Nursing textbooks cardiovascular practice questions
Nursing textbooks · cardiovascular
Nursing textbooks cardiovascular practice questions
You read heart failure, perfusion, and blood-pressure stems and decide what to do before the patient declines. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the Nursing textbooks exam guide or more Nursing textbooks practice questions.
Five cardiovascular questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A client is in the intensive care unit with a diagnosis of severe uncontrolled hypertension. What method of monitoring would best meet the needs of this client?
A. Central venous pressure monitoring
B. Direct blood pressure monitoring
C. Pulmonary artery pressure monitoring
D. Manual blood pressure readings with a sphygmomanometer
Show answer and rationale
Correct answer: B — Direct blood pressure monitoring
Direct blood pressure monitoring continuously displays the waveform and indicates the client's systolic, diastolic, and mean arterial pressures. This type of equipment eliminates the need to auscultate the BP. Direct BP monitoring may be used in clients with severe and sustained hypertension or hypotension and during and after cardiac surgery. Central venous pressure monitoring would be used to detect an excess or deficit in venous blood volume and would not be indicated for this client. Pulmonary artery pressure monitoring aids in the early treatment of fluid imbalances prevents left-sided heart failure or promotes its early correction and helps monitor the client's response to treatment and would not be indicated for this client. A manual reading is dependent on who takes the BP and can vary in its readings. It is not as accurate as the direct blood pressure monitoring.
Question 2
The nurse provides care for a post-cardiac catheterization male client in the postprocedure room. Which is a priority nursing action for this client?
A. Evaluate the client's temperature.
B. Encourage the client to drink fluids.
C. Advise the client to void while lying flat with a urinal.
D. Monitor the client's pressure dressing.
Show answer and rationale
Correct answer: D — Monitor the client's pressure dressing.
Following cardiac catheterization, the client has a pressure dressing placed over the catheter site to control bleeding. After the procedure, the nurse checks the dressing over the insertion site frequently for signs of bleeding. Additionally, the nurse monitors the client's blood pressure (BP) and pulse frequently to detect complications; however, it is not a priority for the nurse to monitor the client's temperature after this procedure. Although the client is encouraged to drink fluids as part of the discharge instructions to assist with flushing the dye used during the procedure, this is not a priority nursing action for this client in the postprocedure period of care. The client is taught to void while lying flat using a urinal; however, this is not the priority action based on the current data.
Question 3
Which suggestion can the nurse provide to an older adult client to reduce the symptoms associated with sarcopenia?
A. Maintain hydration.
B. Avoid heavy lifting.
C. Practice brisk walking.
D. Limit the use of caffeine.
Show answer and rationale
Correct answer: C — Practice brisk walking.
Sarcopenia refers to changes in composition of muscle tissue that can occur in aging because of deconditioning; therefore, increasing daily exercise helps to improve muscle strength, including the heart. Maintaining hydration is important for a client who requires cardiac catheterization to flush the dye used during the procedure from the system and is not an intervention supported by evidence-based practice guidelines for the client who experiences sarcopenia. Heavy lifting is discouraged following cardiac catheterization; however, avoiding lifting is not an activity that reduces symptoms associated with sarcopenia. The nurse discourages the use of caffeine for clients who experience tachycardia; however, this is not an appropriate suggestion to reduce the symptoms associated with sarcopenia.
Question 4
A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client?
A. The development of chronic obstructive pulmonary disease (COPD)
B. The development of left-sided heart failure
C. The development of right-sided heart failure
D. The development of cor pulmonale
Show answer and rationale
Correct answer: B — The development of left-sided heart failure
When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of/left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Cor pulmonale is a condition in which the heart is affected secondarily by lung damage.
Question 5
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?
A. The BP is always higher in a hypertensive emergency
B. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies
C. Hypertensive urgency is treated with rest and benzodiazepines to lower BP
D. Hypertensive emergencies are associated with evidence of target organ damage
Show answer and rationale
Correct answer: D — Hypertensive emergencies are associated with evidence of target organ damage
Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patients BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.
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Question 6
The nurse monitors a client with dark skin for signs of cyanosis. Which manifestation, documented by the nurse, indicates cyanosis for this client?
