1. Blood pressure and peripheral perfusion
1. Normal sinus rhythm 2. Sensation of palpitations
2. Sinus bradycardia 3. Causative factors such as caffeine
3. Sick sinus syndrome 4. Precipitating factors such as infection
4. First-degree heart block.
7.  A client has developed atrial fibrillation, which a
2. A nurse notices frequent artifact on the ECG monitor for a ventricular rate of 150 beats per minute. A nurse assesses
client whose leads are connected by cable to a console at the client for:
the bedside. The nurse examines the client to determine the
cause. Which of the following items is unlikely to be 1. Hypotension and dizziness
responsible for the artifact? 2. Nausea and vomiting
3. Hypertension and headache
1. Frequent movement of the client 4. Flat neck veins
2. Tightly secured cable connections
3. Leads applied over hairy areas 8. A nurse is watching the cardiac monitor, and a client’s
4. Leads applied to the limbs rhythm suddenly changes. There are no P waves; instead,
there are wavy lines. The QRS complexes measure 0.08
3. A nurse is watching the cardiac monitor and notices that second, but they are irregular, with a rate of 120 beats a
the rhythm suddenly changes. There are no P waves, the minute. The nurse interprets this rhythm as:
QRS complexes are wide, and the ventricular rate is regular
but over 100. The nurse determines that the client is 1. Sinus tachycardia
experiencing: 2. Atrial fibrillation
3. Ventricular tachycardia
1. Premature ventricular contractions 4. Ventricular fibrillation
2. Ventricular tachycardia
3. Ventricular fibrillation 9. A client with rapid rate atrial fibrillation asks a nurse why
4. Sinus tachycardia the physician is going to perform carotid massage. The nurse
responds that this procedure may stimulate the:
4. A nurse is viewing the cardiac monitor in a client’s room
and notes that the client has just gone into ventricular 1. Vagus nerve to slow the heart rate
tachycardia. The client is awake and alert and has good skin 2. Vagus nerve to increase the heart rate; overdriving the
color. The nurse would prepare to do which of the rhythm.
following? 3. Diaphragmatic nerve to slow the heart rate
4. Diaphragmatic nerve to overdrive the rhythm
1. Immediately defibrillate
2. Prepare for pacemaker insertion 10. A nurse notes that a client with sinus rhythm has a
3. Administer amiodarone (Cordarone) intravenously premature ventricular contraction that falls on the T wave of
4. Administer epinephrine (Adrenaline) intravenously the preceding beat. The client’s rhythm suddenly changes to
one with no P waves or definable QRS complexes. Instead,
5. A nurse is caring for a client with unstable ventricular there are coarse wavy lines of varying amplitude. The nurse
tachycardia. The nurse instructs the client to do which of the assesses this rhythm to be:
following, if prescribed, during an episode of ventricular
tachycardia? 1. Ventricular tachycardia
2. Ventricular fibrillation
1. Breathe deeply, regularly, and easily. 3. Atrial fibrillation
2. Inhale deeply and cough forcefully every 1 to 3 seconds. 4. Asystole
3. Lie down flat in bed
4. Remove any metal jewelry 11.  While caring for a client who has sustained an MI, the
nurse notes eight PVCs in one minute on the cardiac
monitor. The client is receiving an IV infusion of D5W and
oxygen at 2 L/minute. The nurse’s first course of action
should be to:
1. Increase the IV infusion rate
2. Notify the physician promptly
3. Increase the oxygen concentration
4. Administer a prescribed analgesic
12. The adaptations of a client with complete heart block
would most likely include:
1. Nausea and vertigo
2. Flushing and slurred speech
3. Cephalalgia and blurred vision
4. Syncope and slow ventricular rate
13. A client with a bundle branch block is on a cardiac
monitor. The nurse should expect to observe:
1. Sagging ST segments
2. Absence of P wave configurations
3. Inverted T waves following each QRS complex
4. Widening of QRS complexes to 0.12 second or greater.
14. When ventricular fibrillation occurs in a CCU, the first
person reaching the client should:
1. Administer oxygen
2. Defibrillate the client
3. Initiate CPR
4. Administer sodium bicarbonate intravenously
15. What criteria should the nurse use to determine normal
sinus rhythm for a client on a cardiac monitor? Check all that
apply.
1. The RR intervals are relatively consistent
2. One P wave precedes each QRS complex
3. Four to eight complexes occur in a 6-second strip
4. The ST segment is higher than the PR interval
5. The QRS complex ranges from 0.12 to 0.20 second.
16. When auscultating the apical pulse of a client who has
atrial fibrillation, the nurse would expect to hear a rhythm
that is characterized by:
1. The presence of occasional coupled beats
2. Long pauses in an otherwise regular rhythm
3. A continuous and totally unpredictable irregularity
4. Slow but strong and regular beats
 7) A male client admitted to an acute care facility with
pneumonia is receiving supplemental oxygen, 2 L/minute via
MSN Exam for Coronary Artery Disease & nasal cannula. The client’s history includes chronic
Hypertension rn pedia obstructive pulmonary disease (COPD) and coronary artery
disease. Because of these history findings, the nurse closely
monitors the oxygen flow and the client’s respiratory status.
1) Medical treatment of coronary artery disease includes Which complication may arise if the client receives a high
which of the following procedures? oxygen concentration?
A. Cardiac catheterization A. Apnea
B. Coronary artery bypass surgery B. Anginal pain
C. Oral medication administration C. Respiratory alkalosis
D. Percutaneous transluminal coronary angioplasty D. Metabolic acidosis
2) Atherosclerosis impedes coronary blood flow by which of
8) Women in the lower socioeconomic group have the
the following mechanisms?
highest contribution to CAD related events for their gender.
A. Plaques obstruct the vein
A. True
B. Plaques obstruct the artery
B. False
C. Blood clots form outside the vessel wall
D. Hardened vessels dilate to allow the blood to flow
9) Prolonged occlusion of the right coronary artery produces
through
an infarction in which of he following areas of the heart?
3) A client with pneumonia is receiving supplemental oxygen, A. Anterior
2 L/min via nasal cannula. The client’s history includes chronic B. Apical
obstructive pulmonary disease (COPD) and coronary artery C. Inferior
disease. Because of these findings, the nurse closely monitors D. Lateral
the oxygen flow and the client’s respiratory status. Which
complication may arise if the client receives a high oxygen 10) When teaching a client with coronary artery disease
concentration? about nutrition, the nurse should emphasize
A. Apnea A. Eating 3 balanced meals a day
B. Anginal pain B. Adding complex carbohydrates
C. Respiratory alkalosis C. Avoiding very heavy meals
D. Metabolic acidosis D. Limiting sodium to 7 gms per day

