1. A client is scheduled for a cardiac catheterization using a radiopaque dye.

Which of the following assessments is most

critical before the procedure?
1. Intake and output
2. Baseline peripheral pulse rates
3. Height and weight
4. Allergy to iodine or shellfish
2. A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms. The client
suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a
non-cardiac problem?
1. Have you ever had this pain before?
2. Can you describe the pain to me?
3. Does the pain get worse when you breathe in?
4. Can you rate the pain on a scale of 1-10, with 10 being the worst?
3. 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?
1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances under 200 feet
4. Ad lib activities because the client is monitored.

4. A nurse notes 2+ bilateral 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?
1. Review the intake and output records for the last 2 days
2. Change the time of diuretic administration from morning to evening
3. Request a sodium restriction of 1 g/day from the physician.
4. Order daily weights starting the following morning.
5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram
complexes on the screen. The first action of the nurse is to:
1. Check the client status and lead placement
2. Press the recorder button on the electrocardiogram console.
3. Call the physician
4. Call a code blue
6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate
measurement by avoiding which of the following?
1. Seating the client with arm bared, supported, and at heart level.
2. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
3. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
7. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following
medications is available on the nursing unit?
1. Vitamin K
2. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate
8. A client is at risk for pulmonary embolism and is on anticoagulant therapy withwarfarin (Coumadin). The clients
prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:
1. The same as the clients own baseline level
2. Lower than the needed therapeutic level
3. Within the therapeutic range
4. Higher than the therapeutic range
9. A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications
are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:
1. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
3. Stimulates production of the bodys own thrombolytic substances, but it takes 2-4 days for this to begin.
4. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

10. A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to
his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include
oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse should
first:
1. Administer the morphine
2. Obtain a 12-lead ECG
3. Obtain the lab work
4. Order the chest x-ray
11. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this
drug is to:
1. Help keep him well hydrated
2. Dissolve clots he may have
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias.
12. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.
1. Reflects electrical impulse beginning at the SA node
2. Indicated electrical impulse beginning at the AV node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has duration of normally 0.11 seconds or less.
13. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his
father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to
an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurses next action would be to:
1. Call for the doctor
2. Start an intravenous line
3. Obtain a portable chest radiograph
4. Draw blood for laboratory studies
14. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An
increased myoglobin level suggests which of the following?
1. Cancer
2. Hypertension
3. Liver disease
4. Myocardial infarction
15. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge
that propranolol hydrochloride:
1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
2. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
3. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin
II.
16. The most important long-term goal for a client with hypertension would be to:
1. Learn how to avoid stress
2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
4. Control high blood pressure
17. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected
until symptoms of other system failures occur. This may occur in the form of:
1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction
4. Pulmonary disease
18. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has
had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking
leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is
discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with
increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight
of steps to the friends apartment without pain. Which of the following measures that the nurse could suggest would most
likely help the client deal with this problem?
1. Visit her friend earlier in the day.
2. Rest for at least an hour before climbing the stairs.
3. Take a nitroglycerin tablet before climbing the stairs.
4. Lie down once she reaches the friends apartment.
19. Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her
physician?

1. A change in the pattern of her pain

2. Pain during sex
3. Pain during an argument with her husband
4. Pain during or after an activity such as lawn mowing
20. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this
procedure is being used in this specific case to:
1. Open and dilate the blocked coronary arteries
2. Assess the extent of arterial blockage
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and heart muscle.
21. As an initial step in treating a client with angina, the physician prescribesnitroglycerin tablets, 0.3mg given sublingually.
This drugs principal effects are produced by:
1. Antispasmodic effect on the pericardium
2. Causing an increased myocardial oxygen demand
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium
22. The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
1. Headache
2. High blood pressure
3. Shortness of breath
4. Stomach cramps
23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the
drug when chest pain occurs?
1. Take one tablet every 2 to 5 minutes until the pain stops.
2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes.
3. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain persists after three tablets.
4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician.
24. Which of the following arteries primarily feeds the anterior wall of the heart?
1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery
25. When do coronary arteries primarily receive blood flow?
1. During inspiration
2. During diastolic
3. During expiration
4. During systole
26. Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?
1. Anterior
2. Apical
3. Inferior
4. Lateral
27. A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?
1. Aortic
2. Mitral
3. Pulmonic
4. Tricuspid
28. Which of the following blood tests is most indicative of cardiac damage?
1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)
29. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?
1. Cardiac catheterization
2. Cardiac enzymes
3. Echocardiogram
4. Electrocardiogram (ECG)
30. Which of the following types of pain is most characteristic of angina?
1. Knifelike
2. Sharp
3. Shooting
4. Tightness
31. Which of the following parameters is the major determinant of diastolic blood pressure?
1. Baroreceptors
2. Cardiac output
3. Renal function
4. Vascular resistance
32. Which of the following factors can cause blood pressure to drop to normal levels?

