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94 Cardiac Nursing Questions

Jon Haws RN CCRN

Sandra Haws RD CNSC

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Contents
94 Cardiac Nursing Questions .......................................................................................................................... 1
Free Gift: 63 Must Know Lab Values: ............................................................................................................ 5
Using This Book ..................................................................................................................................................... 6
Management of Care ............................................................................................................................................ 7
Safety and Infection Control .......................................................................................................................... 44
Health Promotion and Maintenance ........................................................................................................... 67
Psychosocial Integrity ...................................................................................................................................... 88
Basic Care and Comfort ................................................................................................................................. 109
Pharmacological and Parenteral Therapies .......................................................................................... 129
Reduction of Risk Potential .......................................................................................................................... 160
Physiological Adaptation .............................................................................................................................. 179
Other Resources From NRSNG.com | NursingStudentBooks.com ................................................ 203
We provide the following resources:
Nursing Education Books
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 About the Authors
Sick of spending hours and hours trying to find all
the information you need for clinical and NCLEX®
study? So was I . . . . That’s why I created
NRSNG.com, a community of nurses and nursing
students wanting to jump start their careers.

I am a registered nurse and CCRN on a

Neurovascular Intensive Care Unit at a Level I
Trauma Hospital. I attended college at Brigham
Young University and later received my Nursing
degree from Methodist College in Peoria, IL. I also
hold a Business Management degree from Touro
University.

Professionally, I precept nursing students and new graduate Registered Nurses . . . and love it!
Come visit us at NRSNG.com or check in on Facebook.com/NRSNG.

Sandra is a dietitian with one of the largest health

care systems in the United States. She works with
intensive care patients. She obtained her
undergraduate degree from Brigham Young
University and her graduate degree from Texas
Woman's University. She holds advanced
certifications in nutrition support management.
 Your Free Gift!
As a way of saying thanks for your purchase, I'm offering a free PDF download:

“63 Must Know NCLEX® Labs”.

With these charts you will be able to take the 63 most important labs with you anywhere
you go!

You can download the 4 page PDF document by clicking here, or going to
NRSNG.com/labs
Using This Book:

This book contains 94 NCLEX® style questions over the cardiac nursing care including "select all that
apply". You can find more books from NRSNG.com and Jon Haws RN CCRN at
NursingStudentBooks.com. The questions are divided into NCLEX® core content areas including:

 Basic Care and Comfort

 Health Promotion and Maintenance
 Management of Care
 Pharmacological and Parenteral Therapies
 Physiological Adaptation
 Psychosocial Integrity
 Reduction of Risk Potential
 Safety and Infection Control

The exam is divided into these eight core content areas with the majority of the questions (17-23%)
coming from Management of Care content. The other two highly tested areas include; Pharmacological
and Parenteral Therapies and Physiological Adaptation both covering (12-18%) of the exam. The other 5
areas of the test cover anywhere from 5-15% of the test plan.

This book is divided into eight sections each covering one of the core content areas with appropriate
percentages of questions coming from each section to match the actual test plan.

After each question there are detailed rationales.

If you have questions regarding one of the questions in this book or general questions about nursing
and NRSNG.com or SIMCLEX.com please contact us at:

