MI and Heart Failure

3. Troponin I
1. Which of the following actions is the first priority of care
4. Creatine kinase (CK)
for a client exhibiting signs and symptoms of coronary artery

disease? 6. What is the primary reason for administering morphine to

a client with an MI?

1. Decrease anxiety

2. Enhance myocardial oxygenation 1. To sedate the client

3. Administer sublingual nitroglycerin 2. To decrease the client’s pain

4. Educate the client about his symptoms 3. To decrease the client’s anxiety

4. To decrease oxygen demand on the client’s heart

2. Medical treatment of coronary artery disease includes

which of the following procedures? 7. Which of the following conditions is most commonly

responsible for myocardial infarction?

1. Cardiac catheterization

2. Coronary artery bypass surgery 1. Aneurysm

3. Oral medication therapy 2. Heart failure

4. Percutaneous transluminal coronary angioplasty 3. Coronary artery thrombosis

4. Renal failure
3. Which of the following is the most common symptom

of myocardial infarction (MI)? 8. Which of the following complications is indicated by a

third heart sound (S3)?

1. Chest pain

2. Dyspnea 1. Ventricular dilation

3. Edema 2. Systemic hypertension

4. Palpitations 3. Aortic valve malfunction

4. Increased atrial contractions

4. Which of the following symptoms is the most likely origin

of pain the client described as knifelike chest pain that 9. After an anterior wall myocardial infarction, which of the

increases in intensity with inspiration? following problems is indicated by auscultation of crackles

in the lungs?
1. Cardiac

2. Gastrointestinal 1. Left-sided heart failure

3. Musculoskeletal 2. Pulmonic valve malfunction

4. Pulmonary 3. Right-sided heart failure

4. Tricupsid valve malfunction

5. Which of the following blood tests is most indicative of

cardiac damage?

1. Lactate dehydrogenase

2. Complete blood count (CBC)

10. What is the first intervention for a client experiencing 15. Which of the following symptoms is most commonly

MI? associated with left-sided heart failure?

1. Administer morphine 1. Crackles

2. Administer oxygen 2. Arrhythmias

3. Administer sublingual nitroglycerin 3. Hepatic engorgement

4. Obtain an ECG 4. Hypotension

11. Which of the following classes of medications protects 16. In which of the following disorders would the nurse

the ischemic myocardium by blocking catecholamines and expect to assess sacral edema in a bedridden client?

sympathetic nerve stimulation?

1. Diabetes

1. Beta-adrenergic blockers 2. Pulmonary emboli

2. Calcium channel blockers 3. Renal failure

3. Narcotics 4. Right-sided heart failure

4. Nitrates
17. Which of the following symptoms might a client with

12. What is the most common complication of an MI? right-sided heart failure exhibit?

1. Cardiogenic shock 1. Adequate urine output

2. Heart failure 2. Polyuria

3. arrhythmias 3. Oliguria

4. Pericarditis 4. Polydipsia

13. With which of the following disorders is jugular vein 18. Which of the following classes of medications maximizes

distention most prominent? cardiac performance in clients with heart failure by

increasing ventricular contractility?

1. Abdominal aortic aneurysm

2. Heart failure 1. Beta-adrenergic blockers

3. MI 2. Calcium channel blockers

4. Pneumothorax 3. Diuretics

4. Inotropic agents
14. Toxicity from which of the following medications may

cause a client to see a green-yellow halo around lights? 19. Stimulation of the sympathetic nervous system produces

which of the following responses?

1. Digoxin

2. Furosemide (Lasix) 1. Bradycardia

3. Metoprolol (Lopressor) 2. Tachycardia

4. Enalapril (Vasotec) 3. Hypotension

4. Decreased myocardial contractility

20. Which of the following conditions is most closely 25. Dyspnea, cough, expectoration, weakness, and edema are

associated with weight gain, nausea, and a decrease in urine classic signs and symptoms of which of the following

output? conditions?

1. Angina pectoris 1. Pericarditis

2. Cardiomyopathy 2. Hypertension

3. Left-sided heart failure 3. MI

4. Right-sided heart failure 4. Heart failure

21. Which of the following heart muscle diseases is unrelated 26. In which of the following types of cardiomyopathy does

to other cardiovascular disease? cardiac output remain normal?

1. Cardiomyopathy 1. Dilated

2. Coronary artery disease 2. Hypertrophic

3. Myocardial infarction 3. Obliterative

4. Pericardial effusion 4. Restrictive

22. Which of the following types of cardiomyopathy can be 27. Which of the following cardiac conditions does a fourth

associated with childbirth? heart sound (S4) indicate?

1. Dilated 1. Dilated aorta

2. Hypertrophic 2. Normally functioning heart

3. Myocarditis 3. Decreased myocardial contractility

4. Restrictive 4. Failure of the ventricle to eject all of the blood during systole

23. Septal involvement occurs in which type of 28. Which of the following classes of drugs is most widely

cardiomyopathy? used in the treatment of cardiomyopathy?