1. Kidneys excretion of sodium only

2. Kidneys retention of sodium and water
3. Kidneys excretion of sodium and water
4. Kidneys retention of sodium and excretion of water
33. Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?
1. Changes in blood pressure
2. Changes in arterial oxygen tension
3. Changes in arterial carbon dioxide tension
4. Changes in heart rate
34. Which of the following terms describes the force against which the ventricle must expel blood?
1. Afterload
2. Cardiac output
3. Overload
4. Preload
35. Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole?
1. Afterload
2. Cardiac index
3. Cardiac output
4. Preload
36. A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension.
Before administered propranolol, which of the following actions should the nurse take first?
1. Monitor the apical pulse rate
2. Instruct the client to take medication with food
3. Question the physician about the order
4. Caution the client to rise slowly when standing.
37. One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia
appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect?
1. Hypocalcemia
2. Hypermagnesemia
3. Hypokalemia
4. Hypernatremia
38. A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?
1. Eat foods high in potassium.
2. Take daily potassium supplements.
3. Discontinue sodium restrictions.
4. Avoid salt substitutes.
39. When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:
1. Impulse to begin atrial contraction
2. Impulse to transverse the atria to the AV node
3. SA node to discharge the impulse to begin atrial depolarization
4. Impulse to travel to the ventricles
40. Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is
inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesnt
understand why he needs to be there because there is nothing that can be done to make him better. The best nursing
response is:
1. Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.
2. Here we teach you to gradually change your lifestyle to accommodate your heart disease.
3. You are probably right but we can gradually increase your activities so that you can live a more active life.
4. Do you feel that you will have to make some changes in your life now?
41. To evaluate a clients condition following cardiac catheterization, the nurse will palpate the pulse:
1. In all extremities
2. At the insertion site
3. Distal to the catheter insertion
4. Above the catheter insertion
42. A clients physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting
radioisotope into the bloodstream is to detect:
1. Normal vs. abnormal tissue
2. Damage in areas of the heart
3. Ventricular function
4. Myocardial scarring and perfusion
43. A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears
normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will
be included in the nursing care plan. Which activity has the highest priority?
1. Monitoring vital signs
2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site