contact@NRSNG.com
Management of Care
1. A patient with heart failure wants to designate a power of attorney for his health
care. Which of the following persons cannot be designated to act as the power of
attorney?
a. The patient’s sister
b. The patient’s son
c. The patient’s physician
d. The patient’s cousin
C – A power of attorney is a type of advance directive enacted by a patient that selects
another person to make healthcare decisions on the patient’s behalf. The power of attorney
can be the patient’s relative or a close friend; however there are some people who are not
able to be the patient’s power of attorney, such as the patient’s physician or a
representative of the healthcare provider caring for the patient.
2. A 67-year-old patient with heart disease must have a cardiac stress test to assess
heart valve function. Besides a physician, which of the following healthcare staff
members may perform the stress test on this patient? Select all that apply.
a. Registered nurse
b. Physical therapist
c. Diagnostic medical sonographer
d. Occupational therapist
e. Exercise physiologist
A, B, E – The American Heart Association has determined that there are specific people
beyond physicians who may perform cardiac stress tests during cardiac rehabilitation. The
physician may delegate these tasks to certain members of the interdisciplinary team,
including exercise physiologists, physical therapists, and registered nurses.
3. A nurse is employed working in a busy cardiac unit, caring for patients recovering
from cardiac surgery. In order to best prioritize her time, which element should the
nurse make as part of her work routine in order to best organize her time? Select all
that apply.
a. Review the physician’s orders for the patient at the beginning of the shift
b. Gather equipment as needed throughout the shift
c. Plan work tasks around break times
d. Avoid taking breaks during highly stressful shifts
e. Organize information for report ahead of time
A, C, E – Nurses work shifts that can be extremely busy; in order to best prioritize time, the
nurse should perform certain functions to make the best use of her time. This includes such
activities as reviewing the physician’s orders right away at the beginning of the shift rather
than waiting to look them up later, planning work tasks around break times in order to
complete tasks in time to still take breaks, and organizing information for report ahead of
time instead of scrambling for the information at the last minute.
4. A 56-year-old male patient has been admitted to the cardiac unit with exacerbation
of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased
cardiac output related to heart failure, as evidenced by a poor ejection fraction,
weakness, edema, and decreased urinary output. Which of the following nursing
interventions are most appropriate in this situation?
a. Administer IV fluid boluses to increase urinary output
b. Increase activity by encouraging ambulation
c. Administer stool softeners as ordered
d. Maintain the patient in the Trendelenburg position while in bed
C – When a patient has a nursing diagnosis of decreased cardiac output, the nurse should
avoid any activities that would put undue stress on the patient’s heart. In this situation, the
nurse can administer stool softeners so that the patient does not have to strain to have a
bowel movement, which would place less stress on his heart.
5. A patient has been admitted for a cardiac catheterization following a myocardial
infarction. Upon admission to the hospital unit, the nurse reviews the patient’s
rights and responsibilities with him. Which of the following would be considered a
patient right upon hospital admission?
a. The right to receive information about the cost of the cardiac catheterization
procedure
b. The right to have a private room and to be left alone
c. The right to receive courtesy and respect from all healthcare workers
d. The right to have the patient’s room cleaned on a daily basis
A –All patients who are admitted to healthcare centers have certain rights associated with
their treatments, as well as responsibilities while participating in their own care. In this
situation, the patient has a right to know information about the cardiac catheterization,
including what will occur during the procedure, as well as how much it will cost and how
the procedure will be billed.
6. The interdisciplinary team at a cardiac rehabilitation center consists of the
physician, the program coordinator, who is a registered nurse; a registered dietitian,
an occupational therapist, a pharmacist, and an exercise physiologist. Which best
describes the role of the program coordinator?
a. Analyzing and improving the cardiovascular function of the patient
b. Providing education to the patient and family about cardiac rehabilitation services
c. Performing nutritional assessments and advising on diet-related concerns
d. Assisting the client with being able to perform his normal activities of daily living
B – The program coordinator of a cardiac rehabilitation center has a busy role of organizing
tasks and activities for the patient to recover from heart disease. Part of the responsibilities
of the cardiac rehabilitation coordinator are to provide education to the patient and his
family about the services available and the expectations of the patient while he is in
rehabilitation.
7. A nurse is caring for an 81-year-old patient with end-stage cardiac disease who has
a do-not-resuscitate order in place. The patient has been in the hospital for over a
week and has had multiple nurses scheduled to care for him during his
hospitalization. Which of the following examples best describes intergroup conflict
in this situation?
a. A nurse who regularly cares for the patient feels guilty that she goes home to her
family every night when she sees the patient alone
b. A nurse who is coming off of the shift disagrees with the new nurse taking over
about when to administer the patient’s medications
c. The members of the quality control council do not agree on whether they should
audit the patient’s chart
d. The nurses on the unit with the patient disagree with the respiratory therapy
department about what procedures the patient can have
D – There are various forms of conflict that develop between different groups, as well as
conflict that develops within the nurse. An intergroup conflict takes place when two
different groups disagree on a situation such that a conflict exists. In this case, the two
groups are the nursing staff and the respiratory therapy staff disagreeing about
appropriate patient procedures.
8. Which of the following situations best describes a breach of duty to act?
a. The patient was harmed as a result of the nurse’s negligence
b. The nurse did not act appropriately or failed to act at all to care for the patient
c. The nurse did not ask for consent before starting a procedure
d. The patient feels that his protected health information was violated
B – A nurse has many moral responsibilities to uphold when providing patient care; when
the nurse does not provide proper care when she is supposed to, as is her duty, she has
committed a breach of duty to act. This occurs when the nurse does not act appropriately to
respond to a situation, or she fails to respond at all to a situation that would otherwise
require her service.
9. When discussing teamwork in the cardiac OR, which definition best describes
collective efficacy on the part of team members?
a. A commitment of team members to working together with the same team each time
b. A sense a competence on the part of the entire group
c. The belief that everyone has a special role to play
d. Acknowledgment that some members of the team, such as the surgeons or
anesthesiologists, play more important roles than others
B – Surgical teams often work together to effectively help patients through surgical
procedures. When a team has worked together on multiple cases, team members start to
recognize each other’s roles and the process goes smoothly. Collective efficacy describes a
situation in which team members feel confident about their duties to provide patient care
and their abilities to work together to be effective.
10. A 71-year-old patient is undergoing coronary artery bypass grafting for coronary
artery disease. The surgical team who is caring for the patient has all worked
together before for a number of different cardiac surgeries. Each team member
understands and recognizes the roles, responsibilities, and strengths of the other
team members so that everyone does their part to provide accurate and consistent
patient care during the procedure. This understanding of the members of the
surgical group is called:
a. cognition.
b. conflict resolution.
c. coordination.
d. communicability.
A – Cognition, when defined in terms of a group working together on a team, is described as
an understanding of each team member’s roles and responsibilities within the team. In this
case, cognition asserts that team members each understand their part when providing
surgical care for the patient undergoing a CABG procedure.
11. A physician has written the following in a cardiac patient’s progress notes: “72-year-
old female with ASO, c/o chest pain and dizziness and has cool, pale extremities.”
According to this note, the abbreviation “ASO” best describes which condition?
a. Acute sinus obfuscation
b. Arteriosclerosis obliterans
c. Antero-sternal order
d. Atrial septal occlusion
B – In this order, the term “ASO” refers to arteriosclerosis obliterans, a type of cardiac
condition that most commonly affects the great vessels near the heart and the vessels in the
extremities. ASO occurs when blood vessels are blocked, which reduces blood flow and
causes such symptoms as dizziness, chest pain; and pale, cool extremities.
12. The term cineangiography refers to:
a. use of a blood vessel from another site in the body to replace a diseased vessel.
b. evaluation of heart function by using sound waves.
c. a record of the heart’s electrical activity.
d. the process of taking pictures as dye moves through blood vessels.
D – Cineangiography is a radiographic technique that allows the practitioner to view the
blood vessels. The procedure involves injecting dye into circulation and then taking
multiple pictures as the dye moves through the blood vessels.
13. A patient is seen in the emergency department for evaluation and treatment of chest
pain. After examining the patient and stabilizing him, the physician decides that the
patient would benefit from being admitted to the clinical decision unit . Which best
describes the purpose of a clinical decision unit in the hospital?
a. An area where a patient can be observed instead of being discharged or admitted to
the hospital
