1.​ The nurse is caring for a client with cardiac tamponade.

Which vital signs are

expected?

A. HR: 109 bpm; RR: 26; BP: 88/71 mmHg

B. HR: 90 bpm; RR: 32; BP: 90/52 mmHg
C. HR: 115 bpm; RR: 22; BP: 140/78 mmHg
D. HR: 54 bpm; RR: 14; BP: 161/52 mmHg
Choice A is correct. Classic manifestations of cardiac tamponade include tachycardia,
tachypnea, jugular venous distention, and hypotension with a narrowed pulse pressure.
Choices B, C, and D are incorrect. Cardiac tamponade would typically cause features of
tachycardia, hypotension, tachypnea, and a narrowed pulse pressure.

2.The nurse is counseling a client with congestive heart failure (CHF) about
newly prescribed torsemide. The nurse determines that the teaching has
been effective when the client plans to

A. decreases their dietary potassium.

[4%]
B. record their daily urinary output.
[10%]
C. measure their weight daily.
[72%]
D. take their blood pressure and pulse daily.

Explanation
Choice C is correct. For a client with congestive heart failure prescribed torsemide, a loop
diuretic, the client should verbalize the importance of weighing themselves daily. Their daily
weight should be obtained in the morning after the first void.
Choices A, B, and D are incorrect. Decreasing dietary potassium would require follow-up
because It is potassium that should be increased. After all, torsemide is a potassium-wasting
diuretic. Recording the client's urinary output is not necessary, nor is it an accurate way to
determine the client's fluid status. Intake and output are crude ways of determining a client's
fluid status. Blood pressure should be monitored while a client takes this medication - but not
daily. Additionally, this medication does not impact the pulse and thus is irrelevant.
 3. The nurse has received a prescription for rivaroxaban. The nurse understands that
this medication is prescribed to treat which condition?
A. Pulmonary Hypertension
[6%]
B. Venous Thromboembolism (VTE)
[77%]
C. Congestive Heart Failure
[8%]
D. Hyperlipidemia
Explanation
Choice B is correct. Rivaroxaban is a factor Xa inhibitor and is commonly prescribed
for the prevention and treatment of venous thromboembolism (VTE), which
encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). An
advantage of rivaroxaban is that no therapeutic monitoring is required, unlike warfarin.

Choice A is incorrect. Pulmonary hypertension is a condition characterized by

increased blood pressure in the pulmonary arteries, which supply the lungs.
Rivaroxaban is not a standard treatment for pulmonary hypertension.

Choice C is incorrect. Congestive heart failure (CHF) is a condition in which the heart
is unable to pump blood effectively, leading to symptoms such as fluid retention,
shortness of breath, and fatigue. While anticoagulant medications like rivaroxaban may
be used in some cases of heart disease to prevent clot formation in the atria (e.g., in
atrial fibrillation), they are not typically prescribed primarily for CHF.

Choice D is incorrect. Hyperlipidemia refers to high levels of lipids (cholesterol and

triglycerides) in the blood. The primary treatment for hyperlipidemia is lifestyle
modifications (diet and exercise) and lipid-lowering medications, such as statins,
fibrates, or bile acid sequestrants. Rivaroxaban is not a medication used to lower lipid
levels.

4. The nurse in the emergency department (ED) is caring for a client with a myocardial
infarction.
The nurse anticipates a prescription for which medications? Select all that apply. 

labetalol
morphine sulfate
nitroglycerin
enalapril
isosorbide
diltiazem
Choice A is correct. Labetalol is a beta-blocker and is the mainstay treatment for acute
myocardial infarction. This medication has been proven to reduce ventricular
dysrhythmias, which can be fatal. Contraindications to a client receiving labetalol (or any
beta-blocker) include heart block, bradycardia, or shock.

Choice B is correct. Morphine sulfate has vasodilation effects and may be beneficial in
dilating the coronary arteries, allowing for more perfusion to the myocardium. This
medication is also used in acute pulmonary edema. The typical dosage is 4 mg.

Choice C is correct. Nitroglycerin is the mainstay treatment in an MI. Nitroglycerin's

potent vasodilation effects are highly efficacious. Nitroglycerin for an MI is dosed
sublingual at 0.4 mg. One tablet is given every five minutes with a maximum of three
tablets. Contraindications to a client receiving nitroglycerin include hypotension and a
right ventricular myocardial infarction.

Choice D is incorrect. Enalapril is an ACE inhibitor and is effective in treating systolic

heart failure. Beta-blockers are highly preferred over ACE inhibitors because they
reduce the likelihood of ventricular dysrhythmias.

Choice E is incorrect. Isosorbide is a maintenance nitrate used to prevent angina. The

client with acute angina should take nitroglycerin sublingually because of its rapid onset
of action. Isosorbide should be taken daily, and the client taking any nitrate should avoid
concurrent administration of medication such as tadalafil or sildenafil because of the risk
of profound hypotension.

Choice F is incorrect. Diltiazem is a calcium channel blocker that is commonly used in

atrial fibrillation. This medication is intended to have a client maintain rate control with
their atrial fibrillation. This medication is not used in an acute myocardial infarction.

5. This nurse is caring for a client who is receiving prescribed amlodipine.

Which of the following findings would indicate a therapeutic response?

A. Hemoglobin A1C 5.6% (﹤ 5.7%)

[2%]
B. Blood pressure 119/79 mm Hg
[74%]
C. Capillary blood glucose 88 mg/dL (70-110 mg/dL)
 [3%]
D. Total cholesterol 190 (﹤ 200 mg/dL)
Choice B is correct. Amlodipine is a calcium channel blocker that reduces blood
pressure and treats certain vascular disorders, such as peripheral arterial disease. A
blood pressure of 119/79 mm Hg is optimal and would indicate a positive response.

Choice A is incorrect. Hemoglobin A1C measures long-term blood glucose control and
is not directly affected by amlodipine. Amlodipine is a calcium channel blocker used
primarily to manage hypertension and angina, not blood glucose levels.

Choice C is incorrect. Capillary blood glucose measures immediate blood glucose

levels, which is not the therapeutic target of amlodipine.

Choice D is incorrect. Total cholesterol levels indicate lipid control and are not directly
influenced by amlodipine.

6/ The nurse is assessing a client who has developed cardiac tamponade. Which
of the following findings would the nurse expect to observe?
Select all that apply.

bibasilar crackles
systolic murmur
bradycardia
jugular venous distention
hypotension

Choices D and E are correct. Classic manifestations of cardiac tamponade include

tachycardia, tachypnea, pericardial rub, jugular venous distention, and hypotension with
a narrowed pulse pressure.

Choices A, B, and C are incorrect. Bibasilar crackles, a systolic murmur, and

bradycardia would not be consistent with cardiac tamponade. The client with cardiac
tamponade would have tachycardia to increase cardiac output and a pericardial friction
rub if the tamponade is caused by inflammation.
 7. The nurse plans care for a client immediately postoperative following a coronary
artery bypass graft surgery (CABG).
Which of the following actions should the nurse take? Select all that apply.

obtain the client's capillary blood glucose

provide tracheostomy care, as needed
teach the client about the driving restrictions after this procedure
ground the epicardial pacing wires to the pacemaker generator
ensure patency of the mediastinal chest tubes
Explanation
Choice A is correct. Tight postoperative glucose control is essential for optimal
outcomes. Amongst the priorities of airway patency, ensuring appropriate
hemodynamics, vital signs, and thermoregulation, the nurse will obtain frequent capillary
blood glucose levels to ensure it is less than 180 mg/dL (9.99 mmol/L) [70-110 mg/dL,
4.0–11.0 mmol/L]. Immediately postoperative, a continuous infusion of regular insulin is
prescribed and is titrated based on the client's glucose level. The stress of this major
surgery raises serum glucose levels and requires appropriate control via regular insulin.

Choice D is correct. Grounding (connecting) the epicardial pacing wires to the

pacemaker generator is appropriate. Epicardial pacing wires are placed on the heart to
control postoperative cardiac dysrhythmias. Also, they are used to increase cardiac
output by increasing the client's heart rate, if necessary.

