Chapter 36: Cardiac Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse performs an apical-radial pulse evaluation, with the result of 100/88. What is the
pulse deficit?
a.
12
b.
24
c.
76
d.
88
2. What is increased in hypertension that in turn causes an increase in the work of the heart?
a.
Preload
b.
Stroke volume
c.
Contractility
d.
Afterload
3. Which heart sound should the nurse record as normal?
a.
Ventricular gallop in a 20-year-old patient
b.
Atrial gallop in a 25-year-old patient
c.
Friction rub in a 45-year-old patient
d.
Medium diastolic murmur in a 50-year-old patient
4. A 49-year-old patient has multiple risk factors for coronary artery disease. Which risk factor is
considered modifiable?
a.
Family history
b.
Age
c.
Smoking
d.
Male gender
5. A patient asks what a transesophageal echocardiogram (TEE) is and what it is expected to do?
What is the best explanation by the nurse?
a.
Measures conductivity
b.
Records the force of contraction
c.
Evaluates the efficiency of the valves
d.
Checks the volume of the preload
6. A nurse records the finding of a normal sinus rhythm (NSR) when the P, Q, R, S, and T are all
present in the electrocardiographic complex. What additional information should the nurse
document?
a.
Rate of 82 seconds
b.
PR interval of 0.36 second
c.
QRS complex of 0.16 second
d.
Inverted T
7. A nurse should anticipate that a patient taking Vasotec, an angiotensin-converting enzyme
(ACE) inhibitor, should have which positive outcome to this drug?
a.
Increased fluid retention
b.
Decreased blood pressure
c.
Decreased urine output
d.
Increased appetite
8. A 29-year-old patient is to receive cardioversion for a dysrhythmia. What should the nurse
instruct the patient to expect?
a.
Administration of a short-acting sedative
b.
Digoxin dose to be taken as scheduled
c.
Procedure to be completely safe
d.
Pacemaker spikes to be carefully monitored
9. A 68-year-old patient is scheduled for open heart surgery in the morning and is crying. What
is the most appropriate response by the nurse?
a.
“Everything will go great! Dr. C. is the best!”
b.
“I know how you feel, so do not cry.”
c.
“Tell me what concerns you the most.”
d.
“I will call the physician for a sedative. You are too upset.”
10. What do fibrous plaques of atherosclerosis serve as when they are laid down in the vessels?
a.
Stent to keep the vessel open
b.
Trap to which other substances adhere
c.
Threat to the integrity of the vessel wall
d.
Embolus
11. A patient with an irregular sinoatrial (SA) node conduction has a permanent pacemaker with
the code AAIOO and is now going home. The patient asks, “What happens when my real SA
node fires on its own?” How should the nurse respond regarding what the pacemaker should
do?
a.
Not fire
b.
Fire only the ventricles
c.
Change the rate of firing
d.
Fire both the atria and the ventricles.
12. A patient with angina pectoris complains of chest pain at rest and needs to take three
nitroglycerin (NTG) pills to relieve the pain. Of what should the nurse assess this as a major
symptom?
a.
Stable angina
b.
Unstable angina
c.
Full-blown acute myocardial infarction (MI)
d.
Pulmonary embolus
13. A nurse explains that cardiac rehabilitation lasts from the end of acute care to the return to
home and beyond. What does this service include?
a.
One-on-one individualized care
b.
Focus on the patient rather than the family
c.
Telemetry-monitored exercise
d.
Rejection from the program for noncompliance
14. On auscultation, a nurse detects a heart murmur. What should the nurse know that a heart
murmur indicates?
a.
Valves that do not close correctly
b.
Pericardium that is inflamed
c.
Decrease in pacemaker cells
d.
Loud ventricular gallop
15. What is an important teaching point for a patient with mitral stenosis?
a.
Obtain a place on the heart transplant list.
b.
Balance activity with oxygen supply.
c.
Increase daily fluid intake to over 2000 mL.
d.
Have an annual electrocardiogram.
16. A physician has ordered continuous pulse oximetry. What should the nurse explain to the
patient about this procedure?
a.
Involves a single prick
b.
Measures the amount of oxygen in the blood
c.
Is applied to the wrist
d.
Identifies damaged cells in the myocardium
17. A stress test is scheduled for a 41-year-old patient. What action should the nurse implement to
prepare the patient for the examination?
a.
Have the patient sign a consent form.
b.
Give the patient a special heart diet.
c.
Prepare the patient for sedation.
d.
Remove all metal objects.
18. What action should a nurse expect to implement when a patient returns from a cardiac
catheterization?
a.
Ambulate the patient in the hall.
b.
Check the puncture site.
c.
Monitor the gag reflex.
d.
Remove the gel from all sites on the skin.
19. A nurse assesses an inverted T wave on the ECG of a patient who had an acute MI two days
earlier. How should the nurse interpret this finding?
a.
Normal recovery
b.
New MI
c.
Abnormal wave form
d.
Congestive heart failure
20. Laboratory tests are performed to identify damage to the heart muscle. Which test is elevated
the earliest with heart damage?
a.
Creatine phosphokinase-MB (CPK-MB)
b.
Lactate dehydrogenase (LDH)
c.
Lipid profile
d.
Troponin
21. A patient is scheduled for a heart catheterization. What action should the nurse implement in
preparation for this examination?
a.
