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a. Circumflex artery
a. During inspiration
a. Cigarette smoking
b. During diastole
b. DM
c. During expiration
c. Heredity
d. During systole
d. HPN
a. Cancer
b. Coronary artery disease
c. Liver failure
a. 100 mg/dl
d. Renal failure
b. 150 mg/dl
c. 175 mg/dl
d. 200 mg/dl
a. Atherosclerosis
b. DM
c. MI
d. Renal failure
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Inferior
d. Tricuspid
d. Lateral
15. Which of the following blood tests is
most indicative of cardiac damage?
11. Which of the following is the most
common symptom of myocardial
infarction?
a. Lactate dehydrogenase
b. Complete blood count
a. Chest pain
c. Troponin I
b. Dyspnea
d. Creatine kinase
c. Edema
d. Palpitations
16. What is the primary reason for
administering morphine to a client with
myocardial infarction?
12. Which of the following landmarks is
the corect one for obtaining an apical
pulse?
a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary
d. Renal failure
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram
b. Blood pressure
a. Cardiogenic shock
c. Radial pulse
b. Heart failure
d. Respiratory rate
c. Arrhythmias
d. Pericarditis
a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension
c. Oliguria
d. Polydipsia
a. Beta-adrenergic blockers
d. Proximal to the renal arteries
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents
a. Bradycardia
b. Enlarged spleen
b. Tachycardia
c. Gastic distention
c. Hypotension
d. Gastritis
d. Decreased myocardial contractility
a. Abdominal pain
a. Abdominal X-ray
b. Arteriogram
c. CT scan
d. Ultrasound
d. Friction rubs
a. Externa
b. Interna
c. Media
d. Interna and Media
a. DM
b. HPN
c. PVD
d. Syphilis
d. Myocardial infarction
a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive
b. DM
b. Beta-adrenergic blockers
c. MI
d. Pericardial effusion
d. Nitrates
1) D
- Sinus tachycardia is often caused by fever,
physical and emotional stress, heart failure,
hypovolemia, certain medications,
nicotine, caffeine, and exercise. Measuring the
client's pulse during each shift will not
decrease the heart rate. Additionally, the
pulse should be taken more frequently than
once each shift. Exercise and fluid restriction
will not alleviate tachycardia.
2) B
- Flammable materials and metal devices or
liquids (that are capable of carrying
electricity) are removed from the client and
bed before discharging the paddles of the
defibrillator. The nitroglycerin patch may have
a metallic backing and should be removed.
3) D
- For the safety of all personnel, when the
defibrillator paddles are being discharged, all
personnel must stand back and be clear of all
contact with the client or the client's bed. It is
4) D
- The client typically receives a dose of
an intravenous sedative or antianxiety agent.
Digoxin may be withheld for up to 48 hours
before cardioversion because it increases
ventricular irritability and may cause
ventricular dysrhythmias post countershock.
The defibrillator is switched to synchronizer
mode to time the delivery of the electrical
impulse to coincide with the QRS and avoid
the T wave, which could causeventricular
fibrillation. Energy level is typically set at 50
to 100 joules. During the procedure, any
oxygen is removed temporarily, because
oxygen supports combustion, and a fire could
result from electrical arcing.
5) A
- When a client is cardioverted, the
defibrillator is charged to the energy level
ordered by the physician. Cardioversion is
usually started at 50 to 100 joules. Options B,
C, and D are incorrect and identify energy
levels that are too high for cardioversion.
6) D
- The client with an ICD maintains a log or
diary of a variety of data. This includes
recording the date and time of the shock, any
activity that took place before the shock, any
symptoms experienced, the number of shocks
delivered, and how the client felt after the
shock. The information is used by the
physician to adjust the medical regimen and
especially the medication therapy, which
must be maintained after ICD insertion.