44. A client is experiencing tachycardia. The nurses understanding of the physiological basis for this symptom is explained
by which of the following statements?
1. The demand for oxygen is decreased because of pleural involvement
2. The inflammatory process causes the body to demand more oxygen to meet its needs.
3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.
4. Respirations are labored.
45. A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94, 24, and 99*F.
The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would expect which cardiac enzyme to
rise within the next 3 to 8 hours?
1. Creatine kinase (CK or CPK)
2. Lactic dehydrogenase (LDH)
3. LDH-1
4. LDH-2
46. A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that
leg ulcers of this nature are usually caused by:
1. Decreased arterial blood flow secondary to vasoconstriction
2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries
4. Trauma to the lower extremities
47. Which of the following instructions should be included in the discharge teaching for a patient discharged with a
transdermal nitroglycerin patch?
1. Apply the patch to a non hairy, nonfatty area of the upper torso or arms.
2. Apply the patch to the same site each day to maintain consistent drug absorption.
3. If you get a headache, remove the patch for 4 hours and then reapply.
4. If you get chest pain, apply a second patch right next to the first patch.
48. In order to prevent the development of tolerance, the nurse instructs the patient to:
1. Apply the nitroglycerin patch every other day
2. Switch to sublingual nitroglycerin when the patients systolic blood pressure elevates to >140 mm Hg
3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
4. Use the nitroglycerin patch for acute episodes of angina only
49. Direct-acting vasodilators have which of the following effects on the heart rate?
1. Heart rate decreases
2. Heart rate remains significantly unchanged
3. Heart rate increases
4. Heart rate becomes irregular
50. When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases
teaching on the knowledge that:
1. Moderate doses of two different types of diuretics are more effective than a large dose of one type
2. This combination promotes diuresis but decreases the risk of hypokalemia
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration rate
Answers and Rationale
Gauge your performance by counter checking your answers to the answers below. Learn more about the question by reading the
rationale. If you have any disputes or questions, please direct them to the comments section.
1. Answer: 4. Allergy to iodine or shellfish
This procedure requires an informed consent because it involves injection of a radiopaque dye into the blood vessel. The risk of allergic
reaction and possible anaphylaxis is serious and must be assessed before the procedure.
2. Answer: 3. Does the pain get worse when you breathe in?
Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the
origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration.
3. Answer: 2. Bathroom privileges and self-care activities
On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances
are encouraged, with distances gradually increased (50, 100, 200 feet).
4. Answer: 1. Review the intake and output records for the last 2 days
Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden
increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved
for clients with severe symptoms.
5. Answer: 1. Check the client status and lead placement
Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible electrode displacement. Accurate assessment of
the client and equipment is necessary to determine the cause and identify the appropriate intervention.
6. Answer: 4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the
legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in
the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder
should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every
6 months to ensure accuracy.
7. Answer: 4. Protamine sulfate

The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur.
Vitamin K is an antidote for warfarin.
8. Answer: 3. Within the therapeutic range
The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the clients control
value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.
9. Answer: 2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an
anticoagulant effect.
Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days
before the therapeutic effect of warfarin is exhibited.
10. Answer: 1. Administer the morphine
Although obtaining the ECG, chest x-ray, and blood work are all important, the nurses priority action would be to relieve the crushing
chest pain.
11. Answer: 2. Dissolve clots he may have
Thrombolytic drugs are administered within the first 6 hours after onset of a MI to lyse clots and reduce the extent of myocardial
damage.
12. Answer: 1, 3, 5
In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted
to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of
the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
13. Answer: 2. Start an intravenous line
Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital
spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the
intravenous line.
14. Answer: 4. Myocardial infarction
Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected
about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less than 90 mg/L is
normal).
15. Answer: 1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and
conduction.
Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranololhydrochloride include reducing heart rate,
decreasing myocardial contractility, and slowing conduction.
16. Answer: 3. Make a commitment to long-term therapy
Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their
hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important
components of hypertension therapy, but the priority goal is related to compliance.
17. Answer: 1. Cerebrovascular accident
Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the
hypertension may go undetected. CVAs can be related to long-term hypertension. Liver or pulmonary disease is generally not
associated with hypertension. Myocardial infarction is generally related to coronary artery disease.
18. Answer: 3. Take a nitroglycerin tablet before climbing the stairs.
Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain free.
Visiting her friend early in the day would have no impact on decreasing pain episodes. Resting before or after an activity is not as likely
to help prevent an activity-related pain episode.
19. Answer: 1. A change in the pattern of her pain
The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.
20. Answer: 2. Assess the extent of arterial blockage
Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A
decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.
21. Answer: 3. Vasodilation of peripheral vasculature
Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary
arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial
oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
22. Answer: 1. Headache
Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and
dizziness. The client should lie or sit down to avoid fainting. Nitro does not cause shortness of breath or stomach cramps.
23. Answer: 3. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if pain
persists after three tablets.
The correct protocol for nitroglycerin used involves immediate administration, with subsequent doses taken at 5-minute intervals as
needed, for a total dose of 3 tablets. Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within
about 10 minutes.
24. Answer: 3. Left anterior descending artery
The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart. The circumflex artery supplies
the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.
25. Answer: 2. During diastolic
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is
supplied during diastole. Breathing patterns are irrelevant to blood flow.
26. Answer: 3. Inferior

