1. :Question -1
A client arrives in the emergency room
complaining of chest pain that began 4
hours ago . A troponin T blood specimen is
obtained , and the results indicate a level
of 0.6 ng/mL . The nurse interprets that
:this result indicates a
:Options
Normal level . 1
Low value that indicates possible . 2
gastritis
Level that indicates a myocardial . 3
infarction
Level that indicates the presence of . 4
possible angina
:Answer
. 3
:Question -2
A 22-year- old adult has a cholesterol
blood test done at a screening clinic
sponsored by a local health club. The nurse
volunteering at the screening teaches the
client that diet and exercise should be
used as health measures to keep the total
:cholesterol level below
:Options
mg/dL 80 . 1
mg/dL 200 . 2
mg/dL 250 . 3
mg/dL 300 . 4
:Answer
. 2
:Rationale
The nurse should counsel the client to keep
the total cholesterol level under 200 mg/dL

2. . This will aid in the prevention of
atherosclerosis, which can lead to a number
of cardiovascular disorders later in life.
Options 3 and 4 are elevated values and
place the client at risk for cardiovascular
disease . Although option 1 is a low
cholesterol level , option 2 identifies the
realistic value to assist in preventing
.cardiovascular disease
:Question -3
A client is suspected of having a
myocardial infarction. The nurse assesses
for elevations in which of the following
isoenzyme values reported with the creatine
?kinase level
:Options
MM . 1
MB . 2
BB . 3
MK . 4
:Answer
. 2
:Rationale
Creatine kinase (CK) is a cellular enzyme
that can be fractionated into three
isoenzymes. The MB band reflects CK from
cardiac muscle. This is the level that
elevates with myocardial infarction. The MM
band reflects CK from skeletal muscle. The
BB band reflects CK from the brain. There
:is no MK band. Question
A client is suspected of having a
myocardial infarction. The nurse assesses
for elevations in which of the following
isoenzyme values reported with the creatine
?kinase level
:Options

3. MM . 1
MB . 2
BB . 3
MK . 4
. Answer:2
:Rationale
Creatine kinase (CK) is a cellular enzyme
that can be fractionated into three
isoenzymes. The MB band reflects CK from
cardiac muscle. This is the level that
elevates with myocardial infarction. The MM
band reflects CK from skeletal muscle. The
BB band reflects CK from the brain. There
.is no MK band
:Question -4
A client with atrial fibrillation who is
receiving maintenance therapy of warfarin
sodium (Coumadin) has a prothrombin time of
35 seconds . Based on the prothrombin
time , the nurse anticipates which of the
?following orders
:Options
Adding a dose of heparin sodium . 1
Holding the next dose of warfarin . 2
Increasing the next dose of warfarin . 3
Administering the next dose of warfarin . 4
:Answer
. 2
:Rationale
The normal prothrombin time (PT) is 9.6 to
11.8 seconds (male adult) or 9.5 to 11.3
seconds (female adult). A therapeutic PT
level is 1.5 to 2.0 times higher than the
normal level . Because the value of 35
seconds is high (and perhaps near the
critical range), the nurse should

4. anticipate that the client would not
.receive further doses at this time
:Question-5
The nurse checks the laboratory result for
a serum digoxin level that was determined
for a client earlier in the day and notes
that the result is 2.4 ng/mL . Which of the
following is the most important action on
?the part of the nurse
:Options
.Notify the physician . 1
.Check the client ’s last pulse rate . 2
Record the normal value on the client . 3
.’s flow sheet
Administer the next dose of the . 4
.medication as scheduled
:Answer
. 1
:Rationale
The normal therapeutic range for digoxin is
0.5 to 2.0 ng/mL . A level of 2.4 ng/mL
exceeds the therapeutic range and indicates
toxicity. The most important action is to
notify the physician, who may give further
orders about holding further doses of
digoxin . Option 3 is incorrect because the
level is not normal. The next dose should
not be administered because the serum
digoxin level exceeds the therapeutic
range. Checking the client ’s last pulse
rate is not incorrect but may have limited
value in this situation. Depending on the
time that has elapsed since the last
assessment, a current assessment of the
.client ’s status may be more useful
:Question-6
A client is receiving a continuous
intravenous infusion of heparin sodium to