7. The nurse is evaluating a hypertensive client's
understanding of a dietary modifications to control
the disease process. The nurse determines that the
client's understanding is satisfactory if the client
made which of the following meal selections?
a) corned beef, fresh carrots, boiled potato
b) hot dogs on a bun, sauerkraut, baked beans
c) turkey, baked potato, salad with oil and vinegar
d) scallops, french fries, salad with bleu cheese
dressing
8. The home-care nurse has given instructions to a
client who was recently discharged from the
hospital regarding the care of an arterial ischemic
leg ulcer. The nurse determines that further
instructions is needed if the client makes which of
the following statements?
a) I should wear shoes and socks
b) I should inspect my feet daily
7) C
- The client with hypertension should avoid
foods that are high in sodium. Foods from the
meat group that are higher in sodium include
bacon, hot dogs, luncheon meat, chipped or
corned beef, Kosher meat, smoked or salted
meat or fish, peanut butter, and a variety of
shellfish.
8) D
- Foot-care instructions for the client with
peripheral arterial ischemia are the same
instructions given to the client with diabetic
mellitus. The client with arterial disease,
however, should avoid raising the legs above
heart level unless instructed to do so as part
of an exercise program (such as Buerger's
9) D
- The client can walk as tolerated after the
repair or resection of an AAA, including
climbing stairs and walking outdoors. The
client should not lift objects that weigh more
than 15 to 20 pounds for 6 to 12 weeks or
engage in any activities that involve pushing,
pulling, or straining. Driving is also prohibited
for several weeks.
10) C
- LDLs are more directly associated with CAD
than are other lipoproteins. LDL levels, along
with levels of cholesterol, have a higher
predictive association with CAD than levels of
triglycerides. Additionally, HDL is inversely
associated with the risk of CAD. Lipase is a
digestive enzyme that breaks down ingested
fats
in
the
gastrointestinal
tract.
11) B
- Buerger disease occurs predominantly
among men who are more than 40 years old
who smoke cigarettes. A familial tendency is
noted, but cigarette smoking is consistently a
risk factor. Symptoms of the disease improve
with smoking cessation. Options A, C, and D
are not risk factors.
12) D
- After an acute MI, many clients are
instructed to take an aspirin daily. Adverse
effects include tinnitus,hearing loss, epigastric
distress, gastrointestinal bleeding, and
nausea. Sexual intercourse usually can be
resumed in 4 to 8 weeks after an acute MI if
the physician agrees and if the client has
been able to achieve traditional parameters
such as climbing two flights of steps without
chest pain or dyspnea. Clients should be
advised to purchase a new supply of
nitroglycerin tablets every 6 months.
Expiration dates on the
medicationbottle should also be checked.
Activities that include lifting and reaching
over the head should be avoided, because
they reduce cardiac output.
13. The home-care nurse provides selfcare instructions to a client with chronic venous
insufficiency caused by deep vein thrombosis.
Which statement by the client indicates the need
for further instructions?
a) I need to avoid prolonged standing or sitting
b) I need to elevate the foot of the bed during
sleep
c) I can cross my legs at the knee but not at the
ankle
d) I should continue to wear elastic hose for at
least 6 to 8 weeks
14. The nurse is providing homecare instructions to a client who had varicose
13) C
- Clients with chronic venous insufficiency are
advised to avoid crossing their legs, sitting in
chairs where their feet do not touch the floor,
and wearing garters or sources of pressure
above the legs (such as girdles). The client
should sleep with the foot of the bed elevated
to promote venous return during sleep. The
client should wear elastic hose for 6 to 8
weeks or, in some situations, for life. Venous
problems are characterized by the insufficient
drainage of blood from the legs returning to
the heart. Because of this, interventions need
to be aimed at promoting the flow of blood
out of the legs and back to the heart.
14) C
- The foot of the bed should be elevated 15
degrees to promote venous drainage.
Standard postoperative care after vein
ligation and stripping consists of bedrest for
24 hours with ambulation for 5 to 10 minutes
every 2 hours thereafter. The continuous
elastic compression of the leg is maintained
usually for 1 week after the procedure, and
this is followed by the long-term use of elastic
hose.