Choice E is correct. After a CABG, clients usually have two mediastinal chest tubes to
drain fluid or blood around the heart. Clearing of this excess fluid and blood prevents
hemodynamic compromise. These tubes are connected to a chest tube drainage
system. The drainage should not exceed no more than 150 mL/hr.

Choice B is incorrect. A client, after a CABG, is not given a tracheostomy. They are
ventilated and oxygenated via an oral endotracheal tube (ETT). The ETT and
mechanical ventilation continue 3 to 6 hours after the end of surgery. The client is
extubated once they have met preset criteria, including hemodynamic stability,
breathing independently, and taking appropriate tidal volumes (as indicated by the
mechanical ventilator). Proving tracheostomy care would be expected after a total
laryngectomy.

Choice C is incorrect. Teaching the client about driving restrictions during the
immediate postoperative period is inappropriate. Education is essential, but during the
immediate postoperative period (1 to 4 hours after the surgery), the nurse must
 concentrate nursing care on ensuring the client's airway is patent, breath sounds are
optimal, and vital signs are within normal limits. Once the client has stabilized, the client
will need to be educated not to drive a vehicle for 4 to 6 weeks to prevent injury to the
sternal incision via the steering wheel or airbag.

8.The nurse is assisting the primary health care provider (PHCP) with an elective
electrical cardioversion for a chronic atrial fibrillation client. Prior to this procedure, the
nurse should perform which action?

A. Remove the client's peripheral vascular access device.

B. Review the client's risk factors for post-procedure bleeding.
C. Ensure that a water-seal chest tube drainage device is readily available.
D. Verify that the informed consent has been obtained by the health care provider (HCP).

Choice D is correct. With very few exceptions (i.e., an unresponsive client without
anyone legally authorized to give it on their behalf, etc.), cardioversion requires
informed consent. Prior to any performing procedure requiring informed consent, it is
the nurses' responsibility to ensure that the PHCP has obtained the informed consent,
the consent form was appropriately witnessed (if the nurse did not serve as the witness
themselves), and the informed consent form is located within the client's medical record.

Choice A is incorrect. When performing an elective electrical cardioversion, a

short-acting anesthetic agent s administered for sedation (e.g., typically intravenous
midazolam while some PHCPs also opt to include a small amount of weight-based
intravenous fentanyl) to make the client comfortable during the procedure. Additionally,
emergency equipment should be readily available during the client's cardioversion,
including a code (or "crash") cart, airway equipment box, and suction equipment in the
event of an emergency. Even in the rare event intravenous medications were not
utilized during a client's cardioversion, a vascular access device would still be required
due to the risks associated with the procedure. Therefore, due to the risks associated
with the procedure and the administration of one or more controlled substances, the
nurse should only discontinue the client's vascular access device just before the client's
discharge from the facility following the completion of the client's elective electrical
cardioversion.

Choice B is incorrect. Due to the rapid, irregular atrial rhythm of atrial fibrillation, the
client is at a greater risk of having atrial thrombi form, significantly increasing the client's
risk of embolic stroke. To prevent thromboembolism in atrial fibrillation clients, long-term
oral anticoagulation is often utilized for clients with risk factors for thromboembolism.
Although the nurse would routinely review every client's medication list and notice that
 any client on anticoagulant therapy is at an increased risk of bleeding, an electrical
cardioversion is a noninvasive procedure and, as such, the client's risk factors for
post-procedure bleeding would not be a substantial concern.

Choice C is incorrect. A water-seal chest tube drainage device is not necessary to

have readily available for a client who is being cardioverted. The emergency equipment
that should be readily available during the client's cardioversion includes a code (or
"crash") cart, airway equipment box, and suction equipment in the event of an
emergency.

9.The nurse is preparing an educational in-service about valsartan.

Which of the following information should the nurse include?

A. “Valsartan blocks the conversion of angiotensin I to angiotensin II.”

B. "Valsartan antagonizes angiotensin II receptors."
C. "Valsartan stimulates alpha-2 adrenoceptors in the brainstem."
D. "Valsartan blocks response to beta1- and beta2-adrenergic stimulation."
Choice B is correct. Valsartan is angiotensin renin blocker. The medication is
prescribed for conditions such as congestive heart failure and hypertension. Valsartan
antagonizes angiotensin II receptors, preventing the binding of angiotension II to the
receptors, therefore reducing blood pressure and cardiomegaly.

Your body has this thing called angiotensin II, which is like a bad guy that makes your
blood vessels tighten up. When your blood vessels get tighter, your blood pressure goes
up—kind of like squeezing a garden hose, making the water shoot out harder.

Valsartan is like a bodyguard that stops angiotensin II from doing its job. It blocks the
spots (receptors) where angiotensin II normally attaches, so it can’t tighten your blood
vessels. This helps keep your blood pressure lower and protects your heart.

Choice A is incorrect. ACE inhibitors such as enalapril prevent the conversion of

angiotensin I to angiotensin II.

Choice C is incorrect. Valsartan does not stimulate alpha-2 adrenoceptors in the

brainstem. Clonidine has this mechanism of action. Clonidine is another
antihypertensive and is used off-label for alcohol withdrawal.
 Choice D is incorrect. Beta-blockers (non-selective) block the response to beta1- and
beta2-adrenergic stimulation. Non-selective beta-blockers include propranolol and
labetalol.

10. The nurse is caring for a client with the following clinical data. Based on the clinical
data, which prescription would the nurse request from the primary healthcare provider
(PHCP)? Select all that apply. See the image below.

albuterol
hydrocortisone
diltiazem
nitroglycerin
furosemide

Choices D and E are correct. Pulmonary edema secondary to acute decompensated

heart failure (ADHF) is a medical emergency and requires rapid treatment. Vasodilators
such as nitroglycerin help decrease preload and afterload, reducing the heart's
workload. This medication is often combined with a loop diuretic such as furosemide or
bumetanide to decrease volume. If vasodilators or loop diuretics are prescribed, close
blood pressure monitoring is essential.

🚨
Pulmonary edema from acute decompensated heart failure (ADHF) = medical
emergency. This means the lungs are filling with fluid because the heart isn't
pumping well, making it hard to breathe.
What helps? (D & E are correct)

✅ Nitroglycerin (D) – This widens blood vessels (vasodilator), making it easier for
✅ Loop diuretics (E) – Like furosemide, these meds get rid of extra fluid by making
the heart to pump and reducing the pressure in the lungs.​

you pee more, which helps clear the fluid from the lungs.

Choices A, B, and C are incorrect. Albuterol would be unnecessary and harmful for a
client with pulmonary edema and ADHF. This would be useful for a client experiencing
bronchoconstriction, such as an asthma exacerbation. The assessment for this client
revealed crackles in the lung fields – not wheezes. Hydrocortisone is a steroid and
would be unhelpful in the management of ADHF. This medication may be detrimental as
this medication leads to fluid retention. Diltiazem is a calcium channel blocker and is
grossly contraindicated in ADHF because of its negative inotropic effects.

11. The nurse is preparing to administer prescribed medications to a client.

After reviewing the client's vital signs below, the nurse plans on holding which
prescribed medication?

A. Amlodipine 5 mg PO
B. Diltiazem 60 mg PO
C. Ibuprofen 500 mg PO
D. Ciprofloxacin 500 mg PO
Explanation
Choice B is correct. The client is experiencing bradycardia. Therefore, it is important to
withhold medications that may exacerbate bradycardia. Diltiazem is a calcium channel
blocker (CCB). Because of its cardiac depressant (negative chronotropic and negative
inotropic) properties, diltiazemreduces the heart rate and contractility. Because of
negative chronotropic action, it can cause bradycardia. For this reason, therapeutic
uses of diltiazem include atrial arrhythmia and paroxysmal supraventricular tachycardia.
When the client has baseline bradycardia, it is important to hold the diltiazem and notify
the healthcare provider for further orders or dosage modification.

The client has a low heart rate (bradycardia), which means their heart is beating too
slowly. Some medications can make this worse, so we have to be careful about which
ones we give.

Which medication should we hold?

✅ Diltiazem (B) → HOLD IT!