b. A unit where a patient goes after being an inpatient but before he is discharged to
home
c. A form of rehabilitation in which a patient prepares for long-term care
d. A unit where family and friends can visit and the patient continues to receive care
before being admitted to the hospital
A – The clinical decision unit is an area of the healthcare center where a patient may be
admitted for a time for observation. A patient may be taken to the clinical decision unit if he
is not yet ready to be discharged or if it is unclear whether he should be admitted as an
inpatient. In this case, the patient may be observed for a time in the clinical decision unit to
determine if his chest pain worsens and he needs to be admitted to the hospital.
14. A nurse is caring for a 65-year-old patient who is undergoing angiography to assess
the state of his coronary vessels. The nurse has ensured that the patient signed the
consent and that he has been NPO for the past 8 hours. Which of the following
actions should the nurse do next before the start of the procedure?
a. Assess the groin site
b. Ask the patient if he is having chest pain
c. Administer methylprednisolone
d. Administer an infusion of albumin
C – Prior to starting angiography, the nurse may administer a corticosteroid to the patient
to prevent a reaction from the procedure. Since dye is administered into circulation to view
the blood vessels, there is a chance that the patient would have a reaction to the dye.
Corticosteroids reduce inflammation that can also occur during the procedure as a reaction
to the process.
15. An 85-year-old patient who has had an implantable cardioverter defibrillator (ICD)
for 15 years has requested that it be deactivated. Which of the following situations is
an indication for ICD deactivation?
a. Prolonged QT syndrome
b. Atrial fibrillation with sinus node dysfunction
c. Transcutaneous pacing
d. Cardiomyopathy
C – Deactivation of an ICD is an ethical decision that must be considered carefully before
proceeding. If a patient wants to have a pacemaker deactivated, he or she is choosing to no
longer control and pace the heart rate so that it stays within normal limits. Indications for
deactivation include such situations as end-of-life care, if the patient receives inappropriate
shocks; or during resuscitation, such as during transcutaneous pacing.
16. A nurse is caring for a patient who has just returned from a cardiac catheterization
procedure. The nurse notes that the patient has developed a hematoma at the
catheter site because the post-op nurse did not provide appropriate pressure. The
nurse feels that she should report the situation. Which activity listed would best
support the nurse’s sense of moral courage in this situation?
a. Fearing that the other nurse would be disciplined for not doing her job
b. Determining whether it is important enough that the nurse mention the situation
c. Exploring other alternatives for treatment of the hematoma
d. Taking deep breaths to control her anger about the situation
B – Moral courage describes the willingness to speak up about a situation, even if
circumstances are dictated otherwise. In this situation, the nurse who wants to speak up
about inappropriate patient care should first determine whether the situation warrants
reporting. If she decides that it does, then the nurse would take further steps of action.
17. A nurse wants to do research on the nursing care provided to patients admitted to
her unit with myocardial infarction. What would be the first step the nurse should
consider as part of conducting research in this situation?
a. Study the statistics of care measures for other cardiac conditions
b. Conduct a small experiment to determine how myocardial infarction patients differ
from patients with other cardiac conditions
c. Explore what knowledge already exists about the situation
d. Perform observations of nursing care among the staff in the unit
C – Conducting research is a process that involves several steps of gathering information
for analysis and comparison. Before starting the process of researching a certain situation,
the nurse should first determine what knowledge already exists about the topic. If there
have been multiple research studies already completed on the topic, it may be better to
read research and make changes according to evidence-based practice, rather than trying
to perform another research study.
18. Which best describes the difference between evidence-based research and
performance improvement?
a. Research is involved with improving patient care, while performance improvement
seeks new knowledge
b. Performance improvement is based on the current research design, while research
utilizes whoever is available at the time
c. Research has a specific scope for practice and sharing of results, while performance
improvement is broad and its results are shared widely
d. Performance improvement typically does not require informed consent or
institutional review board consent, while a research process does
D – Evidence-based research involves getting answers to questions about a particular topic
after conducting an investigation based on evidence available. Performance improvement
seeks to improve productivity within a particular area. While the two are related subjects,
they differ in that when a nurse conducts performance improvement measures, she
typically does not need consent from those involved; however, conducting research
requires consent on the part of the participants and review from an IRB.
Safety and Infection Control
19. A patient who has hypertension asks the nurse about what non-prescription
medications he can take for seasonal allergies. Which response from the nurse is
correct?
a. “You will need to use herbal remedies for allergies, since you cannot take any over-
the-counter medications with your blood pressure.”
b. “You should call and check about the type of medication you want to take before
buying it.”
c. “It is safe for you to take allergy medicine with your condition; you have no
limitations in that area.”
d. “You should only take prescription allergy medication and never over-the-counter
drugs for allergies.”
B – Seasonal allergies—the itching, watery eyes and stuffy nose accompanied by exposure
to environmental irritants—may be worsened if a patient takes certain types of
medications. A patient with seasonal allergies may experience worsening of symptoms
with medications such as acetaminophen, certain antibiotics, decongestants, and some
herbal supplements. The nurse should advise the patient to check about a specific
medication before taking it.
20. A 68-year-old patient is undergoing an ECG; the nurse notes that the patient has
prolonged P-R intervals and widening of the QRS complex. On further analysis, the
nurse notes that the patient’s potassium level is 6.5 mEq/L. Which of the following
interventions is most appropriate?
a. Administer a dose of calcium gluconate as ordered
b. Place the patient supine and administer 100 percent oxygen via face mask
c. Administer sodium bicarbonate as ordered
d. Continue to monitor and recheck the potassium level in 1 hour
A – Hyperkalemia is a condition in which there is an excess of potassium. Too much
potassium could cause life-threatening cardiac changes, as would be seen on an ECG.
Calcium gluconate is sometimes administered for severe hyperkalemia to antagonize the
cardiac effects of the potassium.
21. A nurse is working on a team performing CPR on a patient code in the hospital. The
nurse sets up the monitor and notes that the patient has a pulseless electrical
activity (PEA) rhythm. The physician tells the nurse to set up for a shock. Which
response from the nurse is correct?
a. Set up and prepare to deliver the shock as the doctor ordered
b. Administer atropine before giving the shock
c. Continue to provide bag-mask ventilation and prepare for cardioversion instead
d. Clarify with the physician about the patient’s heart rhythm before giving the shock
D – Pulseless electrical activity (PEA) is considered a non-shockable rhythm and the patient
does not produce enough cardiac activity to produce a pulse. The team should not
administer a shock to the patient, as it will not help the situation. The nurse should clarify
with the physician first before proceeding instead of delivering the shock.
22. A nurse is caring for a patient following his cardiac surgery when the patient
develops acute chest pain. He describes the pain as “tearing” across his chest and his
blood pressure has dropped from 118/80 mmHg to 82/58 mmHg. Which
intervention is most appropriate in this situation?
a. Administer metoprolol and prepare the patient for surgery
b. Begin providing breathing assistance with bag-mask ventilation
c. Call the physician and ask for an order for morphine
d. Increase the IV and administer adenosine
A – The patient in this situation is most likely suffering an aortic dissection, which is a
medical emergency in which a part of the aorta tears, causing excess bleeding. The patient
can quickly bleed to death. The condition causes acute chest pain that is described as
“tearing” or “ripping.” In this case, the nurse should give medication to help the patient’s
blood pressure and quickly prepare him for surgery.
23. Which best describes in-stent restenosis following stent placement?
a. A significant rise in blood pressure as a result of stent blockage to essential organs
b. The overgrowth of tissue in a stent the causes a blockage in the artery
c. A loss of blood flow because of failure of the cardiac stent
d. An increase in left atrial pressure due to backup of fluid and blood in the pulmonary
system
B – When a patient has a procedure to place a stent in a blocked artery as part of treatment
for atherosclerosis, in-stent restenosis could develop at the site. In-stent restenosis occurs
when an overgrowth of tissue surrounds the stent and results in a blockage of the vessel.
The treatment typically requires cardiac catheterization for correction.
24. A nurse who is caring for a patient on the cardiac unit gets the following order from
a physician: “Paxil 75mg po daily.” The nurse knows that the patient does not have a
history of depression, but he does have a clotting disorder and has been taking
Plavix at home. Which of the following interventions should the nurse perform?
a. Check with the pharmacy to verify that the dose of Paxil is correct
b. Contact the physician and ask if he meant Paxil or Plavix
c. Ask the patient if he has some Plavix that he could take from his home medications
d. Contact the charge nurse and file an incident report
B – Occasionally, drug names may be confused because of similar sounding names. If a
physician writes down an incorrect name of a drug or confuses two names of drugs with an
order, the nurse should first clarify the drug before administering it to the patient.
