Chapter 24. Nursing Care of Patients With Occlusive Cardiovascular Disorders My Nursing Test Banks

Chapter 24. Nursing Care of Patients With Occlusive Cardiovascular Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is reinforcing teaching for managing the pain of peripheral arterial disease. Which patient statement indicates correct understanding of discharge instructions?
a. I will lie down frequently.
b. I will use a reclining chair.
c. I will sit with my legs down.
d. I will do knee flexion exercises.
____ 2. A patient is brought to the emergency room by a daughter who reports that the patient has had multiple episodes of chest pain in the past few days and has refused to seek care. The patient states, I feel fine and the pain has only lasted for brief periods. The nurse recognizes that the patient is most likely using which coping technique?
a. Anger
b. Denial
c. Projection
d. Regression
____ 3. The nurse is providing discharge instructions to a patient with brown, leathery, edematous ankles and increased pain when sitting. Which patient statement indicates that teaching has been effective?
a. I should elevate my legs on pillows.
b. I should keep my legs lower than my heart.
c. Elastic bandages should be wrapped from the knee down.
d. I should increase my intake of red meat and dairy products.
____ 4. A patient with peripheral venous disease (PVD) is sitting in a chair and has edematous and purple feet. What action should the nurse to take?
a. Notify the physician.
b. Cover the patient with a blanket.
c. Place the patients legs on a tall footstool.
d. Have the patient lie in bed with pillow under knees.
____ 5. The nurse has reinforced teaching about symptoms of an MI and the importance of seeking medical treatment promptly to a patient who has angina. What should the nurse explain as a common reason prompt treatment is not sought?
a. Lack of insurance
b. Denial of symptoms
c. Lack of transportation
d. Not aware of symptoms
____ 6. The nurse reviews the importance of seeking medical treatment with a patient at risk for an MI. Which patient statement indicates that teaching has been effective?
a. Angina is prevented.
b. Risk factors are decreased.
c. Less heart muscle is damaged.
d. Coronary artery disease is cured.
____ 7. The nurse is contributing to the teaching plan for a patient who is taking nitroglycerin. Which action should be included if chest pain occurs?
a. Take 2 tablets every 3 hours for four doses until pain is relieved.
b. Take 3 tablets every 3 minutes for four doses until pain is relieved.
c. Take 1 tablet every 5 minutes for three doses until pain is relieved.
d. Take 2 tablets every 2 minutes for three doses until pain is relieved.
____ 8. A patient who is apprehensive, gray, cold, and clammy reports pain that is as if an elephant is standing on my chest. The nurse should recognize that these manifestations indicate which health problem?
a. Heartburn
b. Pericarditis
c. An anginal attack
d. Acute MI
____ 9. The nurse is helping prepare a teaching plan to modify risk factors for a patient with coronary artery disease. Which risk factor should the nurse include in this patients teaching plan?
a. Age and gender
b. Gender and ethnicity
c. Heredity and ethnicity
d. Smoking and high fat intake
____ 10. A patient who develops chest pain that radiates down the left arm has all of these measures prescribed. Which one should the nurse do first?
a. Repeat vital signs.
b. Apply oxygen at 2 L/min.
c. Administer nitroglycerin SL.
d. Obtain an electrocardiogram (ECG).
____ 11. A patient has chronic peripheral arterial disease. During neurovascular checks, the nurse finds an absent left pedal pulse and a cyanotic leg. What should the nurse do?
a. Notify the registered nurse (RN) immediately.
b. Massage the patients left foot.
c. Reassess the pulse in 30 minutes.
d. Encourage patient to flex the leg 10 times.
____ 12. A patient is recovering from a cardiac catheterization that was completed through the right femoral site. Which information is most essential for the nurse to collect immediately after the procedure?
a. Left pedal pulse
b. Right pedal pulse
c. Left brachial pulse
d. Right brachial pulse
____ 13. The nurse receives a telephone call from a relative who was diagnosed with angina last year. The relative reports taking 5 nitroglycerin (NTG) tablets but still has chest pain. What would be the best advice for the nurse to give this relative?
a. Take two more NTG tablets and lie down.
b. I will call an ambulance and report your chest pain.
c. Drive yourself to the emergency department immediately.
d. Have someone drive you to the emergency department now.
____ 14. The nurse is caring for a patient recovering from an MI. In which position should the nurse place the patient to decrease preload and the hearts workload?
a. Prone
b. Supine