●​ Diltiazem is a calcium channel blocker that slows the heart down even more.
●​ Since the client already has a slow heart rate, giving diltiazem could make it
dangerously low.
●​ That’s why we hold the medication and call the doctor for further instructions.

Choice A is incorrect. Amlodipine is a dihydropyridine CCB that is more selective to

vascular smooth muscle calcium channels. Therefore, it causes vasodilation and can be
used to treat hypertension. Amlodipine does not cause bradycardia. The client is
experiencing bradycardia but not hypotension. Amlodipine need not be held if there is
asymptomatic bradycardia without hypotension. Side effects of dihydropyridine CCBs
(amlodipine, felodipine, nifedipine) include hypotension, flushing, peripheral edema/
ankle edema, headache, and reflex tachycardia.

Choice C is incorrect. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs do not affect the client's heart rate and can, therefore, be given regardless of
their heart rate.

Choice D is incorrect. Ciprofloxacin is a fluoroquinolone antibacterial and can be given

even if the client's heart rate is low. Ciprofloxacin's most reported cardiac side effects
include QTc prolongation and torsades de pointes(ventricular arrhythmias). Bradycardia
is unusual.
12. The nurse is teaching a group of individuals at a health fair regarding the
prevention of heart disease. It would be correct for the nurse to recommend
Select all that apply.

increasing complex carbohydrates in the diet.

a body mass index greater than 25.
reducing dietary sodium.
exercising at least 150 minutes per week.
chewing tobacco instead of cigarettes.
Explanation
Choices A, C, and D are correct. Dietary recommendations for reducing CAD risk
include increasing dietary complex carbohydrates and vegetable proteins; complex
carbohydrates are dense in fiber and help reduce cholesterol. Reducing sodium intake
is key as it assists with lowering blood pressure. Exercising at least 150 minutes a week
is recommended. Exercising has many benefits, including weight loss, mood
improvement, and vascular perfusion.

Choices B and E are incorrect. A BMI range of 25-29.9 is considered overweight. The
target BMI range is 18.5-24.9. The client should have a target to have BMI of less than
25. All forms of tobacco should be strongly discouraged as they contribute to cancer,
and nicotine causes an increase in blood pressure.

13. The nurse is caring for a client diagnosed with atrial fibrillation.

The nurse should anticipate a prescription for which of the following

medications? Select all that apply. ​
Diltiazem​
Nitroglycerin​
Clonidine​
Atorvastatin​
warfarin
Explanation
Choice A is correct. Diltiazem is a rate-lowering calcium channel blocker used to
manage atrial fibrillation. This medication assists in maintaining rate control.

Choice E is correct. An anticoagulant such as warfarin or rivaroxaban is used in the

management of atrial fibrillation as this arrhythmia puts the patient at high risk for a
stroke.

What’s the issue?

The client has atrial fibrillation (AFib), which is an irregular, fast heartbeat. This
condition increases the risk of strokebecause the blood doesn’t flow properly and
can form clots.

Which meds help with AFib?

✅ Diltiazem (A) – Slows the heart down to keep it from beating too fast and out of
control.​
✅ Warfarin (E) – Prevents blood clots from forming, which lowers the risk of a
stroke.

Choice B is incorrect. Nitroglycerin is not indicated in the management of atrial

fibrillation. This medication is approved for angina.

Choice C is incorrect. Clonidine is an effective treatment for hypertension and ADHD.

The medication is not indicated for atrial fibrillation.

Choice D is incorrect. Atorvastatin is indicated for hyperlipidemia but is not utilized in

the management of atrial fibrillation.
14. The emergency department nurse is caring for a client with congestive heart failure
who reports dyspnea and a persistent cough. The nurse obtains the client's vital signs and
suspects that the client is experiencing which condition? See the image below.

A. Pulmonary embolism
B. Hypovolemic shock
C. Disseminated intravascular coagulation (DIC)
D. Pulmonary edema
Explanation
Choice D is correct. The client's history of congestive heart failure significantly increases
the risk for pulmonary edema. The vital signs show respiratory distress (tachypnea,
hypoxia, and tachycardia), which supports the complication of pulmonary edema.

Choices A, B, and C are incorrect. These conditions are not as likely to occur in an
individual with CHF. While CHF places a client at higher risk for venous
thromboembolism, it is reasonable for the nurse to first suspect the most common
complication, which is pulmonary edema. DIC is quite rare and is highly unlikely.
Hypovolemic shock is not plausible because the client with CHF typically has a problem
with fluid volume excess, not a deficit.

✅ Pulmonary edema happens when fluid fills up the lungs, making it hard to breathe.
The client's signs—fast breathing (tachypnea), low oxygen (hypoxia), and a fast heart
rate (tachycardia)—all point to this.
15. The nurse is caring for a client receiving a continuous infusion of diltiazem who
has the below tracing on the electrocardiogram (ECG). On assessment, the client
has irregular peripheral pulses, an S3 heart sound, and 2+ pedal edema. The nurse
should plan to take which priority action? See the image below.

A. Assess the client for chest pain

B. Perform a 12-lead electrocardiogram
C. Stop the infusion
D. Obtain an immediate troponin level

Choice C is correct. This tracing reflects atrial fibrillation and diltiazem may be used as a
treatment. Diltiazem is a calcium channel blocker and may cause the client to develop
heart failure because of its negative inotropic and chronotropic effects. An S3 heart
sound is one of the earliest manifestations of heart failure. This, combined with pedal
edema, supports the nurses' decision to stop this infusion to prevent further clinical
deterioration.

Since the client is showing signs of worsening heart failure, we need to stop the
diltiazem infusion immediately to prevent things from getting worse. 🚨💊🚫
Choices A, B, and D are incorrect. These manifestations are not suggestive of
myocardial infarction (MI), and assessing the client for chest pain and obtaining a
troponin level would be irrelevant based on symptoms. The nurse should not delay
acting when the client exhibits early signs of an adverse effect such as heart failure. If
the nurse fails to act, the client may develop flash pulmonary edema.
 16. The nurse is caring for a client who has an acute myocardial infarction (AMI).

It would be a priority for the nurse to request a prescription for

A. metoprolol.
B. amiodarone.
C. enalapril.
D. diltiazem.
Explanation
Choice A is correct. Beta-blockers are used in the acute period of a myocardial
infarction (MI). The benefits of a beta-blocker in the acute period of an MI include:

●​ Blood pressure control reduces the risk (and treatment) of hypertension.

●​ Decreases myocardial oxygen consumption by lowering the heart rate.
●​ Reduces the risk of tachydysrhythmias.

The standard of care is that beta-blockers are started within 24 hours of the MI. They
also can be dosed intravenously prior to coronary intervention (PCI or thrombolytics).

Choice B is incorrect. Amiodarone is an antidysrhythmic agent that treats various

cardiac dysrhythmias, such as atrial fibrillation. Amiodarone is not routinely used in an
AMI.

Choice C is incorrect. ACE inhibitors effectively treat systolic heart failure by reducing
the risk of cardiomegaly, thereby optimizing cardiac output. ACE inhibitors are not
routinely used in an AMI.

Choice D is incorrect. Calcium channel blockers are not routinely used in the
treatment of AMI. Calcium channel blockers, such as diltiazem, maintain rate control for
individuals with atrial fibrillation.
 17. The nurse is caring for a client experiencing polyarthritis associated with rheumatic
fever. The nurse anticipates a prescription for which medication?

A. Prazosin
B. Naproxen
C. Verapamil
D. Furosemide

Choice B is correct. Polyarthritis is characterized by swollen, painful, hot joints

that are commonly seen in rheumatic fever. Other manifestations associated with
rheumatic fever include chest pain, fever, muffled heart sounds, pericardial
friction rub, chorea, muscle weakness, and emotional lability. Treatment for
painful polyarthritis is an NSAID or a steroid. Naproxen is commonly used
because of its easy dosing schedule.