25. Which of the following best describes an action a patient can take to uphold his own
safety in the hospital?
a. Recognize that the nurse is overworked and avoid asking for anything beyond
normal care
b. Stay informed about the laws of nursing licensure and professional conduct
c. Participate by contacting the pharmacy ahead of time with potential prescriptions
that will be ordered at dismissal
d. Be proactive and become informed about his current health condition and potential
treatments available
D – A patient in the hospital is at risk of injury from various activities, simply because of
health issues or following surgery. The patient can take steps to protect himself from injury
while in the hospital by staying informed about his treatments and his current health
condition so that if anything changes, he will be aware of it.
26. A cardiac patient is recovering from anesthesia following open heart surgery. The
patient uses a CPAP machine at home while he sleeps at night. Following surgery,
the patient has several periods of apnea because he is not using CPAP. The nurse
contacts respiratory therapy but there are no CPAP machines available to use.
Which action should the nurse perform next?
a. Assist the patient to a sitting position and provide 100 percent oxgyen by facial
mask
b. Turn the patient on his side and work to keep him awake
c. Administer a dose of IV caffeine to reduce episodes of apnea and to prevent the
patient from falling asleep
d. Contact the physician and ask if the patient can use his CPAP machine from home
D – Some patients need to use CPAP while sleeping to prevent breathing disruptions from
diagnosed sleep apnea. When CPAP is not available for use by the hospital respiratory
department, the patient could bring his own CPAP machine to use while in the hospital as
long as it is approved. In this case, it is better that the patient uses his CPAP rather than
going without, as sleep apnea could cause more complications following surgery.
27. A patient is admitted to the hospital for observation following repeated attacks of
angina. While in the hospital, the patient asks the nurse if he can bring in his own
coffee pot to have in the room. Which of the following responses from the nurse is
correct?
a. “I’m sorry, you cannot drink coffee because of your condition.”
b. “I’m sorry, you cannot bring in your own coffeemaker; you’ll have to wait until you
get home.”
c. “Sure, bring in your coffeemaker and I will have maintenance check it.”
d. “Sure, you can have your spouse bring it in and we’ll plug it in over there.”
B – There may be times when a patient wants to bring an electrical item from home to use
while at the hospital. Some items can be checked by the engineering department for safety
of use, particularly if the patient needs it as part of his care, such as with a CPAP machine.
In this case, a coffee pot is not necessary for patient care and is not an essential item. The
patient should be told to leave it at home.
28. A nurse is caring for a patient who is recovering from cardiac surgery and who has
developed mediastinitis as a surgical-site infection. Which of the following factors
would most likely increase the risk of this type of surgical-site infection? Select all
that apply.
a. Obesity
b. Hypotension
c. History of breast cancer
d. Long hospitalization prior to the procedure
e. Diabetes diagnosis
A, D, E – A surgical-site infection is a complication that develops following surgery when
the incision site becomes infected. Surgical-site infections cause complications and
increased disability when they occur after surgery. Mediastinitis develops as a surgical site
infection following cardiac surgery in the mediastinal cavity below the sternum. Several
risk factors increase the chance of this condition developing, including obesity in the
patient, a long hospitalization prior to the procedure, and a patient with a history of
diabetes.
29. A nurse is caring for a 49-year-old patient who is recovering from valve replacement
surgery. Three days after the surgery, the nurse suspects that the patient has
developed infective endocarditis. Which of the following signs or symptoms would
indicate that this condition has developed in the patient?
a. Low-grade fever, splinter hemorrhages
b. A red, beefy tongue and difficulty swallowing
c. A slapped-cheek appearance and profuse sweating
d. Nausea, vomiting, and diarrhea causing electrolyte imbalances
A – Infective endocarditis is a serious infection of bacteria or fungi that affects the heart
valves and surrounding structures. The patient may develop weight loss, fever, a cardiac
murmur, splenomegaly, and skin changes. The characteristic skin changes associated with
infective endocarditis are generalized rashes and small hemorrhages in the nail beds,
known as splinter hemorrhages.
Health Promotion and Maintenance
30. A nurse is caring for a 3-year-old patient who is recovering from heart surgery.
Which of the following best describes deep hypothermic circulatory arrest (DHCA)?
a. A systemic inflammatory response as a result of too cold of body temperature
b. The process of shivering in order to warm the body after becoming too cold during
surgery
c. The process of cooling the body to stop blood circulation during surgery
d. The slowing of muscle activity after administration of certain anesthetics that
causes a profound drop in temperature
C – Deep hypothermic circulatory arrest is the process of cooling the body during a surgical
procedure to the point that blood flow stops. This allows the surgeon to work in an area
that would otherwise be obstructed by blood flow. DHCA is a safe procedure that is used in
many surgeries; the patient’s body is warmed after the procedure to restore blood flow to
normal before going to recovery.
31. A nurse is performing an initial assessment on a 35-year-old patient with heart
disease. The nurse hears a systolic click, which sounds like a high-pitched sound
during the late part of systole. The systolic click heard on auscultation most likely
indicates:
a. a normal heart sound.
b. increased blood flow through the heart chambers.
c. mitral valve prolapse.
d. pulmonary hypertension.
C – When auscultating heart sounds, the nurse may hear a variety of different sounds; some
are normal parts of the heart’s anatomy, while others indicate an abnormality. A systolic
click is a high-pitched sound that is heard at the late part of systole. When this sound is
heard, it can indicate mitral valve prolapse, causing abnormal blood flow through the heart.
32. A baby is born at full term and is taken to the NICU for further observation for
potential cardiac issues. After diagnostic testing, the physician determines that the
infant has tetralogy of Fallot. The four components of this condition include a
ventricular septal defect (VSD), overriding aorta, right ventricular hypertrophy, and:
a. atrial septal defect (ASD).
b. patent foramen ovale (PFO)
c. pulmonary stenosis.
d. patent ductus arteriosus.
C – Tetralogy of Fallot is a serious cardiac condition that develops before birth. It consists
of four conditions that affect the heart; when combined, these abnormalities cause
decreased oxygenation and poor blood flow and the condition must be surgically corrected.
Tetralogy of Fallot consists of a VSD, overriding aorta, ventricular hypertrophy, and
pulmonary stenosis.
33. A nurse is caring for a pregnant patient who is at 28 weeks’ gestation. Which of the
following changes in cardiac output would the nurse expect to see in a patient of this
gestation?
a. A decrease in heart rate that causes a drop in overall blood pressure
b. A decrease in cardiac output that will slowly increase until the time of labor
c. An increase in heart rate and increase in cardiac contractility
d. An increase in heart rate and decreased peripheral vasodilation
C – With a growing fetus, a mother’s circulation changes and cardiac output increases
overall. The mother’s heart pumps more blood and the volume of circulation increases to
accommodate the baby. At 28 weeks’ gestation, the mother would most likely demonstrate
an increase in heart rate and an increase in cardiac contractility.
34. A 44-year-old patient is recovering in the hospital following a myocardial infarction.
The patient asks the nurse if he can participate in cardiac rehabilitation. How does
the nurse explain what it is?
a. “Cardiac rehabilitation is designed for people over the age of 60 who need more
support after a heart attack.”
b. “Cardiac rehabilitation can help you to improve your activity levels and exercise
tolerance after you have had a heart attack.”
c. “Cardiac rehabilitation is designed to teach you what to do if you have a heart attack
again.”
d. “Cardiac rehabilitation is only for people who were born with congenital heart
disease.”
B – Cardiac rehabilitation is available for patients with many different types of cardiac
conditions, including following treatment of an MI. Cardiac rehabilitation helps to
strengthen the patient’s heart by increasing exercise tolerance. The system also works with
the patient regarding other issues that may occur following treatment of heart disease,
such as counseling for dietary problems, help with stress levels, and care of psychosocial
issues.
35. A 66-year-old patient has been in the hospital for care and management of heart
failure. The patient has been given orders for discharge and the nurse is reviewing
dismissal instructions with him. Which of the following information would be
included as part of discharge information for this patient?
a. The patient should not have more than 3 alcoholic beverages per day
b. The patient should take non-steroidal anti-inflammatory drugs (NSAIDs) for pain
control and not acetaminophen
c. The patient should restrict his fluid intake to less than 4,000 mL per day
d. The patient should not eat more than 2,000 mg of sodium each day
D – Heart failure can cause an increase in fluid in the circulatory system, which is a reason
the condition used to be referred to as congestive heart failure. Excess sodium intake can
cause changes in circulatory volume, potentially increasing fluid and contributing to
buildup. Many patients with heart failure are restricted in their dietary sodium to 2,000 mg
a day, although in some cases, the physician may allow for more or less, depending on the
patient’s condition.
36. A 28-year-old patient without any history of heart disease asks the nurse if he
should have his cholesterol checked and at what schedule it should be monitored.
Which answer from the nurse is correct?
a. “You do not need to have your cholesterol checked until you are 40 since you are not
at high risk.”
b. “You should have it checked now and then again every 4 to 6 years since you are not
at high risk.”