4) Which of the following risk factors for coronary artery 11) Which is a symptom of coronary artery disease?
disease cannot be corrected? A. Headache
A. Cigarette smoking B. Sleep problems
B. DM C. Pain or discomfort in the chest, arms or lower jaw
C. Heredity D. Diarrhea
D. HPN
12) Which of the following illnesses is the leading cause of
5) Preventable factors that increase the risk of CAD include: death in the US?
A. High blood cholesterol levels A. Cancer
B. Use of personal protective equipment B. Coronary artery disease
C. Cigarette smoking C. Liver failure
D. Obesity D. Renal failure
E. Exposure to polyacrylamide
13) Which of the following conditions most commonly results
6) There are a number of risk factors associated with coronary in CAD?
artery disease. Which of the following is a modifiable risk A. Atherosclerosis
factor? B. DM
A. Obesity. C. MI
B. Heredity. D. Renal failure
C. Gender.
D. Age. 14) 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
15) One possible treatment for CAD is coronary angioplasty. days ago. The nurse would plan to do which of the following
What does it involve? next?
A. A new section of artery replaces the blocked section A. Review the intake and output records for the last 2
B. A tiny balloon is inflated inside an artery days
C. Medication is used to expand the artery B. Change the time of diuretic administration from
D. None of the above morning to evening
C. Request a sodium restriction of 1 g/day from the
16) Which of the following actions is the first priority care for physician.
a client exhibiting signs and symptoms of coronary artery D. Order daily weights starting the following morning.
disease?
A. Decrease anxiety 23) A client is wearing a continuous cardiac monitor, which
B. Enhance myocardial oxygenation begins to sound its alarm. A nurse sees no electrocardiogram
C. Administer sublignual nitroglycerin complexes on the screen. The first action of the nurse is to:
D. Educate the client about his symptoms A. Check the client status and lead placement
B. Press the recorder button on the electrocardiogram
17) Exceeding which of the following serum cholesterol levels console.
significantly increases the risk of coronary artery disease? C. Call the physician
A. 100 mg/dl D. Call a code blue
B. 150 mg/dl
C. 175 mg/dl 24) A nurse is assessing the blood pressure of a client
D. 200 mg/dl diagnosed with primary hypertension. The nurse ensures
accurate measurement by avoiding which of the following?
18) Which procedure or test is used to diagnose CAD? A. Seating the client with arm bared, supported, and at
A. Electrocardiogram heart level.
B. Treadmill stress test B. Measuring the blood pressure after the client has
C. Cardiac catheterization been seated quietly for 5 minutes.
D. All of the above C. Using a cuff with a rubber bladder that encircles at
least 80% of the limb.
19)  A client is scheduled for a cardiac catherization using a D. Taking a blood pressure within 15 minutes after
radiopaque dye. Which of the following assessments is most nicotine or caffeine ingestion.
critical before the procedure?
A. Intake and output 25) IV heparin therapy is ordered for a client. While
B. Baseline peripheral pulse rates implementing this order, a nurse ensures that which of the
C. Height and weight following medications is available on the nursing unit?
D. Allergy to iodine or shellfish A. Vitamin K
B. Aminocaporic acid
20) A client with no history of cardiovascular disease comes C. Potassium chloride
into the ambulatory clinic with flulike symptoms. The client D. Protamine sulfate
suddenly complains of chest pain. Which of the following
questions would best help a nurse to discriminate pain 26) A client is at risk for pulmonary embolism and is on
caused by a non-cardiac problem? anticoagulant therapy with warfarin (Coumadin). The client’s
A. “Have you ever had this pain before?” prothrombin time is 20 seconds, with a control of 11 seconds.
B. “Can you describe the pain to me?” The nurse assesses that this result is:
C. “Does the pain get worse when you breathe in?” A. The same as the client’s own baseline level
D. “Can you rate the pain on a scale of 1-10, with 10 B. Lower than the needed therapeutic level
being the worst?” C. Within the therapeutic range
21) A client with myocardial infarction has been transferred D. Higher than the therapeutic range
from a coronary care unit to a general medical unit with
cardiac monitoring via telemetry. A nurse plans to allow for 27)  A client who has been receiving heparin therapy also is
which of the following client activities? started on warfarin. The client asks a nurse why both
A. Strict bed rest for 24 hours after transfer medications are being administered. In formulating a
B. Bathroom privileges and self-care activities response, the nurse incorporates the understanding that
C. Unsupervised hallway ambulation with distances warfarin:
under 200 feet A. Stimulates the breakdown of specific clotting factors
D. Ad lib activities because the client is monitored. by the liver, and it takes 2-3 days for this to exert an
anticoagulant effect.
22) A nurse notes 2+ bilateral edema in the lower extremities B. Inhibits synthesis of specific clotting factors in the
of a client with myocardial infarction who was admitted 2 liver, and it takes 3-4 days for this medication to exert
an anticoagulant effect.
 C. Stimulates production of the body’s own 33)   When teaching a client about propranolol hydrochloride,
thrombolytic substances, but it takes 2-4 days for this to the nurse should base the information on the knowledge that
begin. propranolol hydrochloride:
D. Has the same mechanism of action as Heparin, and A. Blocks beta-adrenergic stimulation and thus causes
the crossover time is needed for the serum level of decreased heart rate, myocardial contractility, and
warfarin to be therapeutic. conduction.
B. Increases norepinephrine secretion and thus
28)   A 60-year-old male client comes into the emergency decreases blood pressure and heart rate.
department with complaints of crushing chest pain that C. Is a potent arterial and venous vasodilator that
radiates to his shoulder and left arm. The admitting diagnosis reduces peripheral vascular resistance and lowers blood
is acute myocardial infarction. Immediate admission orders pressure.
include oxygen by NC at 4L/minute, blood work, chest x-ray, D. Is an angiotensin-converting enzyme inhibitor that
an ECG, and 2mg of morphine given intravenously. The nurse reduces blood pressure by blocking the conversion of
should first: angiotensin I to angiotensin II.
A. Administer the morphine
B. Obtain a 12-lead ECG 34)   The most important long-term goal for a client with
C. Obtain the lab work hypertension would be to:
D. Order the chest x-ray A. Learn how to avoid stress
B. Explore a job change or early retirement
29)   When administered a thrombolytic drug to the client C. Make a commitment to long-term therapy
experiencing an MI, the nurse explains to him that the D. Control high blood pressure
purpose of this drug is to:
A. Help keep him well hydrated 35)   Hypertension is known as the silent killer. This phrase is
B. Dissolve clots he may have associated with the fact that hypertension often goes
C. Prevent kidney failure undetected until symptoms of other system failures occur.
D. Treat potential cardiac arrhythmias. This may occur in the form of:
A. Cerebrovascular accident
30)   When interpreting an ECG, the nurse would keep in mind B. Liver disease
which of the following about the P wave? Select all that C. Myocardial infarction
apply. D. Pulmonary disease
A. Reflects electrical impulse beginning at the SA node
B. Indicated electrical impulse beginning at the AV 36)   During the previous few months, a 56-year-old woman
node felt brief twinges of chest pain while working in her garden
C. Reflects atrial muscle depolarization and has had frequent episodes of indigestion. She comes to
D. Identifies ventricular muscle depolarization the hospital after experiencing severe anterior chest pain
E. Has duration of normally 0.11 seconds or less. while raking leaves. Her evaluation confirms a diagnosis of
stable angina pectoris. After stabilization and treatment, the
31)   A client has driven himself to the ER. He is 50 years old, client is discharged from the hospital. At her follow-up
has a history of hypertension, and informs the nurse that his appointment, she is discouraged because she is experiencing
father died of a heart attack at 60 years of age. The client is pain with increasing frequency. She states that she is visiting
presently complaining of indigestion. The nurse connects him an invalid friend twice a week and now cannot walk up the
to an ECG monitor and begins administering oxygen at 2 second flight of steps to the friend’s apartment without pain.
L/minute per NC. The nurse’s next action would be to: Which of the following measures that the nurse could suggest
A. Call for the doctor would most likely help the client deal with this problem?
B. Start an intravenous line A. Visit her friend earlier in the day.