Choices A, C, and D are incorrect. Prazosin is an antihypertensive medication

(alpha-1 blocker) that is indicated to treat hypertension and benign prostatic
hyperplasia. This medication has no involvement in the treatment of rheumatic
fever. Verapamil is a calcium channel blocker indicated in treating hypertension
and migraine headache prophylaxis. It is not indicated in the treatment of
polyarthritis-associated rheumatic fever. Furosemide, a loop diuretic, would have
no indication in treating polyarthritis.

✅ Naproxen (B) → The Best Choice

●​ It’s an NSAID (nonsteroidal anti-inflammatory drug), which reduces pain,
swelling, and inflammation in the joints.
●​ It’s commonly used because it works well and is easy to take.

18.The nurse is caring for a client prescribed a calcium channel blocker to treat
primary hypertension. When providing education about medication
administration, which of these foods will the nurse advise the client to avoid?
A. Eggs
B. Milk
C. Grapefruit
D. Bananas
 Explanation
Choice C is correct. Grapefruit can interfere with other drugs, as well, including
statins (atorvastatin, lovastatin, simvastatin), some antibiotics, and some cancer
drugs. Grapefruit and its juice contain furanocoumarins, which block the
enzymes that are involved in metabolizing many drugs, including calcium
channel blockers. Medication blood levels can increase, resulting in toxicity. The
levels of calcium channel blockers are increased when grapefruit or grapefruit
juice is consumed, potentially causing hypotension. Therefore, the nurse should
advise the client to avoid grapefruit while taking a calcium channel blocker.

Choice A is incorrect. Eggs do not have a significant interaction with calcium

channel blockers. There is no need for the nurse to advise the client to avoid
eggs.

Choice B is incorrect. Milk does not have a significant interaction with calcium
channel blockers. There is no need for the nurse to advise the client to avoid
milk.

Choice D is incorrect. Bananas do not have a significant interaction with calcium

channel blockers. There is no need for the nurse to advise the client to avoid
bananas.

19. This nurse is caring for a client who is receiving prescribed hydralazine. Which of the
following findings would indicate a therapeutic response?

A. Blood pressure 120/70 mm Hg

B. Pulse (P) 67/minute
C. Total cholesterol 185 mg/dL [﹤200 mg/dL]
D. aPTT 45 seconds [30-40 seconds]
 Choice A is correct. Hydralazine is a vasodilator and is intended to treat hypertension.
The client's blood pressure of 120/70 mm Hg is within normal limits and indicates a
therapeutic effect.

Choices B, C, and D are incorrect. The pulse and total cholesterol (< 200 mg/dL) are
within normal limits. However, hydralazine does not impact the pulse or total cholesterol.
The activated partial thromboplastin time (aPTT) is used as a monitoring parameter for
heparin therapy, not hydralazine. The normal aPTT is 30-40 seconds.

20. ​The nurse is teaching a client about newly prescribed nitroglycerin (NTG) sublingual
tablets. Which statement, if made by the client, would indicate a correct understanding
of the teaching?
A. "I should allow this tablet to dissolve in my cheek."
B. "I should keep the tablets in the dark bottle."
C. "I should take this medication standing up to prevent indigestion."
D. "I should take one tablet every 7 to 10 minutes if I get chest pain."
Explanation
Choice B is correct. Nitroglycerin should be stored in a dark place, in an opaque
container, away from heat or moisture. This prevents a decrease in medication potency.

Choice A is incorrect. Nitroglycerin sublingual should be dissolved under the client's

tongue. The client should not chew, crush, or swallow nitroglycerin tablets.

Choice C is incorrect. Nitroglycerin should be taken when the client is sitting down.
Taking the medication standing up could also cause the client to develop orthostatic
hypotension, leading to a fall.

Choice D is incorrect. One nitroglycerin tablet should be taken five minutes apart, with
a maximum of 3 tablets.

21. The nurse is educating nursing students about factors that can influence cardiac
output. Which of the following would cause an increase in cardiac output?

Increased stroke volume

Increased blood volume
Increased sympathetic stimulation
Administration of positive inotropic drugs
Increased systemic vascular resistance (SVR).
Explanation
Choices A, B, C, and D are correct.

A is correct. Stroke volume refers to the amount of blood ejected by the left ventricle
during each contraction. An increase in stroke volume would directly increase cardiac
output, as it is one of the two factors determining cardiac output (Workman, 2021).

B is correct. An increase in blood volume can lead to an increase in cardiac output.

More blood volume can stretch the heart muscle fibers, leading to a more muscular
contraction and stroke volume, thereby increasing cardiac output (Frank-Starling law)
(Workman, 2021).

C is correct. Sympathetic stimulation increases both heart rate and the force of
myocardial contraction, which can increase cardiac output. This is part of the body's
'fight or flight' response (Workman, 2021).

D is correct. Positive inotropic drugs, such as digoxin, increase the force of myocardial
contraction. This can lead to increased stroke volume and cardiac output (Workman,
2021).

Choice E is incorrect.

E is incorrect. Increased systemic vascular resistance, or afterload, actually decreases

cardiac output. Increased SVR means the heart must work harder to pump blood into
the systemic circulation, which may decrease stroke volume and reduce cardiac output.

22 The nurse is assessing a client with clinical manifestations of right ventricular

heart failure (HF). Which of the following statements by the client would be
consistent with this diagnosis?
A. "I notice that my feet are always swollen.”
B. "I can’t seem to get rid of this wet cough."
C. "I develop shortness of breath after I walk a few feet.”
D. "My legs start to burn if I walk long distances."
Explanation
Choice A is correct. Right-sided heart failure manifests with peripheral edema,
hepatosplenomegaly, jugular venous distention, and oliguria. The client states that his
swollen feet would be consistent with right-sided heart failure. This is because of the
fluid backing up into the client's body.

Choices B, C, and D are incorrect. A wet cough, tachypnea, and respiratory

symptoms would be consistent with left-sided heart failure. If the client reports that their
legs burn with ambulation, this is suggestive of potentially something associated with
peripheral arterial disease.

23. The nurse has received a prescription for apixaban. The nurse understands that
this medication is prescribed to treat which condition?
A. Pulmonary Hypertension
B. Venous Thromboembolism (VTE)
C. Congestive Heart Failure
D. Hypertension
explanation
Choice B is correct. Apixaban is a factor Xa inhibitor used in the treatment (and
prevention) of venous thromboembolism (VTE). The advantage of apixaban is that no
therapeutic monitoring is required, unlike warfarin.

Choices A, C, and D are incorrect. Apixaban is a factor Xa inhibitor indicated in the

treatment and prevention of VTE. It is not indicated for these conditions.

24. he emergency department nurse is caring for a client with an abdominal aortic
aneurysm at risk of rupturing. The nurse will anticipate the primary healthcare
provider (PHCP) to prescribe

A. esmolol.
B. dexamethasone.
C. heparin.
D. pantoprazole.
Choice A is correct. For a client with a suspected ruptured (or rupturing) abdominal
aortic aneurysm, tight blood pressure control is essential. Having tight blood pressure
control decreases the pressure on the aneurysm. Esmolol is a beta-blocker and will
exert antihypertensive effects. For a client with an unstable abdominal aortic aneurysm,
the nurse should provide close monitoring of their vital signs and adequate pain control.

Choices B, C, and D are incorrect. These medications are not indicated in the
management of abdominal aortic aneurysms. Dexamethasone is a steroid and has no
role in AAA management. Heparin would be contraindicated for a client with an
abdominal aortic aneurysm because if the client needs surgery, this could cause a
delay. Pantoprazole is used for peptic ulcer disease, not AAA.

25. The nurse in a community-based setting is teaching clients strategies for

preventing cardiovascular disease. Which of the following interventions should
the nurse include? Select all that apply.

Encouraging regular physical exercise

Promoting a diet high in saturated fats
Advising smoking cessation
Recommend no more than 5 alcoholic drinks a day
Educating about the importance of regular blood pressure monitoring
Instructing on the importance of regular cholesterol screenings.

