1. A client admitted with chest pain is being evaluated for a myocardial infarction (MI). Which of the following comments made by the client would best indicate the pain is angina rather than an MI?a. The pain went away when I took a nap.b. I took nitroglycerin but the pain was not relieved.c. I was very short of breath and sweating with the pain.d. The pain started when I was watching television.

Answer: a Rationale: Anginal pain is usually relieved by rest and/or nitroglycerin. A MI is usually not relieved by nitroglycerin and often is accompanied by shortness of breath and diaphoresis. Unstable angina may occur at rest, but option a is the best indicator.

2. The nurse is checking the labora- tory results on a client suspected of having a myocardial infarction (MI).Which of the following would provide the most specific information for this diagnosis? a. low density lipids (LDLs)b. CK-MB c. AST and ALT d. C-reactive protein

Answer: b Rationale: Creatinine kinase-MB is the most specific for diagnosis of a MI; CK levels rise rapidly following the event and the MB fraction is specific to the heart muscle. LDLs identify a risk factor for coronary artery disease (CAD). AST and ALT are more specific to the liver. C-reactive protein indicates inflammation and is another screening test for CAD risk.

3. The nurse is teaching a client with angina about taking nitroglycerin (NTG) tablets. The nurse instructs the client to: a. take the tablet with a large glass of water. b. place a tablet under the tongue as soon as chest pain starts. c. call 911 if pain is not relieved after taking one pill. d. discard any tablets if produce a tingling sensation.

Answer: b Rationale: NTG should be taken as soon as pain begins and is placed sublingually. If no relief is obtained after taking three tablets, then emergency help is sought. A tingling sensation is normal.

4. A female client with coronary heart disease asks the nurse, How will I know if I am having a heart attack if the symptoms are different for women? The nurse informs the client that womens symptoms may differ in the following way:a. Women usually do not become short of breath.b. The pain is not always precipitated by activity.c. The pain is often experienced as nausea and heartburn.d. Fatigue and weakness in the lower extremities often occurs just before the chest pain.

Answer: C Rationale: Chest pain in females is often atypical; it may be silent, experienced as epigastric pain and nausea. It can occur when resting. Shortness of breath is common as well as fatigue and weakness of the shoulders and upper arms.

5. When caring for a client who has just experienced an acute myocardial infarction (MI), the nurse places highest priority on which of the following nursing diagnoses:a. Acute Pain b. Ineffective Coping: Denial c. Anxiety d. Ineffective Breathing Pattern

Answer: a Rationale: Reduction of cardiac workload is essential to protect cardiac muscle cells from further damage; relief of pain will also help to reduce anxiety and improve breathing. Denial may initially help to ease anxiety as well and is a normal coping skill in the early stage.

6. A client with coronary artery disease (CAD) is having frequent premature ventricular contractions (PVCs) and dysrhythmias. It is most important for the nurse to:a. administer prn antianxiety medications.b. maintain client on complete bed rest. c. document the ECG rhythm hourly. d. maintain patency of the intravenous line.

Answer: d Rationale: Many drugs used to treat dysrhythmias must be given intravenously; an existing line must be available in an emergency. The other options may be indicated, but bed rest is not always necessary.

7. Blood work done to identify risk factors for coronary heart disease reveals a client has elevated cholesterol and low-density lipid (LDL) levels. The nurse should make the following suggestions for changes in dietary habits: a. Switch from whole milk to skim milk. b. Eliminate all red meat from the diet. c. Eliminate all simple sugars from the diet. d. Avoid eating eggs or any foods prepared with eggs.

Answer: A Rationale: This offers a realistic option and reduces saturated fat, which contributes to cholesterol and lipid production. Total abstinence from meat is not necessary; the total intake of cholesterol should be less than 25% to 30% of total daily calories. Simple sugars contribute to elevation of triglyceride levels. It is recommended to restrict eggs to two per week.

8. A client is started on statin therapy for reduction of high cholesterol. When the client ask why he needs to have blood work done routinely to monitor his liver functions, the nurse explains:a. The drugs have been known to cause hepatitis in some people.b. All drugs are metabolized in the liver and it is just a safe practice.c. The drugs inhibit cholesterol synthesis in the liver and may produce harmful effects.d. It helps to monitor the response of the drug.

Answer: c Rationale: Because they affect a chemical pathway in the liver, damage can occur to liver cells, which is reflected by abnormal liver function tests.

9. A client with a complete heart block receives a permanent pacemaker. Which of the following discharge instructions should be given by the nurse?a. Donot f ly on commercial airplanes as long as you have the pacemaker.b. You will be taught to take your pulse, and should check it daily when you get home.c. Do not use a microwave to cook your food even if you stand 10 feet from the oven.d. Do not use your right arm for six weeks to avoid injury to the pace- maker incision.

Answer: b Rationale: It is important to monitor the pulse and report a pulse rate greater or lesser than five beats of the preset pulse. Airplane flights are not restricted. Microwaves may be used as long as proper distance is maintained. Restriction of movement is only for 24 hours.