C. Obtain a portable chest radiograph B. Rest for at least an hour before climbing the stairs.
D. Draw blood for laboratory studies C. Take a nitroglycerin tablet before climbing the stairs.
D. Lie down once she reaches the friend’s apartment.
32)   The nurse receives emergency laboratory results for a
client with chest pain and immediately informs the physician. 37)   Which of the following symptoms should the nurse teach
An increased myoglobin level suggests which of the the client with unstable angina to report immediately to her
following? physician?
A. Cancer A. A change in the pattern of her pain
B. Hypertension B. Pain during sex
C. Liver disease C. Pain during an argument with her husband
D. Myocardial infarction D. Pain during or after an activity such as lawnmowing
38)   The physician refers the client with unstable angina for a
cardiac catherization. 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 C. Troponin I
B. Assess the extent of arterial blockage D. Creatine kinase (CK)
C. Bypass obstructed vessels
D. Assess the functional adequacy of the valves and 46)   Which of the following types of pain is most
heart muscle. characteristic of angina?
A. Knifelike
B. Sharp
39)   As an initial step in treating a client with angina, the C. Shooting
physician prescribes nitroglycerin tablets, 0.3mg given D. Tightness
sublingually. This drug’s principle effects are produced by:
A. Antispasmotic effect on the pericardium 47)   Which of the following parameters is the major
B. Causing an increased mycocardial oxygen demand determinate of diastolic blood pressure?
C. Vasodilation of peripheral vasculature A. Baroreceptors
D. Improved conductivity in the myocardium B. Cardiac output
C. Renal function
40)   The nurse teaches the client with angina about the D. Vascular resistance
common expected side effects of nitroglycerin, including:
A. Headache 48)   Which of the following factors can cause blood pressure
B. High blood pressure to drop to normal levels?
C. Shortness of breath A. Kidneys’ excretion of sodium only
D. Stomach cramps B. Kidneys’ retention of sodium and water
C. Kidneys’ excretion of sodium and water
41)   Sublingual nitroglycerin tablets begin to work within 1 to D. Kidneys’ retention of sodium and excretion of water
2 minutes. How should the nurse instruct the client to use the
drug when chest pain occurs? 49)   Baroreceptors in the carotid artery walls and aorta
A. Take one tablet every 2 to 5 minutes until the pain respond to which of the following conditions?
stops. A. Changes in blood pressure
B. Take one tablet and rest for 10 minutes. Call the B. Changes in arterial oxygen tension
physician if pain persists after 10 minutes. C. Changes in arterial carbon dioxide tension
C. Take one tablet, then an additional tablet every 5 D. Changes in heart rate
minutes for a total of 3 tablets. Call the physician if pain
persists after three tablets. 50)   Which of the following terms describes the force against
D. Take one tablet. If pain persists after 5 minutes, take which the ventricle must expel blood?
two tablets. If pain still persists 5 minutes later, call the A. Afterload
physician. B. Cardiac output
C. Overload
42)   Which of the following arteries primarily feeds the D. Preload
anterior wall of the heart?
A. Circumflex artery
B. Internal mammary artery 51)   Which of the following terms is used to describe the
C. Left anterior descending artery amount of stretch on the myocardium at the end of diastole?
D. Right coronary artery A. Afterload
B. Cardiac index
43)   When do coronary arteries primarily receive blood flow? C. Cardiac output
A. During inspiration D. Preload
B. During diastolic
C. During expiration 52)   A 57-year-old client with a history of asthma is
D. During systole prescribed propanolol (Inderal) to control hypertension.
Before administered propranolol, which of the following
44)   A murmur is heard at the second left intercostal space actions should the nurse take first?
along the left sternal border. Which valve is this? A. Monitor the apical pulse rate
A. Aortic B. Instruct the client to take medication with food
B. Mitral C. Question the physician about the order
C. Pulmonic D. Caution the client to rise slowly when standing.
D. Tricupsid 53)   One hour after administering IV furosemide (Lasix) to a
45)   Which of the following blood tests is most indicative of client with heart failure, a short burst of ventricular
cardiac damage? tachycardia appears on the cardiac monitor. Which of the
A. Lactate dehydrogenase following electrolyte imbalances should the nurse suspect?
B. Complete blood count (CBC) A. Hypocalcemia
 B. Hypermagnesemia A. Monitoring vital signs
C. Hypokalemia B. Completing a physical assessment
D. Hypernatremia C. Maintaining cardiac monitoring
D. Maintaining at least one IV access site
54)   A client is receiving spironolactone to treat
hypertension. Which of the following instructions should the 60)   A client is experiencing tachycardia. The nurse’s
nurse provide? understanding of the physiological basis for this symptom is
A. “Eat foods high in potassium.” explained by which of the following statements?
B. “Take daily potassium supplements.” A. The demand for oxygen is decreased because of
C. “Discontinue sodium restrictions.” pleural involvement
D. “Avoid salt substitutes.” 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
55)   When assessing an ECG, the nurse knows that the P-R for oxygen when there is lowered arterial oxygen
interval represents the time it takes for the: tension.
A. Impulse to begin atrial contraction D. Respirations are labored.
B. Impulse to transverse the atria to the AV node
C. SA node to discharge the impulse to begin atrial 61)   A client enters the ER complaining of chest pressure and
depolarization severe epigastric distress. His VS are 158/90, 94, 24, and
D. Impulse to travel to the ventricles 99*F. The doctor orders cardiac enzymes. If the client were
diagnosed with an MI, the nurse would expect which cardiac
56)   Following a treadmill test and cardiac catheterization, enzyme to rise within the next 3 to 8 hours?
the client is found to have coronary artery disease, which is A. Creatine kinase (CK or CPK)
inoperative. He is referred to the cardiac rehabilitation unit. B. Lactic dehydrogenase (LDH)
During his first visit to the unit he says that he doesn’t C. LDH-1
understand why he needs to be there because there is D. LDH-2
nothing that can be done to make him better. The best
nursing response is: 62)   A 45-year-old male client with leg ulcers and arterial
A. “Cardiac rehabilitation is not a cure but can help insufficiency is admitted to the hospital. The nurse
restore you to many of your former activities.” understands that leg ulcers of this nature are usually caused
B. “Here we teach you to gradually change your by:
lifestyle to accommodate your heart disease.” A. Decreased arterial blood flow secondary to
C. “You are probably right but we can gradually vasoconstriction
increase your activities so that you can live a more B. Decreased arterial blood flow leading to hyperemia
active life.” C. Atherosclerotic obstruction of the arteries
D. “Do you feel that you will have to make some D. Trauma to the lower extremities
changes in your life now?”
63)   Which of the following instructions should be included in
57)   To evaluate a client’s condition following cardiac the discharge teaching for a patient discharged with a
catheterization, the nurse will palpate the pulse: transdermal nitroglycerin patch?
A. In all extremities A. “Apply the patch to a nonhairy, nonfatty area of the
B. At the insertion site upper torso or arms.”
C. Distal to the catheter insertion B. “Apply the patch to the same site each day to
D. Above the catheter insertion maintain consistent drug absorption.”
C. “If you get a headache, remove the patch for 4 hours
58)   A client’s physician orders nuclear cardiography and and then reapply.”
makes an appointment for a thallium scan. The purpose of D. “If you get chest pain, apply a second patch right
injecting radioisotope into the bloodstream is to detect: next to the first patch.”
A. Normal vs. abnormal tissue
B. Damage in areas of the heart 64)   In order to prevent the development of tolerance, the
C. Ventricular function nurse instructs the patient to:
D. Myocardial scarring and perfusion A. Apply the nitroglycerin patch every other day
B. Switch to sublingual nitroglycerin when the patient’s
59)   A client enters the ER complaining of severe chest pain. systolic blood pressure elevates to >140 mm Hg
A myocardial infarction is suspected. A 12 lead ECG appears C. Apply the nitroglycerin patch for 14 hours each and
normal, but the doctor admits the client for further testing remove for 10 hours at night
until cardiac enzyme studies are returned. All of the following D. Use the nitroglycerin patch for acute episodes of
will be included in the nursing care plan. Which activity has angina only
the highest priority?
65)   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