15) D
- The use of measures to prevent
vasoconstriction are helpful for the
management of Raynaud disease. The hands
and feet should be kept dry. Gloves and warm
fabrics should be worn in cold weather, and
the client should avoid exposure to nicotine
and caffeine. The avoidance of situations that
trigger stress is also helpful. Options A, B, and
C are not components of the treatment for
this disorder.
16) B
- The long-term management of peripheral
arterial disease consists of measures that
increase peripheral circulation (exercise),
promote vasodilation (warmth), relieve pain,
and maintain tissue integrity (foot care and
nutrition). The application of heat directly to
the extremity is contraindicated. The limb
may have decreased sensitivity and be more
at risk for burns. Additionally, the direct
application of heat raises the oxygen and
nutritional requirements of the tissue even
further.
17) D
- Sodium intake can be increased with the use
of several types of products,
including toothpaste andmouthwashes; overthe-counter medications such as analgesics,
antacids, cough remedies, laxatives, and
sedatives; and softened water as well as
some mineral waters. Water that is bottled,
distilled, deionized, or demineralized may be
used for drinking and cooking. Clients are
advised to read labels for sodium content.
18) A
- Spironolactone (Aldactone) is a potassiumsparing diuretic. If the client is also
taking potassium chloride or
another potassium supplement, the risk for
hyperkalemia exists. Potassium doses would
need to be adjusted while the client is taking
this medication. A dosage adjustment would
not be necessary if the client was taking the
medications identified in options B, C, and D.
19. A client seeks treatment in an ambulatory care
center for symptoms of Raynaud's disease. The
nurse instructs the client to:
a) decrease cigarette smoking by one half
b) alternate exposures to both heat and cold
c) continue activity during vasospasm for quicker
relief of symptoms
d) wear protective items, such as gloves and warm
socks, as necessary
20. The nurse determines that the client with
atherosclerosis understands dietary modifications
19) D
- Treatment for Raynaud's disease includes
the avoidance of precipitating factors such as
cold or damp weather, stress, and cigarettes.
The client should get sufficient rest and sleep,
protect the extremities by wearing protective
clothing, and stop activity during vasospasm.
20) B
- To lower the risk of heart disease, the diet
should be low in saturated fat with the
appropriate number of total calories. The diet
Club
21) D
- The client may feel some mild discomfort at
the catheter insertion site after angioplasty.
This is usually relieved by analgesics such as
acetaminophen (Tylenol). The client is taught
to report to the physician any neurovascular
changes to the affected leg, bleeding or
bruising at the insertion site, and signs of
local infection, such as drainage at the site or
increased temperature.
22) A
- Sodium should be avoided by the client with
hypertension. Fresh fruits and vegetables are
naturally low in sodium. Hypertensive clients
are also advised to keep fat intake to less
than 30% of their total calories as part of
prudent heart living. Each of the incorrect
options contain high amounts of sodium, and
options B and C are also likely to be higher in
fat.
23) D
- Cerebrovascular symptoms of
hypertension include early morning
headaches, occipital headaches, blurred
vision, lightheadedness, vertigo, dizziness,
and epistaxis. The client should be aware of
these symptoms and report them if they
occur. The client should also be taught to selfmonitor the blood pressure. A feeling of
fullness in the head is more likely associated
with a sinus condition.
24) B
- Anginal episodes are triggered by events
such as eating heavy meals, straining during
bowel movements, smoking, overexertion,
and experiencing emotional upset or
temperature extremes. Medication therapy is
monitored and regulated by the physician.
25) D
- Most clients and families benefit from
knowing that there are available resources to
help them cope with the stress of self-care
management at home. These can include
telephone contact with the surgeon, the
cardiologist, and the
nurse; cardiac rehabilitation programs; and
community support groups such as the
American Heart Association Mended Hearts
Club, which is a nationwide program with local
1) C
- the client is experiencing hypoxia. Need for
oxygenation take priority. Choices A, B and D
are expected findings.
2) A
- subcutaneous nodules are painless
swellings. Other signs and
symptoms of rheumatic fever are: migrating
polyarthritis, increased ASO titer, increased
ESR, arthralgia, fever. Choice C describes
kawasaki disease.