Ask the patient about allergies to seafood or iodine.
b.
Remove all metal objects.
c.
Give the patient a special heart diet.
d.
Test arterial blood gases (ABGs).
22. A patient has had atropine sulfate that has been administered intravenously to treat a
dysrhythmia. What should the nurse assess this patient for after administration?
a.
Weight gain
b.
Tachycardia
c.
Muscle twitching
d.
Incontinence of urine
23. A dopamine infusion is being administered to a patient with shock. For what should the nurse
be alert?
a.
Sharp spike in blood pressure
b.
Tremor of the hands
c.
Increasing urinary output
d.
Hyperirritability of the patient
24. A patient with atrial fibrillation is prescribed amiodarone for the dysrhythmia. Which
potential adverse reaction should the nurse report?
a.
Ataxia
b.
Decreasing pulse rate
c.
Decreasing blood pressure
d.
Increase in cardiac output
25. A medication, simvastatin (Zocor), is administered to lower a patient’s cholesterol level.
Follow-up lipid levels are reviewed by the nurse. Which level indicates the desired therapeutic
range?
a.
High-density lipoprotein (HDL), 29 mg/dL; low-density lipoprotein (LDL), 160
mg/dL
b.
HDL, 38 mg/dL; LDL, 120 mg/dL
c.
HDL, 56 mg/dL; LDL, 106 mg/dL
d.
HDL, 42 mg/dL; LDL, 98 mg/dL
26. What information should a nurse include in a patient’s discharge instruction after an acute
myocardial infarction (MI)?
a.
Cautions about the use of morphine
b.
Detailed symptoms that indicate impending MI
c.
Written instructions on diet and follow-up appointments
d.
High-energy exercise program directions
27. A patient with acute congestive heart failure has jugular vein distention, crackles bilaterally,
and dyspnea. Which nursing diagnosis should have the highest priority?
a.
Activity intolerance
b.
Excess fluid volume
c.
Anxiety
d.
Ineffective coping
28.
A nurse is assessing the cardiac complex above. What pattern should the nurse recognize in
this rhythm strip?
a.
NSR
b.
Premature ventricular contractions (PVCs)
c.
Ventricular tachycardia (VT)
d.
AF
29. A diuretic medication, furosemide (Lasix), is being administered for congestive heart failure.
Which assessment is not an anticipated consequence of the therapy?
a.
Increased urinary output
b.
Weight loss
c.
Thirst
d.
Muscle weakness
30. A patient is receiving digoxin 0.25 mg/day. What should the nurse do prior to administering
this medication?
a.
Count an apical pulse for 15 seconds.
b.
Hold the dose if the apical rate is 57 beats/min.
c.
Give the dose if the apical rate is 59 beats/min.
d.
Double the dose if the rate is 62 beats/min.
31. A 46-year-old patient is receiving propranolol (Inderal), a nonselective beta-adrenergic
blocker, for a heart condition. What patient teaching is most appropriate?
a.
Sit or lie down when taking the drug.
b.
Limit caffeine intake.
c.
Double the dose if symptoms occur.
d.
Never stop taking the drug abruptly.
32. Which assessment should be immediately addressed in a patient on lidocaine?
a.
Slowed ventricular rate
b.
Occasional PVCs
c.
Increase in temperature to 102° F
d.
Nausea and vomiting
33.
How should a nurse interpret the arrhythmia in the above strip?
a.
NSR
b.
PVC
c.
VT
d.
AF
34. A nurse records a “1” for the pulse quality of the pedal pulse. What interpretation is correct
regarding the pulse?
a.
Absent
b.
Normal
c.
Thready
d.
Forceful
MULTIPLE RESPONSE
35. Which factors affect stroke volume? (Select all that apply.)
a.
Contractility
b.
Climate
c.
Age
d.
Preload
e.
Afterload
36. Which age-related changes in the heart should a nurse take into consideration? (Select all that
apply.)
a.
Decrease in contractility
b.
Thickened valves
c.
Stiffened valves
d.
Decreased SA node cells
e.
Increased nerve fibers in ventricles
37. What actions should a nurse implement to decrease the workload of the heart in a patient with
acute congestive failure? (Select all that apply.)
a.
Eliminate unnecessary activities.
b.
Direct the patient in active range-of-motion exercises.
c.
Help the patient change positions every 2 hours.
d.
Assist the patient to ambulate to the bathroom.
e.
Give a partial bed bath rather than full bed bath.
38. A nurse urges a 50-year-old overweight executive who had a myocardial infarction (MI) 3
months earlier to take up some conditioning exercises for 30 minutes a day. What rationale
supports this suggestion? (Select all that apply.)
a.
Lose weight.
b.
Improve function of the left ventricle.
c.
Decrease arterial stiffening.
d.
Decrease cholesterol levels.
e.
Improve cardiac dysrhythmia.
COMPLETION
39. At rest, the cardiac cells in the myocardium are electrically polarized, with the inside of the
cell being more _____ than the outside of the cell.
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
OTHER
40. A nurse uses a picture to demonstrate the conduction pathway through the chambers of the
heart. (Arrange the following options in the correct sequence. Separate letters by a comma
and space as follows: A, B, C, D.)
A. The atria contract.
B. Conduction occurs through the bundle branches.
C. The AV node fires.
D. The Purkinje fibers conduct.
E. The SA node fires.
F. The ventricles contract.