66)   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

MSN EXAM FOR HEART FAILURE AND MYOCARDIAL

INFARCTION RN PEDIA

1) The nurse should visit which of the following clients first?

 A. The client with diabetes with a blood glucose of 5) In order to be effective, Percutaneous Transluminal
95mg/dL Coronary Angioplasty (PTCA) must be performed within what
time frame, beginning with arrival at the emergency
B. The client with hypertension being maintained on department after diagnosis of myocardial infarction?
Lisinopril
A. 60 minutes
C. The client with chest pain and a history of angina
B. 30 minutes
D. The client with Raynaud’s disease
C. 9 days

D. 6-12 months
2) A 23 year old patient in the 27th week of pregnancy has
been hospitalized on complete bed rest for 6 days. She
experiences sudden shortness of breath, accompanied by
chest pain. Which of the following conditions is the most 6) Helen, a nurse from the maternity unit is floated to the
likely cause of her symptoms? critical care unit because of staff shortage on the evening
shift. Which client would be appropriate to assign to this
A. Myocardial infarction due to a history of nurse? A client with:
atherosclerosis.
A. Dopamine drip IV with vital signs monitored every 5
B. Pulmonary embolism due to deep vein thrombosis minutes
(DVT).
B. a myocardial infarction that is free from pain and
C. Anxiety attack due to worries about her baby’s dysrhythmias
health.
C. a tracheotomy of 24 hours in some respiratory
D. Congestive heart failure due to fluid overload. distress

D. a pacemaker inserted this morning with intermittent

capture
3) What is the primary reason for administering morphine to
a client with myocardial infarction?