5. treat deep vein thrombosis. The client ’s
activated partial thromboplastin (aPTT)
time is 65 seconds . The client ’s baseline
before the initiation of therapy was 30
seconds . The nurse anticipates that which
? action is needed
:Options
Discontinuing the heparin infusion . 1
Increasing the rate of the heparin . 2
infusion
Decreasing the rate of the heparin . 3
infusion
Leaving the rate of the heparin . 4
infusion as is
:Answer
. 4
:Rationale
The normal activated partial thromboplastin
time (aPTT) varies between 20 and 36
seconds , depending on the type of
activator used in testing. The therapeutic
dose of heparin for treatment of deep vein
thrombosis is to keep the aPTT between 1.5
and 2.5 times normal . Thus , the client ’s
aPTT is within the therapeutic range, and
.the dose should remain unchanged
:Question -7
A client with a history of cardiac disease
is due for a morning dose of furosemide
(Lasix). Which serum potassium level should
be reported to the surgeon before
administering the dose of furosemide?
:Options
mEq/L 3.2 . 1
mEq/L 3.8 . 2
mEq/L 4.2 . 3
mEq/L 4.8 . 4
:Answer

6. . 1
:Rationale
The normal serum potassium level in the
adult is 3.5 to 5.1 mEq/L . Option 1 is the
only value that falls below the therapeutic
range. Administering furosemide to a client
with a low potassium level and a history of
cardiac problems could precipitate
ventricular dysrhythmias . Options 2 , 3 ,
.and 4 are within the normal range
:Question -8
A client with hypertension has been told to
maintain a diet low in sodium. A nurse who
is teaching this client about foods that
are allowed would plan to include which
?food item in a list provided to the client
:Options
Tomato soup . 1
Boiled shrimp . 2
Instant oatmeal . 3
Summer squash . 4
:Answer
. 4
:Rationale
Foods that are lower in sodium include
fruits and vegetables (option 4) , because
they do not contain physiological saline .
Highly processed or refined foods (options
1 and 3) are higher in sodium unless their
food labels specifically state “low sodium.
”Saltwater fish and shellfish are high in
.sodium
:Question -9
A nurse is planning to teach a client with
malabsorption syndrome about the necessity
of following a low- fat diet. The nurse

7. develops a list of high-fat foods to avoid
and includes which food item on the list?
:Options
Oranges . 1
Broccoli . 2
Cream cheese . 3
Broiled haddock . 4
:Answer
. 3
:Rationale
Fruits and vegetables tend to be lower in
fat because they do not come from animal
sources. Fish is also naturally lower in
.fat. Cream cheese is a high-fat food
:Question -10
The nurse is instructing a client with
hypertension on the importance of choosing
foods low in sodium
The nurse should teach the client to limit
?which of the following foods
:Options
Apples . 1
Bananas . 2
Smoked sausage . 3
Steamed vegetables . 4
:Answer
. 3
:Rationale
Smoked foods are high in sodium . Options 1
, 2 , and 4 are fruits and vegetables that
are low in sodium
:Question -11
A nurse is performing cardiopulmonary
resuscitation (CPR) on an adult client. The
nurse understands that when performing
chest compressions, one should depress the
:sternum

8. :Options
to 1 inch ¾ . 1
to ¾ inch ½ . 2
to 2 inches ½ 1 . 3
to 3 inches ½ 2 . 4
:Answer
. 3
:Rationale
When performing cardiopulmonary
resuscitation (CPR) on an adult client ,
the sternum is depressed 1 ½ to 2 inches .
Options 1 and 2 identify compression depths
that would be ineffective in an adult .
Option 4 identifies a depth that could
:Question -12
A client with no history of cardiovascular
disease comes to the ambulatory clinic with
flu-like symptoms. The client suddenly
complains of chest pain. Which of the
following questions would best help a nurse
discriminate pain caused by a noncardiac
?problem
:Options
“ ?Can you describe the pain to me” . 1
“ ?Have you ever had this pain before” . 2
Does the pain get worse when you” . 3
“ ?breathe in
Can you rate the pain on a scale of 1” . 4
“ ?to 10 , with 10 being the worst
:Answer
. 3
:Rationale
Chest pain is assessed by using the
standard pain assessment parameters (e.g.,
characteristics, location , intensity ,
duration , precipitating and alleviating
factors , and associated symptoms). Options
1 , 2 , and 4 may or may not help