The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce
an infarction in that area. The right coronary artery doesnt supply the anterior portion (left ventricle), lateral portion (some of the left
ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
27. Answer: 3. Pulmonic
Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve
abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth
intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the
sternal border.
28. Answer: 3. Troponin I
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin levels arent detectable in people without
cardiac injury.
29. Answer: 4. Electrocardiogram (ECG)
The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes
are used to diagnose MI but cant determine the location. An echocardiogram is used most widely to view myocardial wall function after
an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate
the location of myocardial damage, but the study may not be performed immediately.
30. Answer: 4. Tightness
The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral
muscles and may move to such areas as the chest, neck, and arms.
31. Answer: 4. Vascular resistance
Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac
output determines systolic blood pressure.
32. Answer: 3. Kidneys excretion of sodium and water
The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic
pressure by regulating blood volume.
33. Answer: 1. Changes in blood pressure
Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in pulsatile pressure cause a reflex
increase in heart rate. Chemoreceptors in the medulla are primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the
aorta and carotid arteries are primarily stimulated by oxygen.
34. Answer: 1. Afterload
Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the
resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute.
Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.
35. Answer: 4. Preload
Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The volume of blood in the ventricle at the end of
diastole determines the preload. Afterload is the force against which the ventricle must expel blood. Cardiac index is the individualized
measurement of cardiac output, based on the clients body surface area. Cardiac output is the amount of blood the heart is expelling
per minute.
36. Answer: 3. Question the physician about the order
Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician
before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician
takes priority. The clients apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse
should withhold the drug and notify the physician.
37. Answer: 3. Hypokalemia
Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability,
leading to ventricular tachycardia.
38. Answer: 4. Avoid salt substitutes.
Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium
content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium
restrictions should continue.
39. Answer: 4. Impulse to travel to the ventricles
The P-R interval is measured on the ECG strip from the beginning of the P wave to the beginning of the QRS complex. It is the time it
takes for the impulse to travel to the ventricle.
40. Answer: 1. Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.
Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac
rehabilitation is and does not dwell upon his negativity about it.
41. Answer: 3. Distal to the catheter insertion
Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral
and strong.
42. Answer: 4. Myocardial scarring and perfusion
This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a more specific answer than (1) or (2). Specific
ventricular function is tested by a gated cardiac blood pool scan.
43. Answer: 3. Maintaining cardiac monitoring
Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the
meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Other activities can
be accomplished around the MI monitoring.
44. Answer: 3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.

The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the hearts having to beat faster to meet
the bodys needs for oxygen.
45. Answer: 1. Creatine kinase (CK or CPK)
Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged, CPK leaks out
of the cell membranes and into the bloodstream. Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.
46. Answer: 1. Decreased arterial blood flow secondary to vasoconstriction
Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person
is under stress. Hyperemia occurs when the vasospasm is relieved.
47. Answer: 1. Apply the patch to a non hairy, nonfatty area of the upper torso or arms.
A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best and most consistent absorption rates. Sites should be
rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual
nitroglycerin should be used to treat chest pain.
48. Answer: 3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.
49. Answer: 3. Heart rate increases
Heart rate increases in response to decreased blood pressure caused by vasodilation.
50. Answer: 2. This combination promotes diuresis but decreases the risk of hypokalemia
Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte
imbalance.
1. Which of the following arteries primarily feeds the anterior wall of the heart?
a. Circumflex artery
b. Internal mammary artery
c. Left anterior descending artery
d. Right coronary artery
2. When do coronary arteries primarily receive blood flow?
a. During inspiration
b. During diastole
c. During expiration
d. During systole
3. Which of the following illnesses is the leading cause of death in the US?
a. Cancer
b. Coronary artery disease
c. Liver failure
d. Renal failure
4. Which of the following conditions most commonly results in CAD?
a. Atherosclerosis
b. DM
c. MI
d. Renal failure
5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
a. Plaques obstruct the vein
b. Plaques obstruct the artery
c. Blood clots form outside the vessel wall
d. Hardened vessels dilate to allow the blood to flow through
6. Which of the following risk factors for coronary artery disease cannot be corrected?
a. Cigarette smoking
b. DM
c. Heredity
d. HPN
7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease?
a. 100 mg/dl
b. 150 mg/dl
c. 175 mg/dl
d. 200 mg/dl
8. Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery
disease?
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Administer sublingual nitroglycerin
d. Educate the client about his symptoms
9. Medical treatment of coronary artery disease includes which of the following procedures?
a. Cardiac catheterization
b. Coronary artery bypass surgery