Explanation
Choices A, C, E, and F are correct. Regular physical exercise is important for
maintaining cardiovascular health. It helps to strengthen the heart, improve circulation,
and control weight. Exercise can also help lower blood pressure and cholesterol levels,
reducing the risk of cardiovascular disease. Smoking is a major risk factor for
cardiovascular disease. The nurse should educate clients about the harmful effects of
smoking on the heart and blood vessels. Encouraging smoking cessation is crucial for
 reducing the risk of cardiovascular disease. Cholesterol screenings help identify
individuals with high cholesterol levels, including elevated levels of low-density
lipoprotein (LDL) cholesterol, commonly referred to as "bad" cholesterol. High levels of
LDL cholesterol are a significant risk factor for the development of atherosclerosis, the
buildup of plaque in the arteries. Identifying high cholesterol levels early allows for early
intervention and management.

Choice B is incorrect. A diet high in saturated fats can contribute to high cholesterol
levels and increase the risk of cardiovascular disease. The nurse should promote a
heart-healthy diet that is low in saturated and trans fats, cholesterol, and sodium while
being rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.

Choice D is incorrect. Excessive alcohol consumption can have detrimental effects on

cardiovascular health. 2020-2025 Dietary Guidelines for Americans recommends that
adults of legal drinking age can choose not to drink, or to drink in moderation by limiting
intake to 2 drinks or less in a day for men or 1 drink or less in a day for women.

26. The nurse is caring for a client with an exacerbation of congestive heart
failure (CHF). The client has generalized edema, dyspnea, and jugular venous
distention. The nurse should anticipate a prescription for which medication?

A. Mannitol
B. Furosemide
C. Diltiazem
D. Verapamil
Explanation
Choice B is correct. The client's symptoms suggest fluid volume excess due to
the client's congestive heart failure. A loop diuretic, such as furosemide, is highly
effective in treating this exacerbation.

Choices A, C, and D are incorrect. Mannitol is a diuretic used for the reduction of
increased intracranial pressure. This is because mannitol is an osmotic diuretic
that does not cross the blood-brain barrier. A gradient is developed between
plasma and brain cells, causing a shift from the extracellular space into the blood
 vessels. Calcium channel blockers (diltiazem and verapamil) are contraindicated
for individuals with heart failure. Calcium channel blockers have a significant
negative inotropic effect and would be detrimental to a heart failure diagnosis.

27. A nurse is caring for a client who has developed bradycardia. Which prescription
should the nurse question?

Explanation
Choice A is correct. Propranolol is a non-selective beta-blocker. Propranolol is
used in the management of hypertension and migraine prevention. While it
reduces blood pressure, it can also decrease heart rate (bradycardia) by blocking
beta-1 receptors. Therefore, if a client is experiencing bradycardia, the client
should not receive any medications that can lower the heart rate further.

Choice B is incorrect. Furosemide is a loop diuretic medication used to treat fluid

retention and edema by promoting diuresis. It is not typically contraindicated in
clients with bradycardia, so the nurse would not need to question this
prescription solely based on the presence of bradycardia.

Choice C is incorrect. Spironolactone is a potassium-sparing diuretic often used

in combination with other diuretics to manage fluid retention. Like furosemide,
spironolactone does not directly affect heart rate.

Choice D is incorrect. Valsartan is an angiotensin II receptor blocker (ARB)

medication used to treat hypertension and heart failure by dilating blood vessels
and reducing blood pressure. It does not directly affect heart rate and is not
contraindicated in clients with bradycardia.

28. The following scenario applies to the next 1 items

The nurse in the intensive care unit (ICU) is caring for a 41-year-old male client.

Item 1 of 1

●​ Progress Notes
1544: Received client to ICU immediately following percutaneous transluminal
coronary angioplasty followed by stenting via right femoral artery. Notified
primary health care provider about client status. Awaiting orders.

The nurse contacts the primary healthcare provider for admission orders.

For each potential order, click to specify whether the potential order is indicated
or not indicated for the client.

potential orders indicated not indicated

head of the bed elevated up to 30 degrees

elevate the right leg on a pillow

continuous cardiac monitoring

serial troponin levels

keep the client npo

 obtain serum glucose levels every two hours

Potential Orders Indicated

●​ Following this procedure, the affected extremity should be kept straight, and the
head of the bed should not be greater than 30 degrees—no hip flexion.
●​ This position is usually maintained for 4 to 6 hours after the procedure. This
position prevents bleeding from the catheter insertion site.
●​ The client can turn from side to side.
●​ Continuous cardiac monitoring is essential following this procedure. Arrhythmias
such as atrial fibrillation or, at worst, ventricular tachycardia may occur.
●​ Occasional premature ventricular contractions (PVCs) are expected and benign.

Orders Not Indicated

●​ Serial troponin levels after PCI are not indicated. No specific serial laboratory
monitoring is necessary after a PCI.
●​ If re-infarction is suspected, the nurse should prioritize a 12-lead electrocardiogram
(ECG), as the troponin will likely still be elevated from the first myocardial insult (if
this procedure is being performed after an MI).
●​ Keeping the client NPO is not necessary. The client may eat and drink immediately
following this procedure. Prior to the procedure, the client may be NPO for 6-8
hours.
●​ Serum glucose levels are monitored following a coronary artery bypass graft
(CABG) because this is a major operation, and hyperglycemia impedes healing.
●​ Monitoring glucose levels after PCI is not the standard of care.
 29. The nurse is caring for a client with congestive heart failure (CHF). The nurse
should anticipate a prescription for which medication?

A. Enalapril
B. Verapamil
C. Lovastatin
D. Gemfibrozil

Explanation
Choice A is correct. Enalapril is an ACE inhibitor and this drug class is indicated
in the treatment of heart failure to prevent ventricular remodeling.

Choices B, C, and D are incorrect. Verapamil is a calcium channel blocker, which

is contraindicated in the management of heart failure because of its adverse
effects on cardiac output. Lovastatin and gemfibrozil are medications used to
reduce cholesterol and are not directly used in the management of heart failure.

30. An emergency department nurse is caring for a client who presented with
fatigue, muscular weakness, and dyspnea. Upon assessment, the client was
noted to be coughing frequently and sitting in a tripod position. A subsequent
diagnosis of left ventricular failure was made. The nurse understands that
manifestations of left-sided heart failure present as respiratory issues because:
A. There is venous congestion in the liver.
B. There is hypoperfusion of tissue cells.
C. There is pulmonary congestion.
D. Despite normal cardiac output, the heart cannot meet the accelerated demands of
the body.
Explanation
Choice C is correct. Heart failure (HF) is a syndrome of ventricular dysfunction.
When occurring on the left side, left ventricular (LV) failure (also known as
left-sided heart failure) causes shortness of breath and fatigue. In these clients,
cardiac output decreases and pulmonary venous pressure increases as the heart
failure worsens. As the amount of blood ejected from the left ventricle
diminishes, hydrostatic pressure builds in the pulmonary venous system and
results in fluid-filled alveoli and pulmonary congestion, which results in a cough.
Dyspnea also results from increasing pulmonary venous pressure and pulmonary
congestion. The client's tripod positioning (also known as the orthopneic
 position) is one in which the client is in a forward-bending posture with their arms
held forward in an attempt to facilitate breathing.

Choice A is incorrect. Right ventricular (RV) failure (also known as right-sided

heart failure) causes peripheral and abdominal fluid accumulation. The liver is
most severely affected, but the stomach and intestine also become congested. In
advanced right ventricular failure, ascites and an increased abdominal girth may
develop from severe liver congestion.

Choice B is incorrect. Hypoperfusion of the tissues is a consequence of most

forms of heart failure. In clients with left ventricular (LV) failure, this occurs due to
fluid accumulation in the alveoli, resulting in pulmonary congestion.

Choice D is incorrect. High-output heart failure results from a persistently high

cardiac output (i.e., such as a condition that increases cardiac output), which may
eventually result in an inability of a normal heart to maintain adequate output.
Conditions that may increase cardiac output include end-stage liver disease,
severe anemia, persistent tachycardia, thyrotoxicosis, advanced Paget disease,
etc.

31. The nurse is watching the monitor of a client wearing a continuous cardiac
monitor when it begins to alarm and fails to display any QRS complexes. Which
nursing intervention should the nurse do first?

