Cardiovascular System | Coronary Artery Disease & Hypertension NCLEX Quiz 4

1. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

Cancer

Hypertension

Liver disease

Myocardial infarction

Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction (Remember. less than 90 mg/L is normal).

Explanation

Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction (Remember. less than 90 mg/L is normal).

2. When administered a thrombolytic drug to the client experiencing an MI. the nurse explains to him that the purpose of this drug is to:

Help keep him well hydrated

Dissolve clots he may have

Prevent kidney failure

Treat potential cardiac arrhythmias.

Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.

Explanation

Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.

3. When teaching a client about propranolol hydrochloride. the nurse should base the information on the knowledge that propranolol hydrochloride:

Blocks beta-adrenergic stimulation and thus causes decreased heart rate. myocardial contractility. and conduction.

Increases norepinephrine secretion and thus decreases blood pressure and heart rate.

Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.

Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate. decreasing myocardial contractility. and slowing conduction.

Explanation

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate. decreasing myocardial contractility. and slowing conduction.

4. Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?

A change in the pattern of her pain

Pain during sex

Pain during an argument with her husband

Pain during or after an activity such as lawn mowing

The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

Explanation

The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.

5. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:

Cerebrovascular accident

Liver disease

Myocardial infarction

Pulmonary disease

Hypertension is referred to as the silent killer for adults. because until the adult has significant damage to other systems. hypertension may go undetected. CVA’s can be related to long-term hypertension.Option B and D: Liver or pulmonary disease is generally not associated with hypertension.Option C: Myocardial infarction is generally related to coronary artery disease.

Explanation

Hypertension is referred to as the silent killer for adults. because until the adult has significant damage to other systems. hypertension may go undetected. CVA’s can be related to long-term hypertension.Option B and D: Liver or pulmonary disease is generally not associated with hypertension.Option C: Myocardial infarction is generally related to coronary artery disease.

6. During the previous few months. a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment. the client is discharged from the hospital. At her follow-up appointment. she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend's apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?

Visit her friend earlier in the day.

Rest for at least an hour before climbing the stairs.

Take a nitroglycerin tablet before climbing the stairs.

Lie down once she reaches the friend’s apartment.

Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain-free.Option A: Visiting her friend early in the day would have no impact on decreasing pain episodes.Option B: Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

Explanation

Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain-free.Option A: Visiting her friend early in the day would have no impact on decreasing pain episodes.Option B: Resting before or after an activity is not as likely to help prevent an activity-related pain episode.

7. When interpreting an ECG. the nurse would keep in mind which of the following about the P wave? Select all that apply.

Reflects electrical impulse beginning at the SA node

Indicated electrical impulse beginning at the AV node

Reflects atrial muscle depolarization

Identifies ventricular muscle depolarization

Has a duration of normally 0.11 seconds or less.

In a client who has had an ECG. the P wave represents the activation of the electrical impulse in the SA node. which is then transmitted to the AV node. In addition. the P wave represents atrial muscle depolarization. not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

Explanation

In a client who has had an ECG. the P wave represents the activation of the electrical impulse in the SA node. which is then transmitted to the AV node. In addition. the P wave represents atrial muscle depolarization. not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.

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8. The most important long-term goal for a client with hypertension would be to:

Learn how to avoid stress

Explore a job change or early retirement

Make a commitment to long-term therapy

Control high blood pressure

Compliance is the most critical element of hypertensive therapy. In most cases. hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy. but the priority goal is related to compliance.

Explanation

Compliance is the most critical element of hypertensive therapy. In most cases. hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy. but the priority goal is related to compliance.

9. A client has driven himself to the ER. He is 50 years old. has a history of hypertension. and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to:

Call for the doctor

Start an intravenous line

Obtain a portable chest radiograph

Draw blood for laboratory studies

Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.Options A. C. and D: Calling the physician. obtaining a portable chest radiograph. and drawing blood are important but secondary to starting the intravenous line.

Explanation

Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.Options A. C. and D: Calling the physician. obtaining a portable chest radiograph. and drawing blood are important but secondary to starting the intravenous line.

10. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:

Open and dilate the blocked coronary arteries

Assess the extent of arterial blockage

Bypass obstructed vessels

Assess the functional adequacy of the valves and heart muscle.

Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage. A decision about medical management. angioplasty. or coronary artery bypass surgery will be based on the catheterization results.

Explanation

Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage. A decision about medical management. angioplasty. or coronary artery bypass surgery will be based on the catheterization results.