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Situation: Despite lifestyle modifications and metaprolol (Aldomet) therapy , Richard Gomez’s Blood pressure remains

elevated . He’s admitted to the medical –surgical floor for blood pressure management .

Questions 1-3 refers to this situation.

1. Mr. Barrone’s doctor prescribes hydralazine (Apresoline) as adjunct therapy. What type of drug is hydralazine?

a. Smphatholytic c. Diuretic
b. vasodilator d. Ace-inhibitor

2. While teaching Mr. Barrone about hydralazine therapy , the nurse explains the regimen . When should he take his
daily dose of hydralazine?

a. upon arising in the morning c. Just before bedtime

b. on an empty stomach d. With a meal

3. The nurse teaches Mr. Barrone about the possible adverse reactions to hydralazine. Which of thses adverse reactions
is most likely to occur?

a. dry eye syndrome c. Orthostatic hypotension

b. pharyngitis d. Somnolence

4. A client has prescribed metaprolol (Lopressor ) for HPN (Hypertension). The nurse monitors client compliance
carefully because of which common side effect of the medication?

a. Impotence c. Increased appetite

b. mood swings d. Complete atrioventricular (A-V) block

5. The client presents to the clinic with a serum cholesterol of 275 mg/dl and is placed on rosuvastatin (Crestor). Which
instruction should be given to the client ?

a. report muscle weakness to the physician.

b. allow 6 months for the drug to take effect.
c. take the medication with food
d. ask the doctor to perform a complete blood count prior to starting the medication

6. A 50 year old woman is receiving Digoxin and Lasix twice a day . In planning for her care , the nurse should assess for
which complication?

a. hypokalemia c. Hyperkalemia
b. hypocalcemia d. Hyponatremia
22. The physician refers the client with angina for a cardiac catherization. The nurse explains to the client that this
procedure is being used in this specific case to
a. open and dilate blocked coronary arteries
b. assess the extent of arterial blockage
c. bypass obstructed vessels
d. assess the functional adequacy of the valves and heart muscles

23. A client with angina asks the nurse, “What information does an ECG provide?” The nurse would respond that an
electrocardiogram (ECG) primarily gives information about the
a. electrical conduction of the myocardium
b. oxygenation and perfusion of the heart
c. contractile of the ventricles
d. physical integrity of the heart muscle

24. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3 mg given
sublingually. This drug’s principal effects are produced by
a. antispasmodic effects on the pericardium
b. causing an increased myocardial oxygen demand
c. vasodilation of peripheral vasculature
d. improved conductivity in the myocardium
25. The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including
a. headache
b. high blood pressure
c. shortness of breath
d. stomach cramps

26. 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?
a. Take 1 tablet every 2 to 5 minutes until the pain stops
b. Take 1 tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes
c. take 1 tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain
persists after three tablets.
d. take 1 tablet. If pain persists after 5 min, take two tablets. If pain still persists 5 mins later, call the physician

27. The nurse is obtaining a history from a client diagnosed with coronary artery disease (CAD). The nurse determines
that which item pertinent to the client’s history is modifiable risk factor for CAD?
a. age and obesity
b. family history and stress
c. hypertension and cigarette smoking
d. gender and ethnicity

28. Which of the following conditions most commonly results in CAD?

a. Atherosclerosis
b. DM
c. MI
d. Renal failure

29. 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

30. Which of the following risk factors for coronary artery disease cannot be corrected?
a. Cigarette smoking
b. DM
c. Heredity
d. HPN

31. The client complains of chest pain after mowing the lawn. This pain is most likely the result of which of the following:
a. Pericardial effusion of fluid
b. Pulmonary edema
c. Myocardial ischemia
d. Pulmonary emboli

32. The client presenting with angina pain in the Emergency Department states, "I thought I was having a heart attack."
Which response by the nurse would provide the client with the most accurate information about the difference between
the pain of angina and that of myocardial infarction?
a. "The pain associated with angina is much more intense than that of a heart attack."
b. "The pain associated with a heart attack radiates up the jaw and that of angina radiates down the arm."
c. "The intensity of pain with a heart attack indicates the amount of muscle damage."
d. "The pain of angina is usually relieved by resting or lying down."
33. A client is due to receive a calcium channel blocker and a beta blocker for angina. Vital signs are BP 100/68, pulse 52
bpm, respirations 20. Which of the following is an appropriate action by the nurse?
a. Give the medicine and check vital signs in 30 minutes
b. Hold the medicine until the physician makes rounds
c. Call the physician first
d. Give the medicine as usual