9. discriminate the origin of pain . Pain of
pleuropulmonary origin usually worsens on
.inspiration
:Question -13
A client is admitted to an emergency room
with chest pain that is being ruled out for
myocardial infarction . Vital signs are as
follows : at 11 AM , pulse (P) , 92
beats/min , respiratory rate (RR) , 24
breaths/min , blood pressure (BP) , 140/88
mm Hg ; 11:15 AM , P , 96 beats/min , RR ,
26 breaths/min , BP , 128/82 mm Hg ; 11:30
AM , P , 104 beats/min , RR , 28
breaths/min , BP , 104/68 mm Hg ; 11:45
AM , P , 118 beats/min , RR , 32
breaths/min , BP , 88/58 mm Hg . The nurse
should alert the physician because these
changes are most consistent with which of
?the following complications
:Options
Cardiogenic shock . 1
Cardiac tamponade . 2
Pulmonary embolism . 3
Dissecting thoracic aortic aneurysm . 4
:Answer
. 1
:Rationale
Cardiogenic shock occurs with severe damage
(more than 40%) to the left ventricle .
Classic signs include hypotension, a rapid
pulse that becomes weaker, decreased urine
output, and cool, clammy skin. Respiratory
rate increases as the body develops
metabolic acidosis from shock. Cardiac
tamponade is accompanied by distant,
muffled heart sounds and prominent neck
vessels. Pulmonary embolism presents
suddenly with severe dyspnea accompanying

10. the chest pain. Dissecting aortic aneurysms
.usually are accompanied by back pain
:Question -14
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
:Options
Strict bed rest for 24 hours after . 1
transfer
Bathroom privileges and self-care . 2
activities
Ad lib activities because the client is . 3
monitored
Unsupervised hallway ambulation with . 4
distances under 200 feet
:Answer
. 2
:Rationale
On transfer from the coronary care unit,
the client is allowed self-care activities
and bathroom privileges. Supervised
ambulation in the hall for brief distances
is encouraged, with distances gradually
.(increased (50 , 100 , 200 feet
:Question -15
A client admitted to the hospital with
chest pain and history of type II diabetes
mellitus is scheduled for cardiac
catheterization . Which of the following
medications would need to be held for 48
?hours before and after the procedure
:Options
Regular insulin . 1
(Glipizide (Glucotrol . 2
(Repaglinide (Prandin . 3

11. (Metformin (Glucophage . 4
:Answer
. 4
:Rationale
Metformin (Glucophage) needs to be withheld
48 hours before and after cardiac
catheterization because of the injection of
contrast medium during the procedure. If
the contrast medium affects kidney
function, with metformin in the system, the
client would be at increased risk for
lactic acidosis. The medications in options
1 , 2 , and 3 do not need to be withheld 48
hours before and after cardiac
. catheterization
:Question .-16
A client is in sinus bradycardia with a
heart rate of 45 beats/min , complains of
dizziness , and has a blood pressure of
82/60 mm Hg . Which of the following should
the nurse anticipate will be prescribed ?
:Options
.Defibrillate the client . 1
.(Administer digoxin (Lanoxin . 2
.Continue to monitor the client . 3
.Prepare for transcutaneous pacing . 4
:Answer
. 4
:Rationale
Hypotension and dizziness are signs of
decreased cardiac output. Transcutaneous
pacing provides a temporary measure to
increase the heart rate and thus perfusion
in the symptomatic client. Digoxin will
further decrease the client ’s heart rate.
Defibrillation is used for treatment of
pulseless ventricular tachycardia and
ventricular fibrillation. Continuing to

12. monitor the client delays necessary
.intervention
:Question -17
A nurse notes bilateral + 2 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
:Options
Order daily weights starting on the . 1
.following morning
Review the intake and output records . 2
. for the last 2 days
Request a sodium restriction of 1 g/day . 3
. from the physician
Change the time of diuretic . 4
.administration from morning to evening
:Answer
. 2
:Rationale
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
:Question -18
A nurse is conducting a health history of a
client with a primary diagnosis of heart
failure. Which of the following disorders
reported by the client is unlikely to play
a role in exacerbating the heart failure?
:Options
Atrial fibrillation . 1
Nutritional anemia . 2
Peptic ulcer disease . 3

13. Recent upper respiratory infection . 4
:Answer
. 3
:Rationale
Heart failure is precipitated or
exacerbated by physical or emotional
stress, dysrhythmias, infections, anemia,
thyroid disorders, pregnancy, Paget ’s
disease, nutritional deficiencies
(thiamine, alcoholism), pulmonary disease,
.and hypervolemia
:Question -19
A nurse is preparing for the admission of a
client with heart failure who is being sent
directly to the hospital from the physician
’s office. The nurse would plan on having
which of the following medications readily
?available for use
:Options
(Digoxin (Lanoxin . 1
(Verapamil (Calan . 2
(Propranolol (Inderal . 3
(Diltiazem (Cardizem . 4
:Answer
. 1
:Rationale
Digoxin exerts a positive inotropic effect
on the heart while slowing the overall rate
through a variety of mechanisms. Digoxin is
the medication of choice to treat heart
failure. Diltiazem and verapamil (calcium
channel blockers) and propranolol (β-
adrenergic blocker) have a negative
inotropic effect and would worsen the
.failing heart
:Question -20
A nurse is preparing for the admission of a
client with heart failure who is being sent

