Coronary Artery Disease & Hypertension NCLEX

1. A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the
following assessments is most critical before the procedure?

1. Intake and output

2. Baseline peripheral pulse rates
3. Height and weight
4. Allergy to iodine or shellfish

2. A client with no history of cardiovascular disease comes into the ambulatory clinic with
flu-like symptoms. The client suddenly complains of chest pain. Which of the following
questions would best help a nurse to discriminate pain caused by a non-cardiac problem?

1. “Have you ever had this pain before?”

2. “Can you describe the pain to me?”
3. “Does the pain get worse when you breathe in?”
4. “Can you rate the pain on a scale of 1-10, with 10 being the worst?”

3. A client with myocardial infarction has been transferred from a coronary care unit to a
general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for
which of the following client activities?

1. Strict bed rest for 24 hours after transfer

2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances under 200 feet
4. Ad lib activities because the client is monitored.

4. A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial
infarction who was admitted 2 days ago. The nurse would plan to do which of the
following next?

1. Review the intake and output records for the last 2 days
2. Change the time of diuretic administration from morning to evening
3. Request a sodium restriction of 1 g/day from the physician.
4. Order daily weights starting the following morning.

5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A
nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is
to:

1. Check the client status and lead placement

2. Press the recorder button on the electrocardiogram console.
3. Call the physician
4. Call a code blue

6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension.
The nurse ensures accurate measurement by avoiding which of the following?

1. Seating the client with arm bared, supported, and at heart level.
2. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
3. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

7. IV heparin therapy is ordered for a client. While implementing this order, a nurse
ensures that which of the following medications is available on the nursing unit?

1. Vitamin K
2. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate

8. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin
(Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The
nurse assesses that this result is:

1. The same as the client’s own baseline level

2. Lower than the needed therapeutic level
3. Within the therapeutic range
4. Higher than the therapeutic range

9. A client who has been receiving heparin therapy also is started on warfarin. The client
asks a nurse why both medications are being administered. In formulating a response, the
nurse incorporates the understanding that warfarin:

1. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for
this to exert an anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this
medication to exert an anticoagulant effect.
3. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days
for this to begin.
4. Has the same mechanism of action as Heparin, and the crossover time is needed for the
serum level of warfarin to be therapeutic.

10. A 60-year-old male client comes into the emergency department with complaints of
crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is
acute myocardial infarction. Immediate admission orders include oxygen by NC at
4L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously.
The nurse should first:

1. Administer the morphine

2. Obtain a 12-lead ECG
3. Obtain the lab work
4. Order the chest x-ray

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

1. Help keep him well hydrated

2. Dissolve clots he may have
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias.
12. When interpreting an ECG, the nurse would keep in mind which of the following about
the P wave? Select all that apply.

1. Reflects electrical impulse beginning at the SA node

2. Indicated electrical impulse beginning at the AV node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has duration of normally 0.11 seconds or less.

13. 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:

1. Call for the doctor

2. Start an intravenous line
3. Obtain a portable chest radiograph
4. Draw blood for laboratory studies

14. 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?

1. Cancer
2. Hypertension
3. Liver disease
4. Myocardial infarction

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

1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial
contractility, and conduction.
2. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
3. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and
lowers blood pressure.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the
conversion of angiotensin I to angiotensin II.

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

1. Learn how to avoid stress

2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
4. Control high blood pressure

17. 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:

1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction
4. Pulmonary disease

18. 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?

1. Visit her friend earlier in the day.

2. Rest for at least an hour before climbing the stairs.
3. Take a nitroglycerin tablet before climbing the stairs.
4. Lie down once she reaches the friend’s apartment.

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

1. A change in the pattern of her pain

2. Pain during sex
3. Pain during an argument with her husband
4. Pain during or after an activity such as lawn mowing

20. 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:

1. Open and dilate the blocked coronary arteries

2. Assess the extent of arterial blockage
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and heart muscle.

21. As an initial step in treating a client with angina, the physician prescribes nitroglycerin
tablets, 0.3mg given sublingually. This drug’s principal effects are produced by:

1. Antispasmodic effect on the pericardium

2. Causing an increased myocardial oxygen demand
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium

22. The nurse teaches the client with angina about the common expected side effects of
nitroglycerin, including:

1. Headache
2. High blood pressure
3. Shortness of breath
4. Stomach cramps

23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the
nurse instruct the client to use the drug when chest pain occurs?
1. Take one tablet every 2 to 5 minutes until the pain stops.
2. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10
minutes.
3. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the
physician if pain persists after three tablets.
4. Take one tablet. If pain persists after 5 minutes, take two tablets. If pain still persists 5
minutes later, call the physician.