c. Sims position
d. Semi-Fowlers position
____ 15. The nurse is caring for a patient suspected of having an MI. What laboratory tests should the nurse review to determine if this patient did experience an MI?
a. Troponin I and myoglobin
b. Bleeding time and total cholesterol
c. Urinalysis and complete blood count
d. Alkaline phosphatase and prothrombin time
____ 16. The nurse is reinforcing the importance of leg exercises with a patient who is prescribed bedrest. Which patient statement indicates that teaching has been effective?
a. Prepare for ambulation.
b. Promote urinary and intestinal elimination.
c. Prevent thrombophlebitis and blood clot formation.
d. Decrease the likelihood of pressure ulcer formation.
____ 17. A patient with varicose veins asks how the condition develops. Which response by the nurse is best?
a. Swelling of the vein is caused by bacteria.
b. Veins spasm and twist when they get damaged.
c. They are caused by poor function of the valves in your veins.
d. Veins become blocked by plaque from high-fat diets over time.
____ 18. The nurse is assisting with admission of a patient experiencing symptoms of an acute MI. Which activity would be the highest priority for this patient?
a. Relieve pain.
b. Note emotions.
c. Limit fluid intake.
d. Support the family.
____ 19. A patient who develops chest pain says the pain is a 9 on a scale of 0 to 10. Which action should the nurse take?
a. Notify the RN.
b. Apply telemetry.
c. Administer aspirin.
d. Listen to breathing sounds.
____ 20. A patient reports acute pain and numbness in the left leg. The nurse notes the left leg is pale and cooler than the right leg. What should the nurse do?
a. Notify the RN.
b. Elevate the left leg.
c. Administer pain medication.
d. Apply an extra blanket to the left leg.
____ 21. The nurse is assisting with the care of a patient with an MI. Which specialized diet should the nurse expect to be prescribed for this patient?
a. Soft diet
b. Full liquid
c. Edentulous diet
d. Clear liquid diet
____ 22. A patient recovering from an MI asks for information about the types of meat that can be eaten. What should the nurse respond to the patient?
a. Eat small amounts of any type of meat.
b. Eat only vegetables; you do not need to eat meat.
c. Eat lean red meat to help increase your iron levels.
d. Eat chicken and fish, keeping red meats to a minimum.
____ 23. The nurse is reinforcing instructions provided to a patient to prevent the development of varicose veins. Which patient statement indicates that teaching has been effective?
a. Sit with legs crossed.
b. Wear support stockings.
c. Stand for long periods of time.
d. Sleep with the head of the bed elevated.
____ 24. The nurse is teaching a patient about an upcoming cardiac catheterization and coronary arteriogram. What information should the nurse include in this teaching?
a. You will be able to hear your heart beating.
b. You will see a lot of equipment in the room.
c. You will feel a heavy sensation throughout your body.
d. You will not feel anything because you will be anesthetized.
____ 25. A patient being treated for an acute MI reports severe chest pressure, as if someone is standing on my chest. What should the nurse do first?
a. Obtain vital signs.
b. Notify the physician.
c. Administer nitroglycerin.
d. Order an electrocardiogram.
____ 26. The nurse is assisting with the care of a patient who is receiving an intravenous infusion with potassium. The nurse realizes that fluids containing potassium are administered slowly and cautiously to prevent which health problem?
a. Cardiac arrest
b. Fluid overload
c. Allergic reaction
d. Metabolic acidosis
____ 27. The nurse is reinforcing teaching provided to a patient to decrease the risk of atherosclerosis. Which patient statement indicates that teaching on how to reduce triglycerides with lifestyle changes and prescribed medication was effective?
a. Eat a low-protein diet, limit activity, and take niacin.
b. Limit activity, eat a high-protein diet, and take aspirin.
c. Eat a high-fat diet, avoid smoking, and take daily furosemide (Lasix).
d. Perform daily exercise, eat a low-fat diet, and take gemfibrozil (Lopid).
____ 28. The nurse is collecting data on a patient with an aortic aneurysm. Which manifestation should the nurse expect to find?
a. Paralysis
b. Back pain
c. Chest pain
d. Ankle edema
____ 29. The nurse is reinforcing teaching provided to a patient with Raynauds disease. Which measure should the nurse include to prevent an attack?
a. Get plenty of outdoor exercise all year.
b. Keep affected body areas covered at all times.
c. Avoid stimulation that causes vasoconstriction.
d. Take vasopressors to prevent exacerbation of symptoms.
____ 30. The nurse is reinforcing teaching provided to a patient with an aneurysm. Which patient statement indicates correct understanding of a dissecting aneurysm?
a. An outpouching of one side of the arterial wall.