1. Congestive 1. Antihypertensives

2. Dilated 2. Beta-adrenergic blockers

3. Hypertrophic 3. Calcium channel blockers

4. Restrictive 4. Nitrates

24. Which of the following recurring conditions most 29. If medical treatments fail, which of the following invasive

commonly occurs in clients with cardiomyopathy? procedures is necessary for treating cardiomyopathy?

1. Heart failure 1. Cardiac catheterization

2. Diabetes 2. Coronary artery bypass graft (CABG)

3. MI 3. Heart transplantation

4. Pericardial effusion 4. Intra-aortic balloon pump (IABP)

30. Which of the following conditions is associated with a 35. 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?

1. Anxiety 1. Sit the client down

2. Stable angina 2. Get the client back to bed

3. Unstable angina 3. Obtain an ECG

4. Variant angina 4. Administer sublingual nitroglycerin

31. Which of the following types of angina is most closely 36. Myocardial oxygen consumption increases as which of

related with an impending MI? the following parameters increase?

1. Angina decubitus 1. Preload, afterload, and cerebral blood flow

2. Chronic stable angina 2. Preload, afterload, and renal blood flow

3. Nocturnal angina 3. Preload, afterload, contractility, and heart rate.

4. Unstable angina 4. Preload, afterload, cerebral blood flow, and heart rate.

32. Which of the following conditions is the predominant 37. Which of the following positions would best aid

cause of angina? breathing for a client with acute pulmonary edema?

1. Increased preload 1. Lying flat in bed

2. Decreased afterload 2. Left side-lying

3. Coronary artery spasm 3. In high Fowler’s position

4. Inadequate oxygen supply to the myocardium 4. In semi-Fowler’s position

33. Which of the following tests is used most often to 38. Which of the following blood gas abnormalities is

diagnose angina? initially most suggestive of pulmonary edema?

1. Chest x-ray 1. Anoxia

2. Echocardiogram 2. Hypercapnia

3. Cardiac catheterization 3. Hyperoxygenation

4. 12-lead electrocardiogram (ECG) 4. Hypocapnia

34. Which of the following results is the primary treatment 39. Which of the following is a compensatory response

goal for angina? to decreased cardiac output?

1. Reversal of ischemia 1. Decreased BP

2. Reversal of infarction 2. Alteration in LOC

3. Reduction of stress and anxiety 3. Decreased BP and diuresis

4. Reduction of associated risk factors 4. Increased BP and fluid retention

40. Which of the following actions is the appropriate initial 1. Activate the resuscitation team

response to a client coughing up pink, frothy sputum? 2. Open the client’s airway

3. Check for breathing

1. Call for help
4. Check for signs of circulation
2. Call the physician

3. Start an I.V. line 45. A 55-year-old client is admitted with an acute inferior-

4. Suction the client wall myocardial infarction. During the admission interview,

he says he stopped taking his metoprolol (Lopressor) 5 days

41. Which of the following terms describes the force against
ago because he was feeling better. Which of the following
which the ventricle must expel blood?
nursing diagnoses takes priority for this client?

1. Afterload
1. Anxiety
2. Cardiac output
2. Ineffective tissue perfusion; cardiopulmonary
3. Overload
3. Acute pain
4. Preload
4. Ineffective therapeutic regimen management

42. Acute pulmonary edema caused by heart failure is

46. A client comes into the E.R. with acute shortness of
usually a result of damage to which of the following areas of
breath and a cough that produces pink, frothy sputum.
the heart?
Admission assessment reveals crackles and wheezes, a BP of

85/46, a HR of 122 BPM, and a respiratory rate of 38

1. Left atrium

2. Right atrium breaths/minute. The client’s medical history included DM,

HTN, and heart failure. Which of the following disorders

3. Left ventricle

4. Right ventricle should the nurse suspect?

1. Pulmonary edema
43. An 18-year-old client who recently had an URI is

admitted with suspected rheumatic fever. Which assessment 2. Pneumothorax

3. Cardiac tamponade
findings confirm this diagnosis?
4. Pulmonary embolus
1. Erythema marginatum, subcutaneous nodules, and fever
47. The nurse coming on duty receives the report from the
2. Tachycardia, finger clubbing, and a load S3

3. Dyspnea, cough, and palpitations nurse going off duty. Which of the following clients should

the on-duty nurse assess first?

4. Dyspnea, fatigue, and syncope

44. A client admitted with angina complains of severe chest 1. The 58-year-old client who was admitted 2 days ago with heart

failure, BP of 126/76, and a respiratory rate of 21 breaths a

pain and suddenly becomes unresponsive. After establishing

unresponsiveness, which of the following actions should the minute.

2. The 88-year-old client with end-stage right-sided heart failure,

nurse take first?
BP of 78/50, and a DNR order.

3. The 62-year-old client who was admitted one day ago

with thrombophlebitis and receiving IV heparin. 1. Slightly anxious

4. A 76-year-old client who was admitted 1 hour ago with new- 2. Mildly anxious

onset atrial fibrillation and is receiving IV diltiazem (Cardizem). 3. Moderately anxious

4. Extremely anxious
48. When developing a teaching plan for a client with

endocarditis, which of the following points is most essential 52. A client with pulmonary edema has been on diuretic

for the nurse to include? therapy. The client has an order for

additional furosemide (Lasix) in the amount of 40 mg IV

1. “Report fever, anorexia, and night sweats to the physician.”
push. Knowing that the client also will be started
2. “Take prophylactic antibiotics after dental work and invasive
on Digoxin (Lanoxin), a nurse checks the client’s most
procedures.”
recent:
3. “Include potassium rich foods in your diet.”

