When listening to heart sounds, you can best hear S1 at the:
A) base of the heart.
B) apex of the heart.
C) aortic area.
D) second intercostal space to the right of the sternum.
You're auscultating for heart sounds in a 3-ear-old girl and hear and S3. You assess this sound to be:
A) a normal finding.
B) a probable sign of heart failure.
C) a possible sign of atrial septal defect.
D) a probable sign of mitral stenosis.
When grading arterial pulses, a 1+ grade indicates:
A) bounding pulse.
B) increased pulse.
C) weak pulse.
D) absent pulse.
When assessing a patient for jugular vein distention, you should position him:
A) sitting upright.
B) lying flat on his back.
C) lying on his back, with the head of the bed elevated 30 to 45 degrees.
D) lying on his left side.
Capillary refill time is normally:
A) less than 15 seconds.
B) 7 to 10 seconds.
C) 4 to 6 seconds.
D) 1 to 3 seconds.
The normal pacemaker of the heart is:
A) the SA node.
B) the AV node.
C) the bundle of His.
D) the ventricles.
The pressure ventricle muscle must generate to over-come the higher pressure in the aorta refers to:
A) stroke volume
The vessels that carry oxygenated blood back to the heart and left atrium are the:
B) pulmonary veins.
C) pulmonary arteries.
D) pulmonary arterioles.
The layer of the heart responsible for contraction is the:
Prehypertension is indicated by a systolic blood pressure range of:
A) 100 to 120 mm Hg.
B) 110 to 130 mm Hg.
C) 120 to 139 mm Hg.
D) 140 to 159 mm Hg.
The recommended maximum daily dietary sodium intake is:
A) 2,300 mg per day.
B) 3,300 mg per day.
C) 4,000 mg per day.
D) 5,000 mg per day.
Which risk factors are used to calculate the Framingham Risk Score?
A) Race, age, weight, smoking status, and LDL level
B) Gender, age, LDL level, HDL level, smoking status, and diabetes status
C) Gender, weight, race, age, smoking status, and diabetes status
D) Race, age, smoking status, diabetes status, and HDL level
What is the recommended amount of exercise for decreasing the risk of CVD?
A) 30 minutes of moderate physical activity 1 day per week
B) 1 hour of low-impact activity 2 days per week
C) 30 minutes of moderate physical activity 3 days per week
D) 30 minutes of moderate phyiscal activity most days of the week
The National Cholesterol Program recommends routine screenings for abnormal lipid levels:
A) every 5 years beginning at age 40.
B) every 5 years beginning at age 20.
C) every 10 years beginning at age 30.
D) every 10 years beginning at age 20.
Which test provides the best means of standardizing measurement of PT
to monitor oral anticoagulant therapy?
A) Plasma thrombin time
D) Activated bleeding therapy
The test that's most specific to myocardial damage is:
C) troponin I.
Cardiac enzyme levels are monitored in the patient with chest pain for which reason?
A) Serial measurement of enzyme levels revealing the extent of cardiac damage and helps monitor healing progress.
B) Cardiac enzymes help identify the area of myocardial damage.
C) Decreasing enzyme levels help to estimate the recovery time for the patient with myocardial damage.
D) Cardiac enzyme results will reveal if the patient is truly having chest pain.
TEE combines ultrasonography with which other procedure?
B) Endoscopic retrograde cholangiopancreatography
A noninvasive method of evaluating blood flow is:
A) duplex ultrasonography.
D) cardiac catheterization.
Which measures should be performed immediately following a CABG?
A) Ambulation, 12-lead ECG, and clear liquid diet
B) Vital signs, cardiac rhythm, and pulse oximetry
C) Vital signs, cardiac rhythm, and clear liquid diet
D) 12-lead ECG, vital signs, and ambulation
What are the signs of hemodynamic compromise?
A) Hypotension, decreased cardiac output, and shock
B) Tachycardia, hypertension, and increased urine output
C) Shock, diaphoresis, and increased cardiac output
D) Bradycardia, hypertension, and decreased urine output
What's an important teaching point for the patient receiving a heart transplant?
A) He'll need to stay indoors during the winter months.
B) He'll need to take immunosuppressants for at least 6 months following surgery.
C) He'll be at risk for life-threatening infections because of the medications he'll be taking.
D) After 6 weeks, he'll no longer be at risk for rejection.
In a life-threatening situation, which pacemaker is the best choice?
A) Permanent pacemaker
B) Transcutaneous pacemaker
C) Transvenous pacemaker
D) Epicardial pacemaker
What's a nonsurgical alternative to coronary artery bypass surgery?
During systole, the ventricles contract. This causes:
A) all four heart valves to close.
B) all four heart valves to open.
C) the AV valves to close and the semilunar valves to open.
D) the AV valves to open and the semilunar valves to close.