b. A communication between an artery and a vein.
c. A separation of the inner layer of the arterial wall.
d. An enlargement of the entire circumference of the artery.
____ 31. The nurse is collecting data on a patient with varicose veins. What should the nurse document as a subjective finding of varicosities?
a. Ankle edema
b. Purple lesions
c. Aching of legs
d. Palpable nodules
____ 32. The nurse is contributing to the plan of care for a patient with varicose veins. Which position should be encouraged to reduce the patients pain?
a. Lie prone.
b. Cross legs.
c. Elevate legs.
d. Keep legs dependent.
____ 33. The nurse is reinforcing teaching provided to a patient with coronary artery disease. Which risk factor for an MI should be included in this patients teaching plan?
a. Age
b. Stress
c. Gender
d. Ethnicity
____ 34. The nurse is caring for a patient with an abdominal aortic aneurysm. Which statement indicates that the patient understands this condition?
a. A blood clot in a vein.
b. An incompetent valve in a large vein.
c. An outpouching in the wall of an artery.
d. A deposit of plaque in the wall of an artery.
____ 35. The nurse is collecting data from a patient experiencing an MI. Which finding should the nurse expect?
a. Flushed face
b. Extreme thirst
c. A moist cough
d. Profuse diaphoresis
____ 36. A patient with a history of angina has several medications prescribed. Which medication should the nurse administer when the patient reports chest pain?
a. Nitropaste
b. Aspirin PO
c. Digoxin PO
d. Nitroglycerin SL
____ 37. The nurse is collecting data from a patient who has chronic venous insufficiency of the lower extremities. Which finding should the nurse expect?
a. Leathery, brown skin
b. Diminished pedal pulse
c. Absence of pedal pulses
d. Pallor in the extremities
____ 38. A patient being treated for cardiogenic shock has an order for captopril (Capoten). Vital signs are blood pressure 120/70 mm Hg, pulse 85 beats/min, and respirations 16 breaths/min. What action should the nurse take regarding this medication?
a. Administer the dose.
b. Give the medication 1 hour later.
c. Hold the medication and notify the physician.
d. Ambulate the patient until blood pressure increases.
____ 39. The nurse is contributing to the teaching plan of a patient who is prescribed niacin. What specific recommendation should be included in the teaching plan?
a. Take with meals or milk to avoid gastrointestinal upset.
b. Take aspirin 30 minutes before niacin to reduce flushing.
c. Increase intake of fruits and vegetables to reduce constipation.
d. Take 30 minutes before morning and evening meals to avoid gastrointestinal upset.
____ 40. The nurse is caring for a patient who is being prepared for coronary atherectomy. Which order should the nurse expect to administer?
a. Diuretic
b. Beta blocker
c. An antiplatelet
d. Calcium channel blocker
____ 41. The nurse is caring for a patient who has long-standing asthma and stable angina. Which medication can the nurse safely provide to the patient?
a. Pindolol (Visken)
b. Nadolol (Corgard)
c. Atenolol (Tenormin)
d. Propranolol (Inderal)
____ 42. The physician prescribes nitroglycerin for a patient with anterior MI. The patients vital signs are apical pulse 52 beats/min and blood pressure 80/60 mm Hg. What action should the nurse take?
a. Administer the drug as ordered.
b. Report the vital signs to the RN.
c. Recheck vital signs in 30 minutes.
d. Give medication at half the prescribed dose.
____ 43. The nurse is reinforcing teaching provided to a patient with Buergers disease on the most important modifiable risk factor. Which risk factor should the patient state that indicates teaching has been effective?
a. Diet
b. Smoking
c. Sedentary lifestyle
d. Exposure to cold temperature
____ 44. The nurse is reinforcing teaching provided to a patient who has been prescribed a new medication. For which medication should the patient be instructed there is the possibility of developing a cough when taking the drug?
a. Statin
b. Beta blocker
c. Calcium channel blocker
d. Angiotensin-converting enzyme inhibitor
____ 45. A patient with low back pain is returning from an abdominal computed tomography (CT) scan that revealed an aortic aneurysm. For which finding should the nurse immediately intervene?
a. Patient reports sudden severe flank pain.
b. Patient BP goes from 144/78 mm Hg to 152/80 mm Hg.
c. Patient reports a sense of abdominal fullness after eating.
d. Patient informs the nurse of a family history of hypertension.
____ 46. A patient scheduled for a carotid endarterectomy asks what is going to happen in the procedure. What should the nurse explain to the patient?
a. Procedures are constantly changing, so I dont know what might be planned.
