Adult Health- Cardiovascular

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?
1. Regular insulin
2. Glipizide (Glucotrol)
3. Repaglinide (Prandin)
4. Metformin (Glucophage)

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/minute. Which would be a correct interpretation based on these characteristics?
1. Sinus bradycardia
2. Sick sinus syndrome
3. Normal sinus rhythm
4. First-degree heart block

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse?
1. Call a code.
2. Call the health care provider.
3. Check the client's status and lead placement.
4. Press the recorder button on the electrocardiogram console.

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item?
1. Sensation of palpitations
2. Causative factors, such as caffeine
3. Precipitating factors, such as infection
4. Blood pressure and oxygen saturation

The nurse is evaluating a client's response to cardioversion. Which observation would be of highest priority to the nurse?
1. Blood pressure
2. Status of airway
3. Oxygen flow rate
4. Level of consciousness

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse immediately would assess which item based on priority?
1. Anxiety level of the client and family
2. Presence of a Medic-Alert card for the client to carry
3. Knowledge of restrictions of postdischarge physical activity
4. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?
1. Sinus dysrhythmia
2. Sinus tachycardia
3. Sinus bradycardia
4. Normal sinus rhythm

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status?
1. The neurovascular status is normal because of increased blood flow through the leg.
2. The neurovascular status is moderately impaired, and the surgeon should be called.
3. The neurovascular status is slightly deteriorating and should be monitored for another hour.
4. The neurovascular status is adequate from an arterial approach, but venous complications are arising.

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was unsuccessful?
1. Rising blood pressure
2. Clearly audible heart sounds
3. Client expressions of relief
4. Rising central venous pressure

A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain?
1. Stable angina
2. Variant angina
3. Unstable angina
4. Nonanginal pain

The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication?
1. Flat neck veins
2. A pulse rate of 60 beats/min
3. Muffled or distant heart sounds
4. Wheezing on auscultation of the lungs

The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction?
1. "I need to be sure not to go barefoot around the house."
2. "If I cut my toenails, I need to be sure that I cut them straight across."
3. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes."
4. "I need to be sure that I elevate my leg above my heart level for at least an hour every day."

The nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be avoided. The nurse instructs the client to avoid consuming which item?
1. Bananas
2. Broccoli
3. Antacids
4. Cantaloupe

The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client?
1. Use nail polish to protect the nail beds from injury.
2. Stop smoking because it causes cutaneous vasospasm.
3. Wear gloves for all activities involving use of both hands.
4. Always wear warm clothing even in warm climates to prevent vasoconstriction.

The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention?
1. Keep the legs aligned with the heart.
2. Elevate the legs higher than the heart.
3. Clean the skin with alcohol every hour.
4. Position the client onto the side every shift.

The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit. The nurse notes that a cardiac troponin T level assay was performed while the client was in the intensive care unit. The nurse determines that this test was performed to assist in diagnosing which condition?
1. Heart failure
2. Atrial fibrillation
3. Myocardial infarction
4. Ventricular tachycardia

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/min. The nurse should next assess the client for which finding?
1. Hypotension
2. Flat neck veins
3. Complaints of nausea
4. Complaints of headache

The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function?
1. Listening to lung sounds
2. Monitoring for organomegaly
3. Assessing for jugular vein distention
4. Assessing for peripheral and sacral edema

The nurse is reviewing the electrocardiogram (ECG) rhythm strip obtained on a client with a diagnosis of myocardial infarction. The nurse notes that the PR interval is 0.20 second. The nurse should make which interpretation about this finding?
1. A normal finding
2. Indicative of atrial flutter
3. Indicative of atrial fibrillation
4. Indicative of impending reinfarction

The nurse in the medical unit is assigned to provide discharge teaching to a client with a diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to minimize the effects of the disease process. The client continually changes the subject during the teaching session. The nurse interprets that this client's behavior is most likely related to which problem?
1. Anxiety related to the need to make lifestyle changes
2. Boredom resulting from having already learned the material
3. An attempt to ignore or deny the need to make lifestyle changes
4. Lack of understanding of the material provided at the teaching session and embarrassment about asking questions

The nurse in the medical unit is assigned to provide discharge teaching to a client with a diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to minimize the effects of the disease process. The client continually changes the subject during the teaching session. The nurse interprets that this client's behavior is most likely related to which problem?
1. Anxiety related to the need to make lifestyle changes
2. Boredom resulting from having already learned the material
3. An attempt to ignore or deny the need to make lifestyle changes
4. Lack of understanding of the material provided at the teaching session and embarrassment about asking questions

The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider will most likely prescribe which option?
1. Maintain bed rest.
2. Maintain the affected leg in a dependent position.
3. Administer an opioid analgesic every 4 hours around the clock.
4. Apply cool packs to the affected leg for 20 minutes every 4 hours.