10. A 78-year-old client is admitted with a diagnosis of left-sided congestive heart failure. When assessing the client, what signs and symptoms can the nurse expect to find? a. peripheral dependent edema and bradycardia b. signs of f luid volume deficit, hypokalemia, and hypernatremia c. dyspnea, orthopnea, and cough d. enlarged liver, venous congestion, and distended neck veins

Answer: c Rationale: Manifestations of left-sided heart failure are the result of pulmonary congestion and decreased cardiac output. Impaired left ventricular emptying causes a backup of fluids in the pulmonary vascular system. Peripheral edema, liver congestion, and distended neck veins are seen with right-sided failure. Signs of fluid volume excess, not deficit, would be seen.

11. The nurse is teaching a client recently started on digitalis preparation the signs and symptoms of toxicity. The client is instructed to notify the physician if he experiences: a. vision disturbances, abdominal cramps, and pulse above 80. b. anorexia, nausea, malaise, and blurred vision. c. anorexia, anxiety, and pulse rate below 70. d. loss of night vision, anxiety, and leg cramps.

Answer: b Rationale: Signs and symptoms of digoxin toxicity include palpitations, abdominal pain, anorexia, nausea, weakness, irregular heart rate and/or slow heart rate, and blurred, colored, or double vision.

12. A client has been treated with a cardiac glycoside and diuretics for congestive heart failure (CHF). The nurse determines the treatment has been successful when the client experiences: a. weight loss.b. an increase in energy level. c. clear lung sounds. d. improved level of consciousness.

Answer: c Rationale: Successful treatment of CHF is indicated by absence of the symptoms of pulmonary congestion. Weight loss, increased energy, and improved mental state may occur without improvement of the CHF.

13. When performing a circulatory system assessment, the nurse suspects the client has a total arterial occlusion based on the following findings:a. Extremity suddenly became white, cold, and painful.b. Client complained of absence of sensa- tion or ability to move the extremity.c. Client complained of pain and numbness in the extremity.d. Extremity became deep red and cool to touch.

Answer: b Rationale: The sudden onset of symptoms with coldness, pallor, and pain suggest an arterial thrombus or emboli. The other options describe signs and symptoms of impaired blood flow or neurovascular function.

14. A client is being sent home with a 24-hour Holter monitor device. The nurse instructs the client to: a. change the chest electrodes every 4 hours. b. record any unusual symptoms you may experience. c. remove the Holter monitor when sleeping. d. avoid drinking any alcoholic beverages.

Answer: b Rationale: Activity and unusual symptoms should be recorded in order to provide a record to correlate with the ECG tracings. Electrodes are only changed if needed. The monitor is kept on the entire 24 hours. Food and beverage restrictions are not indicated.

15. A client tells the nurse his recent blood work indicated his high density lipids (HDLs) were 40 mg/dL and asks if this is a good level? The nurse should respond:a. You should ask your primary care provider to explain the results.b. That is a good level. You must be eating healthy.c. It is desirable to have a level above 60 mg/dL.d. HDLs should be lower than your cholesterol level.

Answer: c Rationale: This provides the most accurate statement. HDL levels are generally lower than the total cholesterol level, but option d does not provide the best answer. Deferring to the primary care provider does not answer the clients question, although client should be encouraged to discuss the results of the entire lipid profile.

16. A client with chest pain is seen in the emergency department and is scheduled for blood work to check his heart damage. The nurse anticipates which of the following laboratory studies will be ordered?a. creantine kinase (CK) b. cardiac muscle troponin c. B-naturetic peptide (BNP) d. atrial nuturetic factor (ANF)

Answer: b Rationale: Cardiac muscle troponin is a sensitive indicator of heart muscle damage. CK is more general, found in both cardiac and skeletal muscle. ANF and BNP are more indicative of heart failure.

17. The nurse is performing a cardiovascular assessment on an elderly client. Which of the following findings should be reported to the charge nurse? a. presence of bruising on upper extremities b. sparse hair growth on lower extremities c. weak, thready, irregular pulse d. thin, pale facial hair

Answer: c Rationale: It is not unusual for the elderly to have irregular beats, but the pulse should not be weak and thready. The other findings are normal for an elderly client.

18. A client being seen in the outpatient clinic has had a radionuclear scan of the heart. Upon discharge the client should be instructed to: a. increase fluid intake to 2000 mL in 24 hours. b. avoid close physical contact with others for 24 hours. c. return in 24 hours for follow up x-rays. d. dispose of urine in specially provided containers.

Answer: a Rationale: Fluids are encouraged in order to promote excretion of the radioactive dye from the kidneys and body, thereby reducing contrast-induced renal failure. The amount of radioactive substance is very small and special exposure precautions are not needed. Follow-up x-rays are not done.

19. A client has returned to the nursing unit following a transesophageal echocardiogram (TEE). Nursing responsibilities include: a. keeping client sedated for the remainder of the shift. b. removing chest electrodes and checking for skin irritation. c. checking for return of a gag reflex. d. encouraging client to drink 8 ounces of water every hour.

Answer: c Rationale: Since the client is sedated during the procedure, presence of a gag reflex must be determined prior to resuming fluid or food intake. Further sedation is not necessary. A transducer is mounted endoscopically in the esophagus; electrodes are not applied.

20. The nurse instructs the client scheduled to have blood drawn for a C-reactive protein level to do which of the following prior to the test?a. Fast for 8 hours prior to the test. b. No special fasting or preparation is required. c. Restrict intake of caffeine containing products 24 hours prior to the test. d. Hold any cardiac medication for 24 hours prior to the test.

Answer: b Rationale: No special preparation is necessary.