b. The procedure usually involves removing plaque from the lining of the carotid artery.
c. An endarterectomy is usually done on major vessels of the heart to prevent the need for bypass surgery.
d. Typically a catheter is passed through a large vessel in your groin and threaded up into your heart to allow the injection of dye.
____ 47. A patient with chest pain is a candidate for thrombolytic therapy. How soon should this medication be provided to the patient?
a. 30 minutes
b. 120 minutes
c. 180 minutes
d. 240 minutes
____ 48. A patient reports that chest pain started at 2 pm. The nurse realizes that for thrombolytic treatment to be most effective in dissolving a blood clot, it should be given by:
a. 8 pm
b. 9 pm
c. 12 midnight
d. 2 am
____ 49. The nurse is concerned that a patient is at risk for MI because of the latest total cholesterol level. Which level did the nurse use to cause this concern?
a. 120 mg/dL
b. 138 mg/dL
c. 174 mg/dL
d. 221 mg/dL
____ 50. During a home visit, the nurse is reinforcing teaching provided about nitroglycerin therapy. Which patient statement about the supply indicates that teaching has been effective?
a. I need to replace my supply of nitroglycerin every 2 months.
b. I need to replace my supply of nitroglycerin every 4 months.
c. I need to replace my supply of nitroglycerin every 6 months.
d. I need to replace my supply of nitroglycerin every 10 months.
____ 51. A male patient is prescribed a long-acting nitroglycerin medication for stable angina. Which medication should the nurse remind the patient to avoid while taking the nitroglycerin?
a. Sildenafil (Viagra)
b. Warfarin (Coumadin)
c. Penicillin (Pen-V-K)
d. Hydrochlorothiazide (HCTZ)
____ 52. A patient is recovering from stent placement in an occluded coronary artery. Which medication should the nurse expect to be prescribed for this patient?
a. Antiplatelet
b. Beta blocker
c. ACE-Inhibitor
d. Calcium channel blocker
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 53. The nurse is contributing to the plan of care for a patient experiencing chest pain for 7 hours. The laboratory tests reveal elevated troponin I and myoglobin levels. What action should the nurse take when caring for this patient? (Select all that apply.)
a. Elevate head of bed.
b. Encourage ambulation
c. Provide rest in bed or chair.
d. Offer regular diet with hot tea.
e. Provide bedpan for elimination.
____ 54. The nurse is participating in the preparation of a seminar on coronary heart disease for a group of community members. What should modifiable risk factors for atherosclerosis should the nurse include in this presentation? (Select all that apply.)
a. Ethnic group
b. Hypertension
c. Diabetes mellitus
d. Familial hyperlipidemia
e. Increased serum iron levels
f. Increased homocysteine levels
____ 55. The nurse is caring for a patient with a cardiac history. Which actions should the nurse take when administering diltiazem (Cardizem)? (Select all that apply.)
a. Monitor for constipation.
b. Monitor for development of a round face.
c. Monitor liver and renal functions during therapy.
d. Notify physician if heart rate is less than 50 beats per minute.
e. Obtain apical pulse and blood pressure before giving medication.
f. Notify physician if blood pressure is less than 90 mm Hg systolic.
____ 56. The nurse is contributing to a patients teaching plan. What should be included when teaching a patient about the use of nitroglycerin? (Select all that apply.)
a. Take tablet every morning.
b. Place tablet under the tongue.
c. Rise slowly after taking tablet.
d. Sit or lie down when taking tablet.
e. Take before activity known to cause angina.
f. Have a years supply of the medication at home.
____ 57. The nurse is preparing to apply a nitroglycerin patch to a patient with stable angina. What actions should the nurse take when providing this medication? (Select all that apply.)
a. Apply the new patch before breakfast.
b. Wear gloves when applying the patch.
c. Encourage rest for 1 hour after applying the new patch.
d. Remove the previous patch before applying a new one.
e. Apply the new patch 30 minutes before removing the old one.
____ 58. The spouse of a patient experiencing an acute MI does not understand why the patient is receiving morphine sulfate for pain. What should the nurse explain to the patient and spouse? (Select all that apply.)
a. Decreases anxiety
b. Opens bronchioles
c. Relieves chest pain
d. Decreases preload and afterload
e. Reduces myocardial oxygen needs
____ 59. The nurse determines that a patient recovering from an acute MI is experiencing activity intolerance. What findings did the nurse use to come to this conclusion? (Select all that apply.)
a. Dizziness
b. Extreme diaphoresis
c. Nausea and vomiting
d. Heart rate 140 beats per minute
e. 35 mm Hg increase in systolic blood pressure

