1.

A 50-year-old patient who was admitted with an acute myocardial infarction has had
an uncomplicated clinical course and is being discharged. The patient consistently
presents a pleasant affect and jokes lightly about my poor heart. Which is the
cardiac/vascular nurse's most appropriate response?
I wonder if you are worried about your heart.
It is nice to see you in good spirits.
You were really sick. I'm glad you can talk about it now.
You would not be discharged if you weren't doing fine.

2. Examination of a patient in a supine position reveals jugular veins from the base of
the neck to the angle of the jaw. This finding indicates:
decreased venous return.
increased central venous pressure.
increased pulmonary artery capillary pressure.
left-sided heart failure.

3. When caring for a patient who has intermittent claudication, a cardiac/vascular nurse
advises the patient to:
apply graduated compression stockings before getting out of bed.
elevate the legs when sitting.
refrain from exercise.
walk as tolerated.

4. A cardiac/vascular nurse reviews recommended activities with a male patient who
sustained a myocardial infarction. The patient states, It doesn't really matter what I do
or don't do. I will either get better or die. His statement reflects:
acceptance of his changed health status.
an internal locus of control.
feelings of loss of control.
projection.

5. A female patient who is in the tenth week of outpatient rehabilitation continues to
exhibit symptoms of depression. When developing a discharge plan, the
cardiac/vascular nurse includes:
a referral for counseling and possible medication.
a trial of herbal remedies.
alternative therapies, including yoga and massage.
comprehensive information about the patient's cardiac status to help reduce her anxiety.

6. A patient is experiencing chest pain and electrocardiogram (ECG) changes that are
consistent with an acute myocardial infarction. During an infusion of tissue plasminogen
activator (t-PA), which sign suggests lysis of clots in the patient's coronary artery?
Bleeding from needle puncture sites
Dysrhythmias
Facial flushing
T-wave inversion on the ECG monitor

7. An active male patient who weighs 180 lb (81.65 kg) has undergone dietary
instruction. The patient reports that his current diet consists of 60 g of fat, 200 mg of
cholesterol, and 5 g of sodium per day. A cardiac/vascular nurse advises the patient to:
decrease his cholesterol.
decrease his sodium.
increase his fat intake.
make no dietary change.

8. A patient on a telemetry unit reports shortness of breath. Cardiac telemetry reveals
two runs of six to eight beats of ventricular tachycardia. The cardiac/vascular nurse's
initial response is to:
administer sublingual nitroglycerin (Nitrostat).
carefully assess and document the patient's signs and symptoms.
identify this rhythm pattern as typical of patients who have undergone bypass surgery.
prepare for cardioversion.

9. When reviewing a male patient's four-week diet history, a cardiac/vascular nurse
identifies a pattern of high calorie intake on Monday, Wednesday, and Friday nights.
The patient states that his wife recently started taking a night class on those evenings at
a local university. The patient's diet history indicates:
a disabling family coping behavior.
a lack of dietary instruction.
a need for cooking classes.
an individual coping behavior.

10. Which condition places a patient with cardiac/vascular illness at increased risk of
sudden death?
A depressive disorder
An anxiety disorder
An eating disorder
Persistent pain

11. A patient who underwent a percutaneous transluminal coronary angioplasty four
weeks ago with a subsequent ejection fraction of 30% returns for a followup visit.
Examination reveals lungs that are clear to auscultation and slight pedal edema. The
patient's medications are digoxin (Lanoxin), furosemide (Lasix), enalapril maleate
(Vasotec), and aspirin. The patient reports a 5 lb (2.27 kg) weight gain over the past two
days. The cardiac/vascular nurse's initial action is to:
document the weight and reassess the patient at the next session.
inquire about the patient's medication compliance.
notify the patient's physician.
review the patient's most recent nuclear scan.

12. Which factor is most closely associated with successful smoking cessation?
Enrollment in a short-term support group
Lack of reliance on nicotine gum as a secondary intervention
Preparation of a plan to deal with potential relapses
Reliance on a single intervention

13. As a cardiac/vascular nurse prepares to administer an experimental cardiac drug to
a male patient who is participating in a research study, the patient states that he no
longer wants the medication. The nurse advises the patient that:
he has a right to refuse the medication and to withdraw from the study.
his participation in the study is critical to improving the quality of patient outcomes.
the medication dose has been scheduled for administration.
the primary investigator will speak with the patient about his decision.

