Chapter 17: The Cardiovascular System

Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition

MULTIPLE CHOICE

1. The nurse is educating a female patient with a family history of coronary artery disease (CAD) about
risk factors and prevention of heart disease in women. Which information is most important for the
nurse to include?
a. Women should maintain a body mass index (BMI) of less than 28.
b. Women should utilize estrogen supplementation to decrease risk of heart disease.
c. Women should drink one alcoholic beverage daily.
d. Women should incorporate stress reduction techniques into their daily lifestyle.
ANS: D
Increased stress is a risk factor for cardiovascular disease, especially in women. Women should
incorporate stress reduction techniques into their daily lifestyle. Women should maintain a BMI of less
than 25. Women should discontinue use of estrogen contraception/supplementation as soon as
possible. Women should not consume more than one alcoholic drink per day, and abstaining from
alcohol is beneficial.

DIF: Cognitive Level: Comprehension REF: p. 381 OBJ: 2 (theory)

TOP: Heart Disease in Women KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

2. In a blood pressure of 120/80, what does the "80" indicate?

a. Pulse pressure
b. Pressure in the relaxed ventricles
c. Relative ejection factor
d. Stroke volume
ANS: B
The diastolic pressure of 80 mm Hg is the reading of the pressure during ventricular relaxation.

DIF: Cognitive Level: Knowledge REF: p. 379 OBJ: 1 (theory)

TOP: Diastolic Pressure: Definition KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The 85-year-old patient with a newly diagnosed heart murmur expresses concern that he has never
been notified of this finding before. What is the most likely cause of this patient's heartmurmur?
a. Hypertension
b. Atherosclerosis
c. Insufficient valves
d. Weakened pacemaker
ANS: C
Systolic murmurs commonly appear in people over the age of 80. These murmurs are usually related to
valvular dysfunction caused by thickening of the valves, especially the mitral and aortic valves.

DIF: Cognitive Level: Application REF: p. 394 OBJ: 2 (theory)

TOP: Murmur in the Older Adult KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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4. The nurse is caring for an older adult patient. While auscultating the patient's apical pulse, the nurse
notices an irregular rhythm. The nurse suspects which causative factor for the patient'sdysrhythmia?
a. Loss of cells in the sinoatrial (SA) nodes
b. Increased peripheral resistance
c. Hypertension
d. Atherosclerosis
ANS: A
Loss of cells in the SA nodes via age-related changes is the most common cause of dysrhythmias in
the older adult. This nurse should, however, document these findings and report the findings to the
primary care provider.

DIF: Cognitive Level: Application REF: p. 380 OBJ: 2 (clinical)

TOP: Dysrhythmia in the Older Adult KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse is assessing a female patient with a family history of coronary artery disease (CAD). Which
report is most concerning to the nurse?
a. "I get a little short of breath after climbing the three flights of stairs to my apartment."
b. "I stay tired all of the time, and it feels like my bra is too tight."
c. "I awaken frequently in the night, and my husband says that I snore."
d. "I notice wheezing after I dust or when I exercise."
ANS: B
In addition to displaying a positive family history for CAD, report of fatigue and shoulder and back
discomfort are most concerning to the nurse. Chest pain is often atypical in women and may manifest
as pain in the shoulders, back, or abdomen. Mild shortness of breath after climbing three flights of
stairs is consistent with exertion. Awakening frequently in the night and snoring are suspicious for
obstructive sleep apnea. Wheezing in the presence of dust or with exercise are findings consistent with
potential asthma.

DIF: Cognitive Level: Analysis REF: p. 381 OBJ: 9

TOP: Chest Pain in Women KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance

6. The nurse is outlining a teaching program for diabetic patients. Which teaching point about heart
disease prevention should the nurse emphasize most?
a. Keep blood sugar below 100 mg/dL.
b. Prevent infections.
c. Eat meals at regular times.
d. Use sterile technique in insulin injections.
ANS: A
The diabetic person who maintains the glucose level below 100 mg/dL will avoid the adverse effects
of hyperglycemia on the vessels. Preventing infections, eating at regular times, and using sterile
technique are all valid teaching points for the diabetic patient, but they do not specifically address
prevention of heart disease.

DIF: Cognitive Level: Analysis REF: p. 383, Table 17-1

OBJ: 4 (theory) TOP: Prevention of Heart Disease: Diabetics
KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

7. Which statement accurately describes the purpose of a Doppler flow study?

a. To detect a clot in a coronary artery
b. To visualize obstructions in leg vessels

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 c. To assess efficiency of blood flow through heart chambers
d. To detect a defective heart valve
ANS: B
The Doppler flow study detects obstructions in the vessels of the lower extremities. The Doppler study
may also be performed in other areas of the body, such as the carotid arteries.

DIF: Cognitive Level: Comprehension REF: p. 384, Table 17-2

OBJ: 5 (theory) TOP: Doppler Flow Study
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

8. The nurse is caring for a patient who just returned from a transradial heart catheterization. Which
action indicates the priority care for the postprocedure period?
a. The nurse encourages the patient to increase fluid intake.
b. The nurse checks the presence and strength of pedal pulses.
c. The nurse places the pulse oximeter on the thumb or first digit of the affected hand.
d. The nurse places the blood pressure cuff on the arm corresponding to the affected hand.
ANS: C
Priority postprocedure care involves carefully monitoring circulation checks to ensure adequate blood
flow to the affected hand while maintaining adequate compression on the radial artery to prevent
bleeding. The patient will return with a compression band over the radial puncture site. By placing the
pulse oximetry probe on the thumb or first digit of the affected hand, the nurse can obtain a pulse
oximetry reading that is specific to the radial artery. The nurse can compare this value to the patient's
baseline and ensure that the circulation is adequate. Increasing fluid intake helps flush dye out of the
patient's system, but it is a lesser priority than adequate perfusion and hemostasis. Presence and
strength of pedal pulses are a priority assessment for a transfemoral heart cauterization. The nurse
should avoid placing the blood pressure cuff on the same arm as the catheterization site because cuff
inflation could induce bleeding or compromise circulation at the site.

DIF: Cognitive Level: Analysis REF: p. 384, Table 17-2

OBJ: 5 (theory) TOP: Transradial Heart Catheterization: Postprocedure Care
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

9. The nurse is caring for a patient who is scheduled to undergo a stress echocardiogram. Which
statement indicates that the nurse's teaching about preparation for the test has been successful?
a. "I should eat a full meal to give me energy to walk on the treadmill."
b. "I will avoid smoking for fours before the test."
c. "I will have to move extremely quickly from the treadmill to the table."
d. "I should wear comfortable house shoes during the test."
ANS: C
A stress echocardiogram combines exercise on a treadmill with an ultrasound (echocardiogram). Once
an optimal heart rate is achieved, the patient must transfer extremely quickly from the treadmill to the
table to ensure quality imaging. Patients should avoid eating a heavy meal, avoid smoking for 6 to 8 h
prior to the test, and wear comfortable walking shoes. House shoes are not appropriate footwear for
treadmill exercise.

DIF: Cognitive Level: Application REF: p. 384, Table 17-2

OBJ: 5 (theory) TOP: Stress Echocardiogram: Preparation
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

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10. The 65-year-old patient complains of leg pain that disappears at rest after having walked a short
distance. The nurse recognizes that the patient's symptoms are consistent with which problem?
a. Muscle spasm
b. Deep venous thrombosis
c. Claudication
d. Angiospasm
ANS: C
Intermittent claudication, or cramping pain in the calves, occurs in the presence of arterial
insufficiency. This allows the muscles to build up lactic acid and cause pain.

DIF: Cognitive Level: Knowledge REF: p. 391 OBJ: 5 (theory)

TOP: Claudication: Signs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. While performing a focused cardiac assessment, the nurse auscultates an abnormal swooshing sound.
Which action is most appropriate to clarify the nurse's finding?
a. The nurse uses the diaphragm of the stethoscope while asking the patient to take a deep
breath.
b. The nurse uses the bell of the stethoscope while asking the patient to lean forward.
c. The nurse asks the patient about a history of heart stents.
d. The nurse asks the patient about a history of cardiac dysrhythmias.
ANS: B
Heart murmurs usually generate a swooshing sound that results from turbulent blood flow (usually
through damaged valves). The nurse should use the bell of the stethoscope and place it lightly on the
skin. Leaning the patient forward may amplify or clarify the sound. Asking the patient about heart
stents and abnormal heart rhythms does not clarify the presence or history of a heart murmur.

DIF: Cognitive Level: Application REF: p. 393 OBJ: 5 (theory)

TOP: Auscultating for Murmur KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance

12. When using a 0 to 4+ scale to grade pulse quality, how should the nurse record a normal volume
pulse?
a. 1+
b. 2+
c. 3+
d. 4+
ANS: C
A 0 to 4+ scale for grading pulse quality is as follows: 0-Absent, +1-Weak, thready, +2-Light volume,
+3-Normal volume, and +4-Full, bounding. The nurse should be aware of the type of scale used in
different facilities.