Chapter 24. Nursing Care of Patients With Occlusive Cardiovascular Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: C
Placing the legs down will promote arterial circulation and help relieve pain from ischemia due to reduced blood flow. A. B. D. These actions will impede blood flow and increase pain.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis

2. ANS: B
A normal emotional response is anxiety, denial, or embarrassment for myocardial infarction (MI), which delays treatment. Patients should be taught that time is muscle and to call 911 with symptoms. A. C. D. The patients behavior is not consistent with anger, projection, or regression.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Analysis

3. ANS: A
Elevating legs will promote venous return and help relieve pain from the swelling. B. C. Keeping the legs lower than the heart and using elastic bandages will impede blood return and increase pain. D. No specific dietary recommendations need to be followed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis

4. ANS: C
C. Placing the patients legs on a footstool will increase blood return while the patient is sitting up for short time periods. B. The patients feet are not purple due to being cold. A. It is not necessary to notify the physician, as the patient has PVD, unless there is a significant change. D. Placing a pillow under the knees would constrict blood return, further increasing edema.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

5. ANS: B
A normal emotional response when experiencing chest pain is anxiety, denial, or embarrassment. A. C. D. Insurance, transportation, or unawareness of symptoms is not common reasons for delaying treatment in the patient experiencing chest pain.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

6. ANS: C
Less heart muscle is damaged with prompt treatment, as time is muscle. A. B. D. Seeking proper treatment for an MI is not done to prevent angina, decrease risk factors or cure coronary artery disease.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

7. ANS: C
Take 1 tablet every 5 minutes for three doses until pain is relieved. If pain is not relieved, call 911. A. B. D. The patient should not be instructed to take more than one nitroglycerin tablet at a time.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

8. ANS: D
These are symptoms of an acute MI. A. B. C. These symptoms are not associated with heartburn, pericarditis, or an anginal attack.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

9. ANS: D
Smoking and high fat intake are modifiable risk factors. A. B. C. Age, gender, ethnicity, and heredity are non-modifiable risk factors for coronary artery disease.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

10. ANS: B
Reducing ischemia to relieve chest pain is the priority, so applying oxygen would be the priority action to take. A. C. D. Vital signs, nitroglycerin, and an ECG can be completed after oxygen has been provided to the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentCoordinated Care | Cognitive Level: Application

