Chapter 27 Quiz

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Question #1

The nurse is caring for a client with coronary artery disease. What is the nurse’s priority goal for the client?

A decrease anxiety

B administer sublingual nitroglycerin

C enhance myocardial oxygenation

D educate the client about his symptoms

Question #2

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.),,

A It is viselike and radiates to the shoulders and arms.

B It is relieved by rest and inactivity.

C It subsides after taking nitroglycerin.

D It is substernal in location.

E It is sudden in onset and prolonged in duration.

Question #3

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions?

A “Place the nitroglycerin tablet between cheek and gum.”

B “Call 911 if you develop a headache following nitroglycerin use.”

C “See if rest relieves the chest pain before using the nitroglycerin.”

D “Only take one nitroglycerin tablet for each episode of angina.”

Question #4

A client is admitted for treatment of Prinzmetal’s angina. When developing this client’s care plan, the nurse should keep in mind that this type of angina is a result of what trigger?

A An unpredictable amount of activity.

B Coronary artery spasm.

C The same type of activity that caused previous angina episodes.

D Activities that increase myocardial oxygen demand.

Question #5

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client’s anxiety and decrease cardiac workload?

A IV morphine

B Atenolol

C Amlodipine

D IV nitroglycerin

Question #6

A client diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes which overall goal as a focus of rehabilitation for a client who has had an MI?

A Limit to the effects and progression of atherosclerosis

B Improved quality of life

C Return to work and the lifestyle experienced before the illness

D Prevention of another cardiac event

Question #7

A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client?

A Venous occlusive disease

B Coronary artery disease

C Raynaud’s disease

D Cardiogenic shock

Question #8

A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy?

A recent consumption of a meal

B prior intracranial hemorrhage

C shellfish allergy

D use of heparin

Question #9

A client who has been diagnosed with Prinzmetal’s angina will present with which symptom?

A chest pain of increased frequency, severity, and duration

B radiating chest pain that lasts 15 minutes or less

C chest pain that occurs at rest and usually in the middle of the night

D prolonged chest pain that accompanies exercise

Question #10

Heparin therapy is usually considered therapeutic when the client’s activated partial thromboplastin time (aPTT) is how many times normal?

A 2.5 to 3.0

B .25 to .75

C .75 to 1.5

D 2.0 to 2.5

Question #11

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?

A “The pain occurred while I was mowing the lawn.”

B “The pain lasted about 45 minutes.”

C “The pain got worse when I took a deep breath.”

D “The pain resolved after I ate a sandwich.”

Question #12

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

A Prolonged PR interval

B Elevated ST segment

C Widened QRS complex

D Absent Q wave

Question #13

The nurse is removing a client’s femoral sheath after cardiac catheterization. What medication will the nurse have available?

A heparin

B atropine sulfate

C protamine sulfate

D adenosine

Question #14

The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome?

A decreased erythrocyte sedimentation rate (ESR)

B hypothermia

C pericardial friction rub

D decreased white blood cell (WBC) count

Question #15

The nurse is administering oral metoprolol. Where are the receptor sites mainly located?

A Uterus

B Bronchi

C Blood vessels

D Heart

Question #16

A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse?

A 60 minutes

B 3 minutes

C 30 minutes

D 15 minutes

Question #17

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD?

A A ratio of LDL to HDL, 4.5 to 1.0

B Low density lipoprotein (LDL), 160 mg/dL

C Cholesterol, 280 mg/dL

D High-density lipoprotein (HDL), 80 mg/dL

Question #18

A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse?

A “I should avoid prolonged sitting.”

B “I should expect bruising at the catheter site for up to 3 weeks.”

C “I should expect a low-grade fever and swelling at the site for the next week.”

D “I should avoid taking a tub bath until my catheter site heals.”

Question #19

Which term refers to preinfarction angina?

A Silent ischemia

B Variant angina

C Stable angina

D Unstable angina

Question #20

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client’s care plan, which expected outcome should a nurse include?

A “Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours.”

B “Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol.”

C “Client will verbalize the intention to avoid exercise.”

D “Client will verbalize the intention to stop smoking.”

Question #21

The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond?

A fatty deposits in the lumen of arteries

B blood clots in the arteries

C cholesterol plugs in the lumen of veins

D emboli in the veins

Question #22

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent?

A Clopidogrel

B Diltiazem

C Isosorbide mononitrate

D Metoprolol

Question #23

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient?

A Decreases the sinoatrial node automaticity

B Increases the atrioventricular node conduction

C Increases the heart rate

D Creates a positive inotropic effect

Question #24

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol?

A Sodium nitroprusside

B Digoxin

C Atropine

D Protamine sulfate

Question #25

A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experieincing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, “They did not work all that well.” The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician?