A. Dark red lips and tongue
B. Grayish cast to the skin
C. Pale appearance to the skin
D. Pale pink mucous membranes
Correct answer:
A good light is necessary when monitoring skin color. Many clients with cardiac disorders exhibit changes in skin color (e.g., cyanosis, pallor). Cyanosis can be detected by carefully noting color changes in the oral mucous membranes as well as in the lips, earlobes, skin, and nail beds. In dark-skinned clients, a grayish cast to the skin indicates pallor. In clients who are light skinned, extreme pallor is easy to detect because the skin appears almost bloodless. Dark red lips and tongue are not manifestations associated with cyanosis. A pale appearance can indicate cyanosis for a client with light skin. The presence of pale pink mucous membranes is a normal or expected finding and is not associated with cyanosis.
A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have?
A. Class I (Mild)
B. Class II (Mild)
C. Class III (Moderate)
D. Class IV (Severe)
Correct answer:
Class I is when ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.
The nurse is caring for a client in the hospital with chronic heart failure that has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, he becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)?
A. Class I (Mild)
B. Class II (Mild)
C. Class III (Moderate)
D. Class IV (Severe)
Correct answer:
Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class I is ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.
A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient?
A. Aortic regurgitation
B. Mitral stenosis
C. Mitral valve prolapse
D. Aortic stenosis
Correct answer:
The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurses health education should include which of the following?
A. Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker
B. Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C. Use of strategies to prevent falls stemming from postural hypotension
D. Limiting exercise to avoid injury that can be caused by increased intracranial pressure
Correct answer:
Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension. The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk and activity should not normally be limited.
The nurse provides care for a dying client following a massive myocardial infarction (MI). The nurse notes the client is experiencing dyspnea and has a barely palpable pulse. Which documentation of pulse quality by the nurse is appropriate?
A. The client's pulse is full.
B. The client is exhibiting a thready pulse.
C. The client is experiencing a pulse deficit.
D. The client's pulse indicates a regular rhythm.
Correct answer:
When taking a client's pulse, the nurse notes its rate, rhythm, and quality. The pulse quality refers to its palpated volume. Pulse volume is described as feeling full, weak, or thready, meaning barely palpable. Documentation that the client's pulse is full is inaccurate. The nurse also determines any pulse deficit by counting the heart rate through auscultation at the apex while a second nurse simultaneously palpates and counts the radial pulse for a full minute. The difference, if any, is the pulse deficit. Documenting that the client's pulse indicates a regular rhythm is inaccurate because the documentation in this scenario focuses on the quality, not rhythm.
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?
A. Asystole
B. Premature ventricular contraction
C. Atrial flutter
D. Ventricular fibrillation
Correct answer:
Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.
A client is 2 days postoperative from mitral valve replacement and is in pain at an 8 on a 0 to 10 scale. What intervention(s) can the nurse provide to control the pain before it gets to this level? Select all that apply.
A. Suggest the client be placed on a patient-controlled analgesia (PCA) pump.
B. Administer a non-narcotic analgesic between prescribed doses of narcotic analgesics.
C. Administer the pain medication prior to the pain becoming severe.
D. Wait until the client asks for the pain medication.
E. Administer the narcotic analgesic more frequently.
Correct answer:
Small, frequent self-administration of an opioid drug controls acute pain within consistently tolerable levels. Administer non-narcotic analgesics between prescribed doses of narcotic analgesics. Non-narcotics have a different mechanism of action and are not likely to cause respiratory depression or depressed level of consciousness if given concurrently with narcotics. Pain is more easily controlled by giving analgesic medication before the pain becomes severe, so the nurse would not wait until the client to ask for the pain medication. The nurse cannot administer more of the narcotic than the physician prescriptions.
The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?
A. Warfarin (Coumadin)
B. Furosemide (Lasix)
C. Sodium nitroprusside (Nitropress)
D. Ramipril (Altace)
Correct answer:
The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside (Nitropress), nicardipine hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate (Corlopam), enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is administered orally and would not meet the patients immediate need for BP management. Diuretics, such as Lasix, are not used as initial treatments and there is no indication for anticoagulants such as Coumadin.
The nurse is caring for a patient in the intensive care unit with acute decompensated heart failure (ADHF) who has symptoms of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been prescribed for the patient. Which of the following actions should the nurse implement first?
A. Give IV diazepam 2.5 mg
B. Administer IV morphine sulphate 2 mg
C. Increase nitroglycerin infusion by 5 mcg/min.
D. Increase dopamine infusion by 2 mcg/kg/min.
Correct answer:
Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it also will increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.
About these Nursing textbooks cardiovascular questions
Nursing textbooks cardiovascular practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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