DIF: Cognitive Level: Knowledge REF: p. 394, Box 17-2

OBJ: 5 (theory) TOP: Recording Pulse Quality
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

13. The nurse is caring for a patient with a blood pressure of 140/90, an apical pulse of 82, and a radial
pulse of 76. Which value indicates that the nurse accurately calculated the patient's pulse pressure?
a. 6
b. 50
c. 82

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 d. 90
ANS: B
The pulse pressure is the difference between the systolic and diastolic pressures (140 – 90 = 50). Pulse
deficit is the difference between the radial and the brachial pulses.

DIF: Cognitive Level: Application REF: p. 379 OBJ: 5 (theory)

TOP: Pulse Pressure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance

14. The nurse is caring for a 50-year-old patient who complains of tingling in his toes. Which other
assessment finding would cause the nurse to suspect arterial insufficiency?
a. Equal warmth in bilateral feet
b. Shiny, hairless legs
c. Thin, brittle toenails
d. Pedal edema
ANS: B
To distinguish arterial insufficiency, instruct the patient to dangle the feet. In arterial insufficiency, feet
display delayed color return, and if severe peripheral arterial disease is present, the dangling feet soon
take on a dusky red color (rubor). The skin may be shiny, taunt, and hairless. Equal warmth indicates
equal and sufficient blood flow to the extremities. The nails would be thick rather than thin with
arterial insufficiency, and pedal edema is an indication of venous insufficiency.

DIF: Cognitive Level: Application REF: p. 395 OBJ: 5 (theory)

TOP: Arterial Insufficiency: Signs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance

15. The nurse is caring for a patient with a history of hypertension. Which information is most important
for the nurse to obtain?
a. "Do you take a daily multivitamin?"
b. "Do you use over-the-counter decongestants or diet pills?"
c. "How often do you use laxatives?"
d. "How often do you use antacids?"
ANS: B
Many over-the-counter (OTC) drugs can cause vasoconstriction and elevate blood pressure. Cold
remedies, decongestants, and diet pills are particularly noted for having this effect. Patients sometimes
do not consider OTC items as medications and do not report their use.

DIF: Cognitive Level: Comprehension REF: p. 392 OBJ: 5 (theory)

TOP: Assessing for Causes of Hypertension
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

16. The patient asks if it is harmful for him to drink a glass of wine with dinner on a daily basis. Which is
the nurse's best response?
a. "As long as it is okay with your physician, moderate alcohol intake can be beneficial to
your cardiovascular health."
b. "Drinking wine on a daily basis may lead to you having issues with increased blood
pressure."
c. "You may want to be careful because drinking wine with dinner may stimulate your
appetite significantly."
d. "This practice may cause your triglyceride level to rise, so I would discourage it."
ANS: A

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 Alcohol is a mild vasodilator when consumed in moderate amounts, which can be beneficial to heart
health, depending on the patient's condition.

DIF: Cognitive Level: Application REF: p. 402 OBJ: 2 (clinical)

TOP: Vasodilation With Alcohol KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

17. Which layer of the heart contains muscle fibers that contract to pump blood?
a. Myocardium
b. Endocardium
c. Epicardium
d. Pericardium
ANS: A
The myocardium is the middle layer of muscle fibers of the heart that contract to pump blood. The
endocardium is the lining of the inner surface of the heart chambers, the epicardium is the outer layer
of the heart muscle, and the pericardium is the membranous sac that surrounds the heart.

DIF: Cognitive Level: Knowledge REF: p. 376 OBJ: 1 (theory)

TOP: Structures of the Heart KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The nurse is teaching a patient about the purpose of his telemetry. Which statement indicates that the
nurse's teaching has been successful?
a. "I will need to stay in bed when the monitor is reading my heart waves."
b. "This test will help determine if I have a blockage in my arteries."
c. "If there is a problem with my heart valves, it will show up with telemetry."
d. "The nurses will be able to monitor my heart rate and rhythm."
ANS: D
Telemetry provides monitoring of the heart's rate and rhythm with the use of electrodes and wire leads
from a bedside monitor or battery-operated transmitter unit. Patients may ambulate on the unit and still
be monitored. Blockage of arteries is usually diagnosed with an arteriogram, and valvular problems
may be diagnosed with echocardiography.

DIF: Cognitive Level: Application REF: p. 383 OBJ: 5 (theory)

TOP: Diagnostic Tests and Procedures KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

19. Which preventative measure(s) may protect against development of cardiovascular disease? (Select all
that apply.)
a. Exercising regularly for at least 30 minutes a day
b. Maintaining high-density lipoprotein (HDL) greater than 50 mg/dL
c. Refraining from smoking
d. Obtaining and maintaining a healthy weight
e. Maintaining triglycerides above 150 mg/dL
ANS: A, B, C, D
Behaviors that may help to prevent CAD include: exercising regularly for at least 30 minutes a day,
maintaining HDL greater than 50 mg/dL, refraining from smoking, and obtaining and maintaining a
healthy weight. Triglycerides should be maintained below 150 mg/dL.

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 DIF: Cognitive Level: Comprehension REF: p. 381, Health Promotion
OBJ: 4 (theory) TOP: Behaviors Preventing Cardiovascular Disease
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

20. Which factors may affect the volume of cardiac output? (Select all that apply.)
a. Heart rate
b. Peripheral pulses
c. Preload
d. Contraction strength
e. Afterload
ANS: A, C, D, E
The amount of cardiac output depends on the heart rate, the amount of blood returning to the heart
(venous return or preload), the strength of contraction, and the resistance to the ejection of the blood
(afterload). Peripheral pulses are dependent on cardiac output.

DIF: Cognitive Level: Knowledge REF: p. 377 OBJ: 1 (theory)

TOP: Cardiac Output KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. Which modifiable risk factors increase a patient's risk for heart disease? (Select all that apply.)
a. Smoking
b. Race
c. Obesity
d. Sedentary lifestyle
e. Age
ANS: A, C, D
Smoking, obesity, and sedentary lifestyle are modifiable risk factors that increase risk of CAD. Race
and age are nonmodifiable risk factors for heart disease.

DIF: Cognitive Level: Comprehension REF: p. 383, Table 17-1

OBJ: 2 (theory) TOP: Modifiable Risks
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

22. Which disorder(s) is/are examples of congenital heart defects? (Select all that apply.)
a. Arteriosclerosis
b. Coarctation of the aorta
c. Septal defects
d. Valvular defects
e. Atherosclerosis
ANS: B, C, D
Causes of cardiovascular disorders can be congenital or acquired. Narrowing of the aorta (coarctation),
septal defects, or abnormal cardiac valve formation can occur congenitally. Acquired defects include
narrowing or hardening of the blood vessels from arteriosclerosis (thickening and loss of elasticity) or
atherosclerosis and aneurysms of the large vessels.

DIF: Cognitive Level: Knowledge REF: p. 381 OBJ: 1 (theory)

TOP: Disorders of the Heart KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

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Chapter 18: Care of Patients With Hypertension and Peripheral Vascular Disease
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition

MULTIPLE CHOICE

1. Which blood pressure findings constitute a diagnosis of hypertension?

a. 120/80 × 2, 2 weeks apart
b. 140/90 × 2, 2 weeks apart
c. 120/80 on 3 consecutive days
d. 140/90 every day for a week
ANS: B
A diagnosis of hypertension is made if the systolic pressure is equal to or greater than 140 mm Hg and
the diastolic pressure is equal to or greater than 90 mm Hg at least twice on two different occasions 2
weeks apart.

DIF: Cognitive Level: Comprehension REF: p. 405 OBJ: 10 (theory)

TOP: Hypertension: Diagnosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance

2. The nurse is educating an older adult patient who is taking antihypertensives with diuretics. Which
information regarding safety precautions is most important for the nurse to include?
a. Consider purchasing a home blood pressure monitor.
b. Limit sodium intake in the diet.
c. Sit on the side of the bed before standing.
d. Keep an updated list of all medications.
ANS: C
Age-related changes (reduced baroreceptor sensitivity) and risk for fluid shifts related to diuretics
predispose the older adult patient to orthostatic hypotension. In order to prevent falls, the patient
should change positions slowly and cautiously, like taking time to sit on the edge of the bed before
standing. While purchasing a home blood pressure monitor, limiting sodium in the diet, and keeping
an updated list of medications may assist with management of hypertension, fall prevention and safety
are most important for the older adult patient.

DIF: Cognitive Level: Analysis REF: p. 406, Older Adult Care Points
OBJ: 5 (clinical) TOP: Orthostatic Hypotension
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

3. The home health nurse is caring for a patient with a blood pressure reading of 200/160. The patient
denies any discomfort. The nurse should immediately contact the health care provider to report that the
patient is experiencing which problem?
a. Primary hypertension
b. Hypertensive crisis
c. Essential hypertension
d. Secondary hypertension
ANS: B
The diastolic pressure rising to readings between 140 and 170 and the patient being asymptomatic
indicates hypertensive crisis.

DIF: Cognitive Level: Comprehension REF: p. 412 OBJ: 3 (theory)

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 TOP: Malignant Hypertension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse is caring for a patient who has a new prescription for a loop diuretic. Which nutritional
intervention is most important for the nurse to add to the care plan?
a. Increase intake of leafy green vegetables.
b. Increase intake of bananas and potatoes.
c. Avoid foods like canned soups and hot dogs.
d. Limit caffeine intake.
ANS: B
Loop diuretics are potent, potassium-wasting diuretics. After talking with the health care provider, the
patient should recommend that the patient increase intake of potassium-rich foods like bananas and
potatoes to offset potassium depletion from the diuretic. Leafy green vegetables are rich in vitamin K
and may increase clotting times. Sodium-rich foods like canned soups and hot dogs should be avoided
to prevent excess water retention, but this intervention does not address the risk for potassium
depletion with loop diuretics. Caffeine is a stimulant that causes vasoconstriction and may increase
blood pressure. While avoiding caffeine may improve blood pressure, this intervention does not
address the risk of potassium depletion with a loop diuretic.