4. “Monitor your pulse regularly.” 1. Digoxin level

2. Sodium level
49. A nurse is conducting a health history with a client with a
3. Potassium level
primary diagnosis of heart failure. Which of the following
4. Creatinine level
disorders reported by the client is unlikely to play a role in

exacerbating the heart failure? 53. A client who had cardiac surgery 24 hours ago has a

urine output averaging 19 ml/hr for 2 hours. The client

1. Recent URI
received a single bolus of 500 ml of IV fluid. Urine output for
2. Nutritional anemia
the subsequent hour was 25 ml. Daily laboratory results
3. Peptic ulcer disease
indicate the blood urea nitrogen is 45 mg/dL and the serum
4. A-Fib
creatinine is 2.2 mg/dL. A nurse interprets the client is at

risk for:
50. A nurse is preparing for the admission of a client with

heart failure who is being sent directly to the hospital from

1. Hypovolemia
the physician’s office. The nurse would plan on having which
2. UTI
of the following medications readily available for use?
3. Glomerulonephritis

4. Acute renal failure

1. Diltiazem (Cardizem)

2. Digoxin (Lanoxin)
54. A nurse is preparing to ambulate a client on the 3rd day
3. Propranolol (Inderal)
after cardiac surgery. The nurse would plan to do which of
4. Metoprolol (Lopressor)
the following to enable the client to best tolerate the

ambulation?
51. A nurse caring for a client in one room is told by another

nurse that a second client has developed severe pulmonary

1. Encourage the client to cough and deep breathe
edema. On entering the 2nd client’s room, the nurse would
2. Premedicate the client with an analgesic
expect the client to be:
3. Provide the client with a walker
4. Remove telemetry equipment because it weighs down the 1. Stable angina

hospital gown. 2. Unstable angina

3. Variant angina
55. A client’s electrocardiogram strip shows atrial and
4. Nonanginal pain
ventricular rates of 80 complexes per minute. The PR

interval is 0.14 second, and the QRS complex measures 0.08 59. The physician orders continuous intravenous

second. The nurse interprets this rhythm is: nitroglycerin infusion for the client with MI. Essential

nursing actions include which of the following?

1. Normal sinus rhythm

2. Sinus bradycardia 1. Obtaining an infusion pump for the medication

3. Sinus tachycardia 2. Monitoring BP q4h

4. Sinus dysrhythmia 3. Monitoring urine output hourly

4. Obtaining serum potassium levels daily

56. A client has frequent bursts of ventricular tachycardia on

the cardiac monitor. A nurse is most concerned with this 60. Aspirin is administered to the client experiencing an MI

dysrhythmia because: because of its:

1. It is uncomfortable for the client, giving a sense of impending 1. Antipyretic action

doom. 2. Antithrombotic action

2. It produces a high cardiac output that quickly leads to cerebral 3. Antiplatelet action

and myocardial ischemia. 4. Analgesic action

3. It is almost impossible to convert to a normal sinus rhythm.

61. Which of the following is an expected outcome for a
4. It can develop into ventricular fibrillation at any time.
client on the second day of hospitalization after an MI?

57. A home care nurse is making a routine visit to a client

1. Has severe chest pain
receiving digoxin(Lanoxin) in the treatment of heart failure.
2. Can identify risks factors for MI
The nurse would particularly assess the client for:
3. Agrees to participate in a cardiac rehabilitation walking

1. Thrombocytopenia and weight gain program

2. Anorexia, nausea, and visual disturbances 4. Can perform personal self-care activities without pain

3. Diarrhea and hypotension

62. Which of the following reflects the principle on which a
4. Fatigue and muscle twitching
client’s diet will most likely be based during the acute phase

58. A client with angina complains that the angina pain is of MI?

prolonged and severe and occurs at the same time each day,
1. Liquids as ordered
most often in the morning, On further assessment a nurse
2. Small, easily digested meals
notes that the pain occurs in the absence of precipitating
3. Three regular meals per day
factors. This type of anginal pain is best described as:
4. NPO
63. An older, sedentary adult may not respond to emotional 67. Furosemide is administered intravenously to a client

or physical stress as well as a younger individual because of: with HF. How soon after administration should the nurse

begin to see evidence of the drugs desired effect?

1. Left ventricular atrophy

2. Irregular heartbeats 1. 5 to 10 minutes

3. Peripheral vascular occlusion 2. 30 to 60 minutes

4. Pacemaker placement 3. 2 to 4 hours

4. 6 to 8 hours
64. Which of the following nursing diagnoses would be

appropriate for a client with heart failure? Select all that 68. Which of the following foods should the nurse teach a

apply. client with heart failure to avoid or limit when following a 2-

gram sodium diet?