A. Press record on the electrocardiogram

B. Check the client's lead placement
C. Call the code team
D. Contact the health care provider
Choice B is correct. Before calling a code or contacting the physician, the nurse
should ensure that the leads are correctly placed on the client and have not been
removed. Physically looking and assessing the client as well as the associated
equipment should be the first action when an abnormal rhythm is noticed on the
cardiac monitor.

Choice A is incorrect. The first action is to ensure proper lead placement.

Choice C is incorrect. Calling a code is not appropriate until the nurse has
confirmed the client is experiencing asystole.
 Choice D is incorrect. Contacting the care provider should not be completed until
the nurse is sure that the client leads are working correctly.

32. The nurse reviews newly prescribed laboratory tests and medications for the
following clients. Which of the laboratory tests and prescriptions should the nurse
question?
A. Liver function tests (LFTs) for a client prescribed atorvastatin
B. International normalized ratio (INR) for a client prescribed rivaroxaban
C. Serum creatinine level for a client prescribed lisinopril
D. Glycosylated hemoglobin (HgbA1C) level for a client prescribed olanzapine

Explanation
Choice B is correct. Rivaroxaban is advantageous because it does not require
frequent laboratory monitoring. International Normalized ratio (INR) monitoring is
required for a client receiving selected anticoagulants such as warfarin.
Rivaroxaban and apixaban (direct factor Xa inhibitors) may increase prothrombin
time (PT) and INR. However, these tests are not reliable in assessing the
anticoagulation effects of these agents. Therefore, INR monitoring is not
recommended for clients on prescribed rivaroxaban. The nurse should question
this because it is unnecessary.

Choices A, C, and D are incorrect. All these laboratory tests are appropriate for
the prescribed medication.

●​ LFTs are necessary to trend while a client is on statin therapy because of

the risk of hepatic injury (choice A).
●​ ACE inhibitors such as lisinopril may be nephrotoxic if exposure is
prolonged and at high doses. While ACE-I may be nephroprotective,
monitoring the creatine is a clinical standard while a client is on ACE-I
(choice C).
●​ Olanzapine is an atypical antipsychotic and may cause some of the worst
metabolic derangements, such as dyslipidemia, elevations in blood
glucose, and weight gain. These metabolic abnormalities may lead the
 client to develop diabetes mellitus. The antipsychotic -pines are the worst
metabolically (clozapine, olanzapine, quetiapine). Therefore, HgbA1C
monitoring is warranted for the clients taking these medications.

33, The nurse is presenting at a staff development conference about medications

used to treat heart failure. Which of the following medications are used in the
treatment of heart failure? Select all that apply.
furosemide
metformin
lisinopril
digoxin
warfarin
metoprolol
Explanation
Choices A, C, D, and F are correct. Furosemide helps to reduce fluid overload by
promoting diuresis, often prescribed to manage fluid retention in heart failure
clients. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor frequently
prescribed for heart failure. It helps improve cardiac function and reduce the
workload on the heart. Digoxin is a cardiac glycoside used to enhance heart
contractility. It helps increase cardiac output and reduces symptoms such as
dyspnea and fatigue. Metoprolol is a beta-blocker and helps reduce heart rate and
blood pressure, improving cardiac function.

Choice B is incorrect. Metformin is an oral antidiabetic medication primarily used

to manage type 2 diabetes. While heart failure clients may have diabetes,
metformin is not typically used as a direct treatment for heart failure.

Choice E is incorrect. Warfarin is an oral anticoagulant used to prevent blood clot

formation. While some heart failure clients may require anticoagulation therapy
due to coexisting conditions such as atrial fibrillation, warfarin is not a direct
treatment for heart failure.
34. The nurse is caring for a client who has sustained a myocardial infarction.
Which laboratory test would be increased that is specific to myocardium
damage?

A. CPK-MB
B. Troponin
C. Creatinine kinase
D. Myoglobin
Choice B is correct. Troponin is the most specific cardiac biomarker when
evaluating a client's myocardial infarction (MI). Troponin levels will elevate within
3-4 hours of myocardial infarction and remain elevated for three weeks. This means
that troponin is the most specific cardiac biomarker for an MI and is the most
reliable test to run if the client does not seek care for some time after their
symptoms begin.

Choice A is incorrect. CPK-MB is not the most specific iso-enzyme to myocardial

infarction. CPK-MB is a cardiac iso-enzyme, and levels of this iso-enzyme do
become elevated with damage to the cardiac cells of the myocardium; it is just not
the most specific. Levels of CPK-MB increase about 3 to 6 hours after injury to the
heart muscle, and their levels peak in 24 hours.

Choice C is incorrect. Creatine kinase is not the most specific iso-enzyme to

myocardial infarction. It is an enzyme found in the heart, brain, skeletal muscle, and
other tissues. Any time there is muscle damage, increased amounts of creatinine
kinase are released into the blood. This means, however, that it is not a sensitive
indicator for myocardial infarction because muscle damage will cause elevated
levels. When running this lab after a myocardial infarction is suspected, negative
results are a good thing to aid in ruling out an MI. Still, positive results are not
specific, and further testing must be done.

Choice D is incorrect. Myoglobin levels increase after myocardial infarction

because any muscle breakdown releases myoglobin into the bloodstream. This
means, however, that it is not a sensitive indicator for myocardial infarction
because muscle damage will cause elevated levels. When running this lab after a
myocardial infarction is suspected, negative results are a good thing to aid in ruling
out an MI. Still, positive results are not specific, and further testing must be done.

35. The nurse cares for a client with a complete (3rd-degree) heart block and
hypotension. The nurse should take which appropriate action?
A. prepare the client for temporary transcutaneous pacing
B. obtain a prescription for an esmolol infusion
C. begin chest compressions
D. instruct the client to perform the Valsalva maneuver

Explanation
Choice A is correct. A third-degree heart block (complete heart block) is a
medical emergency because electrical communication is lost between the atria
and the ventricles. On an electrocardiogram, this appears as a complete
dissociation of atrial activity from ventricular activity (P waves are independent of
QRS complexes). A common finding with this heart block is that the heart rate is
usually less than 60 beats per minute. If the escape rhythm is junctional, the heart
rate is between 40 and 60 beats per minute. However, if ventricular escape rhythm
occurs, the heart rate can fall below 40 beats per minute and result in
hemodynamic instability (hypotension). A hemodynamically unstable complete
heart block is highly concerning because of the significant reduction in cardiac
output. Immediate management includes providing supplemental oxygen if the
client has decreased pulse oximetry, pharmacological therapy with atropine,
preparing the client for temporary transcutaneous pacing, and admission to the
critical care unit for close monitoring. The cure for an irreversible complete heart
block would be the placement of a permanent pacemaker.

Choices B, C, and D are incorrect.

●​ Esmolol is a beta-blocker and would be contraindicated because this medication

would worsen an already serious AV block (choice B). If any medications were
administered, they would be atropine or beta-adrenergic agonists to increase
 cardiac output. However, atropine is not always effective in a third-degree heart
block, and it is not recommended to delay treatment with transcutaneous
pacing while using atropine.
●​ Chest compressions should not begin because a complete (or third-degree)
heart block is not characterized by the client having an absent pulse (choice C).
●​ Instructing the client to perform the Valsalva maneuver would be
contraindicated because this maneuver would decrease cardiac output. This
maneuver is advised for tachydysrhythmias such as supraventricular
tachycardia (SVT).

36. The nurse observes the following tracing on the telemetry monitor. The nurse
should take which initial action? See the image below. 

A. Assess the client's level of consciousness

B. Prepare the client for immediate defibrillation
C. Administer a dose of intravenous epinephrine
D. Evaluate the client's cardiac lead placement
Explanation
Choice A is correct. This tracing depicts ventricular fibrillation. This rhythm is
highly concerning because it can be fatal. Because the nurse has just seen this
tracing on the telemetry monitor, the first action the nurse should take is to
 assess the client. Artifact may be confused for ventricular fibrillation, therefore
the nurse should always assess the client first and not the monitor.