For a patient with symptom-producing sinus bradycardia, appropriate nursing interventions include establishing IV access to administer:
C) a calcium channel blocker.
Treatment for symptom-producing sick sinus syndrome includes:
A) beta-adrenergic blockers.
B) ventilatory support.
C) pacemaker insertion.
D) synchronized cardioversion.
The treatment of choice for a patient with ventricular fibrillation is:
B) transesophageal pacing.
C) synchronized cardioversion.
D) digoxin administration.
The term pulseless electrical activity refers to a condition in which there's:
A) a ventricular rate exceeding 100 beats/min.
B) asystole on a monitor or rhythm strip.
C) an extremely slow heart rate but no pulse.
D) electrical activity in the heart but no actual contraction.
In type I second-degree AV block, the PR interval:
A) varies according to the ventricular response rate.
B) progressively lengthens until a QRS complex is dropped.
C) remains constant despite an irregular ventricular rhythm.
D) can't be determined.
In atrial flutter, the key consideration in determining treatment is the:
A) atrial rate.
B) ventricular rate.
C) configuration of the flutter waves.
D) PR interval.
Vegetation from the heart valves results from:
A) bacterial invasion.
B) poor diet.
D) diabetes mellitus.
A focal or diffuse inflammation of the cardiac muscle is known as:
D) myocardial infarction.
Chest pain is described as pleuritic when it:
A) resolves with sublingual nitroglycerin.
B) occurs only during sleep.
C) increases with deep inspiration and decreases when the patient sits up and leans forward.
D) resolves with a deep breath.
Surgical treatment of a valvular disorder includes:
A) coronary artery bypass surgery.
B) balloon angioplasty.
C) cardiac stents.
D) balloon valvuloplasty.
Three risk factors involved with acute coronary syndromes include:
A) smoking, family history of heart disease, and diabetes.
B) family history, diabetes, and active lifestyle.
C) smoking, diabetes, and high high-density lipoprotein level.
D) weight loss, smoking, and low high-density lipoprotein level.
The most common direct cause of sudden death is:
B) pulmonary hypertension.
C) heart failure.
D) coronary artery disease.
Clinical signs of left-sided heart failure include:
A) dyspnea and bradycardia.
B) tachycardia and restlessness.
C) dyspnea and tachycardia.
D) restlessness and cough.
Prehypertension is usually treated with:
B) lifestyle modification instructions.
C) beta-adrenergic blockers.
D) ACE inhibitors.
Suspect an abdominal aortic aneurysm in a patient who complains of generalized, steady abdominal pain and has:
A) pulsating mass in the periumbilical area (if the patient isn't obese)
B) elevated cardiac enzymes.
C) positive Babinski's sign.
D) pink, frothy sputum.
An important diagnostic test used to identify PAD is:
D) cardiac catheterization.
What are the key signs of recurrence of an arterial occlusion?
A) Severe, substernal chest pain diaphoresis; and hypotension
B) Cyanosis, dyspnea, and cough
C) Pain, pallor, numbness, paralysis, coldness, and absence of pulse
D) Chills, fever, fatigue, and cough
A complication of DVT may be:
A) pulmonary embolism.
B) acute renal failure.
D) liver failure.
Which sign would lead you to suspect rupture of an aortic aneurysm?
A) Increased urine output
B) Increased blood pressure
C) Decreased blood pressure
D) Decreased pulse rate
Which interventions are important when caring for a patient with lower extremity thrombophlebitis?
A) Apply cool soaks and keep the patient's legs lower than the level of the heart.
B) Increase the patient's activity level and administer vasoconstrictors.
C) Apply cool soaks and administer nitroglycerin.
D) Apply warm soaks and elevate the patient's legs higher than the level of the heart.
What's the most common site of injury from blunt chest trauma?
B) Left ventricle
C) Superior vena cava
D) Right ventricle
What's the immediate goal of treatment for cardiac tamponade?
A) Relieving pain
B) Alleviating anxiety
C) Improving mobility
D) Relieving intrapericardial pressure
Emergency treatment of hypovolemic shock includes:
A) administration of antibiotics.
B) administration of IV fluids or blood products.
C) relief of pain.
D) administration of vasodilators.
When defibrillating a client, the paddles are placed anterolaterally. One of the paddles is positioned to the right of the upper sternum. Where would the nurse place the other paddle?
A) Over the fifth or sixth intercostal space at the left anterior axillary line
B) Directly over the heart at the precordium to the left of the lower sternal border
C) Under the client's body beneath the heart and immediately below the scapulae
D) On the right side of the chest on on the same level as the nipple line
The physician determines that a client who's critically ill and recently admitted to the emergency department requires a pacemaker. The nurse would assist in preparing the client for which type of pacemaker?
When reviewing the medical record of a client diagnosed with ventricular tachycardia, what would the nurse expect to be the most likely cause associated with the client's condition?