11. ANS: A
Notify the RN immediately, as the patient needs immediate intervention to preserve circulation in the leg. B. Massaging the foot is not going to improve the patients arterial functioning. C. Reassessing the patient in 30 minutes could cause the patient undo harm. D. Exercise will not improve the patients arterial functioning in the limb.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

12. ANS: B
It is essential to monitor the right pedal pulse to ensure that circulation is not compromised distal to the access site. A. C. D. It is not important for the nurse to assess these pulse sites.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

13. ANS: B
Because the NTG did not relieve the pain after three doses, 911 needs to be called now. A. The patient cannot delay care by taking more NTG and lying down. C. It is not safe for the patient to drive himself to the emergency department. D. Emergency personnel should transport a patient to the emergency department and not someone else.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

14. ANS: D
Semi-Fowlers position decreases cardiac workload and stress and allows for improved breathing. A. B. C. These positions do not decrease preload and the hearts workload.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

15. ANS: A
The most useful indicators of an MI are patient history, electrocardiogram (ECG), and serum cardiac troponin I or T, myoglobin, and creatine kinase-MB (CK-MB) levels. B. C. D. Bleeding time, total cholesterol, urinalysis, complete blood count, alkaline phosphatase and prothrombin time are not used to diagnose an MI.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

16. ANS: C
Immobility puts the patient at risk for venous stasis. To prevent thrombophlebitis and blood clot formation, it is essential to teach leg exercises to the patient. A. B. D. Leg exercises are not performed to prepare for ambulation, promote urinary and intestinal elimination, or to decrease the development of pressure ulcers.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

17. ANS: C
Primary varicosities are caused by a structural defect in the vessel wall. Along with the defect, the dilation of the vessel can lead to incompetent venous valves. A. B. D. Varicose veins are not caused by bacteria, vessel spasms and twisting, or blockages from plaque.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

18. ANS: A
Relieving pain is the priority. B. C. D. These actions can be completed at a later time.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Analysis

19. ANS: A
The RN needs to be informed immediately so the physician can be notified for orders. D. Breathing sounds will not clarify the patients clinical status, because chest pain is a symptom of an acute MI. C. Vital signs, oxygen, and nitroglycerin are appropriate interventions however administering aspirin is not. B. Telemetry may also be used but is not the highest priority at this time.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

20. ANS: A
Notify the RN immediately as the patient needs immediate intervention to preserve circulation in the leg. B. Elevating the leg would be contraindicated as it would decrease blood flow further. C. D. Restoration of circulation is needed rather than a blanket or pain medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Application

21. ANS: D
A clear liquid diet is ordered initially to reduce the hearts workload when digesting a meal. A. B. The diet is progressed as able to full liquid and then soft diet. C. Edentulous diets would be on a prn basis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

22. ANS: D
To reduce cholesterol levels and risk of further heart disease, eat chicken and fish, keeping red meats to a minimum. A. C. Red meat should be kept to a minimum. B. The patient does not need to become a vegetarian.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

23. ANS: B
Wearing support stockings promotes venous return to reduce edema and pain. A. C. D. These actions promote the development of varicose veins.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

24. ANS: B
There is a significant amount of equipment in the room during a cardiac catheterization. A. C. D. These statements are not true about a cardiac catheterization.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

25. ANS: A
Data collection should be done first and then reported to the physician so that appropriate orders can be obtained. C. D. After the physician is notified, additional orders may be provided which may or may not include nitroglycerin or an electrocardiogram.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Application

26. ANS: A
Potassium can cause cardiac arrest and should never be given faster than indicated. Potassium is never given IV push. B. C. D. Administration of potassium does not cause fluid overload, allergic reaction, or metabolic acidosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

27. ANS: D
Daily exercise, low-fat diet, and taking medication as prescribed will help the patient reduce triglycerides. A. B. C. These actions will not necessarily help to reduce the patients risk of atherosclerosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

28. ANS: B
Back pain is a classic sign of aortic aneurysm. A. C. D. Paralysis, chest pain, and ankle edema are not manifestations associated with an aortic aneurysm.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