1. Ineffective tissue perfusion related to decreased peripheral

blood flow secondary to decreased cardiac output. 1. Apples

2. Activity intolerance related to increased cardiac output. 2. Tomato juice

3. Decreased cardiac output related to structural and functional 3. Whole wheat bread

changes. 4. Beef tenderloin

4. Impaired gas exchange related to decreased sympathetic

69. The nurse finds the apical pulse below the 5th intercostal
nervous system activity.
space. The nurse suspects:

65. Which of the following would be a priority nursing

1. Left atrial enlargement
diagnosis for the client with heart failure and pulmonary
2. Left ventricular enlargement
edema?
3. Right atrial enlargement

1. Risk for infection related to stasis of alveolar secretions 4. Right ventricular enlargement

2. Impaired skin integrity related to pressure

70. Which of the following arteries primarily feeds the
3. Activity intolerance related to pump failure
anterior wall of the heart?
4. Constipation related to immobility

1. Circumflex artery
66. Captopril may be administered to a client with HF
2. Internal mammary artery
because it acts as a:
3. Left anterior descending artery

1. Vasopressor 4. Right coronary artery

2. Volume expander

3. Vasodilator

4. Potassium-sparing diuretic
 Answers & Rationale
1. Answer: 2. Enhance myocardial oxygenation
Enhancing myocardial oxygenation is always the first priority
when a client exhibits signs or symptoms of cardiac compromise.
Without adequate oxygenation, the myocardium suffers damage.
 Options A and D: Although educating the client and
decreasing anxiety are important in care delivery,
neither are priorities when a client is compromised.
 Option C: Sublingual nitroglycerin is administered to
treat acute angina, but the administration isn’t the first
priority.
2. Answer: 3. Oral medication therapy
Oral medication administration is a noninvasive, medical
treatment for coronary artery disease.
 Option A: Cardiac catheterization isn’t a treatment, but a
diagnostic tool.
 Options B and D: Coronary artery bypass surgery and
percutaneous transluminal coronary angioplasty are
invasive, surgical treatments.
3. Answer: 1. Chest pain
The most common symptom of an MI is chest pain, resulting from
deprivation of oxygen to the heart.
 Option B: Dyspnea is the second most common
symptom, related to an increase in the metabolic needs
of the body during an MI.
 Option C: Edema is a later sign of heart failure, often
seen after an MI.
 Option D: Palpitations may result from reduced cardiac
output, producing arrhythmias.
4. Answer: 4. Pulmonary
Pulmonary pain is generally described by these symptoms.
 Options A and B: Cardiac and GI pains don’t change with
respiration.
 Option C: Musculoskeletal pain only increases with
movement.
5. Answer: 3. Troponin I
Troponin I levels rise rapidly and are detectable within 1 hour of
myocardial injury. Troponin I levels aren’t detectable in people
without cardiac injury.
 Option A: Lactate dehydrogenase (LDH) is present in
almost all body tissues and not specific to heart muscle.
LDH isoenzymes are useful in diagnosing a cardiac
injury.
 Option B: CBC is obtained to review blood counts, and a
complete chemistry is obtained to review electrolytes.
 Option D: Because CK levels may rise with a skeletal
muscle injury, CK isoenzymes are required to detect
cardiac injury.
6. Answer: 4. To decrease oxygen demand on the client’s
heart
Morphine is administered because it decreases myocardial
oxygen demand.
 Options A, B, and C: Morphine will also decrease pain
and anxiety while causing sedation, but it isn’t primarily
given for those reasons.
7. Answer: 3. Coronary artery thrombosis
Coronary artery thrombosis causes an inclusion of the artery,
leading to myocardial death.
 Option A: An aneurysm is an outpouching of a vessel
and doesn’t cause an MI.
 Option B: Heart failure is usually a result from an MI.
 Option D: Renal failure can be associated with MI but
isn’t a direct cause.
8. Answer: 1. Ventricular dilation
Rapid filling of the ventricle causes vasodilation that is
auscultated as S3.
 Option B and D: Increased atrial contraction or systemic
hypertension can result in a fourth heart sound.
 Option C: Aortic valve malfunction is heard as a
murmur.
9. Answer: 1. Left-sided heart failure
The left ventricle is responsible for most of the cardiac output. An
anterior wall MI may result in a decrease in left ventricular
function. When the left ventricle doesn’t function properly,
resulting in left-sided heart failure, fluid accumulates in the
interstitial and alveolar spaces in the lungs and causes crackles.
 Options B, C, and D: Pulmonic and tricuspid
valve malfunction cause right-sided heart failure.
10. Answer: 2. Administer oxygen
Administering supplemental oxygen to the client is the first
priority of care. The myocardium is deprived of oxygen during an
infarction, so additional oxygen is administered to assist in
oxygenation and prevent further damage.
  Options A and C: Morphine and nitro are also used to
treat MI, but they’re more commonly administered after
the oxygen.
 Option D: An ECG is the most common diagnostic tool
used to evaluate MI.
11. Answer: 1. Beta-adrenergic blockers
15. Answer: 1. Crackles
Crackles in the lungs are a classic sign of left-sided heart failure.
These sounds are caused by fluid backing up into the pulmonary
system.
 Option B: Arrhythmias can be associated with both
right- and left-sided heart failure.