A) History of rheumatic heart disease
B) Frequent ingestion of large amounts of tea
C) Report of highly stressful employment
4) Cocaine drug intoxication
While auscultating a client's chest, the nurse notes a high-pitched blowing murmur occurring throughout systole that's heard best at the apex. The murmur doesn't become louder when the client inhales. The nurse interprets this as:
A) tricuspid insufficiency.
B) mitral insufficiency.
C) aortic stenosis.
D) pulmonic stenosis.
While interviewing a client with acute pericarditis, the client describes his complaint of chest pain. Which statement would most likely reflect the pain the client is experiencing?
A) "It feels like someone is putting a huge weight on my chest and I can't breathe."
B) "I feel this burning sensation that happens not long after I eat."
C) "It's the worse pain I've ever felt, like something is tearing inside."
D) "It's sharp and stabbing and gets much worse when I breathe deeply."
The nurse is teaching a client diagnosed with prehypertension about ways to modify his lifestyle. Which client statement indicates that the teaching has been effective?
A) "I guess I can eat more steak and less fish now."
B) "I'll be sure to have two glasses of wine with dinner each night."
C) "I just joined the local health club so that I can exercise at least three times a week."
D) "I can drink water but I need to watch exactly how much I actually drink."
A client is receiving digoxin (Lanoxin) as treatment of heart failure. When teaching the client about this medication, the nurse explains that the drug achieves its effects by:
A) reducing total blood volume.
B) dilating the blood vessels.
C) strengthening myocardial contractility.
D) decreasing systemic vascular resistance.
The nurse is conducting a staff in-service education program about aortic aneurysms, including the different types. Upon the completion of the program, the nurse asks the group to identify the type of aortic aneurysm that involves an outpouching of the arterial wall. The nurse determines that the teaching has been effective when the group correctly identifies the aneurysm as:
Which assessment finding would lead the nurse to suspect that a client is developing cardiac tamponade?
A) Widening pulse pressure
B) Decreased central venous pressure
C) Pulsus paradoxus
D) Decreased right atrial pressure
Assessment of a client with left-sided heart failure reveals dyspnea on exertion, fatigue, weight gain of 5 lb over the last 4 days, swollen ankles, and cough. When developing the care plan for this client, which nursing diagnosis would be the priority?
A) Imbalanced nutrition: More than body requirements
B) Excess fluid volume
C) Deficient knowledge
D) Activity intolerance
A client develops acute atrial fibrillation and is symptomatic. Which intervention would be the priority?
A) Synchronized cardioversion
B) Administration of digoxin
C) Radiofrequency ablation therapy
D) Atrial overdrive pacing
When reviewing a client's electrocardiogram (ECG), the nurse counts the number of small squares between two P waves and divides this number into 1,500. The nurse is determining which parameter?
A) Atrial rhythm
B) Duration of PR interval
C) Ventricular rate
D) Atrial rate
The nurse is assessing a client who has had a pulmonary catheter inserted. Which result would lead the nurse to notify the physician?
A) Pulmonary artery wedge pressure (PAWP) of 9 mm Hg
B) Right arterial pressure (RAP) of 4 mm Hg
C) Systolic pulmonary artery pressure (PAP) of 38 mm Hg
D) Mean PAP of 16 mm Hg
What would the nurse expect to administer as the first-line treatment for a client with dilated cardiomyopathy?
A) Angiotensin-converting enzyme (ACE) inhibitor
B) Beta-adrenergic blocker
C) Cardiac glycoside
When developing the care plan for a client with cardiovascular disease who has a nursing diagnosis of Activity intolerance, which intervention would be most appropriate for the nurse to include?
A) Have the client complete all aspects of care one at a time.
B) Urge the client to consume foods high in calories.
C) Teach the client about energy conservation measures.
D) Encourage activity immediately after eating.
After teaching a client diagnosed with valvular heart disease about the valves of the heart, the nurse determines that the teaching has been successful when the client identifies which valve as responsible for preventing the backflow of blood into the left ventricle?
A) Aortic semilunar
B) Pulmonic Semiluna
Which client would be at greatest risk for digoxin toxicity?
A) A client who's experiencing atrial tachycardia
B) A client who's receiving furosemide (Lasix)
C) A client who has a history of prehypertension
D) A client who's receiving simvastatin (Zocor)
When assessing capillary refill of a client, which finding would the nurse document as normal?
A) 6 seconds
B) 5 seconds
C) 4 seconds
D) 3 seconds
While assessing a client's atrial pulses, the nurse notes that the amplitude increases and decreases with the client's inspiration and expiration. The nurse documents this finding as:
A) pulsus alternans.
B) pulsus bigeminus
C) pulsus paradoxus.
D) pulsus bisferiens.
