PRACTICE QUESTIONS1. A client with no history of cardiovascular disease comes to the ambulatory clinic with flu-like symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse discriminate pain caused by a non-cardiac problem?a. “Can you describe the pain to me?”b. “Have you ever had this pain before?”c. “Does the pain get worse when you breathe in?”d. “Can you rate the pain on a scale of 1 to 10, with 10 being the worst?”2. A client is admitted to an emergency room with chest pain that is being ruled out for myocardial infarction. Vital signs are as follows: at 11 am, pulse (P), 92 beats/min, respiratory rate (RR), 24 breaths/min, blood pressure (BP), 140/88 mm Hg; 11:15 am, P, 96 beats/min, RR, 26 breaths/min, BP, 128/82 mm Hg; 11:30 am, P, 104 beats/min, RR, 28 breaths/min, BP, 104/68 mm Hg; 11:45 am, P, 118 beats/min, RR, 32 breaths/min, BP, 88/58 mm Hg. The nurse should alert thephysician because these changes are most consistent with which of the following complications?a. Cardiogenic shockb. Cardiac tamponadec. Pulmonary embolismd. Dissecting thoracic aortic aneurysm3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?a. Strict bed rest for 24 hours after transferb. Bathroom privileges and self-care activitiesc. Ad lib activities because the client is monitoredd. Unsupervised hallway ambulation with distances under 200 feetd. A client admitted to the hospital with chest pain and history of type II diabetes mellitus is scheduled for cardiac catheterization. Which of the following medications would need to be held for 48 hours before and after the procedure?a. Regular insulinb. Glipizide (Glucotrol)c. Repaglinide (Prandin)d. Metformin (Glucophage)5. A client is in sinus bradycardia with a heart rate of 45 beats/min, complains of dizziness, and has a blood pressure of 82/60 mmHg. Which of the following should the nurse anticipate will be prescribed?a. Defibrillate the client.b. Administer digoxin (Lanoxin).c. Continue to monitor the client.d. Prepare for transcutaneous pacing.6. A nurse notes bilateral 12 edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next?a. Order daily weights starting on the following morning.b. Review the intake and output records for the last 2 days.c. Request a sodium restriction of 1 g/day from the physician.d. Change the time of diuretic administration from morning to evening.7. A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which of the following disorders reported by the client is unlikely to play a role in exacerbating the heart failure?a. Atrial fibrillationb. Nutritional anemiac. Peptic ulcer diseased. Recent upper respiratory infection8. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which of the following would the nurse anticipate when auscultating the client's breath sounds?a. Stridorb. Cracklesc. Scattered rhonchid. Diminished breath sounds9. A client who has developed severe pulmonary edema would most likely exhibit which of the following?a. Mild anxietyb. Slight anxietyc. Extreme anxietyd. Moderate anxiety10. A client with pulmonary edema has been on diuretic therapy. The client has an order for additional furosemide (Lasix) in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin (Lanoxin), the nurse should review which laboratory result?a. Sodium levelb. Digoxin levelc. Creatinine leveld. Potassium level11. A client with myocardial infarction is going into cardiogenic shock. Because of the risk of myocardial ischemia, for which of the following should the nurse carefully assess the client?