Beta-adrenergic blockers work by blocking beta receptors in
the myocardium, reducing the response to catecholamines and
sympathetic nerve stimulation. They protect the myocardium,
helping to reduce the risk of another infarction by decreasing
myocardial oxygen demand.
 Option B: Calcium channel blockers reduce the
workload of the heart by decreasing the heart rate.
 Option D: Left-sided heart failure causes hypertension
secondary to an increased workload on the system.
16. Answer: 4. Right-sided heart failure
The most accurate area on the body to assess dependent edema
in a bed-ridden client is the sacral area. Sacral, or dependent,
edema is secondary to right-sided heart failure.

 Option C: Narcotics reduce myocardial oxygen demand, 17. Answer: 3. Oliguria

promote vasodilation, and decrease anxiety.
 Option D: Nitrates reduce myocardial oxygen
consumption by decreasing left ventricular end-
diastolic pressure (preload) and systemic vascular
resistance (afterload).
12. Answer: 3. Arrhythmias
Arrhythmias, caused by oxygen deprivation to the myocardium,
are the most common complication of an MI.
Inadequate deactivation of aldosterone by the liver after right-
sided heart failure leads to fluid retention, which causes oliguria.
18. Answer: 4. Inotropic agents
Inotropic agents are administered to increase the force of the
heart’s contractions, thereby increasing ventricular contractility
and ultimately increasing cardiac output.
19. Answer: 2. Tachycardia

Stimulation of the sympathetic nervous system causes

 Option A: Cardiogenic shock, another complication of an
tachycardia and increased contractility. The other symptoms
MI, is defined as the end stage of left ventricular
listed are related to the parasympathetic nervous system, which
dysfunction. This condition occurs in approximately
is responsible for slowing the heart rate.
15% of clients with MI.

20. Answer: 4. Right-sided heart failure

 Option B: Because the pumping function of the heart is
compromised by an MI, heart failure is the second most
Weight gain, nausea, and a decrease in urine output are
common complication.
secondary effects of right-sided heart failure.