Choices B, C, and D are incorrect. All of these actions may be appropriate for a
client experiencing ventricular fibrillation. However, none of these assess the
client's level of consciousness, which is the initial step in the basic life support
algorithm. The client with ventricular fibrillation requires immediate defibrillation
as the priority treatment if the client is unconscious and has no pulse.

The nurse is preparing to administer medications to assigned clients.

37. Which prescription should the nurse clarify with the primary healthcare
provider (PHCP)?

A. Warfarin to a client with an international normalized ratio (INR) of 1.8 seconds

[0.9–1.2]
B. Digoxin to a client with a serum potassium level of 3.1 mEq/L [3.5-5 mEq/L,
mmol/L]
C. Enoxaparin to a client with a platelet count of 155,000 mm3 [150-400 mm3,
130–380 × 10⁹/L]
D. Lisinopril to a client with a serum creatinine level of 0.6 mg/dL [Male: 0.6-1.2
mg/dL, Female: 0.5-1.1 mg/dL, Female 30–190 IU/L, Male 30–250 IU/L]

Explanation
Choice B is correct. The nurse should clarify the digoxin prescription. More
specifically, digoxin should not be administered to a client with hypokalemia, as
hypokalemia may precipitate digoxin toxicity. The client's potassium level should
be corrected before resuming digoxin.

Choice A is incorrect. The client's international normalized ratio (INR) is not yet
within the therapeutic range. The nurse should still administer the warfarin to get
the client to a therapeutic level. The therapeutic INR for VTE prevention is 2-3.
 Choice C is incorrect. Enoxaparin is a low molecular weight-based heparin
(LWMH), and platelet monitoring is required for a client receiving it. This
medication may adversely cause heparin-induced thrombocytopenia.

Choice D is incorrect. Lisinopril is indicated for congestive heart failure or

hypertension. This medication may induce nephrotoxicity, and monitoring the
creatinine is required. This client's creatinine is normal.

38. The nurse is caring for a client who was recently admitted to the cardiac floor for
angina. This client states that their chest pain occurs at the same time every day at
rest. The client does not believe there are any precipitating factors. Which of the
following types of angina is this client most likely experiencing?
A. Variant angina
B. Stable angina
C. Unstable angina
D. Nonanginal pain
Explanation
Choice A is correct. Variant angina, also known as Prinzmetal’s angina, occurs at
about the same time every day, usually at rest. Variant angina is treated with
calcium channel blockers.

Choice B is incorrect. Stable angina occurs after activity and is relieved by

nitroglycerin tablets.

Choice C is incorrect. Unstable angina is less predictable and may precipitate

myocardial infarction.

Choice D is incorrect. This type of discomfort does not describe nonanginal pain.

39. While auscultating a client's bowel sounds, the nurse notes a swooshing sound
to the left of the umbilical area. What would be the nurse’s priority action?
A. Percuss over the area to assess for dullness
B. Notify the primary healthcare provider (PHCP)
C. Gently palpate the abdomen to assess for tenderness
D. Ask the client about recent bowel movements

Explanation
Choice B is correct. Upon auscultation, the nurse should suspect this client is
presenting with an abdominal aortic aneurysm (AAA) due to the bruit or
swooshing sound. The nurse should immediately notify the client's healthcare
provider of this urgent situation. An AAA rupture can occur spontaneously or
with trauma. If the aneurysm bursts, it may cause life-threatening bleeding. The
aneurysm should be assessed immediately to determine the need for surgical
intervention.

Choices A, C, and D are incorrect. If a bruit is heard upon auscultation of the

abdominal aorta, the nurse should suspect an aneurysm and not perform
percussion or palpation due to the risk of rupture. Asking the client about bowel
movements (choice D) would be appropriate for assessing the client's
gastrointestinal system but would not be the highest priority for a suspected
aneurysm.

40. The nurse has instructed a client with hyperlipidemia about self-management.
Which statement by the client would require follow-up by the nurse?
A. "I should replace hydrogenated vegetable oils with canola oil when cooking."
B. "I should increase my intake of fish like tuna and salmon more often."
C. "Increasing my fiber intake will help lower my cholesterol."
D. "I am glad that I won't need to reduce red meat from my diet."

Explanation
Choice D is correct. Red meats are rich in saturated fat and should, therefore, be
consumed less often by this client based on the recent diagnosis of
hyperlipidemia. Red meats contribute to high cholesterol levels and would
increase, not decrease, the client's already elevated hyperlipidemia levels.
Therefore, this choice is incorrect.
 Choice A is incorrect. Replacing hydrogenated vegetable oils high in
polyunsaturated fats with canola oil (monounsaturated fats) is more beneficial in
reducing the client's elevated cholesterol levels.

Choice B is incorrect. Fish like tuna and salmon are rich in omega-3 fatty acids,
which help reduce harmful cholesterol levels. Omega-3 fats are an essential type
of polyunsaturated fat. The body cannot produce these fats, so they must come
from food sources.

Choice C is incorrect. Fiber is an effective strategy to keep the client fuller longer,
control blood sugar levels, and lower low-density lipoprotein levels (LDL). It is
recommended that the client increase their dietary intake of fiber.

41, The nurse is caring for a client on postoperative day one following a mitral valve
replacement. The client is getting ready to ambulate for the first time and has a heart
rate of 102 beats/minute. The stroke volume, based on the echocardiogram, is 72 mL.
Which of the following represents the client's cardiac output (CO)?
A. 7.344 L/min
B. 30 L/min
C. 55%
D. 73.444 mL/min
Explanation
Choice A is correct. To answer this question correctly, you must know the right
formula for Cardiac Output(CO).

CO = Heart Rate (HR) x Stroke Volume (SV). Heart rate is measured in beats per
minute, and stroke volume is measured in milliliters (mL).

The HR is the number of times per minute the heart beats, whereas the SV is the
mL of blood that the heart pumps out with each contraction. By multiplying the
two together, you get how many mL of blood the heart is pumping out each
minute. This is the cardiac output.
 Cardiac output is usually reported in liters/min; the average is about 5 L/min but
varies greatly depending on the client's size. A decreased cardiac output
(low-output failure) is seen in congestive heart failure. A high cardiac output state
refers to resting cardiac output more significant than 8 L/min. An increased
cardiac output (high-output failure) may be seen in hyperthyroidism, thiamine
deficiency, and severe uncorrected anemia.

For this problem: Cardiac Output (CO) = 102 beats per minute (HR) x 72 mL (SV) =
7,344 mL/min or 7.344 L/min.

Choice B is incorrect. The calculated cardiac output is 7.344 L/minute, not 30

L/minute. The given stroke volume and heart rate do not yield a cardiac output of
30 L/minute.

Choice C is incorrect. This answer is incorrect. 55% is not a unit of measurement

for cardiac output. Cardiac output is typically expressed in liters per minute
(L/min) or milliliters per minute (mL/min) and represents the volume of blood
pumped by the heart in one minute. This appears to represent an ejection
fraction. Cardiac output should not be confused with ejection fraction. Ejection
fraction (EF) is a “fraction” and is often reported as a percentage (%). The left
ventricular ejection fraction is the percentage of the ventricular blood pumped
out of the left ventricle during systole. An ejection fraction of 55% means that
55% of the blood in the left ventricle is pumped out with each heartbeat. The
normal EF is 55% to 70%. Ejection fraction is decreased in systolic heart failure,
whereas it remains normal in diastolic heart failure.

Choice D is incorrect. The calculated cardiac output is 7.344 L/minute, which is

equivalent to 7344 mL/minute. 73.444 mL/min is not the correct cardiac output
based on the given heart rate and stroke volume.

42. The nurse is preparing to administer amiodarone. Which of the following

laboratory test results should the nurse monitor during the therapy?
A. white blood cell (WBC) count
B. serum glucose level
C. serum uric acid level
D. thyroid-stimulating hormone (TSH) level
Explanation
Choice D is correct. TSH should be monitored because amiodarone tends to
cause both hyper- and hypothyroidism. Amiodarone inhibits the peripheral
conversion of T4 to T3; serum T4 and reverse T3 concentrations may be
increased, and serum T3 may be decreased. TSH is a central part of a thyroid
panel and should be monitored closely.