A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and asks the nurse to describe the procedure. Which response should the nurse make?
1. "It involves tying off the veins so that circulation is redirected in another area."
2. "It involves surgically removing the varicosity, so anesthesia will be required."
3. "It involves tying off the veins to prevent sluggishness of blood from occurring."
4. "It involves injecting an agent into the vein to damage the vein wall and close it off."

A female client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure was performed, she has been experiencing a sensation as though the affected leg is falling asleep. The nurse should make which response to the client?
1. "Apply warm packs to the leg."
2. "Keep the leg elevated as much as possible."
3. "Contact your health care provider right away to report this problem."
4. "This normally occurs after surgery and will subside when the edema goes down."

The nurse is caring for a client who has been hospitalized with a diagnosis of angina pectoris. The client is receiving oxygen via nasal cannula at 2 L/min. The client asks why the oxygen is necessary. The nurse should provide which information to the client?
1. Oxygen has a calming effect.
2. Oxygen will prevent the development of any thrombus.
3. Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle.
4. The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.

A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions?
1. "I need to cut down on cigarette smoking."
2. "I am so relieved that my heart is repaired."
3. "I need to adhere to my dietary restrictions."
4. "I am so relieved that I can eat anything I want to now."

The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage should the nurse instruct the client to select from the menu?
1. Tea
2. Cola
3. Coffee
4. Raspberry juice

The nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse should immediately ask the client which question?
1. "Where is the pain located?"
2. "Are you having any nausea?"
3. "Are you allergic to any medications?"
4. "Do you have your nitroglycerin with you?"

The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions?
1. "I'll need to become a strict vegetarian."
2. "I should use polyunsaturated oils in my diet."
3. "I need to substitute eggs and whole milk for meat."
4. "I should eliminate all cholesterol and fat from my diet."

A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client about the dietary restrictions required with HF. Which statement by the client indicates that further teaching is needed?
1. "I'm not supposed to eat cold cuts."
2. "I can have most fresh fruits and vegetables."
3. "I'm going to weigh myself daily to be sure I don't gain too much fluid."
4. "I'm going to have a ham and cheese sandwich and potato chips for lunch."

The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL, and fasting blood glucose level of 184 mg/dL. The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)?
1. Age
2. Hypertension
3. Hyperlipidemia
4. Glucose intolerance

The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge?
1. "I need to start exercising more to improve my health."
2. "I will be sure to keep my appointment with the cardiologist."
3. "I don't have anyone to help me with doing heavy housework at home."
4. "I think I have a good understanding of what all my medications are for."

The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided?
1. "I will eat enough daily fiber to prevent straining at stool."
2. "I will try to exercise vigorously to strengthen my heart muscle."
3. "I will drink 3000 to 3500 mL of fluid daily to promote good kidney function."
4. "Drinking 2 to 3 oz of liquor each night will promote blood flow by enlarging blood vessels."

A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem?
1. Ambulates 10 feet farther each day
2. Verbalizes the benefits of increasing activity
3. Chooses a healthy diet that meets caloric needs
4. Sleeps without awakening throughout the night

The health care provider has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure?
1. Questions the client about allergies to iodine or shellfish
2. Has the client sign an informed consent form for an invasive procedure
3. Tells the client that the procedure is painless and takes 30 to 60 minutes
4. Keeps the client on nothing-by-mouth (NPO) status for 2 hours before the procedure

A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure?
1. Eat breakfast just before the procedure.
2. Wear firm, rigid shoes, such as workboots.
3. Wear loose clothing with a shirt that buttons in front.
4. Avoid cigarettes for 30 minutes before the procedure.

A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure?
1. Chest pain
2. Urge to cough
3. Warm, flushed feeling
4. Pressure at the insertion site

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge?
1. Sleep with the head of bed flat.
2. Weigh himself or herself on a daily basis.
3. Take a double dose of the diuretic if peripheral edema is noted.
4. Withhold prescribed digoxin (Lanoxin) if slight respiratory distress occurs.

A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions?
1. "It will really hurt when the catheter is first put in."
2. "I will receive general anesthesia for the procedure."
3. "I will have to go to the operating room for this procedure."
4. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours."

A client admitted to the hospital with coronary artery disease complains of dyspnea at rest. The nurse caring for the client uses which item as the best means to monitor respiratory status on an ongoing basis?
1. Apnea monitor
2. Oxygen flowmeter
3. Telemetry cardiac monitor
4. Oxygen saturation monitor

A client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. What type of angina should the nurse determine that the client is experiencing?
1. Stable
2. Variant
3. Unstable
4. Intractable

A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block?
1. Presence of Q waves
2. Tall, peaked T waves
3. Prolonged PR interval
4. Widened QRS complex

The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary to control disease progression. Which statement by the client indicates a need for further teaching?
1. "I will avoid using table salt with meals."
2. "It is best to exercise once a week for 1 hour."
3. "I will take nitroglycerin whenever chest discomfort begins."
4. "I will use muscle relaxation to cope with stressful situations."