24. Which of the following arteries primarily feeds the anterior wall of the heart?

1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery

25. When do coronary arteries primarily receive blood flow?

1. During inspiration
2. During diastolic
3. During expiration
4. During systole

26. Prolonged occlusion of the right coronary artery produces an infarction in which of the
following areas of the heart?

1. Anterior
2. Apical
3. Inferior
4. Lateral

27. A murmur is heard at the second left intercostal space along the left sternal border.
Which valve is this?

1. Aortic
2. Mitral
3. Pulmonic
4. Tricuspid

28. Which of the following blood tests is most indicative of cardiac damage?

1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)

29. Which of the following diagnostic tools is most commonly used to determine the
location of myocardial damage?

1. Cardiac catheterization
2. Cardiac enzymes
3. Echocardiogram
4. Electrocardiogram (ECG)

30. Which of the following types of pain is most characteristic of angina?

1. Knifelike
2. Sharp
3. Shooting
4. Tightness

31. Which of the following parameters is the major determinant of diastolic blood
pressure?

1. Baroreceptors
2. Cardiac output
3. Renal function
4. Vascular resistance

32. Which of the following factors can cause blood pressure to drop to normal levels?

1. Kidneys’ excretion of sodium only

2. Kidneys’ retention of sodium and water
3. Kidneys’ excretion of sodium and water
4. Kidneys’ retention of sodium and excretion of water

33. Baroreceptors in the carotid artery walls and aorta respond to which of the following
conditions?

1. Changes in blood pressure

2. Changes in arterial oxygen tension
3. Changes in arterial carbon dioxide tension
4. Changes in heart rate

34. Which of the following terms describes the force against which the ventricle must
expel blood?

1. Afterload
2. Cardiac output
3. Overload
4. Preload

35. Which of the following terms is used to describe the amount of stretch on the
myocardium at the end of diastole?

1. Afterload
2. Cardiac index
3. Cardiac output
4. Preload

36. A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to

control hypertension. Before administered propranolol, which of the following actions
should the nurse take first?

1. Monitor the apical pulse rate

2. Instruct the client to take medication with food
3. Question the physician about the order
4. Caution the client to rise slowly when standing.
37. One hour after administering IV furosemide (Lasix) to a client with heart failure, a short
burst of ventricular tachycardia appears on the cardiac monitor. Which of the following
electrolyte imbalances should the nurse suspect?

1. Hypocalcemia
2. Hypermagnesemia
3. Hypokalemia
4. Hypernatremia

38. A client is receiving spironolactone to treat hypertension. Which of the following

instructions should the nurse provide?

1. “Eat foods high in potassium.”

2. “Take daily potassium supplements.”
3. “Discontinue sodium restrictions.”
4. “Avoid salt substitutes.”

39. When assessing an ECG, the nurse knows that the P-R interval represents the time it
takes for the:

1. Impulse to begin atrial contraction

2. Impulse to transverse the atria to the AV node
3. SA node to discharge the impulse to begin atrial depolarization
4. Impulse to travel to the ventricles

40. Following a treadmill test and cardiac catheterization, the client is found to have
coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation
unit. During his first visit to the unit he says that he doesn’t understand why he needs to
be there because there is nothing that can be done to make him better. The best nursing
response is:

1. “Cardiac rehabilitation is not a cure but can help restore you to many of your former
activities.”
2. “Here we teach you to gradually change your lifestyle to accommodate your heart
disease.”
3. “You are probably right but we can gradually increase your activities so that you can live a
more active life.”
4. “Do you feel that you will have to make some changes in your life now?”

41. To evaluate a client’s condition following cardiac catheterization, the nurse will
palpate the pulse:

1. In all extremities
2. At the insertion site
3. Distal to the catheter insertion
4. Above the catheter insertion

42. 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:

1. Normal vs. abnormal tissue

2. Damage in areas of the heart
3. Ventricular function
4. Myocardial scarring and perfusion

43. 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?

1. Monitoring vital signs

2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site

44. A client is experiencing tachycardia. The nurse’s understanding of the physiological

basis for this symptom is explained by which of the following statements?

1. The demand for oxygen is decreased because of pleural involvement

2. The inflammatory process causes the body to demand more oxygen to meet its needs.
3. The heart has to pump faster to meet the demand for oxygen when there is lowered
arterial oxygen tension.
4. Respirations are labored.

45. 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?