3) B
- digoxin should be given on empty stomach.
This ensures adequate absorption of the
medication. In an infant, digoxin is not given if
the apical pulse is below 90-110 bpm. For
older children, if the apical pulse is below 70
bpm, the drug is also withheld.
4) D
- internal bleeding will cause accumulation of
blood within the abdominal cavity. Increase in
abdominal girth is an accurate indicator of
this complication.
5) C
- progressive exercises, especially walking
promote arterial collateral circulation
(intermittent claudification is a sign of arterial
insufficiency).
6) C
- puncture site for catheter insertion may be
in the brachial or femoral vein/artery. In case
of bleeding, the initial nursing action is to
assess and apply pressure to the site.
8) D
- the client accepts that a lifestyle change is
lifetime. This is to promote health and wellbeing of the person.
a) excessive thirst
b) prolonged hiccups
c) flushing of the skin
d) increased urine output
9) A
- gather additional information about the
client's condition first. Next action is to notify
the physician. (Assessment is done before
implementation).
10) B
- mitral valve stenosis leads to left-sided heart
failure. This produces pulmonary
manifestations ("left lung"). Left heart
affectation results to lung manifestations like
dyspnea on exertion.
a) chest pain
b) circulatory overload
c) electrolytes imbalance
d) ventricular dysrhythmias
11) A
- age and gender are non-modifiable or
unavoidable risk factors for cardiovascular
disorders. The other options are
modifiable risk factors.
12) A
- elevated troponin levels are the best
indicator of M.I. Troponin I of 1.5
mg/ml, Troponin T greater than 0.1 to 0.2 are
supportive of MI.
13) A
- lithotomy position increases cardiac
workload. The client should be placed in semifowler's position to decrease cardiac workload
and promote oxygenation.
14) A
- after cardiac catheterization involving
femoral artery, the affected leg should be
kept immobile and in extendedposition for few
hours. This is to prevent bleeding and to
promote adequate circulation in the leg.
19. The client has been diagnosed to have rightsided congestive heart failure (RSCHF). Which of
the followingsigns and symptoms does the nurse
expect to observe in the client?
a) shortness of breath
b) ascites
c) rales in the lung apices
d) pink-tinged, frothy sputum
15)
- assessment is the first nursing action. ECG
may reveal dysrhythmias which cause chest
pain after cardiac catheterization. Gather
adequate information before implementation.
16) B
- prolonged hiccups indicate pacemaker
failure. Other signs and symptoms of
pacemaker failure are dysrhythmias,
dizziness, faintness, chest pain, shortness of
breath, increase or decrease in apical rate.
a) quinidine
b) procainamide
c) bretylium
d) lidocaine
17) D
- ventricular dysrhythmias are the primary
causes of decreased cardiac output with
myocardial infarction.
18) C
- digoxin increases force
of cardiac contractility and therefore it
increases cardiac workload.
19) B
- RSCHF is characterized by venous backup,
like ascites. Choices A, C, and D are
manifestations of a client with Left-sided CHF.
20) B
- hypokalemia is characterized by presence of
U-wave, depressed ST segment, and short Twave.
21) A
- cardiac tamponade involves accumulation of
fluid in the pericardial sac. It restricts
ventricular filling and
decreases cardiac output. It is characterized
by distant, muffled sound, distended neck
veins, and diminished or absent pulse (Beck's
triad).
22) B
- cigarette smoking is one of the most
common risks of CAD (Coronary artery
disease).
23) B
- orthopnea, which is difficulty in breathing
when in lying position relieved by
upright position, is a sign of
progressive cardiac disorder.
24) D
- lidocaine is the first line of drug to control
PVC's, VT, VF. Lidocaine exerts anesthetic
effect on the heart thus decreasing
myocardial irritability.
25) B
- elevated BP increases afterload, and
therefore increases cardiac workload. This
leads to increased myocardial oxygen
demand.