The ambulatory care nurse is working with a client who has been diagnosed with Prinzmetal's (variant) angina. What should the nurse plan to teach the client about this type of angina?
1. It is most effectively managed by β-blocking agents.
2. It has the same risk factors as stable and unstable angina.
3. It can be controlled with a low-sodium, high-potassium diet.
4. Generally it is treated with calcium-channel–blocking agents

The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding?
1. The client is not experiencing dyspnea.
2. The client is not experiencing nausea or vomiting.
3. The pain has not been relieved by rest and nitroglycerin tablets.
4. The client says the pain began while she was trying to open a stuck dresser drawer.

A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer?
1. Ad lib activities as tolerated
2. Strict bed rest for 24 hours after transfer
3. Bathroom privileges and self-care activities
4. Unsupervised hallway ambulation for distances up to 200 feet

A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as the most likely indicator that the client is experiencing complications of this therapy?
1. Tarry stools
2. Nausea and vomiting
3. Orange-colored urine
4. Decreased urine output

The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking?
1. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer."
2. "Because most of the damage has already been done, it will be all right to cut down a little at a time."
3. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year."
4. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."

A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted?
1. Rhonchi
2. Wheezes
3. Crackles in the bases
4. Crackles throughout the lung fields

A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms?
1. Left atrium
2. Right atrium
3. Left ventricle
4. Right ventricle

A client has experienced a myocardial infarction. The nurse plans care for the client, knowing that the person's chest pain is caused by tissue hypoxia in which layer of the heart?
1. Myocardium
2. Endocardium
3. Parietal pericardium
4. Visceral pericardium

A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures?
1. Left ventricle to aorta
2. Left atrium to left ventricle
3. Right atrium to right ventricle
4. Right ventricle to pulmonary artery

A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures?
1. Left ventricle to aorta
2. Left atrium to left ventricle
3. Right atrium to right ventricle
4. Right ventricle to pulmonary artery

A hospitalized client is experiencing a decrease in blood pressure. The nurse plans care for the client, knowing that this change will have which primary effect on his or her heart?
1. Decreased heart rate
2. Increased contractility
3. Decreased myocardial blood flow
4. Increased resistance to electrical stimulation

A hospitalized client's serum calcium level is 7.9 mg/dL. The nurse is immediately concerned and takes action, knowing that this level could ultimately lead to which complication?
1. Stroke
2. Cardiac arrest
3. High blood pressure
4. Urinary stone formation

A nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site?
1. Bundle of His
2. Purkinje fibers
3. Sinoatrial (SA) node
4. Atrioventricular (AV) node

A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which response by the student indicates a need for further research on the anatomy and physiology of the heart?
1. "The coronary arteries branch from the aorta."
2. "The coronary arteries supply the heart muscle with blood."
3. "The left coronary artery provides blood for the left atrium and the left ventricle."
4. "The left coronary artery supplies the right atrium and right ventricle with blood."

A nurse is assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. The nurse plans care with the understanding that the heart normally sends out how many liters of blood per minute to the body?
1. 2 L/min
2. 5 L/min
3. 10 L/min
4. 15 L/min

A nurse is caring for a client who has lost a significant amount of blood as a result of complications of a surgical procedure. The nurse understands that which client assessment will provide the earliest indication of new decreases in fluid volume?
1. Pulse rate
2. Blood pressure (BP)
3. Assessment for edema
4. Lung auscultation for crackles

A client who has been exercising in a gymnasium stops to measure his pulse and places his fingers over both carotid arteries simultaneously. A nurse exercising nearby is correct when the nurse cautions him to check the pulse on only one side, primarily for which reason?
1. It is unnecessary to use both hands.
2. The client could occlude the trachea.
3. The heart rate and blood pressure could drop.
4. Feeling dual pulsations may lead to an incorrect measurement.