1. Creatine kinase (CK or CPK)

2. Lactic dehydrogenase (LDH)
3. LDH-1
4. LDH-2

46. 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:

1. Decreased arterial blood flow secondary to vasoconstriction

2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries
4. Trauma to the lower extremities

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

1. “Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”
2. “Apply the patch to the same site each day to maintain consistent drug absorption.”
3. “If you get a headache, remove the patch for 4 hours and then reapply.”
4. “If you get chest pain, apply a second patch right next to the first patch.”

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

1. Apply the nitroglycerin patch every other day

2. Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to
>140 mm Hg
3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
4. Use the nitroglycerin patch for acute episodes of angina only

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

1. Heart rate decreases

2. Heart rate remains significantly unchanged
3. Heart rate increases
4. Heart rate becomes irregular

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

1. Moderate doses of two different types of diuretics are more effective than a large dose of
one type
2. This combination promotes diuresis but decreases the risk of hypokalemia
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration rate

Answers and Rationale

Gauge your performance by counter checking your answers to the answers below. Learn
more about the question by reading the rationale. If you have any disputes or questions,
please direct them to the comments section.

1. Answer: 4. Allergy to iodine or shellfish

This procedure requires an informed consent because it involves injection of a radiopaque

dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and
must be assessed before the procedure.

2. Answer: 3. “Does the pain get worse when you breathe in?”

Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and
4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin
usually worsens on inspiration.

3. Answer: 2. Bathroom privileges and self-care activities

On transfer from the CCU, the client is allowed self-care activities and bathroom privileges.
Supervised ambulation for brief distances are encouraged, with distances gradually
increased (50, 100, 200 feet).

4. Answer: 1. Review the intake and output records for the last 2 days

Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake
greater than output and by a sudden increase in weight. Diuretics should be given in the
morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for
clients with severe symptoms.

5. Answer: 1. Check the client status and lead placement

Sudden loss of electrocardiogram complexes indicates ventricular asystole or possible

electrode displacement. Accurate assessment of the client and equipment is necessary to
determine the cause and identify the appropriate intervention.
6. Answer: 4. Taking a blood pressure within 15 minutes after nicotine or caffeine
ingestion.

BP should be taken with the client seated with the arm bared, positioned with support and
at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak
during the recording. The client should not have smoked tobacco or taken in caffeine in the
30 minutes preceding the measurement. The client should rest quietly for 5 minutes before
the reading is taken. The cuff bladder should encircle at least 80% of the limb being
measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6
months to ensure accuracy.

7. Answer: 4. Protamine sulfate

The antidote to heparin is protamine sulfate and should be readily available for use if
excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.

8. Answer: 3. Within the therapeutic range

The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for
thrombus. Based on the client’s control value, the therapeutic range for this individual
would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.

9. Answer: 2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days
for this medication to exert an anticoagulant effect.

Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting
factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is
exhibited.

10. Answer: 1. Administer the morphine

Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s
priority action would be to relieve the crushing chest pain.

11. Answer: 2. Dissolve clots he may have

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

12. Answer: 1, 3, 5

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.

13. Answer: 2. Start an intravenous line

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

14. Answer: 4. 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 4 to 6 hours after infarction (Remember, less than 90 mg/L is
normal).

15. Answer: 1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate,
myocardial contractility, and conduction.

Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol

hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing
conduction.

16. Answer: 3. Make a commitment to long-term therapy

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.

17. Answer: 1. Cerebrovascular accident

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

18. Answer: 3. Take a nitroglycerin tablet before climbing the stairs.

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

19. Answer: 1. A change in the pattern of her pain

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

20. Answer: 2. Assess the extent of arterial blockage

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.

21. Answer: 3. Vasodilation of peripheral vasculature

Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen

consumption and demand. Vasodilation in coronary arteries and collateral vessels may also
increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial
oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or
conductivity in the myocardium.

22. Answer: 1. Headache

Because of the widespread vasodilating effects, nitroglycerin often produces such side
effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid
fainting. Nitro does not cause shortness of breath or stomach cramps.

23. Answer: 3. Take one tablet, then an additional tablet every 5 minutes for a total of 3
tablets. Call the physician if pain persists after three tablets.

The correct protocol for nitroglycerin used involves immediate administration, with
subsequent doses taken at 5-minute intervals as needed, for a total dose of 3 tablets.
Sublingual nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized
within about 10 minutes.

24. Answer: 3. Left anterior descending artery

The left anterior descending artery is the primary source of blood flow for the anterior wall
of the heart. The circumflex artery supplies the lateral wall, the internal mammary supplies
the mammary, and the right coronary artery supplies the inferior wall of the heart.