A. To sedate the client 7) A female client is brought by ambulance to the hospital

emergency room after taking an overdose of barbiturates is
B. To decrease the client’s pain comatose. Nurse Trish would be especially alert for which of
the following?
C. To decrease the client’s anxiety
A. Epilepsy
D. To decrease oxygen demand on the client’s heart
B. Myocardial Infarction
4) A patient arrives in the emergency department with
symptoms of myocardial infarction, progressing to C. Renal failure
cardiogenic shock. Which of the following symptoms should
the nurse expect the patient to exhibit with cardiogenic D. Respiratory failure
shock?

A. Hypertension.
8) Tissue plasminogen activator (t-PA) is considered for
B. Bradycardia. treatment of a patient who arrives in the emergency
department following onset of symptoms of myocardial
C. Bounding pulse. infarction. Which of the following is a contraindication for
treatment with t-PA?
D. Confusion.
A. Worsening chest pain that began earlier in the
evening.
 B. History of cerebral hemorrhage. 12) Nursing measures for the client who has had an MI
include helping the client to avoid activity that results in
C. History of prior myocardial infarction. Valsalva’s maneuver. Valsalva’s maneuver may cause cardiac
dysrhythmias, increased venous pressure, increased
D. Hypertension. intrathoracic pressure and thrombi dislodgement. Which of
the following actions would help prevent Valsalva’s
maneuver? Have the client:

9) A patient admitted to the hospital with myocardial A. Assume a side-lying position

infarction develops severe pulmonary edema. Which of the
following symptoms should the nurse expect the patient to B. Clench her teeth while moving in bed
exhibit?
C. Drink fluids through a straw
A. Slow, deep respirations.
D. Avoid holding her breath during activity
B. Stridor.

C. Bradycardia.
13) The nurse is giving discharge teaching to a client 7 days
D. Air hunger. post myocardial infarction. He asks the nurse why he must
wait 6 weeks before having sexual intercourse. What is the
best response by the nurse to this question?

10) A 55-year-old client is admitted with chest pain that A. “You need to regain your strength before attempting
radiates to the neck, jaw and shoulders that occurs at rest, such exertion.”
with high body temperature, weak with generalized sweating
and with decreased blood pressure. A myocardial infarction is B. “When you can climb 2 flights of stairs without
diagnosed. The nurse knows that the most accurate problems, it is generally safe.”
explanation for one of these presenting adaptations is:
C. “Have a glass of wine to relax you, then you can try
to have sex.”
A. Catecholamines released at the site of the infarction
causes intermittent localized pain.
D. “If you can maintain an active walking program, you
will have less risk.”
B. Parasympathetic reflexes from the infarcted
myocardium causes diaphoresis.

C. Constriction of central and peripheral blood vessels

causes a decrease in blood pressure. 14) Following myocardial infarction, a hospitalized patient is
encouraged to practice frequent leg exercises and ambulate
D. Inflammation in the myocardium causes a rise in the in the hallway as directed by his physician. Which of the
systemic body temperature. following choices reflects the purpose of exercise for this
patient?

A. Increases fitness and prevents future heart attacks.

11) Which of the following is the most common symptom of
myocardial infarction? B. Prevents bedsores.

C. Prevents DVT (deep vein thrombosis).

A. Chest pain
D. Prevent constipations.
B. Dyspnea

C. Edema

D. Palpitations 15) Alzheimer’s disease is the secondary diagnosis of a client

admitted with myocardial infarction. Which nursing
intervention should appear on this client’s plan of care?
 A. Perform activities of daily living for the client to internal cardioverter-defibrillator. Which of the following
decease frustration. patients is most likely to have this procedure?

B. Provide a stimulating environment. A. A patient admitted for myocardial infarction without

cardiac muscle damage.
C. Establish and maintain a routine.
B. A post-operative coronary bypass patient, recovering
D. Try to reason with the client as much as possible. on schedule.

C. A patient with a history of ventricular tachycardia

and syncopal episodes.
16) Which statement best describes the difference between
the pain of angina and the pain of myocardial infarction? D. A patient with a history of atrial tachycardia and
fatigue.
A. Pain associated with angina is relieved by rest.

B. Pain associated with myocardial infarction is always

more severe.

C. Pain associated with angina is confined to the chest 20) Twenty four hours after admission for an Acute MI, Jose’s
area. temperature is noted at 39.3 C. The nurse monitors him for
other adaptations related to the pyrexia, including:
D. Pain associated with myocardial infarction is referred
to the left arm. A. Shortness of breath

B. Chest pain

17) Patrick who is hospitalized following a myocardial C. Elevated blood pressure

infarction asks the nurse why he is taking morphine. The
nurse explains that morphine: D. Increased pulse rate

A. Decrease anxiety and restlessness

B. Prevents shock and relieves pain 21) Mr. Duffy is admitted to the CCU with a diagnosis of R/O
MI. He presented in the ER with a typical description of pain
C. Dilates coronary blood vessels associated with an MI, and is now cold and clammy, pale and
dyspneic. He has an IV of D5W running, and is complaining of
D. Helps prevent fibrillation of the heart chest pain. Oxygen therapy has not been started, and he is
not on the monitor. He is frightened. During the first three
days that Mr. Duffy is in the CCU, a number of diagnostic
blood tests are obtained. Which of the following patterns of
cardiac enzyme elevation are most common following an MI?
18) An early finding in the EKG of a client with an infarcted
mycardium would be:
A. SGOT, CK, and LDH are all elevated immediately.
A. Disappearance of Q waves
B. SGOT rises 4-6 hours after infarction with CK and
LDH rising slowly 24 hours later.
B. Elevated ST segments
C. CK peaks first (12-24 hours), followed by the SGOT
C. Absence of P wave
(peaks in 24-36 hours) and then the LDH (peaks 3-4
days).
D. Flattened T waves
D. CK peaks first and remains elevated for 1 to 2 weeks.

19) A nurse caring for several patients on the cardiac unit is

told that one is scheduled for implantation of an automatic
22) To prevent a valsalva maneuver in a client recovering
from an acute myocardial infarction, the nurse would
 A. Assist the client to use the bedside commode

B. Administer stool softeners every day as ordered 26) Which patient’s nursing care would be most appropriate
for the charge nurse to assign to the LPN, under the
C. Administer antidysrhythmics prn as ordered supervision of the RN team leader?