DIF: Cognitive Level: Analysis REF: p. 408 OBJ: 3 (theory)

TOP: Loop Diuretics KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. The patient has been prescribed a low-sodium diet. Which food choice indicates that the patient
requires additional teaching?
a. Fresh spinach
b. Pickles
c. Whole-grain pasta
d. Grapefruit
ANS: B
High-sodium foods include pickled vegetables, canned soups, and processed meats. Fresh spinach,
whole-grain pasta, and grapefruit are appropriate low-sodium choices.

DIF: Cognitive Level: Application REF: p. 413, Nutrition Considerations

OBJ: 3 (theory) TOP: Low-Sodium Diet
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

6. Which medication is the most common and effective antiplatelet aggregation agent?
a. Warfarin
b. Aspirin
c. Alteplase (Activase)
d. Tenecteplase (TNKase)
ANS: B
Aspirin is the most common and effective antiplatelet agent.

DIF: Cognitive Level: Knowledge REF: p. 428 OBJ: 9 (theory)

TOP: Antiplatelet Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse is caring for a patient with a history of peripheral arterial disease. The patient complains of
significant claudication, and findings of an ankle-brachial index are abnormal. The nurse anticipates
that this patient will most likely require which type of procedure?

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 a. Left heart catheterization
b. Stress echocardiogram
c. Percutaneous transluminal angioplasty (PTA)
d. Nuclear medicine stress test
ANS: C
PTA may be done to open an artery to reduce claudication symptoms and improve extremity
perfusion.

DIF: Cognitive Level: Knowledge REF: p. 406 OBJ: 10 (theory)

TOP: PTA: Stents KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early

8. The nurse is teaching a pregnant patient who works as a cashier in a grocery store about varicose vein
prevention. Which instruction is most important for the nurse to include in the teaching plan?
a. Add vitamin C to diet.
b. March in place while standing at the counter.
c. Avoid tight support hose.
d. Wear supportive shoes.
ANS: B
Varicose veins are enlarged and tortuous veins that are distorted in shape by accumulations of pooled
blood. Treatment of varicose veins includes exercising the legs and feet periodically throughout the
day, like marching in place while standing at the counter, elevating the legs whenever possible, and
wearing support hose. Supportive shoes and vitamin C do not prevent venous congestion.

DIF: Cognitive Level: Analysis REF: p. 413 OBJ: 5 (clinical)

TOP: Varicose Veins: Prevention KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. An 86-year-old patient asks why her ankles have a brownish discoloration and the skin looks thick.
Which response best addresses the patient's concern?
a. "The valves in the vessels in your legs aren't working as well as they used to, which causes
the discoloration and thickening of your skin."
b. "You probably aren't getting enough iron in your diet. We should talk to your doctor about
adding an iron supplement."
c. "How many years have you smoked? Nicotine will cause these changes in your skin."
d. "These are just normal changes seen in most older people."
ANS: A
Hemosiderin leaks out of the trapped red blood cells in the dilated vessels of the feet and ankles, and
stains the skin of people with venous insufficiency. In addition, fibrous tissue replaces subcutaneous
tissue around the ankles and causes the skin to become thick and hardened. Iron and nicotine do not
play a role in these skin changes with venous insufficiency, and these are not normal changes
associated with aging.

DIF: Cognitive Level: Application REF: p. 429 OBJ: 3 (theory)

TOP: Signs of Chronic Venous Insufficiency: Hemosiderin
KEY: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The nurse is caring for a patient who underwent endovenous laser treatment. Which statement
indicates that the nurse's teaching about postprocedure management has been successful?
a. "I should wear compression stockings for 5 days."
b. "I should walk at least an hour every day for 2 weeks."

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 c. "I should massaging the legs to stimulate circulation."
d. "I should notify my doctor if my foot is warm to the touch."
ANS: B
Endovenous occlusion using laser is done by placing a catheter within the vein under duplex
ultrasound guidance. A laser heats the vessel, causing it to collapse and close off. Patients ambulate
immediately after the procedure for 30 to 60 minutes and 1 to 2 h per day for 1 to 2 weeks. The patient
should wear compression stockings for 1 to 2 weeks. The patient should not massage the legs or notify
the doctor of warm feet (a normal finding).

DIF: Cognitive Level: Application REF: p. 428 OBJ: 10 (theory)

TOP: Endovenous Laser Treatment KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The nurse is caring for a 75-year-old patient with a history of diabetes and peripheral vascular disease
(PVD). The nurse observes an inflamed and excoriated area on the patient's right shin. Which
intervention should the nurse perform first?
a. Document the findings.
b. Review the patient's diet.
c. Notify the primary care provider.
d. Cover with clear occlusive dressing.
ANS: D
The nurse should first cover the area with a clear, occlusive dressing to protect the area from
scratching and infection. The nurse should then document the findings, notify the primary care
provider, and review nutritional intake to confirm adequacy for wound healing.

DIF: Cognitive Level: Analysis REF: p. 418 OBJ: 2 (theory)

TOP: PVD: Skin Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

12. The nurse is caring for a patient with a compression dressing. Which action indicates appropriate
wound care?
a. The nurse changes the compression dressing daily.
b. The nurse uses an alcohol-based cleanser before applying the compression dressing.
c. The nurse places a compression dressing over the wound dressing.
d. The nurse dons a face mask before applying a compression dressing.
ANS: C
Compression therapy options include compression stockings, elastic tubular support bandages,
intermittent compression devices, a paste bandage such as Unna boot, or placement of two to four
layers of compression dressings to the affected area. Venous return is accomplished as the patient
moves his leg and achieves pressure on the calf muscles. Compression dressings can be placed over
wound dressings. The dressings help to reduce ulcer pain, keep the wound moist, and assist
debridement. The dressing is changed from every 2 to 3 days to every few weeks depending on the
type of dressing applied. An alcohol-based cleanser would be drying and harsh. Compression dressings
do not necessitate use of a face mask.

DIF: Cognitive Level: Comprehension REF: p. 424 OBJ: 8 (theory)

TOP: Venous Insufficiency: Compression Dressings
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse is caring for a patient with a deep venous thrombosis (DVT). Which finding requires the
nurse's immediate attention?

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 a. Hematuria
b. Decreased sensation in the affected leg
c. Urine output of 35 mL in 1 h
d. Hemoptysis
ANS: D
The primary concern for a patient with a DVT is the potential for embolisms. Hemoptysis (coughing
up rust colored sputum) is the cardinal sign of a pulmonary embolus and is a medical emergency.
Hematuria (bloody urine) is a finding that requires additional assessment but is not the priority.
Hematuria may occur from trauma from Foley catheter insertion, use of blood thinners to treat the
DVT, or a variety of other causative factors. Decreased sensation in the affected leg is an expected
abnormal finding. Urine output of 35 mL/h is normal.

DIF: Cognitive Level: Analysis REF: p. 423, Clinical Cues

OBJ: 2 (clinical) TOP: Pulmonary Embolus: Signs
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

14. The nurse is caring for a patient with a deep venous thrombosis (DVT). Which medication would
likely be used for initial inpatient treatment?
a. Dabigatran (Pradaxa)
b. Heparin
c. Warfarin (Coumadin)
d. Edoxaban (Lixiana)
ANS: B
Inpatient medical treatment for DVT usually consists of intravenous (IV) heparin.
Low-molecular-weight heparin (LMWH) such as enoxaparin (Lovenox) by injection may be used for
inpatient management and is used more frequently for outpatient treatment. Fondaparinux (Arixtra), a
Factor Xa inhibitor, may be used instead of enoxaparin. After initial IV or injection anticoagulation
treatment, oral anticoagulation is started with warfarin sodium (Coumadin), rivaroxaban (Xarelto),
edoxaban (Lixiana), dabigatran (Pradaxa), or apixaban (Eliquis). Anticoagulation is continued for 3 to
6 months for the first episode of DVT and a year for recurrent episodes (Patel, 2014).

DIF: Cognitive Level: Knowledge REF: p. 424 OBJ: 9 (theory)

TOP: DVT Treatment: Streptokinase KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The nurse is teaching a patient who takes warfarin (Coumadin) about a coagulation monitoring device.
Which blood clotting time should the device monitors?
a. PT
b. PTT
c. INR
d. ACT
ANS: C
A coagulation monitoring device measures the INR level for clotting time for a person on therapeutic
doses of warfarin.

DIF: Cognitive Level: Comprehension REF: p. 425, Nursing Care Plan 18-1
OBJ: 9 (clinical) TOP: INR Standard
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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 16. The student nurse is planning a community group presentation on hypertension. Which group of
individuals should the student identify as having the highest incidence of hypertension?
a. Muslims
b. African Americans
c. Whites
d. Latinos
ANS: B
African Americans have a higher incidence of hypertension than any other minority group or whites.