c. “Once you turn 30, you should have your cholesterol checked with each physical
exam.”
d. “You will need to have it checked now and again every 6 months.”
B – The American Heart Association has given recommendations for when and how often
patients should be screened for certain types of heart disease. Because high cholesterol
levels contribute to atherosclerosis, a patient should be checked periodically to ensure that
his cholesterol levels remain within normal limits. A patient without a history of heart
disease or cholesterol problems should have his cholesterol checked starting at age 20 and
then again every 4 to 6 years after.
37. A nurse is talking with a patient who is a smoker; the nurse wants to provide some
information to the patient about quitting smoking for his health. Which situation
would describe the patient as being in the pre-contemplation phase of change?
a. The patient has no plans to quit smoking
b. The patient has tried to quit several times but cannot
c. The patient has thought about quitting but has not tried to
d. The patient is planning to quit starting next week
A – The phases of change, such as when a person wants to make a change in lifestyle habits,
go through a series that starts with no desire or thought to change all the way to making
the change and following through with it. In the pre-contemplation phase of change, the
patient has not yet thought about quitting smoking and may not have any desire to do so.
With time and further teaching, the patient may move forward in the stages of change and
make plans to quit.
38. A nurse is performing a focused cardiac assessment on a patient with heart disease.
The nurse notes that the patient’s heart is beating in a regular rhythm; his cardiac
conduction system appears to be working correctly upon auscultation. The heart’s
ability to keep a pace using its own electrical activity is known as:
a. contractility.
b. irritability.
c. automaticity.
d. sensitivity.
C – Cardiac automaticity is the ability of the heart to control its own rate and pace. The
heart’s electrical conduction system sends messages to various points across the heart that
stimulate it to contract and propel blood forward into circulation. This is called
automaticity, in that the heart has its own system that is not consciously controlled by the
patient.
39. During a cardiac assessment, the nurse notes that when she aucultates that patient’s
heart, the pulse is regular but the volume of the pulse diminishes from beat to beat.
This condition is best described as:
a. pulsus paradoxus.
b. pulsus alternans.
c. pre-cordial pulsation.
d. pulsus stenosis.
B – During auscultation of the heart, the nurse may hear various sounds that indicate
normal heart function or an abnormality that can affect blood flow. Pulsus alternans
describes a condition in which heart sounds are regular but they reduce in volume from
beat to beat. Pulsus alternans is often associated with left-sided heart failure.
Psychosocial Integrity
40. A 64-year-old patient has a history of heart disease and clinical depression.
Following his stay at the hospital, the nurse talks with the patient about attending
cardiac rehabilitation. Which statement by the nurse is correct?
a. “The exercise you perform during cardiac rehabilitation will make you feel better, so
you won’t need to treat your depression.”
b. “You will need to go to cardiac rehabilitation for your heart and then see a counselor
for your depression.”
c. “Cardiac rehabilitation will address both your heart problems and some of
emotional issues, such as depression.”
d. “You can start cardiac rehabilitation after you have gotten your depression under
control.”
C – Cardiac rehabilitation is designed to meet many of the physical and psychological needs
of cardiac patients. Because depression and anxiety are commonly associated with heart
disease, cardiac rehabilitation focuses on these aspects during care. During cardiac rehab,
the patient may talk with a nurse or counselor and come up with some behavioral
techniques that can help to control symptoms of anxiety or depression.
41. A patient with heart disease recently had an internal cardiac defibrillator implanted
to provide a shock if his heart should stop beating. The patient admits to the nurse
that he feels anxious about having the device in place because of what it is supposed
to do. Which response from the nurse is most appropriate?
a. “I understand that you would feel nervous, but you will not feel the device if it does
need to provide a shock.”
b. “There is no reason to be nervous; this device is in place to save your life.”
c. “I know I would be nervous if I had to wear one of those, but don’t worry, it will be
okay.”
d. “It is common to feel anxious about the device, so we can discuss coping
mechanisms you can use when you feel stress about it.”
D – An internal cardioverter defibrillator provides an electric shock if it senses that the
patient’s heart has stopped beating. This can be frightening and painful for the patient, and
the patient may be anxious about many factors, such as if his heart will stop, what the
shock would feel like, and if it will work to restart his heart. The nurse should let the
patient know that it is normal to feel nervous about it and she should help him come up
with coping mechanisms for dealing with his anxiety.
42. Which best describes the effects of depression and anxiety on treatment of heart
disease?
a. A person with depression or anxiety may be less likely to follow treatment regimens
and healthy routines
b. A person with depression or anxiety may experience changes in renal system
function, increasing the risk of kidney disease
c. A person with depression or anxiety has a higher risk of bleeding and low platelet
function
d. A person with depression or anxiety is not eligible for cardiac rehabilitation
A – Anxiety and depression are commonly associated with heart disease; many patients
who are diagnosed with forms of heart disease suffer from mental health issues as well
because of the time and energy it requires to manage their diseases. A depressed patient
may be less likely to follow through with the sometimes time-consuming treatments
needed to control heart disease. The patient’s condition may also worsen if his depression
prevents him from following through with increasing activity levels or eating well to
manage his heart condition.
43. Which best describes how elevated stress levels in a patient can worsen symptoms
of acute coronary syndrome?
a. Chronic stress causes poor perfusion of the distal extremities
b. Too much stress leads to chronic inflammation and an increased risk of plaque
rupture
c. Chronic stress causes blood clots in the microvasculature of internal organs
d. Too much stress leads to poor muscle tone and decreased activity tolerance
B – Chronic stress has a negative impact on health and can lead to worsening of cardiac
diseases. Not only does chronic stress increase secretion of stress hormones such as
cortisol, it also leads to chronic inflammation in the vascular system. This inflammation can
weaken the vessels and can increase the risk of plaque rupture, which can cause an
embolus if part of the plaque travels through the bloodstream and lodges in another vessel.
44. A 51-year-old patient is getting ready to undergo a cardiac catheterization and is
very anxious about the procedure. Which intervention can the nurse provide that
will most likely help this patient to remain calm?
a. Give the patient literature about the procedure ahead of time so that he can read
about the process
b. Tell the patient that he will receive sedative medications so he will not be alert
during the procedure
c. Explain what the patient will see, hear, feel, and smell during the procedure in terms
that he can understand
d. Have the patient’s family sit next to him during the procedure
C – Some patients are highly anxious when preparing to undergo certain procedures. A
cardiac catheterization can be frightening for a patient; in order to best reduce anxiety, the
nurse should keep the patient informed about what is going on. She should prepare the
patient for how the procedure will feel and continue to talk to him during the process so
that he knows what to expect.
45. Excessive activation of cortisol in the body as a result of ____ can lead to more rapid
progression of atherosclerosis and poor health.
a. Increased carbohydrate intake
b. Decreased sleep
c. Decreased urination
d. Increased stress
D – Excess stress causes harm to health and a person who suffers from chronic stress may
have worsening symptoms of certain diseases, including heart disease. Increased stress
causes the body to secrete greater levels of the stress hormone cortisol, which in turn can
further the progression of atherosclerosis and contribute to poor health.
46. A patient has been diagnosed with atherosclerosis and suffers intermittent episodes
of angina. He has started in a cardiac rehabilitation program and the nurse is
helping him develop coping mechanisms that would most likely help him with
accepting his situation. Which intervention would the nurse use to help the patient
develop coping mechanisms in this situation?
a. Explain to the patient about the importance of making lifestyle changes to benefit
his health
b. Have the patient’s family nearby to help the patient when he feels low
c. Encourage the patient to think of times when he successfully coped with other
challenging situations
d. Explore alternatives to cardiac rehabilitation that will help the patient to better cope
with his situation
C – When helping a person to develop coping mechanisms, it may be beneficial to consider
past successes at coping with difficult times. In this case, the nurse can help the patient to
remember times when he was successful at coping with other difficult situations. The
patient may be able to employ these same mechanisms with managing his angina.
47. A 70-year-old patient with coronary artery disease is being seen at a cardiology
clinic for care. The nurse performs the intake assessment and asks the patient some
questions about his health history. Which of the following questions would assess
for signs of chronic stressors in the patient’s life?
a. “Do you take your medication every day?”
b. “How often do you exercise?”
c. “Would you say that you follow a healthy diet?”
d. “How do you like your job?”
D – Chronic stress contributes to poor health and a worsening of cardiac symptoms. The
nurse can assess for chronic stress by evaluating those situations that would most likely
cause repeated or ongoing stress in a patient’s life, such as stressful times at work, in
relationships with family members, or while managing the household.
48. A patient is seen in the emergency department complaining of chest pain. The ED