14. Which is the primary consideration when preparing to administer thrombolytic
therapy to a patient who is experiencing an acute myocardial infarction (MI)?
History of heart disease
Sensitivity to aspirin
Size and location of the MI
Time since onset of symptoms

15. A 55-year-old male patient who is diagnosed with an evolving myocardial infarction
(MI) insists on going home. The cardiac/vascular nurse encourages the patient to be
admitted, because the greatest risk within the first 24 hours of sustaining an MI is:
heart failure.
pulmonary embolism.
sudden death.
ventricular aneurysm.

16. A patient comes to the emergency department with reports of a swollen, painful leg,
but denies sustaining any injury. Physical examination reveals a tense calf muscle,
decreased sensation to the foot and leg, and absent pedal pulses. The cardiac/vascular
nurse asks the patient when the symptoms began, because:
a compartment syndrome develops days after an arterial occlusion.
an arterial thrombosis is sudden and emergent and an embolism develops gradually.
irreversible anoxic injury to muscles and nerves can occur in as few as 4 hours.
metabolic alkalosis from muscle swelling is cardiotoxic.

17. While a cardiac/vascular nurse preceptor is orienting a graduate nurse on the
telemetry unit, a patient experiences a cardiac arrest. Which action by the preceptor
during the emergency cardiac care procedure facilitates the graduate nurse's
competence and professional development?
Asking the graduate nurse to review the policy and procedure for cardiac arrest
Assigning the graduate nurse to comfort the family during the arrest
Directing the graduate nurse to attempt IV access
Involving the graduate nurse in the resuscitation by assigning a basic task

18. A cardiac/vascular nurse conducts discharge teaching for a patient with diabetes
who underwent a heart transplant. During a followup telephone call, which statement by
the patient indicates an immediate need for further instruction?
I check my blood sugar many times during the day to manage my diabetes better.
I didn't take my beta-blocker today because my blood pressure was less than 100/50 mm Hg.
I will wear my mask when I'm out in public to prevent infection.
I've had a slight fever for two days, but I'm taking acetaminophen to lower it.

19. A cardiac/vascular nurse orientee notifies the preceptor that a patient's cardiac
monitor indicates a new onset of atrial fibrillation. The preceptor directs the orientee to
immediately:
administer a calcium channel blocker IV.
notify the physician of the change in the heart rhythm.
obtain the patient's heart rate and blood pressure reading.
prepare the patient for cardioversion.

20. A male patient is admitted to the hospital for a carotid angiogram with stent
placement. The patient's wife states, I don't want my husband to know that there is a
risk of a stroke connected with this procedure because if he finds out, he won't sign the
consent. The cardiac/vascular nurse's most appropriate action is to:
assess the patient's level of understanding of risks, benefits, and alternatives.
assure the wife that the risk of stroke is minimal.
offer the patient emotional support and reinforce the benefits of the procedure.
perform a neurologic assessment to establish a baseline.

21. A patient who is recovering from a myocardial infarction may benefit from
meditation, because the technique:
decreases sympathetic nervous system activity.
decreases vasodilation.
increases sympathetic nervous system activity.
increases the release of catecholamines.

22. Which parameter is most appropriate for assessing medical utilization in an acute
care facility?
Blood glucose levels
Hospitalizations
Number of consults
Reimbursement

23. A 70-year-old patient with cardiovascular disease attends a group class on disease
process, medications, exercise, nutrition, and stress management. To promote optimal
and effective learning, the cardiac/vascular nurse uses which teaching strategy?
Condensing the information to one session so the patient need not return for a second day
Customizing teaching objectives based on the learner's interests
Preparing a PowerPoint presentation to enhance learning
Teaching the most important information at the end of the session to maximize retention

24. A male patient who underwent coronary artery bypass surgery demonstrates
effective understanding of discharge teaching by:
asking whether smoking one cigarette per day is acceptable.
clarifying when cardiac rehabilitation will begin.
describing plans to relax in a hot tub during recovery.
planning to resume driving his wife to work next week.

25. Which nursing diagnosis is most appropriate for a patient with chronic venous
insufficiency?
Activity Intolerance
Body Image, disturbed
Fluid Volume, deficient
Skin Integrity, impaired