c. Oral medication administration

d. Percutaneous transluminal coronary angioplasty
10. Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?
a. Anterior
b. Apical
c. Inferior
d. Lateral
11. Which of the following is the most common symptom of myocardial infarction?
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations
12. Which of the following landmarks is the correct one for obtaining an apical pulse?
a. Left intercostal space, midaxillary line
b. Left fifth intercostal space, midclavicular line
c. Left second intercostal space, midclavicular line
d. Left seventh intercostal space, midclavicular line
13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases
in intensity with inspiration?
a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary
14. A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this?
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid
15. Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase
16. What is the primary reason for administering morphine to a client with myocardial infarction?
a. To sedate the client
b. To decrease the clients pain
c. To decrease the clients anxiety
d. To decrease oxygen demand on the clients heart
17. Which of the following conditions is most commonly responsible for myocardial infarction?
a. Aneurysm
b. Heart failure
c. Coronary artery thrombosis
d. Renal failure
18. What supplemental medication is most frequently ordered in conjuction withfurosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium
19. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes
are these?
a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic
20. Which of the following complications is indicated by a third heart sound (S3)?
a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions
21. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the
lungs?

a. Left-sided heart failure

b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricuspid valve malfunction
22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?
a. Cardiac catheterization
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram
23. What is the first intervention for a client experiencing myocardial infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram
24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?
a. Tell me about your feeling right now.
b. When the doctor arrives, everything will be fine.
c. This is a bad situation, but youll feel better soon.
d. Please be assured were doing everything we can to make you feel better.
25. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and
sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates
26. What is the most common complication of a myocardial infarction?
a. Cardiogenic shock
b. Heart failure
c. Arrhythmias
d. Pericarditis
27. With which of the following disorders is jugular vein distention most prominent?
a. Abdominal aortic aneurysm
b. Heart failure
c. Myocardial infarction
d. Pneumothorax
28. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein
distention?
a. High-fowlers
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position
29. Which of the following parameters should be checked before administering digoxin?
a. Apical pulse
b. Blood pressure
c. Radial pulse
d. Respiratory rate
30. Toxicity from which of the following medications may cause a client to see a green halo around lights?
a. Digoxin
b. Furosemide
c. Metoprolol
d. Enalapril
31. Which ofthe following symptoms is most commonly associated with left-sidedheart failure?
a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension
32. In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?
a. DM
b. Pulmonary emboli
c. Renal failure
d. Right-sided heart failure
33. Which of the following symptoms might a client with right-sided heart failure exhibit?

a. Adequate urine output

b. Polyuria
c. Oliguria
d. Polydipsia
34. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by increasing
ventricular contractility?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents
35. Stimulation of the sympathetic nervous system produces which of the following responses?
a. Bradycardia
b. Tachycardia
c. Hypotension
d. Decreased myocardial contractility
36. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output?
a. Angina pectoris
b. Cardiomyopathy
c. Left-sided heart failure
d. Right-sided heart failure
37. What is the most common cause of abdominal aortic aneurysm?
a. Atherosclerosis
b. DM
c. HPN
d. Syphilis
38. In which of the following areas is an abdominal aortic aneurysm most commonly located?
a. Distal to the iliac arteries
b. Distal to the renal arteries
c. Adjacent to the aortic branch
d. Proximal to the renal arteries
39. A pulsating abdominal mass usually indicates which of the following conditions?
a. Abdominal aortic aneurysm
b. Enlarged spleen
c. Gastic distention
d. Gastritis
40. What is the most common symptom in a client with abdominal aortic aneurysm?
a. Abdominal pain
b. Diaphoresis
c. Headache
d. Upper back pain
41. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic
aneurysm?
a. Abdominal pain
b. Absent pedal pulses
c. Angina
d. Lower back pain
42. What is the definitive test used to diagnose an abdominal aortic aneurysm?
a. Abdominal X-ray
b. Arteriogram
c. CT scan
d. Ultrasound
43. Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
a. HPN
b. Aneurysm rupture
c. Cardiac arrhythmias
d. Diminished pedal pulses
44. Which of the following blood vessel layers may be damaged in a client with an aneurysm?
a. Externa
b. Interna