26. B
- working in cold weather precipitates
coronary artery spasm. This reduces
myocardial tissue perfusion and oxygenation.
Therefore the client with CAD should
avoid working in cold weather.
27) A
- nicotine causes vasoconstriction. Nicoderm
patch is contraindicated for clients with
history of M.I.
28) A
- dyspnea is the earliest sign that indicates
recurrence of CHF
29) B
- coarctation of aorta is characterized by the
following signs and symptoms:
36. The following are manifestations of leftsided congestive heart failure. Select all that apply
a) hypertension
b) dependent edema
c) hypokalemia
d) paroxysmal nocturnal dyspnea
e) non-productive cough
f) pink-tinged, frothy sputum
g) ascites
a) bleeding on dressing
b) capillary refill of more than 3 seconds
c) feeling of warmth and thirst
d) drowsiness
33) A
- pain in the groin after cardiac
catheterization may indicate hematoma at the
site. This indicates bleeding at the site and
compression of blood vessels by the
hematoma may occur. his in turn, may cause
circulatory impairment in the area.
34) C
- avoid acute hip flexion after cardiac
catheterization involving the femoral artery to
prevent circulatory impairment. HOB may be
elevated only up to 30 deg for the first 6 to 8
hours
35) A
- the client's wishes are primary
considerations in living will.
36) A, C, D, E, F
- these are signs and symptoms of left-sided
CHF. Signs and symptoms of left-sided CHF
are due to pulmonary edema, cellular hypoxia
and activation of renin-angiotensinaldosterone system (RAAS).
37) B
- precipitating events to chest pain in angina
pectoris include exposure to cold, exertion,
eating a large meal, and strong emotions.
38) C
- a dual chamber pacemaker provides both
atrial and ventricular firing.
39) D
- cardiac tamponade, an accumulation of
blood in the pericardial sac is characterized by
Beck's triad signs and symptoms which are as
follows: distended neck vein, muffled heart
sounds and diminished or absent pulse.
40) B
- capillary refill of more than 3 seconds
indicates circulatory impairment, and needs
41) A
- high serum cholesterol level is one of the
most common modifiable risk factor
for coronary artery disease.
42) C
- walking is the best exercise for post-MI
clients undergoing cardiac rehabilitation.
Jogging may not be well-tolerated by the
client. Therefore, choice C indicates
knowledge deficit of the client and these
requires further teaching.
43) C
- close monitoring of the client
after insertion of cardiac pacemaker
especially the vital signs is very essential.
Changes in the vital signs indicate occurrence
of complications.
44) C
- orthopnea, like sleeping in a couch indicates
progressive heart failure like CHF (congestive
heart failure) and pulmonary edema.
45) D
- left-sided congestive heart failure may lead
to pulmonary edema. Signs and
symptoms pertaining to the lungs are
characteristic of left-sided congestive heart
failure.
Choices A, B, and C are due to venous backup which characterize right-sided congestive
heart failure.
46) C
- assessment findings associated with excess
fluid volume include cough, dyspnea,
crackles, tachypnea, tachycardia, an
elevated blood pressure and a bounding
pulse, an elevated CVP, weight gain, edema,
neck and hand vein distention, altered level of
consciousness, and a decreased hematocrit.
Options A, B and D identify signs noted in
deficient fluid volume.
a) hematoma
b) systemic infection
c) electrolyte overload
d) circulatory overload
47) C
- hyperactive bowel sounds indicate
hyponatremia. Options A, B and D are signs of
hypernatremia. In hyponatremia, increased
urinary output and decreased specific gravity
of the urinEdit Postse would be noted. Dry
skin occurs in deficient fluid volume.
48) C
- troponin is a regulatory protein found
in striated muscle. The troponins function
together in the contractile apparatus
for striated muscle in skeletal muscle and in
the myocardium. Increased amounts of
troponins T are released to the bloodstream
when an infarction causes damage to the
myocardium. A troponin T value that is higher
than 0.1 to 0.2 ng/mL is consistent with a
myocardial infarction.