14. directly to the hospital from the physician
’s office. The nurse would plan on having
which of the following medications readily
?available for use
:Options
(Digoxin (Lanoxin . 1
(Verapamil (Calan . 2
(Propranolol (Inderal . 3
(Diltiazem (Cardizem . 4
:Answer
. 1
:Rationale
Digoxin exerts a positive inotropic effect
on the heart while slowing the overall rate
through a variety of mechanisms. Digoxin is
the medication of choice to treat heart
failure. Diltiazem and verapamil (calcium
channel blockers) and propranolol (β-
adrenergic blocker) have a negative
inotropic effect and would worsen the
.failing heart
:Question -21
A client with myocardial infarction
suddenly becomes tachycardic, shows signs
of air hunger, and begins coughing frothy,
pink-tinged sputum. Which of the following
would the nurse anticipate when
?auscultating the client ’s breath sounds
:Options
Stridor . 1
Crackles . 2
Scattered rhonchi . 3
Diminished breath sounds . 4
:Answer
. 2
:Rationale
Pulmonary edema is characterized by extreme

15. breathlessness, dyspnea, air hunger, and
the production of frothy, pink-tinged
sputum. Auscultation of the lungs reveals
crackles. Rhonchi and diminished breath
sounds are not associated with pulmonary
edema. Stridor is a crowing sound
associated with laryngospasm or edema of
.the upper airway
:Question .-22
A client who has developed severe pulmonary
edema would most likely exhibit which of
?the following
:Options
Mild anxiety . 1
Slight anxiety . 2
Extreme anxiety . 3
Moderate anxiety . 4
:Answer
. 3
:Rationale
Pulmonary edema causes the client to be
extremely agitated and anxious. The client
may complain of a sense of drowning,
.suffocation, or smothering
:Question -23
A client with pulmonary edema has been on
diuretic therapy. The client has an order
for additional furosemide (Lasix) in the
amount of 40 mg intravenous push . Knowing
that the client will also be started on
digoxin (Lanoxin), the nurse should review
?which laboratory result
:Options
Sodium level . 1
Digoxin level . 2
Creatinine level . 3
Potassium level . 4
:Answer

16. . 4
:Rationale
The serum potassium level is measured in
the client receiving digoxin and
furosemide. Heightened digoxin effect
leading to digoxin toxicity can occur in
the client with hypokalemia. Hypokalemia
also predisposes the client to ventricular
.dysrhythmias
:Question -24
A client with myocardial infarction is
going into cardiogenic shock. Because of
the risk of myocardial ischemia, for which
of the following should the nurse carefully
?assess the client
:Options
Bradycardia . 1
Ventricular dysrhythmias . 2
Rising diastolic blood pressure . 3
Falling central venous pressure . 4
:Answer
. 2
:Rationale
Classic signs of cardiogenic shock as they
relate to this question include low blood
pressure and tachycardia. The central
venous pressure would rise as the backward
effects of the severe left ventricular
failure became apparent. Dysrhythmias
commonly occur as a result of decreased
oxygenation and severe damage to greater
. than 40% of the myocardium
:Question -25
A nurse assesses the sternotomy incision of
a client on the third day after cardiac
surgery. The incision shows some slight
“puffiness ”along the edges and is

17. nonreddened, with no apparent drainage.
Temperature is 99° F orally . The white
blood cell count is 7500 cells/mm 3 . How
?should the nurse interpret these findings
:Options
Incision is slightly edematous but . 1
.shows no active signs of infection
Incision shows early signs of . 2
infection, although the temperature is
.nearly normal
Incision shows early signs of . 3
infection, supported by an elevated white
blood cell count. 4 . Incision shows no
sign of infection, although the white blood
.cell count is elevated
:Answer
. 1
:Rationale
Sternotomy incision sites are assessed for
signs and symptoms of infection, such as
redness, swelling, induration , and
drainage . Elevated temperature and white
blood cell count after 3 to 4 days
.postoperatively usually indicate infection
:Question -26
A client who had cardiac surgery 24 hours
ago has a urine output averaging 20 mL/hr
for 2 hours . The client received a single
bolus of 500 mL of intravenous fluid .
Urine output for the subsequent hour was 25
mL . Daily laboratory results indicate that
the blood urea nitrogen level is 45 mg/dL
and the serum creatinine level is 2.2 mg/dL
. Based on these findings , the nurse would
anticipate that the client is at risk for
?which of the following
:Options