DIF: Cognitive Level: Comprehension REF: p. 406, Cultural Considerations

OBJ: 1 (clinical) TOP: Hypertension
KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

17. The nurse is caring for a patient diagnosed with an abdominal aortic aneurysm who complains of
sudden, intense abdominal pain, and light-headedness. What action should the nurse takenext?
a. Monitor the patient's blood pressure every 15 minutes.
b. Contact the physician immediately.
c. Notify the patient's family of the change in condition.
d. Continue to assess the patient's pain.
ANS: B
The patient is most likely experiencing a ruptured aneurysm, which is a medical emergency requiring
surgical repair. The nurse should contact the physician immediately. The vital signs may need to be
measured more often than every 15 minutes. Notifying the family is not the priority intervention.
Ongoing assessment of pain should continue, but after the physician is notified of the emergent status
change.

DIF: Cognitive Level: Analysis REF: p. 418 OBJ: 6 (theory)

TOP: Aneurysm KEY: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The nurse is caring for a patient with peripheral arterial disease who complains of 3/10 pain in the
lower extremities. The nurse observes a 0.5 cm × 1 cm ulcer on the left lower leg, and the lower legs
are shiny and hairless bilaterally. The nurse identifies which priority problem statement/nursing
diagnosis?
a. Injury related to loss of peripheral circulation
b. Acute pain related to ischemia to lower extremities
c. Altered skin integrity related to ulcers on lower extremities
d. Insufficient knowledge related to new diagnosis of hypertension
ANS: C
Altered skin integrity is the priority problem statement/diagnosis in this situation. Acute pain is a
nursing diagnosis, but the pain is 3/10 so it is not the priority since there is an open wound. Injury and
insufficient knowledge could be problems, but there is not enough information to support these
diagnoses.

DIF: Cognitive Level: Application REF: p. 415 OBJ: 9 (theory)

TOP: Arterial Ulcer KEY: Nursing Process Step: Diagnosis
MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

19. Which problems are potential complications of uncontrolled hypertension? (Select all that apply.)

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 a. Stroke
b. Kidney failure
c. Heart attack
d. Congestive heart failure
e. Deep vein thrombosis (DVT)
ANS: A, B, C, D
Uncontrolled hypertension may result in stroke, kidney failure, heart attack, and congestive heart
failure. A DVT is not a potential complication of hypertension.

DIF: Cognitive Level: Comprehension REF: p. 408, Patient Teaching

OBJ: 6 (theory) TOP: Hypertension: Complications
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

20. Which findings characterize peripheral vascular disease (PVD)? (Select all that apply.)
a. Narrowed arteries
b. Obstructed veins
c. Involvement of all extremities
d. Defective valve function
e. Thrombophlebitis
ANS: A, B, D, E
Findings that characterize PVD include narrowed arteries, obstructed veins, deficient valvular
function, and thrombophlebitis. PVD usually involves only the lower extremities.

DIF: Cognitive Level: Comprehension REF: p. 415, Table 18-4

OBJ: 6 (theory) TOP: PVD: Characteristics
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. Which factor(s) may be useful in preventing peripheral vascular disease (PVD)? (Select all that apply.)
a. Stress relief
b. Diabetes control
c. Weight control
d. Routine exercise
e. Smoking cessation
ANS: A, B, C, D, E
All strategies are supportive of the prevention of PVD.

DIF: Cognitive Level: Knowledge REF: p. 414 OBJ: 5 (theory)

TOP: PVD: Prevention KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

22. The nurse is caring for a patient with peripheral vascular disease (PVD). The nurse understands that
which age-related changes may cause PVD? (Select all that apply.)
a. Decreasing blood viscosity
b. Loss of elasticity in vessel walls
c. Atherosclerotic changes in vessels
d. Sedentary practices
e. Weakened leg muscles
ANS: B, C, D, E

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 Age-related changes that can lead to PVD include: loss of elasticity in vessel walls, atherosclerotic
changes in vessels, sedentary practices, and weakened leg muscles. Blood viscosity increases with age.

DIF: Cognitive Level: Comprehension REF: p. 416, Older Adult Care Points
OBJ: 2 (clinical) TOP: PVD: Prevention
KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

23. Which intervention(s) is/are important for a patient with venous insufficiency? (Select all that apply.)
a. Avoid swimming.
b. Elevate feet to reduce edema.
c. Wear tight clothing.
d. Decrease fluid intake.
e. Apply elastic compression wraps twice daily.
ANS: B, E
Elevating feet above heart level and wearing elastic compression support wraps decrease edema.
(Wraps should be applied twice daily.) Swimming is encouraged as good exercise that encourages
venous return. Tight clothing should be avoided. Reduction of fluid intake may increase blood
viscosity and promote clotting.

DIF: Cognitive Level: Comprehension REF: p. 414 OBJ: 3 (clinical)

TOP: PVD: Basic Care KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance

24. Which words compose part of the "5 P's" of arterial disease? (Select all that apply.)
a. Pain
b. Paresthesia
c. Purulent
d. Pooling
e. Pallor
ANS: A, B, E
Five P's of arterial disease are pain, pulselessness, pallor, paresthesias, and paralysis.

DIF: Cognitive Level: Knowledge REF: p. 416 OBJ: 3 (clinical)

TOP: 6 Ps of Arterial Disease KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance

25. The nurse is caring for an 80-year-old long-resident in a term care facility. Which intervention(s)
should the nurse plan to enhance blood flow? (Select all that apply.)
a. Apply light blankets over legs while sitting.
b. Elevate legs frequently.
c. Encourage walking.
d. Avoid tight compression stockings.
e. Maintain a warm environment.
ANS: A, B, C, E
Interventions that may enhance blood flow include using light blankets while sitting, elevating legs,
encouraging exercise, and maintaining a warm environment. Compression stockings are beneficial.

DIF: Cognitive Level: Application REF: p. 418 OBJ: 3 (clinical)

TOP: PVD: Maintenance KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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26. The nurse is caring for a patient with Raynaud disease who is employed as a construction worker, has
hypertension, and smokes one-half to one pack of cigarettes per day. What teaching points should the
nurse include in discharge instructions? (Select all that apply.)
a. Wear gloves when handling cold items.
b. Drink plenty of warm beverages, such as coffee.
c. Wear insulated socks when working in cool weather.
d. Attend a smoking program.
e. Use a heating pad to stay warm.
ANS: A, C, D, E
The major nursing interventions for Raynaud disease involve teaching the patient to protect extremities
and prevent injury. The patient should be taught to dress warmly when in cold environments. Clothing
should be layered and nonrestrictive. The patient should wear protective clothing like hats, gloves, and
warm socks. The patient should wear protective gloves when reaching into ovens and when handling
extremely cold items. The patient should also manage stress and stop tobacco use. Caffeine intake
should be limited. The patient should not use a heating pad for warmth due to risk for burns.

DIF: Cognitive Level: Application REF: p. 421 OBJ: 7 (theory)

TOP: Raynaud Disease KEY: Nursing Process Step: Intervention
MSC: NCLEX: Health Promotion and Maintenance

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Chapter 19: Care of Patients With Cardiac Disorders
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition

MULTIPLE CHOICE

1. The nurse is caring for a patient with suspected right-sided heart failure. Which manifestation best
supports this potential diagnosis?
a. Wheezing
b. Orthopnea
c. Edema
d. Pallor
ANS: C
Right-sided heart failure leads to edema from systemic backup. Wheezing, orthopnea, and pallor are
indicative of left-sided failure.

DIF: Cognitive Level: Comprehension REF: p. 436, Table 19-2

OBJ: 1 (theory) TOP: Heart Failure: Right Side
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse is caring for a patient with a history of left-sided congestive heart failure (CHF). Which
finding leads the nurse to suspect that the patient could be experiencing an acute exacerbation of this
condition?
a. The abdomen is tight and shiny.
b. Wheezes are present during lung auscultation.
c. The pupils react sluggishly to light.
d. The heart rate is irregularly irregular.
ANS: B
Left-sided heart failure causes increased pressure on the lungs and may manifest in wheezing. A tight
and shiny abdomen is consistent with ascites, a manifestation of right-sided CHF. Sluggish pupillary
reaction is consistent with a neurologic problem, and an irregularly irregular heart rate is consistent
with a cardiac arrhythmia like atrial fibrillation.

DIF: Cognitive Level: Application REF: p. 436, Table 19-2

OBJ: 1 (theory) TOP: CHF: Signs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The statement indicates that the nurse's teaching about the purpose of an implanted
cardioverter-defibrillator (ICD) has been successful?
a. "The ICD will detect bad rhythms and shock my heart into normal rhythm."
b. "I should avoid handheld security devices at the airport."
c. "I should ask my doctor how often I should have my ICD checked."
d. "I should avoid working on the alternator of my boat."
ANS: A

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 All statements are accurate, but the question asks about the purpose of the ICD. ICDs are devices
indicated for patients with repeated episodes of life-threatening dysrhythmias and for some patients
with cardiomyopathy. This device monitors the heartbeat and provides an electrical shock similar to
that delivered in cardiac defibrillation or cardioversion when a life-threatening rhythm is detected.
Most ICDs have the ability to pace as well as defibrillate. The patient is warned to avoid exposure to
strong magnetic fields such as: microwave towers, transformers and electrical transmitters, electrical
generators, handheld security devices at airports, and arc welding equipment. The patient should not
lean over the alternator of a running car or boat motor. A magnetic field will temporarily inactivate the
device. Moving away from the magnetic source will restore normal function.