A Chest x-ray

B Serum electrolytes

C Nitroglycerin SL

D Ativan 1 mg orally

Question #26

A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect?

A Decreases cholesterol level

B Decreases resting heart rate

C Increases cardiac output

D Decreases platelet aggregation

Question #27

The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse?

A Sinus tachycardia

B Frequent premature atrial contractions (PACs)

C ST elevation

D Isolated premature ventricular contractions (PVCs)

Question #28

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?

A Remove hair from skin insertion sites.

B Inform client of diagnostic tests.

C Assess distal pulses.

D Withhold anticoagulant therapy.

Question #29

The nurse is presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would the nurse name as the most common cause of peripheral arterial problems in the older adult?

A Raynaud’s disease

B Coronary thrombosis

C Arteriosclerosis

D Atherosclerosis

Question #30

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks?

A Myoglobin

B Total creatine kinase

C CK-MB

D Troponin

Question #31

The nurse is working a cardiac care unit with a client on a diltezem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply.,,

A decreasing R to R interval

B slowing heart rate

C ST elevation

D an absent P wave

E T-wave inversion

Question #32

The nurse is teaching the client about coronary artery damage after an abnormal fasting lipid profile. The client asks the nurse what type of lipid is most troublesome. What is the nurse’s best response?

A “The higher the high-density lipoproteins (HDL), the more at risk you are for heart damage or a stroke.”

B “The low-density lipoproteins (LDL) pose a threat to plague formation and can cause a heart attack of stroke.”

C “The total cholesterol level of 252 mg/dL warrants medication treatment alone.”

D “The triglycerides levels measure good fat, so the higher the level, the less risk you are for a heart attack or stroke.”

Question #33

The nurse notes that the post cardiac surgery client demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025). What will the nurse anticipate the health care provider will order?

A Irrigate the urinary catheter

B Prepare the client for diaylsis

C Decrease intravenous fluids

D Increase intravenous fluids

Question #34

A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates

A a cardiac dysrhythmia.

B an old MI.

C an evolving MI.

D variant angina.

Question #35

A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?

A Cool, clammy skin and a diaphoretic, pale appearance

B Chest discomfort not relieved by rest or nitroglycerin

C Intermittent nausea and emesis for 3 days

D Anxiousness, restlessness, and lightheadedness

Question #36

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer?

A Nitroglycerin transdermal patch

B Isosorbide mononitrate (Isordil)

C Meperidine hydrochloride (Demerol)

D Morphine sulfate (Morphine)

Question #37

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD?

A To dilate coronary arteries

B To prevent angiotensin II conversion

C To decrease homocysteine levels

D To decrease workload of the heart

Question #38

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation?

A Hourly IV infusion

B Prothrombin time (PT) or international normalized ratio (INR)

C Urine output

D Vascular sites for bleeding

Question #39

A client is admitted to the emergency department with chest pain and doesn’t respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

A Within 24 to 48 hours

B Within 6 hours

C Within 12 hours

D Within 5 to 7 days

Question #40

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment?

A Prepare the client for pulmonary artery catheterization.

B Ensure that the client’s family is kept informed of the client’s status.

C Assess the client’s level of pain and administer prescribed analgesics.

D Assess the client’s level of anxiety and provide emotional support.

Question #41

A client is beginning to have more breathlessness with aortic stenosis. What is the treatment does the nurse anticipate for the client?

A cardiac graft procedure

B balloon angioplasty

C balloon valvuloplasty

D cardiac catheterization

Question #42

A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding?

A “What color is your urine?”

B “Is your skin drier than normal?”

C “How is your appetite?”

D “Do you have any breathing problems?”

Question #43

A client is given a prescription for metoprolol after being examined by the health care provider. What is the most important teaching for the nurse to give to the client?

A Don’t suddenly stop taking the medication without calling your health care provider.

B If dizziness occurs, adjust the medication.

C Take the medication at the same time each day.

D Dress warmly. Blood circulation may be reduced in the extremities.

Question #44

The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause?

A Decreased sensation to pain

B Gender bias

C Vague symptoms

D Chest pain is typical

Question #45

A Coronary artery disease

B Venous occlusive disease

C Raynaud’s disease

D Cardiogenic shock

Question #46

A client’s lipid profile reveals an LDL level of 122 mg/dL. This is considered a:

A normal LDL level.

B high LDL level.

C low LDL level.

D fasting LDL level

Question #47

Which medication is an antidote to heparin?

A Protamine sulfate

B Aspirin

C Alteplase

D Clopidogrel

Question #48

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug?

A beta-adrenergic blocker

B diuretic

C calcium-channel blocker

D nitrate

Question #49

Which of the following is inconsistent as a condition related to metabolic syndrome?