A client has just returned after undergoing insertion of an intra-aortic balloon pump (IABP) for counterpulsation. Which intervention would be most appropriate?
A) Elevating the head of the client's bed at least 45 degrees
B) Monitoring pulses every 2 hours
C) Encouraging active range-of-motion (ROM) exercises of all joints of the four extremities every hour
D) Applying direct pressure to catheter insertion site if bleeding occurs
A client comes to the health care facility for a follow-up visit because his blood pressure was 132/84 mm Hg. On this visit, his blood pressure is 138/88 mm Hg. He states, "When I saw the doctor a couple of months ago, my blood pressure was 122/80 mm Hg." The nurse interprets this finding to suggest that the client is experiencing:
A) normal blood pressure.
C) stage 1 hypertension.
D) stage 2 hypertension.
When planning the care for a client with left-sided heart failure, which outcome would be most appropriate to include as part of the care plan?
A) Client exhibits a weight gain of 2 to 3 lb per week.
B) Client verbalizes understanding about the need for strict bed rest.
C) Client demonstrates the ability to monitor pulse rate and rhythm.
D) Client describes the need for ingestion of high-fiber foods.
When teaching a class on health promotion and cardiovascular disease prevention to a local community group, the nurse focuses on ways to address the common causes of sudden death. What would the nurse include as the most common cause?
C) Cardiogenic shock
D) Coronary artery disease (CAD)
The nurse is preparing a client for an echocardiogram. Which statement indicates that the client has understood the nurse's teaching?
A) "I'll have to lie really still during the test and will probably hear a banging noise."
B) "A device placed on my chest picks up sounds waves that are recorded."
C) "A radioactive substance will be injected into my vein to show the injured area."
D) "A device attached to a scope is inserted into my esophagus to take pictures of my heart."
Which client would the nurse expect to be discharged first?
A) A client who has had a percutaneous transluminal coronary angioplasty (PTCA)
B) A client who has undergone a minimally invasive direct coronary artery bypass
C) A client who has had an aortic valve replacement
D) A client who has undergone repair of an aortic aneurysm
Which order should the nurse anticipate from the physician when a patient shows a rhythm of tachycardia?
A) Medicate with atropine 1 mg IV.
B) Medicate with adenosine 6 mg IV, no repeats.
C) Begin with adenosine 6 mg IV rapid infusion, and if not converted, repeat with 12 mg IV rapid infusion.
D) Begin CO2 monitoring.
The rhythm strip of a client reveals that the atrial rate is greater than the ventricular rate, the P wave appears saw-toothed in shape, the T wave can't be identified, and the QT interval can't be measured. The nurse interprets this waveform as:
A) atrial fibrillation.
B) atrial flutter.
C) ventricular tachycardia.
C) ventricular fibrillation.
Which nursing diagnosis would be the priority for a client who develops cardiogenic shock?
A) Activity intolerance related to increased metabolic demands
B) Risk for injury related to invasive treatment methods
C) Deficient knowledge related to complication development
D) Decreased cardiac output related to pump failure
A 36-year-old client is brought to the emergency department after being stabbed in the upper chest near the sternum. The client is diagnosed with cardiac trauma. The nurse would continuously monitor the client for signs and symptoms of:
C) cardiac tamponade.
D) cardiogenic shock.
The nurse is preparing a presentation about risk reduction and coronary artery disease (CAD) for a health fair at a local facility. The nurse is planning to discuss the role of lipids in contributing to a person's risk. Which statement would be most appropriate for the nurse to include in the presentation?
A) Elevated high-density lipoprotein (HDL) levels are associated with an increased risk for developing CAD.
B) Triglycerides are the key to determining a person's risk for CAD.
C) Total cholesterol levels greater than 240 mg/dl are considered normal for adults.
D) Elevated low-density lipoprotein (LDL) levels are associated with an increased risk for developing CAD.
A client's electrocardiogram strip reveals asystole. Which action would be initiated first?
A) Administration of epinephrine IV push
B) Cardiopulmonary resuscitation (CPR)
C) Administration of vasopressin (40 units IV)
D) Endotracheal (ET) intubation
The nurse is auscultating a client's heart sounds and places the stethoscope at the mitral valve area. What best describes this location?
A) Third intercostal space at the left sternal border
B) Second intercostal space at the right sternal border
C) Second intercostal space at the left sternal border
D) Fifth intercostal space near the midclavicular line
A client is to receive heparin 1,000 units/hour via an IV infusion as treatment for deep vein thrombophlebitis. The pharmacy supplies a 500-ml bad containing 50,000 units of heparin. The nurse is using an infusion pump. The nurse would set the infusion pump to administer how many milliliters per hour?
What would alert the nurse to a possible arterial occlusion in a client who has undergone a vascular repair of an aneurysm?
A) Decreased urine output
B) Severely diminished or absent peripheral pulses
D) Shallow respirations