DIF: Cognitive Level: Analysis REF: p. 451 OBJ: 2 (clinical)

TOP: ICD KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. The nurse is caring for a patient with severe congestive heart failure (CHF) who denies pain and is
fearful of taking prescribed morphine. Which explanation best works to alleviate the patient's anxiety
about risk of addiction?
a. "Many people with CHF use morphine for pain control."
b. "We can treat your pain with aspirin or ibuprofen."
c. "Morphine has properties that help relieve air hunger in CHF patients."
d. "You can refuse to take it."
ANS: C
The primary purpose of morphine is its relief of air hunger and anxiety. Nonsteroidal
anti-inflammatory drugs do not have the same vasodilation properties as morphine. Telling the patient
that many CHF patients take morphine provides a generalized statement that does not therapeutically
address the patient's anxiety or confusion about the medication. Telling the patient that he may refuse
is a dismissive, nontherapeutic response.

DIF: Cognitive Level: Application REF: p. 438 OBJ: 4 (clinical)

TOP: CHF Treatment: Morphine KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. The nurse is caring for a patient with congestive heart failure (CHF). Which intervention should the
nurse include in the plan of care?
a. Encourage intake of canned soups.
b. Place the patient in a side-lying position to prevent venous pooling.
c. Encourage large meals for increased nutritional impact.
d. Alternate rest with activity.
ANS: D
Alternating rest with activity preserves the patient's energy. Canned soups are high in sodium, and
CHF patients are often placed on restricted-sodium diets. Patients are more comfortable in
semi-Fowler position to ease breathing and should eat small meals that are easy to chew and use less
energy.

DIF: Cognitive Level: Application REF: p. 442 OBJ: 1 (clinical)

TOP: CHF: Nursing Care KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. The nurse is caring for a patient with a heart rate of 115 beats per minute and complaints of shortness
of breath. The nurse anticipates that these findings are most likely related which underlyingproblem?
a. Pulmonary edema
b. Decreased cardiac output

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 c. Impending pneumonia
d. Increasing anxiety
ANS: B
When the heart is beating rapidly, the stroke volume decreases. This diminishes the cardiac output,
causing reduced oxygen to tissues and tissue hypoxia.

DIF: Cognitive Level: Comprehension REF: p. 444 OBJ: 2 (clinical)

TOP: Tachycardia: Complications KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. The nurse is teaching the patient with an arrhythmia. Which statement indicates that the patient
requires further teaching?
a. "I've cut my coffee from 10 cups to 2 cups a day."
b. "I don't drink regular cola drinks anymore."
c. "I have given up drinking those high-energy drinks."
d. "I've switched from 5 cups of coffee to 5 cups of tea."
ANS: D
The patient with an arrhythmia should decrease caffeine intake. Tea has as much caffeine as coffee
does, or more. All other options will reduce the caffeine intake.

DIF: Cognitive Level: Comprehension REF: p. 445, Clinical Cues

OBJ: 2 (clinical) TOP: Arrhythmias: Caffeine Reduction
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. The nurse is analyzing a patient's telemetry strip and observes a sawtooth appearance with no P waves.
How should the nurse document this finding?
a. Premature ventricular contraction (PVC)
b. Atrial flutter
c. Ventricular tachycardia (VT)
d. Premature atrial contraction (PAC)
ANS: B
Atrial flutter displays a sawtooth appearance generated from small ineffective contractions prior to the
QRS complex. An abnormally shaped P wave appears on the electrocardiogram (ECG) before the QRS
wave in PAC. PVC is seen as an early beat without a P wave and with a wide QRS complex. VT is
seen as three or more PVCs in a row with a ventricular rate of greater than 100 beats per minute.

DIF: Cognitive Level: Application REF: p. 445 OBJ: 2 (clinical)

TOP: Arrhythmias: Atrial Flutter KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. The nurse is caring for a patient with atrial fibrillation who asks why she needs to take warfarin.
Which statement best answers the patient's question?
a. Warfarin increases the ejection fraction.
b. Warfarin prevents clots from forming in the atria.
c. Warfarin keeps the atrial fibrillation from involving the ventricles.
d. Warfarin increases the cardiac output.
ANS: B
Warfarin keeps clots from forming in the retained blood in the atria left there by the ineffective atrial
contractions.

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 DIF: Cognitive Level: Comprehension REF: p. 447 OBJ: 3 (clinical)
TOP: Arrhythmias: Warfarin KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. The nurse caring for a patient who is taking amiodarone (Cordarone). What side effect could this
patient experience?
a. Sudden increase in temperature
b. Hypotension
c. Bradycardia
d. Depressed ventilation
ANS: B
Hypotension with the attendant fatigue is a side effect of amiodarone (Cordarone).

DIF: Cognitive Level: Analysis REF: p. 448, Table 19-4

OBJ: 4 (clinical) TOP: Amiodarone (Cordarone): Side Effects
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

11. Which disorganized ECG pattern is recognized as the most fatal of all arrhythmias?
a. Ventricular fibrillation
b. Premature ventricular beats
c. Atrial fibrillation
d. Ventricular tachycardia (VT)
ANS: A
Ventricular fibrillation is a disorganized pattern of totally ineffective contractions and no cardiac
output. This is a medical emergency and, if not corrected, is fatal.

DIF: Cognitive Level: Knowledge REF: p. 447 OBJ: 2 (clinical)

TOP: Arrhythmias: Ventricular Fibrillation
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

12. Which statement accurately explains how calcium channel blocker verapamil assists to correct an
arrhythmia?
a. The medication desensitizes the heart to the impulse to contract.
b. The medication increases the strength of the impulse from the atrioventricular (AV) node.
c. The medication alters the impulse from the sinoatrial (SA) node.
d. The medication inhibits transmission of the impulse from the AV node.
ANS: D
Verapamil blocks calcium from the cardiac cells, inhibiting the transmission of the impulse from the
AV node.

DIF: Cognitive Level: Knowledge REF: p. 448, Table 19-4

OBJ: 4 (clinical) TOP: Arrhythmias: Verapamil
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse caring for a patient who requires a temporary transvenous pacemaker. Which statement
indicates that the patient understands the nurse's teaching?
a. "I may experience uncomfortable muscle contractions."
b. "The procedure will use general anesthesia."
c. "I will be given a sedative after the procedure."
d. "This device may be left in place for 6 weeks."

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 ANS: A
A temporary transvenous pacemaker is placed if a transient rhythm such as heart block develops after a
myocardial infarction or drug toxicity. It is important that the patient understands the uncomfortable
muscle contractions are normal. Transvenous pacemakers are inserted by fluoroscopy with local
anesthesia, and the leads are attached to an external power source. Patient consent is required, and a
sedative is given to the patient before the procedure. Epicardial pacemaker wires are often placed
during cardiac surgery for quick use should the patient need to be "paced" in the postoperative period.
The wires are brought through the chest wall and are attached to an external power source. When the
need for the wires is past, the surgeon will pull them out. The device is a short-term solution and is
only used until the problem resolved or a permanent device is inserted.

DIF: Cognitive Level: Application REF: p. 450 OBJ: 6 (clinical)

TOP: Temporary Pacemaker KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

14. Which teaching point will the nurse include when providing discharge instructions to the patient with a
new permanent pacemaker?
a. "You will be able to have an MRI for diagnostic purposes."
b. "Avoid using microwave ovens."
c. "Avoid lifting heavy objects for as long as your physician prescribes."
d. "Airport screening devices may cause your pacemaker to fire incorrectly."
ANS: C
The postoperative patient with a permanent pacemaker can assume normal activity when the physician
prescribes. Using the arm for lifting and other activities may dislodge the leads from their positions.
MRIs must be avoided since the large magnet can interfere with the pacemaker's function. Microwaves
and airport security devices do not affect the pacemaker.

DIF: Cognitive Level: Application REF: p. 451, Patient Teaching

OBJ: 5 (clinical) TOP: Permanent Pacemaker: Postoperative Expectations
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. The nurse is caring for a patient who is taking digitalis. The patient complains of increased thirst, and
the nurse observes dry mucous membranes. Which additional finding warrants the nurse's immediate
attention?
a. Sudden, sharp knee pain
b. Blurred vision
c. Epistaxis
d. Chills
ANS: B
Blurred vision, halos around lights, nausea, vomiting and diarrhea, and fatigue are all indicators of
toxicity to digitalis. Assessment is especially important for the dehydrated patient because of the rising
potassium level.

DIF: Cognitive Level: Analysis REF: p. 457 OBJ: 4 (clinical)

TOP: Digitalis: Toxicity KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. The nurse is caring for several patients on a cardiac care unit. Which patient is most likely to have
aortic stenosis?
a. A 35-year-old with a history of Raynaud disease
b. A 63-year-old with uncontrolled diabetes

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 c. A 73-year-old with a history of hypertension
d. An 86-year-old with a history of atherosclerosis
ANS: D
The older 86-year-old patient with atherosclerosis is most likely to have degenerative calcification of
the valve. Risk for aortic stenosis increases with age, and congenital valve malformations and
rheumatic fever are causes in younger patients.