D. Maintain the client on strict bed rest A. A 51-year-old patient with bilateral adrenalectomy
just returned from the post-anesthesia care unit

B. An 83-year-old patient with type 2 diabetes and

23) A male client with chronic obstructive pulmonary disease chronic obstructive pulmonary disease
(COPD) is recovering from a myocardial infarction. Because
the client is extremely weak and can’t produce an effective C. A 38-year-old patient with myocardial infarction who
cough, the nurse should monitor closely for: is preparing for discharge

A. Pleural effusion. D. A 72-year-old patient admitted from long-term care

with mental status changes
B. Pulmonary edema.

C. Atelectasis.
27) During the second day of hospitalization of the client after
D. Oxygen toxicity. a Myocardial Infarction. Which of the following is an expected
outcome?

A. Able to perform self-care activities without pain

24) A 42-year-old client admitted with an acute myocardial
infarction asks to see his chart. What should the nurse do B. Severe chest pain
first?
C. Can recognize the risk factors of Myocardial
A. Allow the client to view his chart Infarction

B. Contact the supervisor and physician for approval D. Can Participate in cardiac rehabilitation walking
program
C. Ask the client if he has concerns about his care

D. Tell the client that he isn’t permitted to view his

chart. 28) The client with an acute myocardial infarction is
hospitalized for almost one week. The client experiences
nausea and loss of appetite. The nurse caring for the client
recognizes that these symptoms may indicate the:
25) A client with a history of an anterior wall myocardial
infarction is being transferred from the coronary care unit A. Adverse effects of spironolactone (Aldactone)
(CCU) to the cardiac stepdown unit (CSU). While giving report
to the CSU nurse, the CCU nurse says, “His pulmonary artery B. Adverse effects of digoxin (Lanoxin)
wedge pressures have been in the high normal range.” The
CSU nurse should be especially observant for: C. Therapeutic effects of propranolol (Indiral)

A. hypertension D. Therapeutic effects of furosemide (Lasix)

B. high urine output

C. dry mucous membranes 29) Dr. Marquez orders a continuous intravenous

nitroglycerin infusion for the client suffering from myocardial
D. pulmonary crackles infarction. Which of the following is the most essential
nursing action?

A. Monitoring urine output frequently

 B. Monitoring blood pressure every 4 hours C. A bologna sandwich, fresh eggplant, 2 oz fresh fruit,
tea, and apple juice
C. Obtaining serum potassium levels daily
D. 3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh
D. Obtaining infusion pump for the medication green beans, milk, and 1 orange

30) On the evening shift, the triage nurse

evaluates several clients who were brought to the emergency 33) The greatest danger of an uncorrected atrial fibrillation
department. Which in the following clients should receive for a male patient will be which of the following:
highest priority?
A. Pulmonary embolism
A. an elderly woman complaining of a loss of appetite
and fatigue for the past week B. Cardiac arrest

B. A football player limping and complaining of pain C. Thrombus formation

and swelling in the right ankle
D. Myocardial infarction
C. A 50-year-old man, diaphoretic and complaining of
severe chest pain radiating to his jaw

D. A mother with a 5-year-old boy who says her son has 34) Jose, who had a myocardial infarction 2 days earlier, has
been complaining of nausea and vomited once since been complaining to the nurse about issues related to his
noon hospital stay. The best initial nursing response would be to:

A. Allow him to release his feelings and then leave him

alone to allow him to regain his composure
31) Nurse Betty is assigned to the following clients. The client
that the nurse would see first after endorsement? B. Refocus the conversation on his fears, frustrations
and anger about his condition

C. Explain how his being upset dangerously disturbs his

A. A 34 year-old post operative appendectomy client of need for rest
five hours who is complaining of pain.
D. Attempt to explain the purpose of different hospital
B. A 44 year-old myocardial infarction (MI) client who is routines
complaining of nausea.

C. A 26 year-old client admitted for dehydration whose

intravenous (IV) has infiltrated. 35) Nurse Patricia finds a female client who is post-
myocardial infarction (MI) slumped on the side rails of the
D. A 63 year-old post operative’s abdominal bed and unresponsive to shaking or shouting. Which is the
hysterectomy client of three days whose incisional nurse next action?
dressing is saturated with serosanguinous fluid.
A. Call for help and note the time.

B. Clear the airway

32) After a myocardial infarction, a client is placed on a
sodium restricted diet. When the nurse is teaching the client C. Give two sharp thumps to the precordium, and check
about the diet, which meal plan would be the most the pulse.
appropriate to suggest?
D. Administer two quick blows.
A. 3 oz. broiled fish, 1 baked potato, ½ cup canned
beets, 1 orange, and milk

B. 3 oz. canned salmon, fresh broccoli, 1 biscuit, tea,

and 1 apple
36) Which of the following actions is the first priority of care 40) Which of the following blood tests is most indicative of
for a client exhibiting signs and symptoms of coronary artery cardiac damage?
disease?
A. Lactate dehydrogenase
A. Decrease anxiety
B. Complete blood count (CBC)
B. Enhance myocardial oxygenation
C. Troponin I
C. Administer sublingual nitroglycerin
D. Creatine kinase (CK)
D. Educate the client about his symptoms

41)       What is the primary reason for administering

37) Medical treatment of coronary artery disease includes morphine to a client with an MI?
which of the following procedures?
A. To sedate the client
A. Cardiac catherization
B. To decrease the client’s pain
B. Coronary artery bypass surgery
C. To decrease the client’s anxiety
C. Oral medication therapy
D. To decrease oxygen demand on the client’s heart
D. Percutaneous transluminal coronary angioplasty

42)       Which of the following conditions is most commonly

38)  Which of the following is the most common symptom of responsible for myocardial infarction?
myocardial infarction (MI)?
A. Aneurysm
A. Chest pain
B. Heart failure
B. Dyspnea
C. Coronary artery thrombosis
C. Edema
D. Renal failure
D. Palpitations

E.
43)       Which of the following complications is indicated by a
third heart sound (S3)?

39) Which of the following symptoms is the most likely A. Ventricular dilation
origin of pain the client described as knifelike chest pain that
increases in intensity with inspiration? B. Systemic hypertension

A. Cardiac C. Aortic valve malfunction

B. Gastrointestinal D. Increased atrial contractions

C. Musculoskeletal

D. Pulmonary 44)       After an anterior wall myocardial infarction, which of

the following problems is indicated by auscultation of crackles
in the lungs?