29. ANS: C
Teach avoiding causes of vasoconstriction, such as smoking, alcohol, caffeine, and reducing stress levels. B. Wearing gloves is only needed when being exposed to cold. D. Vasodilators help avoid peripheral vasoconstriction. A. Going out in the cold should be avoided.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

30. ANS: C
A dissecting aneurysm is a separation of the inner layer of the arterial wall. A. B. D. These statements do not explain the mechanism of an aneurysm.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

31. ANS: C
A subjective finding is one in which the patient reports. The patient would report a feeling of aching, which is not observable (objective) by the nurse as the others are. A. B. D. Ankle edema, purple lesions, and palpable nodules can all be assessed objectively by the nurse.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

32. ANS: C
Elevating legs will promote venous return and help relieve pain from the swelling. A. B. D. These positions will not promote blood return to decrease pain.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

33. ANS: B
Stress increases heart workload and risk for hypertension and is a modifiable risk factor. A. C. D. These are not modifiable risk factors.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

34. ANS: C
An aneurysm is a bulging, ballooning, or dilation at a weakened point of an artery. A. B. D. An aneurysm is not a blood clot in the vein, an incompetent valve, or a plaque deposit in an arterial wall.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

35. ANS: D
Symptoms during an MI may include chest pain, shortness of breath, fatigue, weakness, or dizziness caused by decreased blood supply and oxygen to the heart. Other symptoms may include diaphoresis or nausea. A. B. C. Facial flushing, thirst, and a moist cough are not manifestations of an acute MI.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

36. ANS: D
Chest pain results from ischemia, so giving a vasodilator, NTG, will dilate the coronary arteries to bring more oxygen to the heart and relieve the chest pain. A. Nitropaste will not work as quickly as sublingual nitroglycerin. B. C. Aspirin and Digoxin will not help relieve anginal chest pain.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

37. ANS: A
In chronic venous insufficiency, dysfunctional valves cause venous stasis, which results in edema and a brownish discoloration of the leg and foot, with the surrounding skin hardened and leathery in appearance. B. C. D. Changes in pulses and pallor are not associated with chronic venous insufficiency.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

38. ANS: A
Vital signs are within normal limits, so it is acceptable to give the medication as ordered. B. The nurse does not need to wait an hour to give the medication. C. The medication does not need to be held nor the physician notified. D. The patient does not need to be ambulated to increase the blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

39. ANS: B
The patient should be instructed to take aspirin 30 minutes prior to taking the niacin to reduce flushing. A. C. D. The patient does not need to take niacin with meals or milk. This medication does not cause constipation. It also does not need to be taken before meals to avoid gastrointestinal distress.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

40. ANS: D
Calcium channel blockers are given before atherectomy to prevent vasospasms from the vibrating cutter. C. An antiplatelet agent is given after the procedure. A. B. Diuretics and beta blockers are not prescribed prior to or after this procedure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

41. ANS: C
With asthma or chronic obstructive pulmonary disease, nonselective beta-adrenergic blockers are avoided due to bronchoconstriction. Metoprolol and Atenolol are more cardioselective and are used with asthma. A. B. D. The nurse should question before administering these medications.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

42. ANS: B
The vital signs are low and should be reported to the RN prior to giving medication, as the physician should be notified and will likely give orders to hold the medication. A. Administering the drug as prescribed would not be safe. C. Rechecking the vital signs in 30 minutes would be unsafe. D. Changing a prescribed dose of medication is beyond the nurses scope of practice.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Analysis

43. ANS: B
Heavy cigarette smoking is a major contributing factor to Buergers disease. Some studies indicate an autoimmune response to tobacco products as a possible cause. A. C. D. The most important modifiable risk factor for this disease is not diet, sedentary lifestyle, or exposure to cold temperatures.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

44. ANS: D
Angiotensin-converting enzyme inhibitors may cause a persistent cough to develop in 20% of patients. A. B. C. Cough is not an adverse effect of statins, beta blockers, or calcium channel blockers.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