DIF: Cognitive Level: Application REF: p. 452 OBJ: 3 (clinical)

TOP: Cardiac Valve Disorders KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. The home health nurse is caring for a patient with congestive heart failure (CHF). Which assessment
finding should the nurse report immediately to the physician?
a. Moderate shortness of breath after walking down the hall
b. A 3-pound weight gain over the course of a week
c. Heart rate of 104 beats per minute after ambulating to the bathroom
d. Increase in urinary output to 50 mL in the last hour
ANS: B
A weight gain without an increase in caloric intake is indicative of fluid retention, which is an
indication of worsening heart failure. Moderate shortness of breath after exercise and a mild increase
in heart rate after activity are expected. A decrease in urinary output would be of concern.

DIF: Cognitive Level: Analysis REF: p. 437 OBJ: 8 (theory)

TOP: Home Care Considerations: Heart Failure
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

18. When the nurse assesses an apical pulse of 52, the nurse documents this arrhythmia as?
a. Tachycardia
b. Bradycardia
c. Normal rate
d. Atrial Flutter
ANS: B
An apical pulse of less than 60 is considered to be bradycardia. Tachycardia is a pulse rate greater than
100. A normal pulse rate is 60 to 100. Atrial flutter is not a regular pulse rate.

DIF: Cognitive Level: Knowledge REF: p. 443 OBJ: 1 (clinical)

TOP: Bradycardia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

19. The nurse is caring for a 60-year-old African American patient with hypertension. The patient is obese
and a smoker. Which modifiable risk factors place this patient at an increased risk for heart disease?
(Select all that apply.)
a. Age
b. Race
c. Hypertension
d. Obesity
e. Smoking

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 ANS: C, D, E
Modifiable risk factors that increase the patient's risk of heart disease include hypertension, obesity,
and cigarette smoking. The patient could lessen his risk by strictly controlling blood pressure, losing
weight with diet and exercise, and implementing a smoking cessation plan. Age and race are
nonmodifiable risk factors for heart disease.

DIF: Cognitive Level: Comprehension REF: p. 458 OBJ: 6 (clinical)

TOP: Modifiable Risk Factors KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

20. The nurse is performing an initial assessment on a new patient with suspected right-sided heart failure.
Which finding(s) is/are consistent with the patient's potential diagnosis? (Select all that apply.)
a. Clammy skin
b. Splenomegaly
c. Abdominal distention
d. Wheezing
e. Dyspnea
ANS: B, C, E
Signs and symptoms of right-sided CHF include fatigue, peripheral edema, gastrointestinal congestion
and abdominal distention, ascites with liver congestion, splenomegaly, and dyspnea. Clammy skin and
wheezing are symptoms of left-sided CHF.

DIF: Cognitive Level: Application REF: p. 436, Table 19-2

OBJ: 1 (theory) TOP: Heart Failure Assessment
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

21. The nurse in a skilled nursing facility is caring for an 80-year-old patient who develops a productive
cough with pink, frothy sputum. Which independent interventions should the nurse implement
immediately? (Select all that apply.)
a. Limit the patient's activity.
b. Administer morphine.
c. Administer lasix.
d. Place the patient in high Fowler position.
e. Weigh the patient daily.
ANS: A, D
Acute pulmonary edema (acute left ventricular failure) is a medical emergency that must be treated
promptly. The patient with this condition has severe dyspnea; a cough productive of frothy,
pink-tinged sputum; tachycardia; and moist, bubbling respirations with cyanosis. Nursing interventions
for acute pulmonary edema include placing the patient in high Fowler position to relieve the dyspnea;
administering oxygen, diuretics, morphine, and other prescribed drugs; limiting and monitoring
activity; and assessing cardiopulmonary status. Limiting activity and placing the patient in high Fowler
do not require a physician's order and should be implemented immediately. Acute pulmonary edema is
a medical emergency, and activity necessary to obtain a daily weight is not indicated at this time.
Administering morphine and diuretics are dependent nursing interventions.

DIF: Cognitive Level: Analysis REF: p. 439 OBJ: 5 (clinical)

TOP: Acute Pulmonary Edema: Independent Nursing Interventions
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

22. Which statement(s) accurately describe(s) characteristics of normal sinus rhythm (NSR)? (Select all
that apply.)

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 a. One atrial contraction (P wave)
b. One ventricular contraction (QRS complex)
c. One T wave
d. Heart rate 60 to 100
e. P wave immediately follows the QRS complex
ANS: A, B, C, D
The P wave precedes the QRS complex. All other options are seen in NSR.

DIF: Cognitive Level: Knowledge REF: p. 446, Figure 19-5

OBJ: 1 (clinical) TOP: Normal Sinus Rhythm
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. Which factor(s) is/are potential causative agents for arrhythmias? (Select all that apply.)
a. Hyperkalemia
b. Valvular prolapse
c. Infarct damage
d. Properly functioning sinoatrial (SA) node
e. Excess fluid
ANS: A, B, C, E
Electrolyte imbalances, especially a high-potassium level, valvular prolapse, heart damage after a heart
attack, and fluid overload are all potential causative factors for abnormal heart rhythms. A properly
functioning SA node results in normal sinus rhythm.

DIF: Cognitive Level: Comprehension REF: p. 443 OBJ: 5 (theory)

TOP: Arrhythmias: Etiology KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
24. The nurse is educating a patient about cardiomyopathy. The nurse includes information that which
circumstance(s) may increase risk for cardiomyopathy? (Select all that apply.)
a. Systemic hypertension
b. Chronic excessive alcohol consumption
c. Pregnancy
d. Diabetes
e. Systemic infection
ANS: A, B, C, E
Cardiomyopathy is a group of disorders that result in enlargement of the heart and subsequent
inefficient pumping action. Risk factors include systemic hypertension, chronic alcohol consumption,
pregnancy, and certain systemic infections. Diabetes is not considered a risk factor for
cardiomyopathy.

DIF: Cognitive Level: Comprehension REF: p. 454 OBJ: 3 (clinical)

TOP: Cardiomyopathy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

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Chapter 20: Care of Patients With Coronary Artery Disease and Cardiac Surgery
Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition

MULTIPLE CHOICE

1. The nurse is caring for a patient with angina pectoris who asks what happens to make his body
experience pain. The nurse explains that pain results from which underlying causative factor?
a. Congestion that backs up into the lungs
b. Inadequate blood flow and poor oxygen supply
c. Edema from fluid overload
d. Inflammation in the vessels
ANS: B
Angina pectoris (chest pain) occurs when blood supply to the heart is decreased or totally obstructed.
Pain results from ischemia (inadequate blood and oxygen supply).

DIF: Cognitive Level: Comprehension REF: p. 464 OBJ: 2 (theory)

TOP: CAD: Pain KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. How does a myocardial infarction (MI) alter the pumping efficiency of the heart?
a. An MI reduces the impulse from the sinoatrial node.
b. An MI causes myocardial necrosis.
c. An MI shunts all myocardial blood flow to a specific cardiac region.
d. An MI causes myocardial swelling and inflammation.
ANS: B
Myocardial necrosis (damaged or dead heart muscle tissue) cannot contract effectively, which
decreases pumping efficiency (cardiac output).

DIF: Cognitive Level: Comprehension REF: p. 462 OBJ: 2 (theory)

TOP: MI: Pathophysiology KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI). The
nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new
laboratory results. Which laboratory value should the nurse report immediately?
a. Troponin of 2.4 mcg/L
b. Potassium of 3.4 mEq/L
c. Creatine phosphokinase of 134 IU/L
d. Sodium of 133 mEq/L
ANS: A
The patient has a significantly elevated troponin. The abnormal troponin, along with ECG changes,
indicates that the patient is likely experiencing an MI. (Elevated troponin levels are most indicative of
an MI as these enzymes are specific to heart muscle damage.) While the nurse should report the low
potassium and sodium, these findings are of lesser priority than the elevated troponin.

DIF: Cognitive Level: Analysis REF: p. 470 OBJ: 5 (theory)

TOP: MI: Cardiac Enzymes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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4. The nurse is caring for a post–myocardial infarction (MI) patient who has been started on daily
simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse's teaching has
been successful?
a. "I will need to have blood work every month while taking Zocor."
b. "I should take my Zocor with grapefruit juice to help absorption.
c. "I should call my doctor if I experience unexplained muscle pain."
d. "I should take Zocor an hour before my biggest meal of the day."
ANS: C
Statins can injure muscle tissue and are toxic to the liver in some patients. Patients should report any
unexplained muscle tenderness or pain persisting for more than a few days. Laboratory tests for liver
enzymes are recommended at the start of therapy and only when clinically indicated. Grapefruit juice
interferes with drug metabolism and should be avoided to prevent increased risk of toxicity. Zocor can
be taken without regard to meals.

DIF: Cognitive Level: Application REF: p. 464, Clinical Cues

OBJ: 2 (clinical) TOP: Statins: Precaution
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. The nurse is educating a patient on a low-fat, low-cholesterol diet after a myocardial infarction (MI).
Which food choice should the nurse recommend?
a. "Avoid eating frozen foods."
b. "Replace a serving of red meat with a serving of fish."
c. "Use nondairy creamer in your decaffeinated coffee."
d. "Drink a serving of grapefruit juice each day."
ANS: B
Fish have a high content of omega-3 fatty acids, which are helpful in reducing cholesterol. Not all
frozen foods are unhealthy. Frozen vegetables with no sodium added are a good choice for a low-fat,
low-cholesterol diet. Nondairy creamer is high in trans fat and saturated fat. Grapefruit juice often
interferes with metabolism of a variety of medications.