A. Left-sided heart failure

 B. Pulmonic valve malfunction 49)   Toxicity from which of the following medications may
cause a client to see a green-yellow halo around lights?
C. Right-sided heart failure
A. Digoxin
D. Tricupsid valve malfunction
B. Furosemide (Lasix)

C. Metoprolol (Lopressor)
45)   What is the first intervention for a client experiencing
MI? D. Enalapril (Vasotec)

A. Administer morphine 50)   Which of the following symptoms is most commonly

associated with left-sided heart failure?
B. Administer oxygen
A. Crackles
C. Administer sublingual nitroglycerin
B. Arrhythmias
D. Obtain an ECG
C. Hepatic engorgement

D. Hypotension
46)   Which of the following classes of medications protects
the ischemic myocardium by blocking catecholamines and 51)   In which of the following disorders would the nurse
sympathetic nerve stimulation? expect to assess sacral edema in a bedridden client?

A. Beta-adrenergic blockers A. Diabetes

B. Calcium channel blockers B. Pulmonary emboli

C. Narcotics C. Renal failure

D. Nitrates D. Right-sided heart failure

52)   Which of the following symptoms might a client with

right-sided heart failure exhibit?
47)   What is the most common complication of an MI?
A. Adequate urine output
A. Cardiogenic shock
B. Polyuria
B. Heart failure
C. Oliguria
C. arrhythmias
D. Polydipsia
D. Pericarditis
53)   Which of the following classes of medications maximizes
cardiac performance in clients with heart failure by increasing
ventricular contractibility?
48)   With which of the following disorders is jugular vein
distention most prominent? A. Beta-adrenergic blockers

B. Calcium channel blockers

A. Abdominal aortic aneurysm
C. Diuretics
B. Heart failure
D. Inotropic agents
C. MI
54)   Stimulation of the sympathetic nervous system produces
D. Pneumothorax
which of the following responses?
 A. Bradycardia B. Diabetes

B. Tachycardia C. MI

C. Hypotension D. Pericardial effusion

D. Decreased myocardial contractility 60)   Dyspnea, cough, expectoration, weakness, and edema
are classic signs and symptoms of which of the following
55)   Which of the following conditions is most closely conditions?
associated with weight gain, nausea, and a decrease in urine
output? A. Pericarditis

A. Angina pectoris B. Hypertension

B. Cardiomyopathy C. MI

C. Left-sided heart failure D. Heart failure

D. Right-sided heart failure 61)   In which of the following types of cardiomyopathy does
cardiac output remain normal?
56)   Which of the following heart muscle diseases is
unrelated to other cardiovascular disease? A. Dilated

A. Cardiomyopathy B. Hypertrophic

B. Coronary artery disease C. Obliterative

C. Myocardial infarction D. Restrictive

D. Pericardial effusion 62)   Which of the following cardiac conditions does a fourth
heart sound (S4) indicate?
57)   Which of the following types of cardiomyopathy can be
associated with childbirth? A. Dilated aorta

A. Dilated B. Normally functioning heart

B. Hypertrophic C. Decreased myocardial contractility

C. Myocarditis D. Failure of the ventricle to eject all of the blood

during systole
D. Restrictive
63)   Which of the following classes of drugs is most widely
58)   Septal involvement occurs in which type of used in the treatment of cardiomyopathy?
cardiomyopathy?
A. Antihypertensives
A. Congestive
B. Beta-adrenergic blockers
B. Dilated
C. Calcium channel blockers
C. Hypertrophic
D. Nitrates
D. Restrictive
64)   If medical treatments fail, which of the following invasive
59)   Which of the following recurring conditions most procedures is necessary for treating cariomyopathy?
commonly occurs in clients with cardiomyopathy?
A. Cardiac catherization
A. Heart failure
B. Coronary artery bypass graft (CABG)
 C. Heart transplantation C. Reduction of stress and anxiety

D. Intra-aortic balloon pump (IABP) D. Reduction of associated risk factors

65)   Which of the following conditions is associated with a 70)   Which of the following interventions should be the first
predictable level of pain that occurs as a result of physical or priority when treating a client experiencing chest pain while
emotional stress? walking?

A. Anxiety A. Sit the client down

B. Stable angina B. Get the client back to bed

C. Unstable angina C. Obtain an ECG

D. Variant angina D. Administer sublingual nitroglycerin

71)   Myocardial oxygen consumption increases as which of

the following parameters increase?
66)   Which of the following types of angina is most closely
related with an impending MI? A. Preload, afterload, and cerebral blood flow

A. Angina decubitus B. Preload, afterload, and renal blood flow

B. Chronic stable angina C. Preload, afterload, contractility, and heart rate.

C. Noctural angina D. Preload, afterload, cerebral blood flow, and heart

rate.
D. Unstable angina
72)   Which of the following positions would best aid
67)   Which of the following conditions is the predominant breathing for a client with acute pulmonary edema?
cause of angina?
A. Lying flat in bed
A. Increased preload
B. Left side-lying
B. Decreased afterload
C. In high Fowler’s position
C. Coronary artery spasm
D. In semi-Fowler’s position
D. Inadequate oxygen supply to the myocardium
73)   Which of the following blood gas abnormalities is initially
68)   Which of the following tests is used most often to most suggestive of pulmonary edema?
diagnose angina?
A. Anoxia
A. Chest x-ray
B. Hypercapnia
B. Echocardiogram
C. Hyperoxygenation
C. Cardiac catherization
D. Hypocapnia
D. 12-lead electrocardiogram (ECG)
74)   Which of the following is a compensatory response to
69)   Which of the following results is the primary treatment decreased cardiac output?
goal for angina?
A. Decreased BP
A. Reversal of ischemia
B. Alteration in LOC
B. Reversal of infarction
C. Decreased BP and diuresis
 D. Increased BP and fluid retention C. Check for breathing