18. Hypovolemia . 1
Acute renal failure . 2
Glomerulonephritis . 3
Urinary tract infection . 4
:Answer
. 2
:Rationale
The client who undergoes cardiac surgery is
at risk for renal injury from poor
perfusion, hemolysis, low cardiac output,
or vasopressor medication therapy. Renal
insult is signaled by decreased urine
output and increased blood urea nitrogen
and creatinine levels. The client may need
medications to increase renal perfusion and
possibly could need peritoneal dialysis or
hemodialysis. No data in the question
indicate the presence of hypovolemia,
urinary tract infection, or
.glomerulonephritis
:Question -27
A nurse is preparing to ambulate a client
on the third day after cardiac surgery. The
nurse would plan to do which of the
following to enable the client to best
?tolerate the ambulation
:Options
.Remove telemetry equipment . 1
.Provide the client with a walker . 2
Premedicate the client with an . 3
.analgesic
Encourage the client to cough and deep . 4
.breathe
:Answer
. 3
:Rationale
The nurse should encourage regular use of

19. pain medication for the first 48 to 72
hours after cardiac surgery because
analgesia will promote rest, decrease
myocardial oxygen consumption resulting
from pain, and allow better participation
in activities such as coughing, deep
breathing, and ambulation. Options 2 and 4
will not help in tolerating ambulation .
Removal of telemetry equipment is
.contraindicated unless prescribed
:Question -28
The nurse is reviewing an electrocardiogram
rhythm strip. The P waves and QRS complexes
are regular. The PR interval is 0.16 second
, and QRS complexes measure 0.06 second .
The overall heart rate is 64 beats/min .
Which of the following would be a correct
interpretation based on these
?characteristics
:Options
Sinus bradycardia . 1
Sick sinus syndrome . 2
Normal sinus rhythm . 3
First-degree heart block . 4
:Answer
. 3
:Rationale
Normal sinus rhythm is defined as a regular
rhythm , with an overall rate of 60 to 100
beats/min . The PR and QRS measurements are
normal , measuring 0.12 to 0.20 second and
.0.04 to 0.10 second , respectively
:Question
A client ’s electrocardiogram strip shows
atrial and ventricular rates of 110
beats/min . The PR interval is 0.14
second , the QRS complex measures 0.08
second , and the PP and RR intervals are

20. regular. How should the nurse correctly
?interpret this rhythm
:Options
Sinus arrhythmia . 1
Sinus tachycardia . 2
Sinus bradycardia . 3
Normal sinus rhythm . 4
:Answer
. 2
:Rationale
Sinus tachycardia has the characteristics
of normal sinus rhythm, including a regular
PP interval and normal width PR and QRS
intervals; however, the rate is the
differentiating factor. In sinus
tachycardia, the atrial and ventricular
. rates are higher than 100 beats/min
:Question -30
A nurse notices frequent artifact on the
electrocardiographic monitor for a client
whose leads are connected by cable to a
console at the bedside. The nurse examines
the client to determine the cause. Which of
the following items is unlikely to be
?responsible for the artifact
:Options
Frequent movement of the client . 1
Tightly secured cable connections . 2
Leads applied over hairy areas . 3
Leads applied to the limbs . 4
:Answer
. 2
:Rationale
Motion artifact, or “noise, ”can be caused

21. by frequent client movement, electrode
placement on limbs, and insufficient
adhesion to the skin, such as placing
electrodes over hairy areas of the skin.
Electrode placement over bony prominences
also should be avoided. Signal interference
also can occur with electrode removal and
.cable disconnection
:Question -31
A nurse is watching the cardiac monitor and
notices that the rhythm suddenly changes.
There are no P waves , the QRS complexes
are wide , and the ventricular rate is
regular but over 100 beats/min . The nurse
determines that the client is experiencing
?which of the following dysrhythmias
:Options
Sinus tachycardia . 1
Ventricular fibrillation . 2
Ventricular tachycardia . 3
Premature ventricular contractions . 4
:Answer
. 3
:Rationale
Ventricular tachycardia is characterized by
the absence of P waves, wide QRS complexes
(longer than 0.12 second) , and typically a
rate between 140 and 180 impulses/min . The
rhythm is regular. Level of
:Question -32
?most concerned about with this dysrhythmia
:Options
It can develop into ventricular . 1
.fibrillation at any time
It is almost impossible to convert to a . 2
.normal rhythm
It is uncomfortable for the client, . 3