a. Bradycardiab. Ventricular dysrhythmiasc. Rising diastolic blood pressured. Falling central venous pressure12. A nurse assesses the sternotomy incision of a client on the third day after cardiac surgery. The incision shows some slight “puffiness” along the edges and is nonreddened, with no apparent drainage. Temperature is 99° F orally. The white blood cell count is 7500 cells/mm3. How should the nurse interpret these findings?a. Incision is slightly edematous but shows no active signs of infection.b. Incision shows early signs of infection, although the temperature is nearly normal.c. Incision shows early signs of infection, supported by an elevated white blood cell count.d. Incision shows no sign of infection, although the white blood cell count is elevated.13. A client who had cardiac surgery 24 hours ago has a urine output averaging 20 mL/hr for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL and the serum creatinine level is 2.2 mg/dL. Based on these findings, the nurse would anticipate that the client is at risk for which of the following?a. Hypovolemiab. Acute renal failurec. Glomerulonephritisd. Urinary tract infection14. A nurse is preparing to ambulate a client on the third day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation?a. Remove telemetry equipment.b. Provide the client with a walker.c. Premedicate the client with an analgesic.d. Encourage the client to cough and deep breathe.15. The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/min. Which of the following would be a correct interpretation based on these characteristics?a. Sinus bradycardiab. Sick sinus syndromec. Normal sinus rhythmd. First-degree heart block16. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which of the following should be the priority action of the nurse?a. Call a code blue.b. Call the physician.c. Check the client status and lead placement.d. Press the recorder button on the electrocardiogram console.17. A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/min. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?a. Sinus arrhythmiab. Sinus tachycardiac. Sinus bradycardiad. Normal sinus rhythm18. A nurse notices frequent artifact on the electrocardiographic monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact?a. Frequent movement of the clientb. Tightly secured cable connectionsc. Leads applied over hairy areasd. Leads applied to the limbs19. A nurse is watching the cardiac monitor and notices that the rhythm changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100 beats/min. The nurse determines that the client is experiencing which of the following dysrhythmias?a. Sinus tachycardiab. Ventricular fibrillationc. Ventricular tachycardiad. Premature ventricular contractions20. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. Why should the nurse be most concerned about with this dysrhythmia?a. It can develop into ventricular fibrillation at any time.b. It is almost impossible to convert to a normal rhythm.c. It is uncomfortable for the client, giving a sense of impending doom.d. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.21. A nurse is caring for a client with unstable ventricular tachycardia. Thenurse instructs the client to do which of the following, if prescribed,during an episode of ventricular tachycardia?

1. Lie down flat in bed.2. Remove any metal jewelry.3. Breathe deeply, regularly, and easily.4. Inhale deeply and cough forcefully every 1 to 3 seconds.22. A client is having frequent premature ventricular contractions. A nursewould place priority on assessment of which of the following?1. Sensation of palpitationsChapter 59 Cardiovascular Disorder Page 166 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEdition2. Causative factors, such as caffeine3. Precipitating factors, such as infection4. Blood pressure and oxygen saturation23. A client has developed atrial fibrillation, with a ventricular rate of 150beats/min. The nurse should assess the client for which associatedsigns or symptoms?1. Flat neck veins2. Nausea and vomiting3. Hypotension and dizziness4. Hypertension and headache24. A nurse is watching the cardiac monitor, and a client's rhythmsuddenly changes. There are no P waves; instead, there are fibrillatorywaves before each QRS complex. How should the nurse correctlyinterpret the client's heart rhythm?1. Atrial fibrillation2. Sinus tachycardia3. Ventricular fibrillation4. Ventricular tachycardia25. A client with rapid rate atrial fibrillation asks a nurse why thephysician is going to perform carotid sinus massage. Which of thefollowing would be reflective of a correct explanation provided by thenurse?1. The vagus nerve slows the heart rate.2. The diaphragmatic nerve slows the heart rate.3. The diaphragmatic nerve overdrives the rhythm.Chapter 59 Cardiovascular Disorder Page 167 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEdition4. The vagus nerve increases the heart rate, overdriving the rhythm.26. A nurse notes that a client with sinus rhythm has a prematureventricular contraction that falls on the T wave of the preceding beat.The client's rhythm suddenly changes to one with no P waves, nodefinable QRS complexes, and coarse wavy lines of varyingamplitude. How would the nurse correctly interpret this rhythm?1. Asystole2. Atrial fibrillation3. Ventricular fibrillation4. Ventricular tachycardia27. A nurse is preparing to defibrillate a client in ventricular fibrillation.After placing the paddles on the client's chest and before dischargingthem, which of the following should be done?1. Ensure that the client has been intubated.2. Set the defibrillator to the “synchronize” mode.3. Administer lidocaine hydrochloride (Xylocaine).4. Confirm that the rhythm is actually ventricular fibrillation.28. A client in ventricular fibrillation is about to be defibrillated. A nurseknows that to convert this rhythm effectively, the machine should beset at which of the following energy levels (in joules, J) for the firstdelivery?1. 50 J2. 100 J3. 200 J4. 360 JChapter 59 Cardiovascular Disorder Page 168 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEdition29. A nurse would evaluate that defibrillation of a client was mostsuccessful if which of the following observations was made?