physician sees him briefly and then says, “let’s get a cardiology consult in here.” The
patient becomes very upset and asks the nurse if he is going to die. Which response
from the nurse is most appropriate?
a. “You are not going to die; I won’t let that happen to you.”
b. “Since you have chest pain, we want to make sure your heart is working properly
and a cardiologist will help us to know more about your condition.”
c. “The doctor thinks you are suffering from an acute myocardial infarction; the
cardiologist may be able to tell us if you need angioplasty.”
d. “I know this is scary for you, but we won’t know anything for a long time yet; you
will just have to wait and be patient.”
B – Nurses and physicians must be very careful when giving orders and using terminology
that patients do not understand; callous remarks or statements said in passing that are
heard by the patient can cause increased anxiety. In this situation, the patient may already
be anxious about his condition and the physician has contributed extra stress. It is
important to manage the amount of stress contributed by hospital staff and avoid adding
extra factors that contribute to the patient’s already stressful state.
49. A 69-year-old patient has been diagnosed with cardiomyopathy. The nurse gives the
patient a nursing diagnosis of powerlessness because the patient has said that she
feels sad and angry about what she will miss out on with her diagnosis. Which
nursing intervention is most appropriate for this nursing diagnosis?
a. Help the patient identify factors that she can control
b. Have the patient write down all of the things she likes about herself
c. Talk about the patient’s feelings before she is dismissed to go home
d. Have the patient discuss her feelings with another patient who also has the nursing
diagnosis of powerlessness
A – Powerlessness is a nursing diagnosis that can be given when a patient feels a lack of
control over his or her situation. The patient may demonstrate this powerlessness by
avoiding self-care measures or grieving heavily over the situation. With a nursing diagnosis
of powerlessness, the nurse can help the patient to identify those factors that she can
control, which may help her to feel as if she has power in some areas of her life, even if she
cannot control her medical condition.
Basic Care and Comfort
50. Which best describes the purpose of a ventricular assist device?
a. Pumping deoxygenated blood to the pulmonary system to acquire oxygen
b. Assisting in gas exchange between oxygen and carbon dioxide at the alveolar level
c. Pumping blood from the lower chamber of the heart to perfuse the organs and
tissues
d. Opening the coronary vessels to provide more room for blood to flow through
C – A ventricular assist device is used for some patients undergoing heart surgery. It pumps
blood from the ventricles to perfuse the organs and tissues in the same way that the heart
normally would. This device may be used to support a patient’s heart following surgery and
when he needs time to heal, or while waiting for a heart transplant.
51. A patient who has been suffering from severe diarrhea has developed hypokalemia
and cardiac arrhythmias as a result. Which of the following treatments would most
likely be ordered for this patient to correct the situation?
a. IV administration of potassium
b. Oral intake of potassium by electrolyte preparations
c. Encouraged intake of potassium-rich foods, such as bananas
d. No intervention but continue to monitor the patient’s hemodynamic status
A – Hypokalemia occurs when there is not enough potassium; this decrease in potassium
can cause life-threatening arrhythmias. Although hypokalemia may be treated in various
ways by adding potassium to the diet, if the condition is severe enough that it is causing
heart conduction changes, the patient should receive potassium as soon as possible to
correct the situation, preferably through an IV.
52. A 78-year-old patient is recovering from coronary artery bypass graft (CABG)
surgery. Because of the patient’s health status and his level of immobility, he is at
risk of skin breakdown due to pressure ulcers. Which of the following factors is
considered an intrinsic patient factor in the development of post-operative pressure
ulcers? Select all that apply.
a. The patient’s age
b. Excess sweating that contributes to moist bed linens
c. Difficulties with getting out of bed to the chair
d. The patient’s weight
e. The temperature of the patient’s room
A, C, D – A patient who is immobile following major cardiac surgery is at increased risk of
skin breakdown if he is unable to keep his body clean or if skin breaks down from lack of
blood flow. Skin breakdown can occur because of intrinsic factors (within the patient) or
extrinsic factors (within the environment). Examples of intrinsic factors include advancing
age, immobility, and the patient’s weight.
53. A cardiac patient is at high risk of developing a DVT during the post-op period
following heart surgery. The factors that increase the patient’s risk of developing a
DVT, which are known as Virchow’s triad, include venous stasis, hypercoagulability,
and:
a. elevated glucose levels.
b. vessel wall injury.
c. peripheral edema.
d. clotting disorder.
B – Virchow’s triad is a collection of three factors that increase the risk of thrombosis in a
patient. The components of the triad are venous stasis, hypercoagulability, and vessel wall
injury. When all of these factors are present, the patient is at greater risk of blood clots,
including deep vein thrombosis, which could lead to an embolism or ischemia.
54. A patient is recovering from a heart transplant surgery and is at risk of blood clots
because of his immobility status. The nurse has given the patient a nursing diagnosis
of Ineffective Peripheral Tissue Perfusion related to decreased venous blood flow.
Which of the following interventions would the nurse utilize with this diagnosis?
a. Have the patient ambulate at least 5 times per day
b. Massage the lower legs to promote circulation
c. Measure calf and thigh circumference daily
d. Administer intravenous potassium supplements as ordered
C –An immobile patient is at risk of deep vein thrombosis (DVT), which develops as a blood
clot in a major vein of the pelvis or the lower extremities. If untreated, the clot could break
off and travel through the bloodstream to lodge in a small vessel and occlude blood flow,
causing a stroke or pulmonary embolism. Because a DVT may develop in a large vein of the
calf, the nurse can check for signs of DVT by measuring the calf circumference daily. If a
DVT develops, the calf may be enlarged with swelling.
55. A patient has arrived at the primary care clinic with complaints of chest pain for the
past 3 hours. The patient states that the pain radiates from his chest to his left arm
and rates the pain as a “7” on a numeric rating scale of 0-10. Which of the following
questions should the nurse ask to determine the quality of the patient’s pain?
a. “Do you have a history of heart disease?”
b. “How would you describe your pain?”
c. “Do you think this pain is somatic or visceral pain?”
d. “Where do you notice the pain the most?”
B – The quality of a patient’s pain is how the patient describes the pain. The patient may
use terms such as “burning,” “aching,” or “stabbing” to describe pain. The nurse can assess
the quality of the patient’s pain by asking him how he would describe it.
56. A nurse is reviewing appropriate pain medications that a patient with heart failure
should take if he develops pain. The nurse reminds the patient that he should not
take non-steroidal anti-inflammatory drugs (NSAIDs) with symptomatic heart
failure. What best describes the rationale for this?
a. NSAIDs are ineffective in treating the pain of heart failure
b. NSAIDs cause breakdown of the stomach lining more readily among heart failure
patients when compared to the general population
c. NSAIDs can cause a decrease in renal function and subsequent fluid overload in the
heart failure patient
d. NSAIDs cause increased pulmonary congestion in the heart failure patient, which
can worsen breathing
C – Some pain medications, such as NSAIDs, can worsen symptoms of heart failure and
should be avoided. NSAIDs require the kidneys to work harder and can cause a decrease in
renal function. When this occurs, the kidneys may be unable to filter blood properly or to
create appropriate amounts of urine. Fluid can therefore back up into circulation, causing a
worsening of heart failure symptoms.
57. During an initial assessment of a patient with coronary artery disease, the nurse
wants to assess the patient’s dietary intake to determine if diet is contributing to his
health condition. Which question would most likely give the nurse an idea of the
patient’s regular diet?
a. “How much milk do you drink?”
b. “Please tell me what foods and drinks you have had in the past 24 hours.”
c. “Are you allergic to any medications?”
d. “I will say the name of a food, and you tell me if you like it or not.”
B – One of the best ways of determining examples of a patient’s diet is to ask for a 24-hour
intake of all of the foods the patient has eaten in the last day. Unless there are abnormal
circumstances and the patient has eaten differently when compared to other days, the 24-
hour intake usually provides a good example of the foods consumed during meals and
snacks on a typical day.
58. A nurse is discussing dietary intake for a patient with symptomatic heart failure.
Which of the following foods should the nurse tell the patient to avoid?
a. Salad with balsamic vinegar dressing
b. Canned peaches
c. Macaroni salad
d. Fresh fish
C – The nurse should assess whether the patient with heart failure is eating foods with too
much sodium, as this can increase intravascular volume and contribute to worsening of
symptoms. The nurse should tell the patient to avoid foods high in sodium, such as
processed meats and pre-packaged soups; macaroni salad, when purchased already
packaged, often contains large amounts of sodium.
59. A patient with acute decompensated heart failure has been prescribed intravenous
diuretic medications to control fluid and congestion. Which nursing intervention
would the nurse need to perform in order to best monitor fluid and electrolyte
balance in this patient?
a. Insert a Foley catheter
b. Check the patient’s weight daily
c. Monitor for signs of pancreatic dysfunction
d. Administer pain medications as ordered
B – Decompensated heart failure can cause a patient to experience fluid overload, leading
to difficulties with breathing and increased amounts of fluid in peripheral tissues, as seen
as edema. In this case, the nurse can check the patient’s weight every day; if the patient is
retaining too much fluid, he may gain weight.