49) B
- the normal prothrombin time (PT) is 9.6 to
11.8 seconds (male adult) or 9.5 to 11.3
seconds (female adult). A therapeutic PT level
is 1.5 to 2.0 times higher than the normal
level. Because the value of 35 seconds is high
(and perhaps near the critical range), the
nurse should anticipate that the client would
not receive further doses at this time.
50) D
- circulatory (fluid overload) is a complication
of intravenous therapy. Signs include rapid
breathing, dyspnea, a moist cough, and
crackles. When circulatory overload is
present, the client's blood pressure would also
increase. Hematoma is characterized by
ecchymosis, swelling and leakage at the
IV insertion site, and hard and painful lumps
at the site. Systemic infection is characterized
by chills, fever, malaise, headache, nausea,
vomiting, backaches, and tachycardia. Signs
of electrolyte imbalance depend on the
specific electrolyte.
51) D
- to avoid infections, visitors with active
infections should not be allowed to visit the
client; otherwise, restrictions are not required.
Stress causes increased heart workload, and
the client should be instructed to avoid stress.
Too much weight gain can place further
demands on the heart. Resting should be
done by lying on the side to promote blood
return.
52) A
- constipation can cause the client to use
Valsalva's maneuver. This maneuver can
cause blood to rush to the heart and overload
the cardiac system. Therefore, high-fiber
53) C
- The child with aortic stenosis shows signs of
exercise intolerance, chest pain, and dizziness
when standing for long periods of time. Pallor
may be noted but is not specific to this type of
disorder alone. Options B and D are not
related to this disorder.
54) B
- The mother should be instructed that lotions
and powders should not be applied to the
incision site. Lotions and powders can irritate
the surrounding skin, which could lead to skin
breakdown and subsequent infection of the
incision site. Options A, C and D are
accurate instructions regarding home care
after cardiac surgery.
55) D
- The parents need to be instructed that if the
child vomits after the digoxin is administered,
they are not to repeat the dose. Options A, B
and C are accurate instructions regarding the
administration of this medication. In addition,
the parents should be instructed that if a dose
is missed and is not identified until 4 hours
later, the dose should not be administered.
56) C
- The early signs of congestive heart
failure (CHF) include tachycardia, tachypnea,
profuse scalp sweating, fatigue and
irritability, sudden weight gain, and
respiratory distress. A cough may occur in
CHF as a result of mucosal swelling and
irritation but is not an early sign. Pallor may
be noted in the infant with CHF but is also not
an early sign.
57) D
Crying exhausts the limited energy supply,
increases the workload of the heart, and
increases the oxygen demands. Oxygen
administration may be prescribed for stressful
periods, especially during bouts of crying or
invasive procedures. Options A,B, C are
not likely to produce crying in the infant.
58) D
A weight gain of 0.5 kg (1 lb) in 1 day is
caused by the accumulation of fluid. The
nurse should assess urine output, assess for
evidence of facial or peripheral edema,
a) sherbet
b) steak sauce
c) apple juice
d) leafy green vegetables
60) B
- The nurse should counsel the client to keep
the total cholesterol level under 200 mg/dL.
This will aid in the prevention of
atherosclerosis, which can lead to a number
of cardiovascular disorders later in life.
Options C and D are elevated values and
place the client at risk for cardiovascular
disease. Although option A is a low
cholesterollevel, option B identifies the
realistic value to assist in preventing
cardiovascular disease.
61) B
- As an isolated occurrence, the PVC is not life
threatening. In this situation, the nurse should
continue to monitor the client. Frequent PVCs,
however, may be precursors of more lifethreatening rhythms, such as ventricular
tachycardia and ventricular fibrillation. If this
occurs, the physician needs to be notified.
62) C
- The nurse monitors for postoperative
complications such as deep vein thrombosis,
pulmonary emboli, and wound infection. Pain
in the calf area could indicate a deep vein
thrombosis. Change in color, temperature, or
size of the client's calf could also indicate this
complication. Options A and B could result in
an embolus if in fact the client had a deep
vein thrombosis. Administering pain
medication for this client complaint is not the
appropriate nursing action. Further
assessment needs to take place.