 Option D: Pericarditis most commonly results from a

 Option A: Angina pectoris doesn’t cause weight gain,
bacterial or viral infection but may occur after the MI.
nausea, or a decrease in urine output.
13. Answer: 2. Heart failure
 Option B: Cardiomyopathy is usually identified as a
symptom of left-sided heart failure.
Elevated venous pressure, exhibited as jugular vein distention,
indicates a failure of the heart to pump.
 Option C: Left-sided heart failure causes primarily
pulmonary symptoms rather than systemic ones.
 Options A and D: JVD isn’t a symptom of abdominal
aortic aneurysm or pneumothorax.
21. Answer: 1. Cardiomyopathy
 Option C: An MI, if severe enough, can progress to heart
Cardiomyopathy isn’t usually related to an underlying heart
failure, however, in and of itself, an MI doesn’t cause
disease such as atherosclerosis. The etiology in most cases is
JVD.
unknown.
14. Answer: 1. Digoxin
 Options B and C: CAD and MI are directly related to
atherosclerosis.
One of the most common signs of digoxin toxicity is the visual
disturbance known as the “green-yellow halo sign.” The other
medications aren’t associated with such an effect.
  Option D:Pericardial effusion is the escape of fluid into
the pericardial sac, a condition associated with
Pericarditis and advanced heart failure.
22. Answer: 1. Dilated
Although the cause isn’t entirely known, cardiac dilation and
heart failure may develop during the last month of pregnancy or
the first few months after birth. The condition may result from a
preexisting cardiomyopathy not apparent prior to pregnancy.
 Option B: Hypertrophic cardiomyopathy is an abnormal
symmetry of the ventricles that has an unknown
etiology but a strong familial tendency.
 Option C: Myocarditis isn’t specifically associated with
childbirth.
 Option D: Restrictive cardiomyopathy indicates
constrictive pericarditis; the underlying cause is usually
myocardial.
23. Answer: 3. Hypertrophic
In hypertrophic cardiomyopathy, hypertrophy of the ventricular
septum—not the ventricle chambers—is apparent. This
abnormality isn’t seen in other types of cardiomyopathy.
24. Answer: 1. Heart failure
Because the structure and function of the heart muscle is
affected, heart failure most commonly occurs in clients with
cardiomyopathy.
 Option C: MI results from prolonged myocardial
ischemia due to reduced blood flow through one of the
coronary arteries.
 Option D: Pericardial effusion is most predominant in
clients with pericarditis.
25. Answer: 4. Heart failure
These are the classic signs of failure.
 Option A: Pericarditis is exhibited by a feeling of
fullness in the chest and auscultation of a pericardial
friction rub.
 Option B: Hypertension is usually exhibited by
headaches, visual disturbances, and a flushed face.
 Option D: MI causes heart failure but isn’t related to
these symptoms.
26. Answer: 2. Hypertrophic
Cardiac output isn’t affected by hypertrophic cardiomyopathy
because the size of the ventricle remains relatively unchanged.
All of the rest decrease cardiac output.
27. Answer: 4. Failure of the ventricle to eject all of the blood
during systole
An S4 occurs as a result of increased resistance to ventricular
filling after atrial contraction. The increased resistance is related
to decreased compliance of the ventricle.
 Option A: A dilated aorta doesn’t cause an extra heart
sound, though it does cause a murmur.
 Option B: An S4 isn’t heard in a normally functioning
heart.
 Option C: Decreased myocardial contractility is heard as
a third heart sound.
28. Answer: 2. Beta-adrenergic blockers
By decreasing the heart rate and contractility, beta-
blockers improve myocardial filling and cardiac output, which
are primary goals in the treatment of cardiomyopathy.
 Option A: Antihypertensives aren’t usually indicated
because they would decrease cardiac output in clients
who are already hypotensive.
 Option C: Calcium channel blockers are sometimes used
for the same reasons as beta-blockers; however, they
aren’t as effective as beta-blockers and cause
increased hypotension.
 Option D: Nitrates aren’t used because of their dilating
effects, which would further compromise the
myocardium.
29. Answer: 3. Heart transplantation
The only definitive treatment for cardiomyopathy that can’t be
controlled medically is a heart transplant because the damage to
the heart muscle is irreversible.
30. Answer: 2. Stable angina
The pain of stable angina is predictable in nature, builds
gradually, and quickly reaches maximum intensity.
 Option C: Unstable angina doesn’t always need a trigger,
is more intense, and lasts longer than stable angina.
 Option D: Variant angina usually occurs at rest—not as
a result of exercise or stress.
31. Answer: 4. Unstable angina
Unstable angina progressively increases in frequency, intensity,
and duration and is related to an increased risk of MI within 3 to
18 months.
32. Answer: 4. Inadequate oxygen supply to the myocardium
Inadequate oxygen supply to the myocardium is responsible for
the pain accompanying angina.
 Option A: Increased preload would be responsible for
right-sided heart failure.
 Option B: Decreased afterload causes increased cardiac
output.
 Option C: Coronary artery spasm is responsible for
variant angina.
33. Answer: 4. 12-lead electrocardiogram (ECG)
The 12-lead ECG will indicate ischemia, showing T-wave
inversion. In addition, with variant angina, the ECG shows ST-
segment elevation.
 Option A: A chest x-ray will show heart enlargement or
signs of heart failure, but isn’t used to diagnose angina.
34. Answer: 1. Reversal of ischemia
Reversal of the ischemia is the primary goal, achieved by
reducing oxygen consumption and increasing oxygen supply.
 Option B: An infarction is permanent and can’t be
reversed.
35. Answer: 1. Sit the client down
The initial priority is to decrease the oxygen consumption; this
would be achieved by sitting the client down.
 Option B and D: After the ECG, sublingual nitro would
be administered. When the client’s condition is
stabilized, he can be returned to bed.
 Option C: An ECG can be obtained after the client is
sitting down.
36. Answer: 3. Preload, afterload, contractility, and heart
rate.
Myocardial oxygen consumption increases as preload, afterload,
renal contractility, and heart rate increase. Cerebral blood flow
doesn’t directly affect myocardial oxygen consumption.
37. Answer: 3. In high Fowler’s position
A high Fowler’s position promotes ventilation and facilitates
breathing by reducing venous return.
 Options A and B: Lying flat and side-lying positions
worsen the breathing and increase the workload of the
heart.
 Option D: Semi-Fowler’s position won’t reduce the
workload of the heart as well as the Fowler’s position
will.
38. Answer: 4. Hypocapnia
In an attempt to compensate for increased work of breathing due
to hyperventilation, carbon dioxide decreases, causing
hypocapnea. If the condition persists, CO2 retention occurs and
hypercapnia results.
39. Answer: 4. Increased BP and fluid retention
The body compensates for a decrease in cardiac output with a
rise in BP, due to the stimulation of the sympathetic NS and an
increase in blood volume as the kidneys retain sodium and water.
 Option A: Blood pressure doesn’t initially drop in
response to the compensatory mechanism of the body.
 Option B: Alteration in LOC will occur only if
the decreased cardiac output persists.
40. Answer: 1. Call for help
Production of pink, frothy sputum is a classic sign of acute
pulmonary edema. Because the client is at high risk for
decompensation, the nurse should call for help but not leave the
room. The other three interventions would immediately follow.
41. Answer: 1. Afterload
Afterload refers to the resistance on maintained by the aortic and
pulmonic valves, the condition and tone of the aorta, and the
resistance offered by the systemic and pulmonary arterioles.
 Option B: Cardiac output is the amount of blood
expelled by the heart per minute.
 Option C: Overload refers to an abundance of circulating
volume.
 Option D: Preload is the volume of blood in the ventricle
at the end of diastole.
42. Answer: 3. Left ventricle
The left ventricle is responsible for the majority of force for the
cardiac output. If the left ventricle is damaged, the output
decreases and fluid accumulates in the interstitial and alveolar
spaces, causing pulmonary edema.
 Option A: Damage to the left atrium would contribute to
heart failure but wouldn’t affect cardiac output or,
therefore, the onset of pulmonary edema.
 Options B and D: If the right atrium and right ventricle
were damaged, right-sided heart failure would result.
43. Answer: 1. Erythema marginatum, subcutaneous
nodules, and fever
Diagnosis of rheumatic fever requires that the client have either
two major Jones criteria or one minor criterion plus evidence of a
previous streptococcal infection. Major criteria include carditis,
polyarthritis, Sydenham’s chorea, subcutaneous nodules, and
erythema marginatum (transient, non pruritic macules on the