Pharmacological and Parenteral Therapies

60. Following a cardiac procedure, a patient in the recovery room requires transfusion
of packed red blood cells for low hemoglobin levels. Which of the following are
other risk factors for which a patient would most likely need a blood product
transfusion following cardiac surgery? Select all that apply.
a. The patient received pre-operative antiplatelet drugs
b. The surgery was an emergency procedure
c. The patient has a high hematocrit level
d. The patient also has a diagnosis of hypothyroidism
e. The anesthesiologist administered propofol
A, B – When a patient has cardiac surgery, he may suffer blood loss or anemia that requires
an infusion of blood products following the procedure. While this is not always the case,
there are some situations that increase the risk of a patient needing blood products after
cardiac surgery. If the patient received anti-platelet drugs prior to surgery, he may be at
higher risk of bleeding if his blood does not clot well. Further, if the procedure was done as
an emergency, the patient is at higher risk of bleeding and may need blood products.
61. A patient undergoing a CABG requires a blood transfusion for management of post-
operative hemorrhage. The nurse has placed the order for packed red blood cells
and received the unit from the blood bank. When the unit arrives, the nurse checks
the bag to ensure that it is intact and correct. Which of the following would require
the nurse to return the unit back to the blood bank unused?
a. There is a label placed on the bag
b. The expiration date is present on the back of the bag
c. The bag is leaking
d. There is no particulate matter present
C – When preparing to administer blood products, the nurse must check the bag she
receives from the blood bank for any signs that the blood is not fit to infuse. There is a small
risk that the blood has become contaminated or has clotted and should not be used. In this
case, if the bag is leaking, it should be sent back to the blood bank right away to be
replaced.
62. Which of the following best describes how an esophageal Doppler measures blood
flow in the cardiac patient?
a. The stroke volume is estimated using the pressure calculated from an arterial line
b. Carbon dioxide levels are measured using a specialized loop of tubing attached to
the ventilator of an intubated patient
c. Electrical stimulation is applied to the body to track changes caused by the heart
beating
d. Blood flow velocity is multiplied by the area of the aorta, which is calculated using
an echocardiogram
D – Esophageal Doppler monitoring measures cardiac output in a high-risk patient. It is
most often performed in critically ill patients. The process involves using a Doppler as an
ultrasound to calculate the area of the aorta. This area is then multiplied by blood flow
velocity to measure cardiac output. It is often used in such patients as those who have
severe hemorrhage or a patient with coarctation of the aorta.
63. A nurse receives an order to administer norepinephrine IV to a patient at a rate of
30 mL/hr. The nurse receives the medication in a 500 mL bag of D5W that contains
40 mg of the drug. How many mcg/min will the patient receive?
a. 20
b. 40
c. 60
d. 80
B – In this case, the patient will receive 40 mcg/min of norepinephrine. To calculate this
result, the nurse should first calculate the amount of mg/hour. To do this, the nurse takes
the rate and divides it by the volume in the bag:
30 mL/hr  500 mL = 0.06
This is then multiplied by the dose available:
0.06 x 40 mg (in the bag) = 2.4 mg/hr
The dose is then converted from mg/hr to mcg/min:
2.4 mg/hr 60 minutes = 0.04 x 1000 = 40 mcg/min
64. A nurse is working on the rapid response team (RRT) of the hospital and is called for
a situation in which a patient with acute coronary syndrome is experiencing chest
pain and shortness of breath. The nurse has standing orders for administration of
drugs in this situation. Which of the following medications would most likely be
administered first after the nurse arrives?
a. Aspirin
b. Sodium bicarbonate
c. Acetaminophen
d. Atenolol
A – When a patient is experiencing chest pain but has not collapsed, the nurse should
administer a dose of aspirin as an initial drug. Aspirin is an anti-platelet medication, which
slows platelet aggregation and improves blood flow. The recommended dose for a patient
with acute coronary syndrome is 160 to 325 mg of baby aspirin.
65. A nurse is caring for a patient who is being discharged after cardiac surgery. The
patient has a prescription for enoxaparin to take at home. Which of the following
discharge information should the nurse give to this patient?
a. Use a soft toothbrush for brushing teeth and an electric razor for shaving
b. Avoid wearing sandals or shoes for longer than 6 hours at a time
c. Do not eat red meat or any substance that contains tyramine
d. Drink an 8 oz. glass of water each evening before going to bed
A – Enoxaparin is a form of low-dose heparin that prevents blood clots. When a patient
takes this kind of medication, he is at higher risk of bleeding from even minor cuts or
scrapes and he should be careful with his daily tasks. The nurse can reinforce this by
recommending that the patient use a soft toothbrush to avoid bleeding gums or an electric
razor to avoid cutting himself while shaving.
66. A nurse must administer nitroglycerin 0.4 mg sublingually to a patient experiencing
chest pain. Which best describes how nitroglycerin works to relieve chest pain?
a. Nitroglycerin acts on pain receptors in the brain so the patient does not feel the pain
b. Nitroglycerin slows blood clotting, which improves blood flow to the heart
c. Nitroglycerin relaxes the smooth muscles of the coronary arteries to improve blood
flow
d. Nitroglycerin reduces cell damage, which restores blood flow to the heart
C – Nitroglycerin is a vasodilator medication that increases the size of the blood vessels.
When a patient is experiencing chest pain because of lack of blood flow, administration of
nitroglycerin can increase the size of the vessels and improve blood flow, which often
reduces the chest pain.
67. The drug clopidogrel would be classified into which of the following categories?
a. Beta blocker
b. Pain reliever
c. ACE inhibitor
d. Platelet inhibitor
D – Clopidogrel (Plavix®) is an anti-platelet medication that prevents the buildup of
platelets in certain areas of the bloodstream. This reduces the risk of blood clots and
potential emboli in the bloodstream as well. It may also be referred to by some patients as a
“blood thinner.”
68. A patient who is in the cardiac unit and who suffers from heart failure has been
given a dose of enalapril IV. What effect should most likely occur after
administration of this drug?
a. Decreased orthostatic hypotension with movement
b. Increased cardiac output and decreased blood pressure
c. Increased urinary output and reduction of peripheral edema
d. Decreased clotting time and improved blood flow
B – Enalapril (Vasotec®) is a drug typically used to treat high blood pressure. Enalapril
works to increase cardiac output and decrease blood pressure among patients with
hypertension. It is considered an ACE inhibitor.
69. Adenosine is a cardiac drug that is most likely indicated for the treatment of which
type of cardiac rhythm?
a. Narrow QRS-complex tachycardia
b. Atrial fibrillation
c. Premature junctional contractions
d. Sinus bradycardia
A – Adenosine is an anti-arrhythmic that is used during cardiac emergencies for treatment
of narrow QRS-complex tachycardia. Adenosine slows the cardiac conduction system when
the heart rate is too fast. When given, it may cause a brief period of asystole before
converting the heart into normal sinus rhythm.
70. A nurse is working on a team responding to cardiac arrest in the hospital. Because
the patient’s heart stopped, his body has gone into a state of acidosis. Which of the
following medications would most likely correct metabolic acidosis that occurs
during cardiac arrest?
a. Lidocaine
b. Procainamide
c. Dobutamine
d. Sodium bicarbonate
D – When a patient’s heart stops during cardiac arrest, his body may go into a state of
acidosis, in which the pH of the bloodstream is too low and acidic wastes have built up in
the bloodstream. Sodium bicarbonate can be given to correct acidosis and to bring the
blood back into a normal state.
71. A 56-year-old patient is suffering from multiple premature ventricular contractions
(PVCs) that cause her to feel lightheaded and dizzy. Which drug would most likely
be prescribed for the management of PVCs?
a. Calcium chloride
b. Carvedilol
c. Epinephrine
d. Aspirin
B – Carvedilol (Coreg®) is a medication that may be given to regulate the heart rate when a
patient has frequent premature ventricular contractions that cause him to be symptomatic.
Carvedilol is a beta blocker that is also used for other cardiac conditions, such as heart
failure, high blood pressure, and angina.
72. A 79-year-old male patient requires a continuous infusion of dopamine for support
of hypotension. Which of the following situations is a contraindication for using
dopamine?
a. Poor perfusion of vital organs
b. Ventricular fibrillation
c. Low urine output
d. Septicemia
B – Dopamine is a vasopressor medication that is used for the treatment of low blood
pressure, often when it occurs due to illness or injury. Dopamine is typically administered
intravenously and works to improve blood pressure and overall blood flow, but there are
some conditions in which it should not be used. When a patient has ventricular fibrillation
and the heart is not beating, dopamine should not be used, as it will have no effect on the
circulatory system and cannot be distributed.
73. Which condition would most likely indicate administration of parenteral nutrition in
a post-op cardiac patient?
a. Swallowing impairment
b. Hypoglycemia
c. Mediastinitis
d. Malabsorption
D – Parenteral nutrition refers to the administration of intravenous solutions that contain a
mixture of vitamins and nutrients to support nutrition in a high-risk client. Parenteral
nutrition is most often warranted when a patient is malnourished, such as after major
surgery or a significant injury in which the patient is unable to feed himself or take in
enough nutrients on his own.
74. Which element would be added to total parenteral nutrition to support osmotic
pressure in the circulatory system?
a. Potassium
b. Chloride
c. Calcium
d. Vitamin D
B – Several vitamins and nutrients are added to parenteral nutrition to support the
patient’s health and to prevent malnutrition. The physician determines the patient’s overall
state of health and orders each element of parenteral nutrition. Chloride is an electrolyte
that may be added to parenteral nutrition; it supports osmotic pressure in the circulatory
system and regulates acid-base balance.
Reduction of Risk Potential
75. A patient is undergoing cardiac stress testing at a rehabilitation center. During the
test, the nurse notes that the patient becomes short of breath and his blood pressure
drops from 130/80 mmHg to 98/58 mmHg. Which action of the nurse is most
appropriate?
a. Continue to monitor the patient’s blood pressure and continue the stress testing
b. Have the patient take a break for 5 minutes before resuming the test
c. Administer a cardiac glycoside medication such as Digoxin
d. Stop the stress test immediately
D – A cardiac stress test may be performed as an outpatient procedure to determine
whether the patient’s heart can tolerate exercise or other stressors. If the patient develops
symptoms of illness during the test, it can indicate that his heart is not tolerating the test
well. In this case, with the drop in blood pressure in addition to shortness of breath, the
nurse should stop the stress test and evaluate the patient.
76. A patient who needs to have cardiac stress testing is physically unable to get on a
treadmill for the test. The nurse administers regadenoson for the test instead.
Which best describes the effects of this drug?
a. Controlling heart rate in a patient with ventricular dysfunction
b. Dilation of the coronary blood vessels
c. Inhibition of platelet aggregation
d. Increasing peripheral blood flow while decreasing coronary blood flow
B – Regadenoson is a selective A2A receptor agonist that may be administered to produce
similar effects to exercise on a treadmill with a cardiac stress test. Regadenoson works by
increasing the size of the coronary blood vessels, which increases blood flow to the heart
and improves perfusion, reducing cardiac ischemia.
77. A nurse auscultates a patient’s heart sounds during an initial assessment. The nurse
listens to sounds at the angle of Louis on the patient’s chest. Which best describes
this location?
a. The boundary of the superior and inferior portion of the mediastinum
b. The level between the 4th and 5th intercostal space on the left side
c. The indentation on the superior portion of the manubrium
d. The point where the floating ribs meet the sternum
A –The angle of Louis, also called the sternal angle, is located on the boundary of the
superior and inferior portions of the mediastinum. It is just below the suprasternal notch.
78. A 77-year-old patient is seen in the ED for chest pain; the patient believes he has had