DIF: Cognitive Level: Application REF: p. 464, Nutrition Considerations

OBJ: 3 (clinical) TOP: Low-Fat Diet: Omega-3
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The nurse is caring for a male patient with angina who has a new prescription for sublingual
nitroglycerin. What information is most important for the nurse to include in the teachingplan?
a. Nitroglycerin tablets expire 3 months after the bottle is opened.
b. Take a second tablet 15 minutes after the first dose and call the physician if pain persists.
c. Store nitroglycerin tablets in a cool, dark location.
d. Nitroglycerin may cause an unsafe drop in heart rate when combined with certain
medications for erectile dysfunction.
ANS: C
Sublingual nitroglycerin tablets should be kept in a cool, dark place and should be carried by the
patient at all times. If chest pain persists after the first dose, the patient should repeat the dose in 5
minutes. The patient should contact emergency services, not the physician. Nitroglycerin may cause an
unsafe drop in blood pressure (BP) if combined with certain medications for erectile dysfunction.

DIF: Cognitive Level: Application REF: p. 464, Clinical Cues

OBJ: 3 (clinical) TOP: Angina: Nitroglycerin Tablets
KEY: Nursing Process Step: Implementation

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 MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse is explaining the difference between exertional angina and unstable angina. Which statement
about unstable angina is accurate?
a. Unstable angina occurs with moderate exercise.
b. Unstable angina occurs when the blood pressure increases sharply.
c. Unstable angina occurs when the body reacts to high stress levels.
d. Unstable angina occurs unpredictably, even in sleep.
ANS: D
Unstable angina attacks are unpredictable and do not follow a pattern, as do stable angina attacks.
Unstable angina can progress into a myocardial infarction (MI) and a medical emergency.

DIF: Cognitive Level: Knowledge REF: p. 469 OBJ: 3 (theory)

TOP: Angina: Unstable Angina KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful. Which reply is
best?
a. Low-dose aspirin helps reduce clotting.
b. Low-dose aspirin helps dilate coronary vessels.
c. Low-dose aspirin helps alleviates pain associated with angina.
d. Low-dose aspirin helps lower cholesterol.
ANS: A
Daily doses of aspirin reduce clotting by prolonging clotting time, thus helping prevent clots that can
cause an MI.

DIF: Cognitive Level: Comprehension REF: p. 466 OBJ: 4 (theory)

TOP: Angina: Use of Aspirin KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The nurse is caring for a female patient with a family history of heart disease who is undergoing a
workup for cardiovascular disease. Which finding is most concerning to the nurse?
a. Fainting
b. Dry mouth
c. Dizziness
d. Fatigue
ANS: D
Women frequently experience fatigue with heart disease. Many women do not even experience chest
pain. Fainting, dry mouth, and dizziness are not typical signs of heart disease in women.

DIF: Cognitive Level: Comprehension REF: p. 462, Box 20-1

OBJ: 2 (theory) TOP: CAD in Women
KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

10. The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the
postprocedure care has changed. Which response by the nurse is most accurate?
a. "We will only roll you to the same side as the catheter insertion site."
b. "You will lay flat for several hours, and we will place a sandbag over the dressing in the
groin."
c. "You will most likely be able to ambulate within a few hours if your doctor uses an
arterial closure device at the catheter insertion site."
d. "We will encourage you to flex and extend your legs when you return from the procedure

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 to prevent a clot from forming at the insertion site."
ANS: C
Most physicians use an arterial closure device at the puncture site, which enables the patient to be
ambulatory within 2 h after the cardiac catheterization procedure. The patient may be turned to either
side. Sandbags were used in the past to prevent bleeding from the puncture site and the patient had to
lay flat for several hours. Flexing and extending the legs immediately after the procedure would likely
cause bleeding from the site.

DIF: Cognitive Level: Application REF: p. 462 OBJ: 4 (theory)

TOP: Angiogram: Aftercare KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI). Which statement
accurately describes the purpose of this medication?
a. "Alteplase (t-PA) dissolves the obstruction in the coronary artery."
b. "Alteplase (t-PA) dilates vessels to relieve pain."
c. "Alteplase (t-PA) strengthens cardiac contraction."
d. "Alteplase (t-PA) increases cardiac output."
ANS: A
Alteplase (t-PA) is a thrombolytic drug that will dissolve the clot if given within 12 h of the MI.

DIF: Cognitive Level: Comprehension REF: p. 471 OBJ: 2 (clinical)

TOP: MI: t-PA KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The nurse is caring for a patient with uncontrolled hypertension, diabetes, asthma, and
gastroesophageal reflux disease (GERD). Which problem serves as a contraindication for a
thrombolytic agent?
a. Uncontrolled hypertension
b. Diabetes
c. Asthma
d. GERD
ANS: A
Thrombolytic agents are contraindicated in people with uncontrolled hypertension, GI bleeds, recent
intracranial or intraspinal surgery, or aneurysm because of threat of excessive bleeding.

DIF: Cognitive Level: Application REF: p. 471 OBJ: 2 (clinical)

TOP: MI: Thrombolytic Agents KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse is caring for a post-myocardial infarction (MI) patient. The patient questions the reason for a
stool softener and denies constipation. Which statement indicates that the patient accurately
understands the nurse's teaching?
a. "Stool softeners help me keep from straining during bowel movements, which can lower
my heart rate."
b. "Stool softeners help me to get rid of extra wastes that can harm my heart."
c. "Stool softeners help reduce swelling that can increase work on my heart."
d. "Stool softeners help to reduce discomfort from gas pains."
ANS: A
Bearing down or straining at stool can stimulate the vagal nerve and induce bradycardia.

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 DIF: Cognitive Level: Comprehension REF: p. 472 OBJ: 3 (clinical)
TOP: MI: Aftercare KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary
angiography earlier in the day. The patient denies pain and no longer requires bed rest. The groin is
soft with no palpable hematoma. Which postprocedure care is most important for the patient at this
time?
a. Encourage increased fluid intake.
b. Administer pain medications as ordered.
c. Obtain vital signs every 15 minutes.
d. Assist the patient with ambulation.
ANS: A
The procedure uses a large volume of dye, which can be harmful to the kidneys. Increasing fluid intake
is the priority focus for care at this time after hemostasis is obtained. Keeping the patient hydrated
increases the rate of urine flow, dilutes the urine, and helps prevent kidney damage as the contrast is
excreted. The patient denies pain. Vital signs are taken every 15 minutes for the first hour and are
checked progressively less frequently unless there is evidence of bleeding or instability. The patient
can now ambulate, but ambulation is a lesser priority than flushing out the hypertonic dye.

DIF: Cognitive Level: Analysis REF: p. 471, Safety Alert

OBJ: 4 (theory) TOP: Cardiac Catheterization
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The nurse assesses a friction rub in a patient who is 2 days post–myocardial infarction (MI). The nurse
recognizes this finding indicates which problem?
a. A recurrent MI
b. Pleural effusion
c. Pericarditis
d. Angina
ANS: C
Friction rubs occur in pericarditis when the inflamed area of the infarct rubs the pericardium.

DIF: Cognitive Level: Comprehension REF: p. 472, Table 20-3

OBJ: 2 (theory) TOP: MI: Complications
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

16. The 60-year-old female in the post-coronary care unit confides to the nurse, "My life is over. I'll never
be able to care for my family, take a vacation, or work in my garden." Which response is most
supportive?
a. "You are doing great! You can do all of those things in a few weeks."
b. "You may have to give up some things, but there are other activities you might enjoy."
c. "You are feeling a little blue today. Would you like medication to help your anxiety?"
d. "You sound a little down. Tell me what you think is going to keep you from those
activities; we might be able to address the problems."
ANS: D
Helping patients identify and face depression is helpful in dispelling it, and talking about her concerns
will open up conversation and address the concerns in a problem-solving approach. Telling her that
she will be able to resume all activities may be instilling false hope. Medication is not warranted at this
point.

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 DIF: Cognitive Level: Application REF: p. 480 OBJ: 8 (theory)
TOP: MI: Depression KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

17. A patient who presented to the emergency room with a myocardial infarction (MI) becomes pale,
diaphoretic, and hypotensive. What action should the nurse take first?
a. Notify the physician immediately.
b. Ensure that the patient has patent IV access.
c. Request assistance from respiratory therapy.
d. Inform the patient's family of the change in status.
ANS: A
If the left ventricle is badly damaged, cardiogenic shock may occur. Signs and symptoms are those that
accompany decreased cardiac output, such as decreased BP, confusion, restlessness, diaphoresis, rapid
and thready pulse, increased respiratory rate, cold and clammy skin, and diminishing urinary output to
less than 20 mL/h. This condition is a medical emergency that requires immediate notification of the
physician. The nurse should then ensure that the IV is patent. Respiratory therapy assistance will likely
be beneficial, especially if the patient's condition further deteriorates. The nurse should finally notify
the patient's family about the change in status.