trunk or inner aspects of the upper arms or thighs). Minor
criteria include fever, arthralgia, elevated levels of acute phase
reactants, and a prolonged PR-interval on ECG.
44. Answer: 1. Activate the resuscitation team
Immediately after establishing unresponsiveness, the nurse
should activate the resuscitation team. The next step is to open
the airway using the head-tilt, chin-lift maneuver and check for
breathing (looking, listening, and feeling for no more than 10-
seconds). If the client isn’t breathing, give two slow breaths using
a bag mask or pocket mask. Next, check for signs of circulation by
palpating the carotid pulse.
45. Answer: 2. Ineffective tissue perfusion; cardiopulmonary
MI results from prolonged myocardial ischemia caused by
reduced blood flow through the coronary arteries. Therefore, the
priority nursing diagnosis for this client is Ineffective tissue
perfusion (cardiopulmonary).
 Options A, C, and D: Anxiety, acute pain, and ineffective
therapeutic regimen management are appropriate but
don’t take priority.
46. Answer: 1. Pulmonary edema
SOB, tachypnea, low BP, tachycardia, crackles, and a cough
producing pink, frothy sputum are late signs of pulmonary
edema.
47. Answer: 4. A 76-year-old client who was admitted 1 hour
ago with new-onset atrial fibrillation and is receiving
IV diltiazem (Cardizem).
The client with A-fib has the greatest potential to become
unstable and is on IV medication that requires close monitoring.
After assessing this client, the nurse should assess the client
with thrombophlebitis who is receiving a heparin infusion, and
then go to the 58-year-old client admitted 2-days ago with heart
failure (her s/s are resolving and don’t require immediate
attention). The lowest priority is the 89-year-old with end stage
right-sided heart failure, who requires time-consuming
supportive measures.
48. Answer: 1. “Report fever, anorexia, and night sweats to
the physician.”
An essential teaching point is to report signs of relapse, such
as fever, anorexia, and night sweats, to the physician.
 Option B: To prevent further endocarditis episodes,
prophylactic antibiotics are taken before and
sometimes after dental work, childbirth, or GU, GI, or
gynecologic procedures.
 Options C and D: A potassium-rich diet and daily pulse
monitoring aren’t necessary for a client with
endocarditis.
49. Answer: 3. Peptic ulcer disease
Heart failure is precipitated or exacerbated by physical or
emotional stress, dysrhythmias, infections, anemia, thyroid
disorders, pregnancy, Paget’s disease, nutritional deficiencies
(thiamine, alcoholism), pulmonary disease, and hypervolemia.
50. Answer: 2. Digoxin (Lanoxin)
Digoxin exerts a positive inotropic effect on the heart while
slowing the overall rate through a variety of
mechanisms. Digoxin is the medication of choice to treat heart
failure.
 Options A, C, and D: Diltiazem (calcium channel blocker)
and propranolol and metoprolol (beta blockers) have a
negative inotropic effect and would worsen the failing
heart.
51. Answer: 4. Extremely anxious
Pulmonary edema causes the client to be extremely agitated and
anxious. The client may complain of a sense of drowning,
suffocation, or smothering.
52. Answer: 3. Potassium level
The serum potassium level is measured in the client
receiving digoxin and furosemide. Heightened digitalis effect
leading to digoxin toxicity can occur in the client
with hypokalemia. Hypokalemia also predisposes the client to
ventricular dysrhythmias.
53. Answer: 4. Acute renal failure
The client who undergoes cardiac surgery is at risk for renal
injury from poor perfusion, hemolysis, low cardiac output, or
vasopressor medication therapy. Renal insult is signaled by
decreased urine output and increased BUN and creatinine levels.
The client may need medications such as dopamine (Intropin) to
increase renal perfusion and possibly could need peritoneal
dialysis or hemodialysis.
54. Answer: 2. Premedicate the client with an analgesic
The nurse should encourage regular use of pain medication for
the first 48 to 72 hours after cardiac surgery because analgesia
will promote rest, decrease myocardial oxygen consumption
resulting from pain, and allow better participation in activities
such as coughing, deep breathing, and ambulation.
 Options A and C will not help in tolerating ambulation.
  Option D: Removal of telemetry equipment is
contraindicated unless prescribed.
55. Answer: 1. Normal sinus rhythm
56. Answer: 4. It can develop into ventricular fibrillation at
any time.
Ventricular tachycardia is a life-threatening dysrhythmia that
results from an irritable ectopic focus that takes over as the
pacemaker for the heart.
 Option A: Client’s frequently experienced a feeling of
impending death. Ventricular tachycardia is treated
with antiarrhythmic medications or magnesium sulfate,
cardioversion (client awake), or defibrillation (loss of
consciousness).
 Option B: The low cardiac output that results can lead
quickly to cerebral and myocardial ischemia.
 Option D: Ventricular tachycardia can deteriorate into
ventricular fibrillation at any time.
57. Answer: 2. Anorexia, nausea, and visual disturbances
The first signs and symptoms of digoxin toxicity in adults include
abdominal pain, N/V, visual disturbances (blurred, yellow, or
green vision, halos around lights), bradycardia, and other
dysrhythmias.
58. Answer: 3. Variant angina
Variant angina, or Prinzmetal’s angina, is prolonged and severe
and occurs at the same time each day, most often in the morning.
 Option A: Stable angina is induced by exercise and is
relieved by rest or nitroglycerin tablets.
 Option B: Unstable angina occurs at lower and lower
levels of activity and rest, is less predictable and is often
a precursor of myocardial infarction.
59. Answer: 1. Obtaining an infusion pump for the
medication
IV nitro infusion requires an infusion pump for precise control of
the medication.
 Option B: BP monitoring would be done with a
continuous system, and more frequently than every 4
hours.
 Option C: Hourly urine outputs are not always required.
 Option D: Obtaining serum potassium levels is not
associated with nitroglycerin infusion.
60. Answer: 2. Antithrombotic action
Aspirin does have antipyretic, antiplatelet, and analgesic actions,
but the primary reason ASA is administered to the client
experiencing an MI is its antithrombotic action.
61. Answer: 4. Can perform personal self-care activities
without pain
By day 2 of hospitalization after an MI, clients are expected to be
able to perform personal care without chest pain. Day 2
hospitalization may be too soon for clients to be able to identify
risk factors for MI or begin a walking program; however, the
client may be sitting up in a chair as part of the cardiac
rehabilitation program. Severe chest pain should not be present.
62. Answer: 2. Small, easily digested meals
Recommended dietary principles in the acute phase of MI include
avoiding large meals because small, easily digested foods are
better digested foods are better tolerated. Fluids are given
according to the client’s needs, and sodium restrictions may be
prescribed, especially for clients with manifestations of heart
failure. Cholesterol restrictions may be ordered as well.
 Options A and D: Clients are not prescribed a diet of
liquids only or NPO unless their condition is very
unstable.
63. Answer: 1. Left ventricular atrophy
In older adults who are less active and do not exercise the heart
muscle, atrophy can result. Disuse or deconditioning can lead to
abnormal changes in the myocardium of the older adult. As a
result, under sudden emotional or physical stress, the left
ventricle is less able to respond to the increased demands on the
myocardial muscle.
64. Answer: A and C.
HF is a result of structural and functional abnormalities of the
heart tissue muscle. The heart muscle becomes weak and does
not adequately pump the blood out of the chambers. As a result,
blood pools in the left ventricle and backs up into the left atrium,
and eventually into the lungs. Therefore, greater amounts of
blood remain in the ventricle after contraction thereby
decreasing cardiac output. In addition, this pooling leads
to thrombus formation and ineffective tissue perfusion because
of the decrease in blood flow to the other organs and tissues of
the body. Typically, these clients have an ejection fraction of less
than 50% and poorly tolerate activity.
 Option B: Activity intolerance is related to a decrease,
not increase, in cardiac output.
 Option D: Gas exchange is impaired. However, the
decrease in cardiac output triggers compensatory
mechanisms, such as an increase in sympathetic
nervous system activity.
65. Answer: 3. Activity intolerance related to pump failure
Activity intolerance is a primary problem for clients with heart
failure and pulmonary edema. The decreased cardiac
output associated with heart failure leads to reduced oxygen
and fatigue. Clients frequently complain of dyspnea and fatigue.