22. .giving a sense of impending doom
It produces a high cardiac output that . 4
quickly leads to cerebral and myocardial
:ischemia. Answer
. 1
:Rationale
Ventricular tachycardia is a life-
threatening dysrhythmia that results from
an irritable ectopic focus that takes over
as the pacemaker for the heart. The low
cardiac output that results can lead
quickly to cerebral and myocardial
ischemia. Clients frequently experience a
feeling of impending doom. Ventricular
tachycardia is treated with antidysrhythmic
medications, cardioversion (client awake),
or defibrillation (loss of consciousness).
Ventricular tachycardia can deteriorate
.into ventricular fibrillation at any time
:Question -33
A nurse is viewing the cardiac monitor in a
client ’s room and notes that the client
has just gone into ventricular tachycardia.
The client is awake and alert and has good
skin color. The nurse would prepare to do
?which of the following
:Options
.Immediately defibrillate . 1
.Prepare for pacemaker insertion . 2
Administer amiodarone (Cordarone) . 3
.intravenously
Administer epinephrine (Adrenalin) . 4
.intravenously
:Answer
. 3
:Rationale
First-line treatment of ventricular
tachycardia in a client who is

23. hemodynamically stable is the use of
antidysrhythmics such as amiodarone
(Cordarone), lidocaine (Xylocaine), and
procainamide (Pronestyl). Cardioversion
also may be needed to correct the rhythm
(cardioversion is recommended for stable
ventricular tachycardia). Defibrillation is
used with pulseless ventricular
tachycardia. Epinephrine would stimulate an
already excitable ventricle and is
.contraindicated
:Question -34
A nurse is caring for a client with
unstable ventricular tachycardia. The nurse
instructs the client to do which of the
following, if prescribed, during an episode
?of ventricular tachycardia
:Options
.Lie down flat in bed . 1
.Remove any metal jewelry . 2
.Breathe deeply, regularly, and easily . 3
Inhale deeply and cough forcefully . 4
. every 1 to 3 seconds
:Answer
. 4
:Rationale
Cough cardiopulmonary resuscitation (CPR)
sometimes is used in the client with
unstable ventricular tachycardia. The nurse
tells the client to use cough CPR, if
prescribed, by inhaling deeply and coughing
forcefully every 1 to 3 seconds . Cough CPR
may terminate the dysrhythmia or sustain
the cerebral and coronary circulation for a
short time until other measures can be
implemented . Options 1 , 2 , and 3 will
.not assist in terminating the dysrhythmia

24. :Question -35
A client has developed atrial
fibrillation , with a ventricular rate of
150 beats/min . The nurse should assess the
client for which associated signs or
?symptoms
:Options
Flat neck veins . 1
Nausea and vomiting . 2
Hypotension and dizziness . 3
Hypertension and headache . 4
:Answer
. 3
:Rationale
The client with uncontrolled atrial
fibrillation with a ventricular rate more
than 100 beats/min is at risk for low
cardiac output because of loss of atrial
kick. The nurse assesses the client for
palpitations, chest pain or discomfort,
hypotension, pulse deficit, fatigue,
weakness, dizziness, syncope, shortness of
.breath, and distended neck veins
:Question -36
A nurse is watching the cardiac monitor,
and a client ’s rhythm suddenly changes.
There are no P waves; instead, there are
fibrillatory waves before each QRS complex.
How should the nurse correctly interpret
?the client ’s heart rhythm
:Options
Atrial fibrillation . 1
Sinus tachycardia . 2
Ventricular fibrillation . 3
Ventricular tachycardia . 4
:Answer
. 1
:Rationale

25. Atrial fibrillation is characterized by a
loss of P waves and fibrillatory waves
before each QRS complex. The atria quiver,
which can lead to thrombi formation
:Question -37
A client with rapid rate atrial
fibrillation asks a nurse why the physician
is going to perform carotid sinus massage.
Which of the following would be reflective
of a correct explanation provided by the
:nurse? Options
.The vagus nerve slows the heart rate . 1
The diaphragmatic nerve slows the heart . 2
.rate
The diaphragmatic nerve overdrives the . 3
.rhythm
The vagus nerve increases the heart . 4
.rate, overdriving the rhythm
:Answer
. 1
:Rationale
Carotid sinus massage is one maneuver used
for vagal stimulation to decrease a rapid
heart rate and possibly terminate a
tachydysrhythmia. The others include
inducing the gag reflex and asking the
client to strain or bear down. Medication
therapy often is needed as an adjunct to
keep the rate down or maintain the normal
rhythm . Options 2 , 3 , and 4 are
. incorrect descriptions of this procedure
:Question -38
A nurse notes that a client with sinus
rhythm has a premature ventricular
contraction that falls on the T wave of the
preceding beat. The client ’s rhythm
suddenly changes to one with no P waves, no
definable QRS complexes, and coarse wavy

