Cardiovascular System | Coronary Artery Disease & Hypertension NCLEX Quiz 7

1. A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90. 94. 24. and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI. the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?

Creatine kinase (CK or CPK)

Lactic dehydrogenase (LDH)

LDH-1

LDH-2

Creatine kinase (CK. formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged. CPK leaks out of the cell membranes and into the bloodstream.Options B. C. and D: Lactic dehydrogenase rises in 24-48 hours. and LDH-1 and LDH-2 rises in 8-24 hours.

Explanation

Creatine kinase (CK. formally known as CPK) rises in 3-8 hours if an MI is present. When the myocardium is damaged. CPK leaks out of the cell membranes and into the bloodstream.Options B. C. and D: Lactic dehydrogenase rises in 24-48 hours. and LDH-1 and LDH-2 rises in 8-24 hours.

2. A client is experiencing tachycardia. The nurse's understanding of the physiological basis for this symptom is explained by which of the following statements?

The demand for oxygen is decreased because of pleural involvement

The inflammatory process causes the body to demand more oxygen to meet its needs.

The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.

Respirations are labored.

The arterial oxygen supply is lowered and the demand for oxygen is increased. which results in the heart’s having to beat faster to meet the body’s needs for oxygen.

Explanation

The arterial oxygen supply is lowered and the demand for oxygen is increased. which results in the heart’s having to beat faster to meet the body’s needs for oxygen.

3. To evaluate a client's condition following cardiac catheterization. the nurse will palpate the pulse:

In all extremities

At the insertion site

Distal to the catheter insertion

Above the catheter insertion

Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

Explanation

Palpating pulses distal to the insertion site is important to evaluate for thrombophlebitis and vessel occlusion. They should be bilateral and strong.

4. Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?

“Apply the patch to a non hairy. nonfatty area of the upper torso or arms.”

“Apply the patch to the same site each day to maintain consistent drug absorption.”

“If you get a headache. remove the patch for 4 hours and then reapply.”

“If you get chest pain. apply a second patch right next to the first patch.”

A nitroglycerin patch should be applied to a nonhairy. nonfatty area for the best and most consistent absorption rates.Option B: Sites should be rotated to prevent skin irritation.Option C: The drug should be continued if headache occurs because tolerance will develop.Option D: Sublingual nitroglycerin should be used to treat chest pain.

Explanation

A nitroglycerin patch should be applied to a nonhairy. nonfatty area for the best and most consistent absorption rates.Option B: Sites should be rotated to prevent skin irritation.Option C: The drug should be continued if headache occurs because tolerance will develop.Option D: Sublingual nitroglycerin should be used to treat chest pain.

5. When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together. the nurse bases teaching on the knowledge that:

Moderate doses of two different types of diuretics are more effective than a large dose of one type

This combination promotes diuresis but decreases the risk of hypokalemia

This combination prevents dehydration and hypovolemia

Using two drugs increases osmolality of plasma and the glomerular filtration rate

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

Explanation

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.

6. A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse understands that leg ulcers of this nature are usually caused by:

Decreased arterial blood flow secondary to vasoconstriction

Decreased arterial blood flow leading to hyperemia

Atherosclerotic obstruction of the arteries

Trauma to the lower extremities

Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.

Explanation

Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is more problematic in colder climates or when the person is under stress. Hyperemia occurs when the vasospasm is relieved.

7. A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal. but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?

Monitoring vital signs

Completing a physical assessment

Maintaining cardiac monitoring

Maintaining at least one IV access site

Even though initial tests seem to be within normal range. it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime. the client needs to be watched for bradycardia. heart block. ventricular irritability. and other arrhythmias. Other activities can be accomplished by the MI monitoring.

Explanation

Even though initial tests seem to be within normal range. it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime. the client needs to be watched for bradycardia. heart block. ventricular irritability. and other arrhythmias. Other activities can be accomplished by the MI monitoring.

8. A client's physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose of injecting radioisotope into the bloodstream is to detect:

Normal vs. abnormal tissue

Damage in areas of the heart

Ventricular function

Myocardial scarring and perfusion

This scan detects myocardial damage and perfusion. an acute or chronic MI.Option D: Specific ventricular function is tested by a gated cardiac blood pool scan.

Explanation

This scan detects myocardial damage and perfusion. an acute or chronic MI.Option D: Specific ventricular function is tested by a gated cardiac blood pool scan.

9. In order to prevent the development of tolerance. the nurse instructs the patient to:

Apply the nitroglycerin patch every other day

Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg

Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night

Use the nitroglycerin patch for acute episodes of angina only

Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.

Explanation

Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day.

10. Direct-acting vasodilators have which of the following effects on the heart rate?

Heart rate decreases

Heart rate remains significantly unchanged

Heart rate increases

Heart rate becomes irregular

Heart rate increases in response to decreased blood pressure caused by vasodilation.

Explanation

Heart rate increases in response to decreased blood pressure caused by vasodilation.