63) C
- The client with uncontrolled atrial fibrillation
with a ventricular rate over 100 beats per
minute is at risk for low cardiac output caused
by loss of atrial kick. The nurse assesses the
client for palpitations, chest pain or
discomfort, hypotension, pulse deficit, fatigue,
weakness, dizziness, syncope, shortness of
breath, and distended neck veins.
64) D
- The purpose of EPS is to study the heart's
electrical system. During this invasive
procedure, a special wire is introduced into
the heart to produce dysrhythmias. To prepare
for this procedure, the client should be NPO
for 6 to 8 hours before the test, and all
antidysrhythmics are held for at least 24
hours before the test in order to study the
dysrhythmias without the influence of
medications. Because the client's verbal
responses to the rhythm changes are
extremely important, sedation is avoided if
possible.
65) B
- Steak sauce is high in sodium. Leafy green
vegetables, any juice (except tomato or V8
brand vegetable), and sherbet are all low in
sodium. Clients with CHF should monitor
sodium intake.
66) D
- Nitroglycerin dilates both arteries and veins,
causing peripheral blood pooling, thus
reducing preload, afterload, and myocardial
workload. This action accounts for the primary
side effect of nitroglycerin, which is
hypotension. In the absence of an arterial
monitoring line, the nurse should have a
noninvasive blood pressure monitor for use at
the bedside.
67. A client is in ventricular tachycardia and the
physician orders intravenous (IV) lidocaine
(xylocaine). The nurse plans to dilute the
concentrated solution of lidocaine with:
a) lactated ringer's
b) normal saline 0.9%
c) 5% dextrose in water
d) normal saline 0.45%
67) C
- Lidocaine for IV administration is dispensed
in concentrated and dilute formulations. The
concentrated formulation must be diluted with
5% dextrose in water.
68) B
- In PTCA, a balloon-tipped catheter is used to
compress the plaque against the coronary
blood vessel wall. Option C describes coronary
atherectomy, option A describes placement of
a coronary stent, and option D describes part
of the process used in cardiac catheterization.
69) C
- Sodium restriction reduces water retention
and improves cardiac efficiency. A standard
dietary modification for the client with heart
failure is sodium restriction.
70) D
- Creatine kinase (CK)-MB isoenzyme is a
sensitive indicator of myocardial damage.
Levels begin to rise 3 to 6 hours after the
onset of chest pain, peak at approximately 24
hours, and return to normal in about 3 days.
Troponin is a regulatory protein found
in striated muscle (skeletal and myocardial).
Increased amounts of troponins are released
into the bloodstream when an infarction
causes damage to the myocardium.
Therefore, the client's results are compatible
with new-onset MI. Options A, B, and C all
refer to angina. These levels would not be
elevated in angina.
71) D
- With an arterial leg ulcer, the nurse applies
tape only to the bandage. Tape is never used
directly on the skin because it could
cause further tissue damage. For the same
reason, Montgomery straps could not be
applied to the skin (although these are
generally intended for use on abdominal
wounds, anyway). Standard dressing
technique includes the use of Kling rolls on
circumferential dressings.
72) A
74) B
- Standard interventions upon admittance to
the CCU as they relate to this question include
continuous cardiac monitoring, administering
oxygen at a rate of 2 to 4 liters per minute
unless otherwise ordered, and ensuring an
adequate IV line insertion of an intermittent
lock. If an IV infusion is administered, it is
maintained at a keep vein open rate to
prevent fluid overload and heart failure.
Thrombolytic therapy may or may not be
prescribed by the physician. Thrombolytic
agents are most effective if administered
within the first 6 hours of the coronary event.
75) A
- Standard ECG graph paper measurements
are 0.04 second for each small box on the
horizontal axis (measuring time) and 1 mm
(measuring voltage) for each small box on the
vertical axis.
W/ God,
Nothing is
impossible
Wilma Bongotan
Padawil