26. lines of varying amplitude. How would the
?nurse correctly interpret this rhythm
:Options
Asystole . 1
Atrial fibrillation . 2
Ventricular fibrillation . 3
Ventricular tachycardia . 4
:Answer
. 3
:Rationale
Ventricular fibrillation is characterized
by irregular chaotic undulations of varying
amplitudes. Ventricular fibrillation has no
measurable rate and no visible P waves or
QRS complexes and results from electrical
.chaos in the ventricles
:Question -39
A nurse notes that a client with sinus
rhythm has a premature ventricular
contraction that falls on the T wave of the
preceding beat. The client ’s rhythm
suddenly changes to one with no P waves, no
definable QRS complexes, and coarse wavy
lines of varying amplitude. How would the
?nurse correctly interpret this rhythm
:Options
Asystole . 1
Atrial fibrillation . 2
Ventricular fibrillation . 3
Ventricular tachycardia . 4
:Answer
. 3
:Rationale
Ventricular fibrillation is characterized
by irregular chaotic undulations of varying
amplitudes. Ventricular fibrillation has no
measurable rate and no visible P waves or
QRS complexes and results from electrical

27. .chaos in the ventricles
:Question -40
A client in ventricular fibrillation is
about to be defibrillated. A nurse knows
that to convert this rhythm effectively,
the machine should be set at which of the
following energy levels (in joules, J) for
?the first delivery
:Options
J 50 . 1
J 100 . 2
J 200 . 3
J 360 . 4
:Answer
. 3
:Rationale
The client may be defibrillated up to three
times in succession . The energy levels
used are 200 , 300 , and 360 J for the
first , second , and third attempts ,
. respectively
:Question -41
A nurse would evaluate that defibrillation
of a client was most successful if which of
?the following observations was made
:Options
Arousable , sinus rhythm , BP 116/72 mm . 1
Hg
Arousable , marked bradycardia , BP . 2
86/54 mm Hg
Nonarousable , supraventricular . 3
tachycardia , BP 122/60 mm Hg
Nonarousable , sinus rhythm , BP 88/60 . 4
mm Hg
:Answer
. 1

28. :Rationale
After defibrillation, the client requires
continuous monitoring of
electrocardiographic rhythm, hemodynamic
status, and neurological status.
Respiratory and metabolic acidosis develops
during ventricular fibrillation because of
lack of respiration and cardiac output.
These can cause cerebral and
cardiopulmonary complications. Arousable
status, adequate blood pressure, and a
sinus rhythm indicate successful response
.to defibrillation
:Question -42
A nurse is performing cardiopulmonary
resuscitation on a client who has had a
cardiac arrest. An automatic external
defibrillator is available to treat the
client. Which of the following activities
will allow the nurse to assess the client
?’s cardiac rhythm
:Options
Hold the defibrillator paddles firmly . 1
.against the chest
Apply adhesive patch electrodes to the . 2
.chest and move away from the client
Apply standard electrocardiographic . 3
monitoring leads to the client and observe
the rhythm. 4 . Connect standard
electrocardiographic electrodes to a
:transtelephonic monitoring device. Answer
. 2
:Rationale
The nurse or rescuer puts two large
adhesive patch electrodes on the client ’s
chest in the usual defibrillator positions.
The nurse stops cardiopulmonary
resuscitation and orders anyone near the

29. client to move away and not touch the
client. The defibrillator then analyzes the
rhythm, which may take up to 30 seconds .
The machine then indicates if
. defibrillation is necessary
:Question -43
A nurse employed in a cardiac unit
determines that which of the following
clients is the least likely to have
implantation of an automatic internal
?(cardioverter-defibrillator (AICD
:Options
A client with syncopal episodes related . 1
to ventricular tachycardia
A client with ventricular dysrhythmias . 2
despite medication therapy
A client with an episode of cardiac . 3
arrest related to myocardial infarction
A client with three episodes of cardiac . 4
arrest unrelated to myocardial infarction
:Answer
. 3
:Rationale
An automatic internal cardioverter-
defibrillator (AICD) detects and delivers
an electrical shock to terminate life-
threatening episodes of ventricular
tachycardia and ventricular fibrillation.
These devices are implanted in clients who
are considered high risk, including those
who have survived sudden cardiac death
unrelated to myocardial infarction, those
who are refractive to medication therapy,
and those who have syncopal episodes
.related to ventricular tachycardia
:Question
A nurse is caring for a client immediately
after insertion of a permanent demand