1. Arousable, sinus rhythm, BP 116/72 mm Hg2. Arousable, marked bradycardia, BP 86/54 mm Hg3. Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg4. Nonarousable, sinus rhythm, BP 88/60 mm Hg30. A nurse is evaluating a client's response to cardioversion. Which of thefollowing observations would be of highest priority to the nurse?1. Blood pressure2. Status of airway3. Oxygen flow rate4. Level of consciousness31. A nurse is performing cardiopulmonary resuscitation on a client whohas had a cardiac arrest. An automatic external defibrillator is availableto treat the client. Which of the following activities will allow thenurse to assess the client's cardiac rhythm?1. Hold the defibrillator paddles firmly against the chest.2. Apply adhesive patch electrodes to the chest and move awayfrom the client.3. Apply standard electrocardiographic monitoring leads to theclient and observe the rhythm.4. Connect standard electrocardiographic electrodes to atranstelephonic monitoring device.32. A nurse employed in a cardiac unit determines that which of thefollowing clients is the least likely to have implantation of anautomatic internal cardioverter-defibrillator (AICD)?Chapter 59 Cardiovascular Disorder Page 169 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEdition1. A client with syncopal episodes related to ventricular tachycardia2. A client with ventricular dysrhythmias despite medicationtherapy3. A client with an episode of cardiac arrest related to myocardialinfarction4. A client with three episodes of cardiac arrest unrelated tomyocardial infarction33. A nurse is caring for a client who has just had implantation of anautomatic internal cardioverter-defibrillator. The nurse immediatelywould assess which of the following items based on priority?1. Anxiety level of the client and family2. Presence of a Medic-Alert card for the client to carry3. Knowledge of restrictions of postdischarge physical activity4. Activation status of the device, heart rate cutoff, and number ofshocks it is programmed to deliver34. A nurse is caring for a client immediately after insertion of apermanent demand pacemaker via the right subclavian vein. Which ofthe following activities will assist with preventing dislodgement of thepacing catheter?1. Limiting movement and abduction of the left arm2. Limiting movement and abduction of the right arm3. Assisting the client to get out of bed and ambulate with a walker4. Having the physical therapist do active range-of-motionexercises to the right arm35. A client diagnosed with thrombophlebitis 1 day ago suddenlycomplains of chest pain and shortness of breath and is visibly anxious.Chapter 59 Cardiovascular Disorder Page 170 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEditionThe nurse should immediately assess the client for signs and symptomsof which of the following?1. Pneumonia2. Pulmonary edema3. Pulmonary embolism4. Myocardial infarction36. A client seeks treatment in a physician's office for unsightly varicoseveins, and sclerotherapy is recommended. Before leaving theexamining room, the client says to the nurse, “Can you tell me againhow this sclerotherapy is done?” Which of the following statementswould reflect accurate teaching by the nurse?1. “The varicosity is surgically removed.”