DIF: Cognitive Level: Analysis REF: p. 473 OBJ: 5 (theory)

TOP: MI: Cardiogenic Shock KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The nurse performs patient teaching about minimally invasive direct coronary artery bypass
(MIDCAB). Which statement indicates that the patient needs further instruction?
a. "It frightens me to think that my heart will be stopped for a long time during surgery."
b. "This surgery bypasses my artery that is blocked, and replaces it with sections of a vein or
artery taken from another part of my body."
c. "This surgery will hopefully control my angina since nothing else we have tried has
worked."
d. "I may come out of surgery with vessels removed from my legs."
ANS: A
The MIDCAB procedure is less invasive than the traditional coronary artery bypass graft (CABG)
procedure and does not require the patient be placed on the heart-lung machine due to stopping the
heart for an extended period. Both procedures are used to treat angina that has not responded to more
conservative treatment and utilize either the mammary artery or sections of the saphenous vein for the
graft.

DIF: Cognitive Level: Application REF: p. 474 OBJ: 7 (theory)

TOP: CABG and MIDCAB Surgery KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

19. The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which
response is best for the nurse to make?
a. "I'm not really sure. It is better if you ask your surgeon."
b. "Every patient has different circumstances, but the average 3-year survival rate is 75%."
c. "The survival rate is excellent. Almost all patients with a heart transplant live past 10
years."
d. "There are not any really good statistics for me to give you an accurate estimate."
ANS: B

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 The average 1-year survival rate of about 85% to 90%, a 3-year survival rate of about 75%, and a
5-year survival rate of 60% (Eisen, 2018). A significant number of heart transplant patients survive
beyond 10 years.

DIF: Cognitive Level: Application REF: p. 477 OBJ: 7 (theory)

TOP: Heart Transplant KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

20. Place the events of arterial obstruction in proper sequence.

Step 1

a. Platelets adhere to plaque.

b. Deposits of low-density lipoproteins (LDLs) accumulate.
c. Fibrous plaque is laid down in vessel.
d. Streaks of fatty material are laid down in arteries.
e. Platelets clump.
f. Platelets calcify.
ANS: D DIF: Cognitive Level: Comprehension REF: p. 463, Figure 20-1
OBJ: 2 (theory) TOP: Thrombus Formation
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. Place the events of arterial obstruction in proper sequence.

Step 2

a. Platelets adhere to plaque.

b. Deposits of low-density lipoproteins (LDLs) accumulate.
c. Fibrous plaque is laid down in vessel.
d. Streaks of fatty material are laid down in arteries.
e. Platelets clump.
f. Platelets calcify.
ANS: B DIF: Cognitive Level: Comprehension REF: p. 463, Figure 20-1
OBJ: 2 (theory) TOP: Thrombus Formation
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

22. Place the events of arterial obstruction in proper sequence.

Step 3

a. Platelets adhere to plaque.

b. Deposits of low-density lipoproteins (LDLs) accumulate.
c. Fibrous plaque is laid down in vessel.
d. Streaks of fatty material are laid down in arteries.
e. Platelets clump.
f. Platelets calcify.
ANS: C DIF: Cognitive Level: Comprehension REF: p. 463, Figure 20-1
OBJ: 2 (theory) TOP: Thrombus Formation
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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 23. Place the events of arterial obstruction in proper sequence.

Step 4

a. Platelets adhere to plaque.

b. Deposits of low-density lipoproteins (LDLs) accumulate.
c. Fibrous plaque is laid down in vessel.
d. Streaks of fatty material are laid down in arteries.
e. Platelets clump.
f. Platelets calcify.
ANS: A DIF: Cognitive Level: Comprehension REF: p. 463, Figure 20-1
OBJ: 2 (theory) TOP: Thrombus Formation
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

24. Place the events of arterial obstruction in proper sequence.

Step 5

a. Platelets adhere to plaque.

b. Deposits of low-density lipoproteins (LDLs) accumulate.
c. Fibrous plaque is laid down in vessel.
d. Streaks of fatty material are laid down in arteries.
e. Platelets clump.
f. Platelets calcify.
ANS: E DIF: Cognitive Level: Comprehension REF: p. 463, Figure 20-1
OBJ: 2 (theory) TOP: Thrombus Formation
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

25. Place the events of arterial obstruction in proper sequence.

Step 6

a. Platelets adhere to plaque.

b. Deposits of low-density lipoproteins (LDLs) accumulate.
c. Fibrous plaque is laid down in vessel.
d. Streaks of fatty material are laid down in arteries.
e. Platelets clump.
f. Platelets calcify.
ANS: F DIF: Cognitive Level: Comprehension REF: p. 463, Figure 20-1
OBJ: 2 (theory) TOP: Thrombus Formation
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

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26. The nurse is caring for a 38-year-old African American patient with diabetes. The patient manages her
diabetes with dietary control, takes oral contraceptives, and is a nonsmoker. Which characteristic(s) in
this patient's history increase the patient's risk for coronary artery disease (CAD)? (Select all that
apply.)
a. Age
b. Race
c. Diabetes
d. Nonsmoker status
e. Use of oral contraceptives
ANS: B, C, E
African Americans have an ethnic tendency to CAD. Taking birth control pills and diabetes are both
risk factors for CAD. Older patients are at increased risk for CAD, and a nonsmoking status decreases
the likelihood of developing CAD.

DIF: Cognitive Level: Application REF: p. 462 OBJ: 1 (theory)

TOP: CAD: Risk Factors KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium. Which
factors are causative agents for angina? (Select all that apply.)
a. Exertion
b. Emotional excitement
c. Eating heavy meals
d. Exposure to cold
e. Allergic reactions
ANS: A, B, C, D
Angina may be caused by exertion, emotional excitement, eating heavy meals, and exposure to cold.
Angina is not brought on by allergy.

DIF: Cognitive Level: Comprehension REF: p. 469, Patient Teaching

OBJ: 3 (theory) TOP: Angina: Precipitators
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. Which herbs and supplements lower cholesterol? (Select all that apply.)
a. Garlic
b. Bananas
c. Oatmeal
d. St. John's wort
e. Soy products
ANS: A, C, E
Garlic, whole-grain foods, and soy products are thought to decrease cholesterol. Bananas and St.
John's wort are not known to lower cholesterol.

DIF: Cognitive Level: Knowledge REF: p. 463, Complementary and Alternative Therapies
OBJ: 3 (clinical) TOP: Hyperlipidemia: Herbal Remedies
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

29. The nurse is aware that a positive diagnosis of a myocardial infarction (MI) is based on which
diagnostic test finding(s)? (Select all that apply.)
a. Electrocardiographic (ECG) changes in the QRS complex

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 b. Elevation of low-density lipoprotein (LDL)
c. Elevation of troponin levels
d. Elevated white blood cell (WBC) count
e. Elevated bilirubin levels
ANS: A, C
Diagnosis of MI is made by patient history, ECG, and serum cardiac enzyme levels. Elevated LDL,
WBC, or bilirubin levels are not indicative of an MI.

DIF: Cognitive Level: Knowledge REF: p. 470 OBJ: 1 (theory)

TOP: MI: Diagnosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. The nurse clarifies that the MONA protocol for drug administration in the emergent stage of a
myocardial infarction (MI) involves the use of which therapies? (Select all that apply.)
a. Aspirin
b. Morphine
c. Nitrates
d. Antibiotics
e. Oxygen
f. Anticoagulants
ANS: A, B, C, E
Morphine, oxygen, nitrates, and aspirin are the components of MONA therapy. Antibiotics are not part
of the MONA protocol.

DIF: Cognitive Level: Comprehension REF: p. 471 OBJ: 2 (clinical)

TOP: MONA Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
31. The nurse encourages the patient who has had a myocardial infarction (MI) to enroll in the outpatient
cardiac rehabilitation in order to receive which service(s)? (Select all that apply.)
a. Nutritional counseling
b. Supervised progressive exercise
c. Stress-reduction techniques
d. Sexual counseling
e. Administration of cardiotonic drugs
ANS: A, B, C
Cardiac rehab services include nutritional counseling, specialized exercise programs, and
stress-reduction techniques. Sexual counseling and administration of medications are not services of
cardiac rehab.

DIF: Cognitive Level: Comprehension REF: p. 473 OBJ: 3 (clinical)

TOP: Cardiac Rehabilitation: Services KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

32. During the acute phase following a myocardial infarction (MI), the nurse anticipates that the patient
may require a temporary pacemaker in which situation(s)? (Select all that apply.)
a. The patient's heart rate remains above 120 beats per minute.
b. The patient experiences worsening anginal pain.
c. The patient experiences complete heart block.
d. The patient's systolic BP drops to 60.
e. The patient's pulse rate remains below 40 beats per minute.

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 ANS: C, E
A temporary pacemaker is warranted when the patient's pulse consistently remains below 40 beats per
minute and when the patient experiences complete heart block. Complete heart block means that the
electrical impulse for contraction does not go through the atrioventricular node to the ventricles and
the ventricles are not signaled to contract. Tachycardia, above 100, continued angina pain, and
hypotension are not correct indications for a pacemaker.

DIF: Cognitive Level: Application REF: p. 472 OBJ: 6 (theory)

TOP: Temporary Pacemaker KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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