c. Media
d. Interna and Media
45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
a. Right upper quadrant
b. Directly over the umbilicus
c. Middle lower abdomen to the left of the midline
d. Midline lower abdomen to the right of the midline
46. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
a. DM
b. HPN
c. PVD
d. Syphilis
47. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic
aneurysm client?
a. Bruit
b. Crackles
c. Dullness
d. Friction rubs
48. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
a. Lower back pain, increased BP, decreased RBC, increased WBC
b. Severe lower back pain, decreased BP, decreased RBC, increased WBC
c. Severe lower back pain, decreased BP, decreased RBC, decreased WBC
d. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
49. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal
area?
a. Hernia
b. Stage 1 pressure ulcer
c. Retroperitoneal rupture at the repair site
d. Rapid expansion of the aneurysm
50. Which hereditary disease is most closely linked to aneurysm?
a. Cystic fibrosis
b. Lupus erythematosus
c. Marfans syndrome
d. Myocardial infarction
51. Which of the following treatments is the definitive one for a ruptured aneurysm?
a. Antihypertensive medication administration
b. Aortogram
c. Beta-adrenergic blocker administration
d. Surgical intervention
52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
a. Cardiomyopathy
b. Coronary artery disease
c. Myocardial infarction
d. Pericardial Effusion
53. Which of the following types of cardiomyopathy can be associated with childbirth?
a. Dilated
b. Hypertrophic
c. Myocarditis
d. Restrictive
54. Septal involvement occurs in which type of cardiomyopathy?
a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive
55. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?
a. Heart failure
b. DM
c. MI
d. Pericardial effusion
56. What is the term used to describe an enlargement of the heart muscle?
a. Cardiomegaly
b. Cardiomyopathy

c. Myocarditis
d. Pericarditis
57. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following
conditions?
a. Pericarditis
b. Hypertension
c. Obliterative
d. Restrictive
58. Which of the following types of cardiomyopathy does not affect cardiac output?
a. Dilated
b. Hypertrophic
c. Restrictive
d. Obliterative
59. Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
a. Dilated aorta
b. Normally functioning heart
c. Decreased myocardial contractility
d. Failure of the ventricle to eject all the blood during systole
60. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
a. Antihypertensive
b. Beta-adrenergic blockers
c. Calcium channel blockers
d. Nitrates
Answers and Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores. If you have any
disputes or need more clarification to a certain question, please direct them to the comments section.
1. c. Left anterior descending artery
The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the
lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.
2. b. During diastole
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is
supplied during diastole. Breathing patterns are irrelevant to blood flow
3. b. Coronary artery disease
Coronary artery disease accounts for over 50% of all deaths in the US. Cancer accounts for approximately 20%. Liver failure and renal
failure account for less than 10% of all deaths in the US.
4. a. Atherosclerosis
Atherosclerosis, or plaque formation, is the leading cause of CAD. DM is a risk factor for CAD but isnt the most common cause. Renal
failure doesnt cause CAD, but the two conditions are related. Myocardial infarction is commonly a result of CAD.
5. b. Plaques obstruct the artery
Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in
the artery. Hardened vessels cant dilate properly and, therefore, constrict blood flow.
6. c. Heredity
Because heredity refers to our genetic makeup, it cant be changed. Cigarette smoking cessation is a lifestyle change that involves
behavior modification. Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Altering ones diet,
exercise, and medication can correct hypertension.
7. d. 200 mg/dl
Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also
helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk
for CAD.
8. b. Enhance myocardial oxygenation
Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise.
Without adequate oxygen, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but its
administration isnt the first priority. Although educating the client and decreasing anxiety are important in care delivery, nether are
priorities when a client is compromised.
9. c. Oral medication administration
Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catheterization isnt a treatment
but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical
treatments.
10. c. Inferior
The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce

an infarction in that area. The right coronary artery doesnt supply the anterior portion ( left ventricle ), lateral portion ( some of the left
ventricle and the left atrium ), or the apical portion ( left ventricle ) of the heart.
11. a. Chest pain
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most
common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often
seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.
12. b. Left fifth intercostal space, midclavicular line
The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum
impulse and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where the pulmonic
sounds are auscultated. Normally, heart sounds arent heard in the midaxillary line or the seventh intercostal space in the midclavicular
line.
13. d. Pulmonary
Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increase with movement. Cardiac and GI pains
dont change with respiration.
14. c. Pulmonic
Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Aortic valve
abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth
intercostal space in the midclavicular line. Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the
sternal border.
15. c. Troponin I
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels arent detectable in people without
cardiac injury. Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are
useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review
electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.
16. d. To decrease oxygen demand on the clients heart
Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while
causing sedation, but isnt primarily given for those reasons.
17. c. Coronary artery thrombosis
Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and
doesnt cause an MI. Renal failure can be associated with MI but isnt a direct cause. Heart failure is usually the result of an MI.
18. c. Potassium
Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Chloride and
sodium arent loss during diuresis. Digoxin acts to increase contractility but isnt given routinely with furosemide.
19. d. Metabolic
Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Mechanical changes are those that
affect the pumping action of the heart, and electrophysiologic changes affect conduction. Hematologic changes would affect the blood.
20. a. Ventricular dilation
Rapid filling of the ventricles causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can
result is a fourth heart sound. Aortic valve malfunction is heard as a murmur.
21. a. Left-sided heart failure
The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular
function. When the left ventricle doesnt function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and
alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.
22. d. Electrocardiogram
The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes
are used to diagnose MI but cant determine the location. An echocardiogram is used most widely to view myocardial wall function after
an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate
the location of myocardial damage, but the study may not be performed immediately.
23. b. Administer oxygen
Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction,
so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublingual nitroglycerin are
also used to treat MI, but theyre more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to
evaluate MI.
24. a. Tell me about your feeling right now.
Validation of the clients feelings is the most appropriate response. It gives the client a feeling of comfort and safety. The other three
responses give the client false hope. No one can determine if a client experiencing MI will feel or get better and therefore, these
responses are inappropriate.
25. a. Beta-adrenergic blockers
Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and
sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the
workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by

decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decreased anxiety. Nitrates reduce
myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance
(afterload).
26. c. Arrhythmias
Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. cardiogenic shock,
another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of
clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common
complication. Pericarditis most commonly results from a bacterial of viral infection but may occur after MI.
27. b. Heart failure
Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein distention isnt a
symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of
itself, an MI doesnt cause jugular vein distention.
28. c. Raised 30 degrees
Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of
highest pulsation with the head of the bed inclined between 15 and 30 degrees. Inclined pressure cant be seen when the client is
supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore,
not visible). In high Fowlers position, the veins would be barely discernible above the clavicle.
29. a. Apical pulse
An apical pulse is essential or accurately assessing the clients heart rate before administering digoxin. The apical pulse is the most
accurate point in the body. Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would
withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and therefore, wont always accurately depict the
heart rate. Digoxin has no effect on respiratory function.
30. a. Digoxin
One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other medications arent
associated with such an effect.
31. a. Crackles
Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary
system. Arrhythmias can be associated with both right and left-sided heart failure. Left-sided heart failure causes hypertension
secondary to an increased workload on the system.
32. d. Right-sided heart failure
The most accurate area on the body to assed dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema
is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and renal disease arent directly linked to sacral edema.
33. c. Oliguria
Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria.
Adequate urine output, polyuria, and polydipsia arent associated with right-sided heart failure.
34. d. Inotropic agents
Inotropic agents are administered to increase the force of the hearts contractions, thereby increasing ventricular contractility and
ultimately increasing cardiac output. Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately
decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload
of the heart.
35. b. Tachycardia
Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. The other symptoms listed are related to
the parasympathetic nervous system, which is responsible for slowing the heart rate.
36. d. Right-sided heart failure
Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Cardiomyopathy is usually
identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic
ones. Angina pectoris doesnt cause weight gain, nausea, or a decrease in urine output.
37. a. Atherosclerosis
Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing
an aneurysm. Although the other conditions are related to the development of an aneurysm, none is a direct cause.
38. b. Distal to the renal arteries
The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isnt surrounded by stable
structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature,
making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic
(descending) aorta.
39. a. Abdominal aortic aneurysm
The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as
in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastric
distention cause pulsation.
40. a. Abdominal pain
Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region.

Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. Headache
and diaphoresis arent associated with abdominal aortic aneurysm.
41. d. Lower back pain
Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is
referred to the lower back. Abdominal pain is most common symptom resulting from impaired circulation. Absent pedal pulses are a
sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with
atherosclerosis of the coronary arteries.
42. b. Arteriogram
An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An
abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound dont give a direct view of the
vessels and dont yield as accurate a diagnosis as the arteriogram.
43. b. Aneurysm rupture
Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client.
Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, a sign
of poor circulation to the lower extremities, are associated with an aneurysm but isnt life threatening. Cardiac arrhythmias arent
directly linked to an aneurysm.
44. c. Media
The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so its
more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.
45. c. Middle lower abdomen to the left of the midline
The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.
46. b. HPN
Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic
changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isnt as strong as it is with hypertension.
Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesnt have direct link to aneurysm.
47. a. Bruit
A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs.
Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface.
48. b. Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture
occurs, the pain is constant because it cant be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of
blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldnt increase. For
the same reason, the RBC count is decreased not increase. The WBC count increases as cells migrate to the site of injury.
49. c. Retroperitoneal rupture at the repair site
Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused
by leakage at the repair site. A hernia doesnt cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with
rapid expansion of the aneurysm, a hematoma wont form.
50. c. Marfans syndrome
Marfans syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more
likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasnt been linked to aneurysms. Lupus erythematosus
isnt hereditary. Myocardial infarction is neither hereditary nor a disease.
51. d. Surgical intervention
When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and betaadrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an
aneurysm.
52. a. Cardiomyopathy
Cardiomyopathy isnt usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown.
Coronary artery disease and myocardial infarction are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into
the pericardial sac, a condition associated with pericarditis and advanced heart failure.
53. a. Dilated
Although the cause isnt entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first
few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic
cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis
isnt specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually
myocardial.
54. c. Hypertrophic
In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum not the ventricle chambers is apparent. This abnormality isnt
seen in other types of cardiomyopathy.
55. a. Heart failure
Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy.

Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries.
Pericardial effusion is most predominant in clients with percarditis. Diabetes mellitus is unrelated to cardiomyopathy.
56. a. Cardiomegaly
Cardiomegaly denotes an enlarged heart muscle. Cardiomyopathy is a heart muscle disease of unknown origin. Myocarditis refers to
inflammation of heart muscle. Pericarditis is an inflammation of the pericardium, the sac surrounding the heart.
57. d. Restrictive
These are the classic symptoms of heart failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a
pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances and a flushed face. Myocardial infarction
causes heart failure but isnt related to these symptoms.
58. b. Hypertrophic
Cardiac output isnt affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Dilated
cardiomyopathy, and restrictive cardiomyopathy all decrease cardiac output.
59. d. Failure of the ventricle to eject all the blood during systole
An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to
decrease compliance of the ventricle. A dilated aorta doesnt cause an extra heart sound, though it does cause a murmur. Decreased
myocardial contractility is heard as a third heart sound. An s4 isnt heard in a normally functioning heart.
60. b. Beta-adrenergic blockers
By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary
goals in the treatment of cardiomyopathy. Antihypertensives arent usually indicated because they would decrease cardiac output in
clients who are often already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic
blockers; however, they arent as effective as beta-adrenergic blockers and cause increase hypotension. Nitrates arent used because
of their dilating effects, which would further compromise the myocardium.