45. ANS: A
Severe, sudden back, flank, or abdominal pain and a pulsating abdominal mass can indicate an aneurysm may be about to rupture. C. A sense of abdominal fullness is not associated with an abdominal aneurysm or impending rupture. B. The patients blood pressure is stable with normal variability. D. Hypertension and heredity may play a role in the development of an abdominal aneurysm, but this is not the priority.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

46. ANS: B
An endarterectomy is commonly performed on the carotid artery. The artery is clamped on both sides of the occlusion, and an incision is made into the artery. The plaque is removed with forceps. A. This procedure has not changed. C. A carotid endarterectomy is not performed on heart vessels. D. This explains a cardiac catheterization.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

47. ANS: A
For patients who are candidates for thrombolytic therapy, a door to needle interval of 30 minutes should be the goal. B. C. D. This time interval is too long to wait to provide the medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

48. ANS: A
For thrombolytic treatment to be most effective in dissolving a blood clot, it should be given within 6 hours of the onset of symptoms or for this patient, by 8 pm. B. C. D. Medication given at these times would not be the most effective to dissolve the clot.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

49. ANS: D
Total cholesterol levels greater than 200 mg/dL increase the risk of MI. A. B. C. These levels are below 200 mg/dL which reduces the patients risk for an MI.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

50. ANS: C
Nitroglycerin needs to be replaced every 6 months. A. B. The supply does not need to be replaced every 2 or 4 months. D. The supply needs to be replaced before 10 months.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

51. ANS: A
Patients prescribed nitrates should not use drugs, such as sildenafil (Viagra), for erectile dysfunction, because this drug dilates blood vessels and may cause a significant drop in blood pressure if used together. B. C. D. There is no reason for the patient to avoid taking warfarin, penicillin, or hydrochlorothiazide while taking a nitrate medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

52. ANS: A
Antiplatelet medications are recommended after stent placement to help prevent clot formation. B. C. D. Beta blockers, ACI-inhibitors, and calcium channel blockers are not indicated after stent placement for an occluded vessel.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

MULTIPLE RESPONSE

53. ANS: C, E
Rest and providing a bedpan for elimination will reduce the strain on the heart. A. B. D. Elevating the head of the bed, encouraging ambulation, and offering a regular diet with hot tea would increase strain on the heart.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

54. ANS: B, C, E, F
Hypertension, diabetes mellitus, and increased iron and homocysteine levels can be modified. A. D. Ethnic group and hereditary health problems cannot be modified.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

55. ANS: A, C, D, E, F
Monitoring for constipation, monitoring laboratory values on liver and renal function, notifying the physician of a slow heart rate and low blood pressure, and measuring apical pulse and blood pressure before administration are all actions that should be performed when administering this medication. B. A round face is associated with steroid administration.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

56. ANS: B, C, D, E
The patient should be instructed on how to take the medication sublingually, taking time to rise slowly after taking the medication, to sit or lie down when taking the medication, and to take the medication before an activity known to cause chest pain. A. This medication is not taken routinely every morning. F. The patient needs a 6 month supply of the medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

57. ANS: B, D
When applying transdermal nitroglycerin, the nurse should wear gloves to protect against hypotension from touching the ointment or patch medication. Always remove the prior ointment or patch before applying a new one to prevent overdose. A. The patch does not need to be applied before breakfast. C. The patient does not need to rest for 1 hour after applying the new patch. E. The new patch is not to be applied 30 minutes before removing the old patch.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

58. ANS: A, B, C, D
Morphine sulfate is the most commonly used narcotic for MI. In addition to pain relief, morphine helps decrease anxiety, opens bronchioles, and increases peripheral blood pooling to decrease preload (blood returning to heart) and afterload (pressure within the aorta), which can help increase blood supply and oxygen to the myocardium. E. Morphine does not affect myocardial oxygen needs.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

59. ANS: A, B, D, E
Abnormal responses to activity include heart rate over 120 bpm or 20 beats over resting rate, systolic BP increased over 20 mm Hg during activity, chest pain, dizziness, skin color changes, diaphoresis, dyspnea, dysrhythmias, excessive fatigue, and ST-segment changes on ECG. C. Nausea and vomiting are not manifestations of activity intolerance.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

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