25. Answer: 2. During diastolic

Although the coronary arteries may receive a minute portion of blood during systole, most
of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are
irrelevant to blood flow.

26. Answer: 3. Inferior

The right coronary artery supplies the right ventricle, or the inferior portion of the heart.
Therefore, prolonged occlusion could produce an infarction in that area. The right coronary
artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left
ventricle and the left atrium), or the apical portion (left ventricle) of the heart.

27. Answer: 3. Pulmonic

Abnormalities of the pulmonic valve are auscultated at the second left intercostal space
along the left sternal border. Aortic valve abnormalities are heard at the second intercostal
space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth
intercostal space in the midclavicular line. Tricupsid valve abnormalities are heard at the 3rd
and 4th intercostal spaces along the sternal border.

28. Answer: 3. Troponin I

Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin
levels aren’t detectable in people without cardiac injury.

29. Answer: 4. Electrocardiogram (ECG)

The ECG is the quickest, most accurate, and most widely used tool to determine the location
of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the
location. An echocardiogram is used most widely to view myocardial wall function after an
MI has been diagnosed. Cardiac catheterization is an invasive study for determining
coronary artery disease and may also indicate the location of myocardial damage, but the
study may not be performed immediately.

30. Answer: 4. Tightness

The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain.
Pain impulses originate in the most visceral muscles and may move to such areas as the
chest, neck, and arms.

31. Answer: 4. Vascular resistance

Vascular resistance is the impedance of blood flow by the arterioles that most
predominantly affects the diastolic pressure. Cardiac output determines systolic blood
pressure.

32. Answer: 3. Kidneys’ excretion of sodium and water

The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This
response ultimately affects systolic pressure by regulating blood volume.

33. Answer: 1. Changes in blood pressure

Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure. Decreases in
pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are
primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid
arteries are primarily stimulated by oxygen.

34. Answer: 1. Afterload

Afterload refers to the resistance normally maintained by the aortic and pulmonic valves,
the condition and tone of the aorta, and the resistance offered by the systemic and
pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per
minute. Overload refers to an abundance of circulating volume. Preload is the volume of
blood in the ventricle at the end of diastole.

35. Answer: 4. Preload

Preload is the amount of stretch of the cardiac muscle fibers at the end of diastole. The
volume of blood in the ventricle at the end of diastole determines the preload. Afterload is
the force against which the ventricle must expel blood. Cardiac index is the individualized
measurement of cardiac output, based on the client’s body surface area. Cardiac output is
the amount of blood the heart is expelling per minute.

36. Answer: 3. Question the physician about the order

Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma,
so the nurse should question the physician before giving the dose. The other responses are
appropriate actions for a client receiving propranolol, but questioning the physician takes
priority. The client’s apical pulse should always be checked before giving propranolol; if the
pulse rate is extremely low, the nurse should withhold the drug and notify the physician.

37. Answer: 3. Hypokalemia

Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn,

hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

38. Answer: 4. “Avoid salt substitutes.”

Because spironolactone is a potassium-sparing diuretic, the client should avoid salt

substitutes because of their high potassium content. The client should also avoid potassium-
rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions
should continue.

39. Answer: 4. Impulse to travel to the ventricles

The P-R interval is measured on the ECG strip from the beginning of the P wave to the
beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

40. Answer: 1. “Cardiac rehabilitation is not a cure but can help restore you to many of
your former activities.”

Such a response does not have false hope to the client but is positive and realistic. The
answer tells the client what cardiac rehabilitation is and does not dwell upon his negativity
about it.

41. Answer: 3. Distal to 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.

42. Answer: 4. Myocardial scarring and perfusion

This scan detects myocardial damage and perfusion, an acute or chronic MI. It is a more
specific answer than (1) or (2). Specific ventricular function is tested by a gated cardiac blood
pool scan.

43. Answer: 3. Maintaining cardiac monitoring

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 around the MI monitoring.

44. Answer: 3. The heart has to pump faster to meet the demand for oxygen when there is
lowered arterial oxygen tension.

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.

45. Answer: 1. Creatine kinase (CK or CPK)

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.
Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.

46. Answer: 1. Decreased arterial blood flow secondary to vasoconstriction

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.

47. Answer: 1. “Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”

A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best and most
consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug
should be continued if headache occurs because tolerance will develop. Sublingual
nitroglycerin should be used to treat chest pain.

48. Answer: 3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at
night

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

49. Answer: 3. Heart rate increases

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

50. Answer: 2. This combination promotes diuresis but decreases the risk of hypokalemia

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic.

Giving these together minimizes electrolyte imbalance.