 Options A, B, and D: The client could be at risk for

infection related to stasis of secretions or impaired skin
integrity related to pressure. However, these are not the
priority nursing diagnoses for the client with HF and
pulmonary edema, nor is constipation related to
immobility.

66. Answer: 3. Vasodilator

ACE inhibitors have become the vasodilators of choice in the

client with mild to severe HF. Vasodilator drugs are the only class
of drugs clearly shown to improve survival in overt heart failure.

67. Answer: 1. 5 to 10 minutes

After IV injection of furosemide, diuresis normally begins in

about 5 minutes and reaches its peak within about 30 minutes.
Medication effects last 2 to 4 hours.

68. Answer: 2. Tomato juice

Canned foods and juices, such as tomato juice, are typically high
in sodium and should be avoided on a sodium-restricted diet.

69. Answer: 2. Left ventricular enlargement

A normal apical impulse is found under over the apex of the heart
and is typically located and auscultated in the left fifth intercostal
space in the midclavicular line. An apical impulse located or
auscultated below the fifth intercostal space or lateral to the
midclavicular line may indicate left ventricular enlargement.

70. Answer: 3. Left anterior descending artery

The left anterior descending artery is the primary source of blood

for the anterior wall of the heart.

 Options A, B, and D: The circumflex artery supplies the

lateral wall, the internal mammary artery supplies the
mammary, and the right coronary artery supplies the
inferior wall of the heart.