75)   Which of the following actions is the appropriate initial D. Check for signs of circulation
response to a client coughing up pink, frothy sputum?
80)   A 55-year-old client is admitted with an acute inferior-
A. Call for help wall myocardial infarction. During the admission interview, he
says he stopped taking his metoprolol (Lopressor) 5 days ago
B. Call the physician because he was feeling better. Which of the following nursing
diagnoses takes priority for this client?
C. Start an I.V. line
A. Anxiety
D. Suction the client
B. Ineffective tissue perfusion; cardiopulmonary
76)   Which of the following terms describes the force against
which the ventricle must expel blood? C. Acute pain

A. Afterload D. Ineffective therapeutic regimen management

B. Cardiac output

C. Overload

D. Preload 81)   A client comes into the E.R. with acute shortness of
breath and a cough that produces pink, frothy sputum.
77)   Acute pulmonary edema caused by heart failure is Admission assessment reveals crackles and wheezes, a BP of
usually a result of damage to which of the following areas of 85/46, a HR of 122 BPM, and a respiratory rate of 38
the heart? breaths/minute. The client’s medical history included DM,
HTN, and heart failure. Which of the following disorders
should the nurse suspect?
A. Left atrium

B. Right atrium A. Pulmonary edema

C. Left ventricle B. Pneumothorax

D. Right ventricle C. Cardiac tamponade

78)   An 18-year-old client who recently had an URI is D. Pulmonary embolus

admitted with suspected rheumatic fever. Which assessment
findings confirm this diagnosis? 82)   The nurse coming on duty receives the report from the
nurse going off duty. Which of the following clients should the
on-duty nurse assess first?
A. Erythema marginatum, subcutaneous nodules, and
fever
A. The 58-year-old client who was admitted 2 days ago
B. Tachycardia, finger clubbing, and a load S3 with heart failure, BP of 126/76, and a respiratory rate
of 21 breaths a minute.
C. Dyspnea, cough, and palpitations
B. The 88-year-old client with end-stage right-sided
D. Dyspnea, fatigue, and synocope heart failure, BP of 78/50, and a DNR order.

79)   A client admitted with angina compains of severe chest C. The 62-year-old client who was admitted one day
pain and suddenly becomes unresponsive. After establishing ago with thrombophlebitis and receiving IV heparin.
unresponsiveness, which of the following actions should the
nurse take first? D. A 76-year-old client who was admitted 1 hour ago
with new-onset atrial fibrillation and is receiving IV
diltiazem (Cardizem).
A. Activate the resuscitation team

B. Open the client’s airway

83)   When developing a teaching plan for a client with A. Digoxin level
endocarditis, which of the following points is most essential
for the nurse to include? B. Sodium level

A. “Report fever, anorexia, and night sweats to the C. Potassium level

physician.”
D. Creatinine level
B. “Take prophylactic antibiotics after dental work and
invasive procedures.” 88)   A client who had cardiac surgery 24 hours ago has a
urine output averaging 19 ml/hr for 2 hours. The client
C. “Include potassium rich foods in your diet.” received a single bolus of 500 ml of IV fluid. Urine output for
the subsequent hour was 25 ml. Daily laboratory results
D. “Monitor your pulse regularly.” indicate the blood urea nitrogen is 45 mg/dL and the serum
creatinine is 2.2 mg/dL. A nurse interprets the client is at risk
84)   A nurse is conducting a health history with a client with a for:
primary diagnosis of heart failure. Which of the following
disorders reported by the client is unlikely to play a role in A. Hypovolemia
exacerbating the heart failure?
B. UTI
A. Recent URI
C. Glomerulonephritis
B. Nutritional anemia
D. Acute renal failure
C. Peptic ulcer disease
89)   A nurse is preparing to ambulate a client on the 3 rd day
D. A-Fib after cardiac surgery. The nurse would plan to do which of the
following to enable the client to best tolerate the
85)   A nurse is preparing for the admission of a client with ambulation?
heart failure who is being sent directly to the hospital from
the physician’s office. The nurse would plan on having which A. Encourage the client to cough and deep breathe
of the following medications readily available for use?
B. Premedicate the client with an analgesic
A. Diltiazem (Cardizem)
C. Provide the client with a walker
B. Digoxin (Lanoxin)
D. Remove telemetry equipment because it weighs
down the hospital gown.
C. Propranolol (Inderal)
90)   A client’s electrocardiogram strip shows atrial and
D. Metoprolol (Lopressor)
ventricular rates of 80 complexes per minute. The PR interval
is 0.14 second, and the QRS complex measures 0.08 second.
86)   A nurse caring for a client in one room is told by another
The nurse interprets this rhythm is:
nurse that a second client has developed severe pulmonary
edema. On entering the 2nd client’s room, the nurse would
expect the client to be: A. Normal sinus rhythm

A. Slightly anxious B. Sinus bradycardia

B. Mildly anxious C. Sinus tachycardia

C. Moderately anxious D. Sinus dysrhythmia

D. Extremely anxious 91)   A client has frequent bursts of ventricular tachycardia on

the cardiac monitor. A nurse is most concerned with this
87)   A client with pulmonary edema has been on diuretic dysrhythmia because:
therapy. The client has an order for additional furosemide
(Lasix) in the amount of 40 mg IV push. Knowing that the A. It is uncomfortable for the client, giving a sense of
client also will be started on Digoxin (Lanoxin), a nurse checks impending doom.
the client’s most recent:
 B. It produces a high cardiac output that quickly leads
to cerebral and myocardial ischemia.

C. It is almost impossible to convert to a normal sinus

rhythm.

D. It can develop into ventricular fibrillation at any

time.

92)   A home care nurse is making a routine visit to a client

receiving digoxin (Lanoxin) in the treatment of heart failure.
The nurse would particularly assess the client for:

A. Thrombocytopenia and weight gain

B. Anorexia, nausea, and visual disturbances

C. Diarrhea and hypotension

D. Fatigue and muscle twitching

93)   A client with angina complains that the angina pain is

prolonged and severe and occurs at the same time each day,
most often in the morning, On further assessment a nurse
notes that the pain occurs in the absence of precipitating
factors. This type of anginal pain is best described as:

A. Stable angina

B. Unstable angina

C. Variant angina

D. Nonanginal pain