a heart attack. The physician orders lab work to determine if damage has been done
to the heart muscle. Which lab test is a cardiac enzyme that would be ordered to
check for heart damage?
a. Diastase
b. Bromelain
c. Phytase
d. CK-MB
D – When a myocardial infarction occurs, the body releases certain enzymes into the
bloodstream. By checking these enzymes, the physician can determine if damage has been
done to the heart muscle when the enzymes are elevated. The types of cardiac enzymes
checked include such components as troponin and creatine-kinase myocardial band (CK-
MB).
79. Which of the following patients would be at highest risk of complications from a
cardiac catheterization? Select all that apply.
a. An older adult
b. History of thyroid disease
c. Previous cardiac procedures
d. History of renal disease
e. Male gender
A, C, D – Cardiac catheterization increases the risk of patient bleeding and can cause other
complications, such as a stroke. Certain factors increase a patient’s risk of developing
complications following a cardiac catheterization, including advanced age, a history of
previous cardiac procedures, and a history of renal disease.
80. A nurse is conducting a pre-op screening on a patient preparing for a coronary
artery bypass graft procedure. Which substance used by the patient would most
likely indicate that the patient is at higher risk of post-op bleeding?
a. Vitamin E supplements
b. Omeprazole
c. Loperamide
d. Bisacodyl
A – When performing a pre-op assessment, the nurse must check for whether the patient
takes medications that could increase his risk of bleeding. With certain procedures, such as
a CABG, the risk of bleeding is even greater because of the surgery’s complexity. Over-the-
counter medications that can increase the risk of bleeding include supplements such as
vitamin E, gingko, garlic, or ginseng; as well as some analgesics, such as ibuprofen.
81. A nurse is caring for a patient who is being treated for acute myocardial infarction.
The nurse knows that a percentage of patients with acute MI go on to develop
cardiogenic shock, which can be fatal. Based on the nurse’s understanding of this
condition, the nurse knows to look for which of the following signs of cardiogenic
shock?
a. Hypotension of less than 100 mmHg systolic for more than 15 minutes
b. Oliguria and increased lactic acid levels
c. Hot, flushed extremities
d. Muscle and/or joint pain
B –Cardiogenic shock is a serious complication that can develop following cardiac surgery
or an injury to the heart, such as a myocardial infarction. Cardiogenic shock develops when
the body cannot get blood to the tissues and organs because of a problem with the heart.
Signs and symptoms are associated with decreased tissue perfusion and include low blood
pressure, cool extremities, and decreased urine output.
82. A patient is brought to the ICU following cardiac surgery in which his body was
therapeutically cooled while he was on cardiac bypass. Although the surgical team
has given the patient time to warm up, his temperature remains 95. 8F. Which
action should the nurse perform first?
a. Administer cold IV fluids to promote shivering
b. Provide forced-air warming blankets to cover the patient
c. Give a unit of packed red blood cells after it has been in the blood warmer
d. Raise the head of the bed and give the patient a hat
B – Some cardiac procedures involve cooling the patient’s body to the point that blood flow
stops, which allows the surgeon to work in the affected field. After the procedure, the
patient’s body is re-warmed to restore blood flow and to start the recovery process. At
times, even after re-warming, the patient may still have a low body temperature, often
because of other factors in the surgical suite, such as decreased room temperature. The
nurse should first help to warm the patient by applying forced-air warming blankets
through a mechanical warming system to bring the temperature up.
83. When listening to a patient’s heart sounds during auscultation, which sounds would
most likely be heard using the bell of the stethoscope?
a. S1
b. S2
c. S3
d. High-frequency murmurs
C – There are two sides of the stethoscope that the nurse may use with auscultation: the
bell and the diaphragm. The bell side is used to hear low-pitched sounds, while the
diaphragm is used for high-pitched sounds. The bell may also be used to assess the S3 and
S4 heart sounds.
Physiological Adaptation
84. Which has been shown to be a benefit of minimally invasive cardiac surgery? Select
all that apply.
a. Decreased risk of hyperglycemia
b. Small scars
c. Decreased risk of infection
d. Shorter recovery time
e. Fewer anesthesia drugs to administer
B, C, D – Minimally-invasive cardiac surgery is performed through much smaller incisions
in the patient’s chest or side and can be done on a multitude of procedures in some
locations. Minimally invasive procedures have the benefits of smaller scars, a decreased
risk of infection, and a shorter recovery time for the patient. Some types of minimally
invasive surgeries that may be performed include valve repairs or removal of cardiac
tumors.
85. A patient is preparing to undergo a procedure in which a balloon-tipped catheter is
inserted into a coronary artery blocked by atherosclerosis to dilate the size of the
vessel and improve blood flow. This procedure is best known as:
a. directional coronary atherectomy.
b. cardiomyoplasty.
c. percutaneous transluminal coronary angioplasty.
d. transmyocardial revascularization.
C – Percutaneous transluminal coronary angioplasty (PTCA) is a procedure that is used to
restore blood flow in an artery blocked by atherosclerosis. PTCA involves inserting a
balloon-tipped catheter into the blocked vessel and advancing it through an atherosclerotic
lesion where it is then inflated. This process dilates the size of the vessel, making room for
blood to flow through.
86. A nurse is working with a patient who has a central catheter in place that is
measuring central venous pressure. When looking at the waveform, the nurse
understands that the x descent of the wave means:
a. relaxation of the atria.
b. an open tricuspid valve.
c. contraction of the atria.
d. contraction of the ventricles.
A – The central venous pressure produces a waveform on the monitor that the nurse
should check to ensure that central venous pressure is being measured appropriately. The
x descent follows the a wave and represents the period of atrial relaxation.
87. During insertion of a pulmonary artery catheter, the nurse watches the patient’s
cardiac monitor for changes in the waveform. As the nurse is assisting the physician
with obtaining a wedge pressure, the nurse notes that the procedure has caused
ventricular tachycardia. What the is the first action in response?
a. Silence the alarm
b. Pull back on the catheter
c. Place the patient on his side
d. Flush with 10 mL of normal saline
B – Insertion of a pulmonary artery catheter may stimulate the heart to produce occasional
arrhythmias, which are not considered abnormal unless they are sustained. While
advancing the pulmonary artery catheter, if the patient enters a state of arrhythmia that is
prolonged, the first action is to pull back slightly on the catheter, away from the area where
it had been advanced. If this action does not correct the arrhythmia, then medications may
be necessary to normalize the heart rhythm.
88. Which description best defines preload?
a. The ability of the heart’s muscle fibers to stretch enough to force blood into
pulmonary circulation
b. The pressure the ventricles must press against to pump blood into the aorta
c. The amount of blood returning to the heart and filling the ventricles at the end of
diastole
d. The closing of the mitral and tricuspid valves at the end of systole
C – The heart follows a specific cycle of filling and contracting that is effective in pumping
blood to the organs and tissues. Preload occurs at the end of diastole of the previous
heartbeat. The muscle fibers in the ventricles stretch in preparation for the next
contraction. The preload is determined by the amount of blood returning to the heart and
filling the ventricles.
89. Which of the following would be considered a non-shockable rhythm when
assessing cardiac function during a cardiac arrest code?
a. Ventricular fibrillation
b. Ventricular tachycardia
c. Pulseless electrical activity (PEA)
d. Torsades de pointes
C – During a code for patient resuscitation, the team may be able to shock the patient’s
heart to get it to start beating in a normal pattern. However, there are some rhythms that
are considered to be non-shockable, which means that even if the team shocked the patient,
it would not restore normal heart rhythm. Pulseless electrical activity (PEA) is a state in
which there is electrical activity that can be seen on the monitor, but there is no heart
rhythm. Because the heart is not actually beating, the patient does not have a pulse. This
condition cannot be corrected by administering a shock.
90. A patient with pericarditis is being evaluated for dizziness and shortness of breath.
His heart rate on the monitor demonstrates supraventricular tachycardia. Which of
the following interventions is most appropriate in this situation?
a. Start CPR at a rate of 100 compressions per minute
b. Have the patient perform the Valsalva maneuver
c. Administer a vasopressor medication, such as epinephrine
d. Give the patient 8 oz. of water to drink
B – Supraventricular tachycardia is a type of cardiac arrhythmia in which the heart beats
extremely fast. The rhythm originates in the atria of the heart and can cause a heart rate of
up to 300 bpm. The patient becomes lightheaded and dizzy because his heart is not
effectively pumping blood, even with the rapid rate. The initial method of management is to
ask the patient to bear down and perform the Valsalva maneuver. This causes increased
intrathoracic pressure and may convert the arrhythmia back into a normal rhythm.
91. A nurse is caring for a patient who underwent open-heart surgery 12 hours ago.
While recovering in his room, the patient develops chest pain and becomes very
restless. After testing, the physician determines that the patient has developed
cardiac tamponade. Which describes the most likely treatment for this condition?
a. Swan-Ganz insertion
b. Echocardiogram
c. Electrocardiogram
d. Pericardiocentesis
D – Cardiac tamponade develops when fluid accumulates in the pericardial sac that
surrounds the heart. The condition can be life threatening if too much fluid accumulates, as
the fluid compresses and squeezes the heart, preventing adequate contractions. Cardiac
tamponade is treated by pericardiocentesis, in which the physician inserts a needle into the
pericardial sac and drains the fluid. The physician may use an echocardiogram to guide the
needle to ensure that it does not puncture the heart.
92. A patient has undergone percutaneous coronary intervention (PCI) for management
of acute coronary syndrome. Following the procedure, the patient develops a
retroperitoneal hemorrhage. Which of the following nursing interventions is most
beneficial if this occurs?
a. Apply pressure to the lower back
b. Assist the patient to get out of bed to ambulate
c. Maintain bed rest and give fluids
d. Prepare for intubation and mechanical ventilation
C – Retroperitoneal hemorrhage occurs as bleeding into the retroperitoneal cavity as a
complication of PCI. The patient may have a drop in blood pressure and the situation could
become severe if bleeding is not controlled. If the patient is stable, the first intervention is
typically to have the patient rest and increase fluid administration. However, if the patient’s
condition is not stable, he may need surgery to correct the bleeding.
93. A visitor has collapsed in the hallway of the hospital. A nurse stops to help while
another healthcare worker goes for help. The patient is gasping occasionally but not
breathing regularly. He has a heart rate of 60 bpm. The nurse should provide rescue
breaths at a rate of:
a. 1 breath every second.
b. 1 breath every 3 to 5 seconds.
c. 1 breath every 5 to 10 seconds.
d. 1 breath every 15 seconds.
B – When performing CPR on a patient who has collapsed, if the patient has a pulse but is
not breathing, the nurse should provide rescue breaths. Rescue breaths should be
administered at a rate of one breath every 3 to 5 seconds.
94. A patient is brought into the ED after suffering a chest injury following a car
accident. The nurse performs the primary survey by using the mnemonic ABCDE to
assess for airway, breathing, circulation, disability, and:
a. effective gag reflex.
b. exhibiting pallor.
c. exposure and environment.
d. extent of the disease.
C –The primary survey is conducted at the beginning of the assessment period for a patient
who requires emergency care. The primary survey can be memorized by remembering A-
B-C-D-E, where A stands for airway and cervical spine immobilization, B stands for
breathing, C stands for circulation, and D stands for disability. The E part of the mnemonic
stands for exposure and environment, which consists of exposing any injuries that patient
may have sustained and keeping the patient warm.
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