A Dyslipidemia

B Insulin resistance

C Hypotension

D Abdominal obesity

Question #50

A Elevated ST segment

B Widened QRS complex

C Prolonged PR interval

D Absent Q wave

Question #51

The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse?

A serum glucose of 124 mg/dL

B weight gain of 6 ounces

C bilateral rales and rhonchi

D potassium level of 6 mEq/L

Question #52

The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration?

A Measure the blood pressure for hypertension.

B Count the respiratory rate for bradypnea.

C Check the radial pulse for dysrhythmias.

D Measure urinary output for dehydration.

Question #53

A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is?

A Accompanied by diaphoresis and dyspnea

B Associated with nausea and vomiting

C Described as crushing and substernal

D Relieved by rest and nitroglycerin

Question #54

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having?

A Sodium

B Calcium

C Magnesium

D Potassium

Question #55

The nurse is caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client?

A Examine for pain around the shoulder and neck region

B Examine the client’s mental and emotional status.

C Examine the legs for color, capillary refill time, and tissue integrity.

D Examine the extremities for skin lesions.

Question #56

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.,,

A Race

B Obesity

C Gender

D Hyperlipidemia

E Tobacco use

Question #57

Which is a diagnostic marker for inflammation of vascular endothelium?

A C-reactive protein (CRP)

B Triglyceride

C High-density lipoprotein (HDL)

D Low-density lipoprotein (LDL)

Question #58

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?

A The client exhibits a heart rate above 100 beats/minute.

B The client demonstrates ability to tolerate more activity without chest pain.

C The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking.

D The client states that sublingual nitroglycerin usually relieves his chest pain.

Question #59

A client comes to the health care provider’s office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction?

A “Client’s 24-hour dietary recall reveals low intake of fat and cholesterol.”

B “Client walks 4 miles in 1 hour every day.”

C “Client verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest.”

D “Client performs relaxation exercises three times per day to reduce stress.”

Question #60

The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain?

A complete closure of an artery

B a destroyed part of the heart muscle

C a lack of oxygen in the heart muscle that causes the death of cells

D incomplete blockage of a major coronary artery

Question #61

After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse’s initial action?

A Notify the health care provider.

B Review the results of the latest blood cell count, especially the hemoglobin and hematocrit.

C Apply manual pressure at the site of the insertion of the sheath.

D Decrease anticoagulant or antiplatelet therapy.

Question #62

The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome?

A hypothermia

B decreased erythrocyte sedimentation rate (ESR)

C pericardial friction rub

D decreased white blood cell (WBC) count

Question #63

The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure?

A a serum creatinine of 1.0 mg/dL

B a serum BUN of 70 mg/dL

C a urine specific gravity reading of 1.021

D an hourly urine output of 50 to 70 mL

Question #64

The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin. The client requires bleeding precautions. Bleeding precautions include which measure?

A Use an electric toothbrush

B Avoid subcutaneous injections

C Avoid continuous BP monitoring

D Avoid the use of nail clippers

Question #65

The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?

A Assess the skin of the client.

B Assess the client’s mental and emotional status.

C Assess for any kind of drug abuse.

D Assess the characteristics of chest pain.

Question #66

A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication?

A Atelectasis

B Urinary tract infection (UTI)

C Elevated blood glucose level

D Hyperkalemia

Question #67

Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery?

A Mental alertness

B Inadequate tissue perfusion

C Activity intolerance

D Blood glucose concentration

Question #68

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse’s priority action?

A Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider.

B Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team.

C Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

D Complete the client’s registration information, perform an electrocardiogram, gain I.V. access, and take vital signs.

Question #69

A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn’t subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin?

A Flushing, dizziness, headache, and pedal edema.

B Sedation, nausea, vomiting, constipation, and respiratory depression.

C Nausea, vomiting, depression, fatigue, and impotence.

D Headache, hypotension, dizziness, and flushing.

Question #70

The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD?

A myocardial infarction

B diabetes mellitus

C atherosclerosis

D renal failure

Question #71

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent?

A Isosorbide mononitrate

B Diltiazem

C Clopidogrel

D Metoprolol

Question #72

To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)?

A 9 days

B 60 minutes

C 30 minutes

D 6 to 12 months

Question #73

Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?

A Cleanse the site with disinfectants and dress the wound appropriately

B Refrain from sexual activity for 1 month

C Monitor the site for bleeding or hematoma.

D Normal activities of daily living can be resumed the first day after surgery

Question #74

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

A Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses.

B Restrict alcohol intake to two drinks per day.

C Lie down or sit in a chair for 5 to 10 minutes after taking the drug.

D Store the drug in a cool, well-lit place.

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