2. “The vein is tied off at the upper end to prevent stasis fromoccurring.”3. “The vein is tied off at the lower end to prevent stasis fromoccurring.”4. “An agent is injected into the vein to damage the vein wall andclose the vein off.”37. A client is having a follow-up physician office visit after vein ligationand stripping. The client describes a sensation of “pins and needles” inthe affected leg. Which of the following would be an appropriateaction by the nurse based on evaluation of the client's comment?1. Instruct the client to apply warm packs.2. Report the complaint to the physician.3. Reassure the client that this is only temporary.4. Advise the client to take acetaminophen (Tylenol) until it is gone.Chapter 59 Cardiovascular Disorder Page 171 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEdition38. Postoperatively, a nurse is caring for a client who had a percutaneousinsertion of an inferior vena cava filter and was on heparin therapybefore surgery. The nurse would inspect the surgical site most closelyfor evidence of which of the following?1. Bleeding and infection2. Thrombosis and infection3. Bleeding and wound dehiscence4. Wound dehiscence and evisceration39. A client with angina has a 12-lead electrocardiogram taken during anepisode of chest pain. A nurse examines the tracing for whichelectrocardiographic change caused by myocardial ischemia?1. Tall peaked T waves2. Prolonged PR interval3. Widened QRS complex4. ST segment elevation or depression40. A client is scheduled for a cardiac catheterization using a radiopaquedye. Which of the following assessments is most critical before theprocedure?1. Intake and output2. Height and weight3. Allergy to iodine or shellfish4. Baseline peripheral pulse rates41. A nurse is assessing the neurovascular status of a client who returnedto the surgical nursing unit 4 hours ago after undergoing aortoiliacbypass graft. The affected leg is warm, and the nurse notes redness andedema. The pedal pulse is palpable and unchanged from admission.Chapter 59 Cardiovascular Disorder Page 172 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEditionHow would the nurse correctly interpret the client's neurovascularstatus?1. The neurovascular status is normal because of increased bloodflow through the leg.2. The neurovascular status is moderately impaired, and thesurgeon should be called.3. The neurovascular status is slightly deteriorating and should bemonitored for another hour.4. The neurovascular status is adequate from an arterial approach,but venous complications are arising.42. A nurse is evaluating the condition of a client after pericardiocentesisperformed to treat cardiac tamponade. Which of the followingobservations would indicate that the procedure was unsuccessful?1. Rising blood pressure2. Clearly audible heart sounds3. Client expressions of relief4. Rising central venous pressure43. A nurse is assessing a client with an abdominal aortic aneurysm.Which of the following assessment findings by the nurse is probablyunrelated to the aneurysm?1. Pulsatile abdominal mass2. Hyperactive bowel sounds in the area

3. Systolic bruit over the area of the mass4. Subjective sensation of “heart beating” in the abdomen44. A nurse is caring for a client who had a resection of an abdominalaortic aneurysm yesterday. The client has an intravenous infusion witha rate of 150 mL/hr, unchanged for the last 10 hours. The client's urineChapter 59 Cardiovascular Disorder Page 173 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEditionoutput for the last 3 hours was 90, 50, and 28 mL (28 mL most recent).The client's blood urea nitrogen level is 35 mg/dL and serum creatininelevel is 1.8 mg/dL, measured this morning. Which of the followingactions should the nurse take next?1. Call the physician.2. Check the urine specific gravity.3. Check to see if the client had a sample for serum albumin leveldrawn.4. Put the intravenous line on a pump so that the infusion rate issure to stay stable.45. Cardiac magnetic resonance imaging (MRI) is prescribed for a client.The nurse identifies that which of the following is a contraindicationfor performance of this diagnostic study?1. Client has a pacemaker.2. Client is allergic to iodine.3. Client has diabetes mellitus.4. Client has a biological porcine valve.46. A client with angina complains that the anginal pain is prolonged andsevere and occurs at the same time each day, most often at rest in theabsence of precipitating factors. How would the nurse best describethis type of anginal pain?1. Stable angina2. Variant angina3. Unstable angina4. Nonanginal painChapter 59 Cardiovascular Disorder Page 174 of 208Comprehensive Review for the NCLEX-RN Examination, 4thEditionALTERNATE ITEM FORMAT: MULTIPLE RESPONSE