30. pacemaker via the right subclavian vein.
Which of the following activities will
assist with preventing dislodgement of the
?pacing catheter
:Options
Limiting movement and abduction of the . 1
left arm
Limiting movement and abduction of the . 2
right arm
Assisting the client to get out of bed . 3
and ambulate with a walker
Having the physical therapist do active . 4
range-of-motion exercises to the right arm
:Answer
. 2
:Rationale
In the first several hours after insertion
of a permanent or a temporary pacemaker,
the most common complication is pacing
electrode dislodgement. The nurse helps
prevent this complication by limiting the
client ’s activities of the arm on the side
.of the insertion site
:Question -45
A client diagnosed with thrombophlebitis 1
day ago suddenly complains of chest pain
and shortness of breath and is visibly
anxious. The nurse should immediately
assess the client for signs and symptoms of
?which of the following
:Options
Pneumonia . 1
Pulmonary edema . 2
Pulmonary embolism . 3
Myocardial infarction . 4
:Answer
. 3
:Rationale

31. Pulmonary embolism is a life-threatening
complication of deep vein thrombosis and
thrombophlebitis. Chest pain is the most
common symptom, which is sudden in onset,
and may be aggravated by breathing. Other
signs and symptoms include dyspnea, cough,
.diaphoresis, and apprehension
:Question -46
A client seeks treatment in a physician ’s
office for unsightly varicose veins, and
sclerotherapy is recommended. Before
leaving the examining room, the client says
to the nurse, “Can you tell me again how
this sclerotherapy is done? ”Which of the
following statements would reflect accurate
?teaching by the nurse
:Options
.The varicosity is surgically removed” . 1
“
The vein is tied off at the upper end” . 2
“ .to prevent stasis from occurring
The vein is tied off at the lower end” . 3
“ .to prevent stasis from occurring
An agent is injected into the vein to” . 4
damage the vein wall and close the vein
“ .off
:Answer
. 4
:Rationale
Sclerotherapy is the injection of a
sclerosing agent into a varicosity. The
agent damages the vessel and causes aseptic
thrombosis, which results in vein closure.
With no blood flow through the vessel,
there is no distention. The surgical
procedure for varicose veins is vein
ligation and stripping. This procedure
involves tying off the varicose vein and

32. large tributaries and then removing the
vein with hook and wires via multiple small
.incisions in the leg
:Question -47
A client is having a follow-up physician
office visit after vein ligation and
stripping. The client describes a sensation
of “pins and needles ”in the affected leg.
Which of the following would be an
appropriate action by the nurse based on
?evaluation of the client ’s comment
:Options
Instruct the client to apply warm . 1
.packs
.Report the complaint to the physician . 2
Reassure the client that this is only . 3
.temporary
Advise the client to take acetaminophen . 4
.(Tylenol) until it is gone
:Answer
. 2
:Rationale
Hypersensitivity or a sensation of “pins
and needles ”in the surgical limb may
indicate temporary or permanent nerve
injury following surgery. The saphenous
vein and saphenous nerve run close together
in the distal third of the leg. Because
complications from this surgery are
relatively rare, this symptom should be
.reported
:Question -48
A 24-year- old man seeks medical attention
for complaints of claudication in the arch
of the foot . A nurse also notes
superficial thrombophlebitis of the lower
leg. For which risk factor should the nurse
?assess based on these clinical findings

33. :Options
Smoking history . 1
Recent exposure to allergens . 2
History of recent insect bites . 3
Familial tendency toward peripheral . 4
vascular disease
:Answer
. 1
:Rationale
The mixture of arterial and venous
manifestations (claudication and phlebitis,
respectively) in the young male client
suggests thromboangiitis obliterans
(Buerger ’s disease). This disorder is
characterized by inflammation and
thrombosis of smaller arteries and veins.
It typically is found in young adult males
who smoke. The cause is not known precisely
but is suspected to have an autoimmune
component
:Question -49
A nurse has given instructions to the
client with Raynaud ’s disease about self-
management of the disease process. The
nurse determines that the client needs
further reinforcement of teaching if the
?client states which of the following
:Options
“ .Smoking cessation is important” . 1
.Moving to a warmer climate is needed” . 2
“
Sources of caffeine should be” . 3
“ .eliminated from the diet
Taking nifedipine (Procardia) as” . 4
“ .prescribed will decrease vessel spasm
:Answer
. 2
:Rationale

34. Raynaud ’s disease responds favorably to
eliminating caffeine from the diet and
cessation of smoking. Medications may
inhibit vessel spasm and prevent symptoms.
Avoiding exposure to cold through a variety
of means is important. However, moving to a
warmer climate may not necessarily be
beneficial because the symptoms still could
occur with the use of air conditioning and
during periods of cooler
weather