Choice A is incorrect. White blood cell count does not need to be monitored with
amiodarone. WBC count should be monitored for a client taking long-term
corticosteroids and clozapine because both medications may cause leukopenia.

Choice C is incorrect. Serum uric acid level does not need to be monitored with
amiodarone. This lab may be monitored for a client with medication conditions
like gout.

Choice B is incorrect. Serum glucose level does not need to be monitored with
amiodarone. This lab needs monitoring for a client taking insulin or total
parenteral nutrition.

43. The nurse is teaching a group of clients about varicose veins and home care
management. Which of the following should the nurse include in the teaching
session?
A. When you are sitting, keep your legs lower than your heart
B. Wear compression stockings during the day
C. Participate in activities that have you stand for long periods
D. Take a low-dose aspirin to prevent the development of new varicose veins

Explanation
Choice B is correct. Compression stockings/hose are effective because the
external pressure promotes venous return. Compression hose combined with
 frequent position changes, daily walks, and keeping the legs elevated to facilitate
venous return is recommended.

Choices A, C, and D are incorrect. These measures are not recommended when a
client is managing varicose veins. Keeping the legs dependent is recommended
for arterial insufficiency, where legs elevated is recommended to promote venous
return. Standing in positions for a long period of time is not recommended. The
nurse should advise the client to change positions frequently and engage in daily
walks. Finally, aspirin may help with the pain associated with varicose veins, but
they do not prevent the formation of varicose veins.

44. The nurse is assisting a physician in performing a bronchoscopy. The nurse

suspects the client is experiencing a vasovagal response as evidence by the client's
Incorrect
Correct Answer(s): D
A. hypertension.
[6%]
B. bronchodilation.
[11%]
C. increase in heart rate (HR).
[21%]
D. decrease in heart rate (HR).
[62%]

Explanation
Choice D is correct. Upon seeing a sudden, noticeable drop in the client's heart
rate, the nurse would notate a vasovagal response. Here, during the
bronchoscopy, the involvement of a foreign object (i.e., the scope used in the
bronchoscopy) in the client's pharynx likely caused vagus nerve stimulation. This
stimulation resulted in a vasovagal response by the client, manifested by a
sudden decrease in the client's heart rate.
 Choice A is incorrect. Stimulation of the vagus nerve does not cause a client's
blood pressure to increase. The parasympathetic activity causes a reduction in
pulse and blood pressure which may cause the client to develop syncope.

Choice B is incorrect. Stimulation of the vagus nerve does not cause

bronchodilation. Bronchoconstriction is expected during a vagal response.

Choice C is incorrect. During vagus nerve stimulation, parasympathetic activity

reduces the heart rate. The heart rate increase is not a consistent finding during a
vasovagal response.

45. The nurse is providing discharge teaching to a client following coronary artery
bypass graft (CABG) surgery. The nurse should advise the client that they may
resume sexual activity
A. after exercise tolerance is assessed.
B. one week after surgery.
C. when the client can comfortably jog two miles.
D. three months after surgery.
Explanation
Choice A is correct. Clients who have undergone cardiac surgery should have
their exercise tolerance evaluated by a physician before resuming sexual activity.
Many physicians agree that a client may return to sexual activity if they can climb
two flights of stairs without symptoms.

Choice B is incorrect. All clients recover differently. Therefore, a time frame is not
the best way to evaluate readiness for sexual activity.

Choice C is incorrect. Jogging two miles may be strenuous even for clients
without cardiac surgery. This is not the best way to judge readiness for sexual
activity.

Choice D is incorrect. All clients recover differently. Therefore, a time frame is not
the best way to evaluate readiness for sexual activity.
46. The nurse has provided education to a client with atrial fibrillation.
Which of the following statements by the client would require a follow-up? Select
all that apply.

“I have an increased risk for a stroke.”

“I should weigh myself daily at the same time.”
“I may be prescribed medications such as amiodarone.”
“I should wear a mask when I am in public.”
“I should seek medical care if I develop shortness of breath.”

Explanation
Choice B is correct. Clients with atrial fibrillation do not need to weigh
themselves daily. This is appropriate teaching for a client with congestive heart
failure, as this intervention is useful for detecting excessive fluid retention. This
statement requires follow-up.

Choice D is correct. Wearing a mask in public is unnecessary as a client with

atrial fibrillation is not more at risk for developing an infection. This statement
requires follow-up.

Choice A is incorrect. Atrial fibrillation is a common dysrhythmia that results in a

decrease in an atrial kick. A client with atrial fibrillation is at risk for an ischemic
stroke because of the formation of clots in the atrial appendage. This statement
indicates effective understanding.

Choice C is incorrect. Treatment for atrial fibrillation ranges from medications

(diltiazem, amiodarone) to cardiac ablation. This statement indicates effective
understanding.

Choice E is incorrect. Finally, the client needs to seek medical care if they
develop dyspnea because this could be an indication of atrial fibrillation with a
rapid ventricular response (RVR). This condition significantly reduces cardiac
output. This statement indicates effective understanding.
 47. A client has been placed on a sodium-restricted diet following a myocardial
infarction. Which of the following would be the most appropriate meals to
suggest?

A. Turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1 orange.
B. Broiled fish, 1 baked potato, ½ cup canned beets, 1 orange, and milk.
C. Canned salmon, fresh broccoli, 1 biscuit, tea, and 1 apple.
D. A bologna sandwich, fresh eggplant, 2 oz fresh fruit, tea, and apple juice.

Choice A is correct. People with heart failure may improve their symptoms by
reducing the amount of sodium in their diet. Sodium is a mineral found in many
foods, especially salt. Overeating salt causes the body to keep or retain too much
water, worsening the fluid buildup. Patients should be encouraged to follow a
low-sodium diet to help manage symptoms of hypertension and to reduce edema.
One of the most natural things a patient can do at home is to reduce the amount
of sodium intake. They can also eat fresh vegetables rather than canned. If
canned vegetables are the only option, the patient should rinse the plants with
clean water and cook them with unsalted water.

Choice B is incorrect. Canned vegetables should be avoided.

Choices C and D are incorrect. Canned or processed meats are higher in sodium
and should be avoided.

NCSBN Client Need Topic: Physiological Integrity, Subtopic: Basic Care and
Comfort

48. The nurse is caring for a client with atrial fibrillation. Which of the following client
findings requires immediate follow-up by the nurse?
A. Irregular QRS complexes on telemetry reading
B. Irregular peripheral pulse
C. Reports of intermittent palpitations
D. Blurred vision
Explanation
 Choice D is correct. Blurred vision is an unexpected manifestation of atrial
fibrillation and may signify that the client has had a stroke. Ischemic stroke is a
significant complication of atrial fibrillation which explains why most clients with
atrial fibrillation will be prescribed anticoagulants to prevent this life-threatening
complication.

Choice A is incorrect. Irregular QRS complexes are expected in atrial fibrillation

because this is an irregular rhythm.

Choice B is incorrect. Since atrial fibrillation is irregularly irregular, the client is

expected to have an irregular peripheral pulse.

Choice C is incorrect. Intermittent palpitations or fluttering is an expected finding

with atrial fibrillation.

49. The nurse assesses the following electrocardiogram (ECG) strips for assigned
clients.
The nurse should immediately follow up with the client with which ECG strip?

A.

B.

C.
D.

Choice C is correct. Ventricular tachycardia is depicted in this rhythm strip, and

the nurse must prioritize this client because of the emergent nature of this
dysrhythmia.

Choice A is incorrect. This rhythm strip shows normal sinus rhythm and does not
require immediate follow-up. This is an optimal rhythm.

Choice B is incorrect. This rhythm strip is interpreted as normal sinus rhythm

with premature ventricular contraction (PVC). PVCs are generally benign and may
be caused by stress, anxiety, and electrolyte abnormalities such as low
potassium and/or magnesium levels.

Choice D is incorrect. This rhythm strip depicts sinus tachycardia. Sinus

tachycardia may be caused by febrile illness, stress, hyperthyroidism, anxiety,
and potentially a warning sign for shock. This rhythm strip does not prioritize
ventricular tachycardia, a life-threatening dysrhythmia.