34. A client with chest pain is given nitroglycerin (NTG) sublingual for complaint of angina pectoris. Prior to the NTG, his
blood pressure was 110/78. After 5 minutes, he says the chest pain is better but not gone. The nurse should first:
a. Give another NTG
b. Check the pulse rate
c. Give morphine sulfate instead of NTG
d. Check the blood pressure (BP)

35. During the past few months, a 56 y/o woman has 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 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 visits an invalid friend twice a week and now cannot walk up the second flight
of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would
most likely help the client deal with this problem?
a. Visit her friend early in the day
b. Rest for at least an hour before climbing the stairs
c. Take a nitroglycerin tablet before climbing the stairs
d. Lie down once she reaches the friend’s apartment

36. A 60-year-old male client comes into the emergency departments with complaints of crushing substernal chest pain
that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction (MI). immediate
admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead
electrocardiogram (ECG), and 2 mg of morphine sulfate given intravenously. The nurse should first
a. administer the morphine
b. obtain a 12-lead ECG
c. obtain the blood work
d. order the chest radiograph

37. When administering a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose
of the drug is to
a. Help keep him well hydrated
b. Dissolve clots that he may have
c. Prevent kidney failure
d. Treat potential cardiac dysrhythmias

38. If the client who was admitted for MI develops cardiogenic shock, which characteristic sign should the nurse expect
to observe?
a. Oliguria
b. Bradycardia
c. Elevated blood pressure
d. Fever

39. When teaching the client with MI, the nurse explains that the pain associated with MI is caused by
a. Left ventricular overload
b. Impending circulatory collapse
c. Extracellular electrolyte imbalances
d. Insufficient oxygen reaching the heart muscle

40. After an MI, the hospitalized client is taught to move the legs about while resting in bed. This type of exercise is
recommended primarily to help
a. prepare the client for ambulation
b. promote urinary and intestinal elimination
c. prevent thrombophlebitis and blood clot formation
d. decrease the likelihood of decubitus ulcer formation

41. The client in the Emergency Department was diagnosed with acute myocardial infarction (MI). He asks the nurse to
explain what this is. The nurse should tell him that an MI usually results from which of the following?
a. Obstruction of a coronary artery with death of tissue distal to the blockage
b. Spasm of a coronary artery causing temporary decreased blood supply
c. A slow heart rate leading to decreased blood supply to myocardium
d. Dilation of the ventricular wall causing decreased blood supply

42. During a teaching session with a client who has experienced an myocardial infarction, the nurse determines a need
for further discussion when the client states:
a. "I want to stay as pain-free as possible."
b. "I am not good at remembering to take medications."
c. "I should not have any problems in reducing my salt intake."
d. "I wrote down my medication information for future reference."

43. The nurse teaches a client with heart failure to take oral furosemide in the morning. The primary reason for this is to
a. prevent electrolyte imbalances
b. retard rapid drug absorption
c. excrete excessive fluids accumulated during the night
d. prevent sleep disturbances during the night

44. The nurse should teach the client that signs of digitalis toxicity include which of the following
a. skin rash over the chest and back
b. increased appetite
c. visual disturbances such as seeing yellow spots
d. elevated blood pressure

45. The nurse should be especially alert for signs and symptoms of digitalis toxicity if serum levels indicate that the client
a. low sodium level
b. high glucose level
c. high calcium level
d. low potassium level

46. The nurse’s discharge teaching plan for the client with congestive heart failure would stress the significance of which
of the following?
a. Maintaining a high fiber diet
b. Walking 2 miles every day
c. Obtaining daily weights at the same time each day
d. Remaining sedentary for most of the day

47. What supplemental medication is most frequently ordered in conjunction with furosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium

48. 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

49. The doctor prescribes digoxin (Lanoxin) twice a day until a therapeutic level is attained. When the nurse takes the
patient’s apical pulse on the third day, the patient’s pulse is 52 beats per minute and she complains of nausea. The nurse
a. Withhold the digoxin and notify the doctor
b. Withhold the digoxin and obtain a serum digoxin level
c. Administer the digoxin and medicate nausea
d. Administer the digoxin and notify the doctor

50. 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