A nursing student who is researching a medication at the nursing station asks the registered nurse (RN) what an α1-adrenergic receptor is. The RN responds by telling the student that these receptors are found primarily in which peripheral vascular structures and produce which actions?
1. The peripheral arteries and veins, and when stimulated cause vasoconstriction
2. Arterial and bronchial walls, and when stimulated cause vasodilation and bronchodilation
3. The heart, and when stimulated cause an increase in heart rate, atrioventricular (AV) node conduction, and contractility
4. Several tissues, and when stimulated cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation

A nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin (Lanoxin) notes that the heart rate is 52 beats/min. The nurse should make which interpretation about this information?
1. Normal, because of the client's age
2. Abnormal, requiring further assessment
3. Normal, as a result of the effects of digoxin
4. Normal, because this is the reason the client is receiving digoxin

A client who is beginning an exercise program asks the nurse why his heart "feels like it's pounding" when he is exercising vigorously. In formulating a response, the nurse understands that this effect occurs because of the client's primary need for which increased cardiac response?
1. Pulse rate
2. Cardiac index
3. Cardiac output
4. Stroke volume

A nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The health care provider (HCP) tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse determines that the HCP is referring to which arteries?
1. Circumflex coronary artery
2. Right coronary artery (RCA)
3. Posterior descending coronary artery (PDA)
4. Left anterior descending coronary artery (LAD)

A nurse is assigned to the care of a client hospitalized with a diagnosis of hypothermia. The nurse anticipates that the client will exhibit which findings on assessment of vital signs?
1. Increased heart rate and increased blood pressure
2. Increased heart rate and decreased blood pressure
3. Decreased heart rate and increased blood pressure
4. Decreased heart rate and decreased blood pressure

A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse's response incorporates the information that bearing down or straining would trigger which physical response?
1. Vagus nerve stimulation, causing a decrease in heart rate and cardiac contractility
2. Vagus nerve stimulation, causing an increase in heart rate and cardiac contractility
3. Sympathetic nerve stimulation, causing an increase in heart rate and cardiac contractility
4. Sympathetic nerve stimulation, causing a decrease in heart rate and cardiac contractility

A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement?
1. "The work of breathing is increased when the client is anemic."
2. "Blood flows more slowly when the hemoglobin or hematocrit is low."
3. "The body has to work harder to fight infection in the presence of anemia."
4. "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? 
1. Chloride level of 98 mEq/L
2. Sodium level of 135 mEq/L
3. Potassium level of 6.8 mEq/L
4. Magnesium level of 1.6 mEq/L

A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise?
1. Oxygen saturation decreased from 96% to 91%.
2. Pulse rate increased from 80 to 104 beats per minute.
3. Blood pressure decreased from 140/86 to 112/72 mm Hg.
4. Respiratory rate increased from 16 to 19 breaths per minute.

A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction?
1. Take antibiotics until the chest pain is fully resolved.
2. Take acetaminophen (Tylenol) if the chest pain worsens.
3. Use a firm-bristle toothbrush and floss vigorously to prevent cavities.
4. Notify all health care providers (HCP) of the history of infective endocarditis before any invasive procedures.

The nurse is concerned about the adequacy of peripheral tissue perfusion in the post–cardiac surgery client. Which action should the nurse include within the plan of care for this client?
1. Use the knee-gatch on the bed.
2. Cover the legs lightly when sitting in a chair.
3. Encourage the client to cross legs when sitting in a chair.
4. Provide pillows for the client to place under the knees as desired.

The nurse is instructing the post–cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse should include which item in the instructions?
1. Driving is permitted so long as the lap and shoulder seat belts are worn.
2. Lifting should be restricted to objects that do not weigh more than 25 pounds.
3. Use the arms for balance, not weight support, when getting out of bed or a chair.
4. Activities that involve straining may be resumed so long as they do not cause pain.

The nurse is assessing an electrocardiogram (ECG) rhythm strip for a client. The P waves and QRS complexes are regular. The PR interval is 0.14 second, and the QRS complexes measure 0.08 second. The overall heart rate is 82 beats/min. The nurse interprets the cardiac rhythm to be which rhythm?
1. Sinus bradycardia
2. Sick sinus syndrome
3. Normal sinus rhythm
4. First-degree heart block

A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse interpret this rhythm?
1. Sinus tachycardia
2. Sinus dysrhythmia
3. Sinus bradycardia
4. Normal sinus rhythm

The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm?
1. Sinus tachycardia
2. Ventricular fibrillation
3. Ventricular tachycardia
4. Premature ventricular contractions (PVCs)

A client with myocardial infarction is experiencing new, multiform premature ventricular contractions (PVCs). Knowing that the client is allergic to lidocaine hydrochloride, the nurse plans to have which medication available for immediate use?
1. Procainamide
2. Digoxin (Lanoxin)
3. Verapamil (Calan SR)
4. Metoprolol (Lopressor)

A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding?
1. Occur in pairs
2. Appear to be multifocal
3. Fall on the second half of the T wave
4. Decrease to a frequency of less than 6 per minute

The nurse is assessing the client's condition after cardioversion. Which observation should be of highest priority to the nurse?
1. Blood pressure
2. Status of airway
3. Oxygen flow rate
4. Level of consciousness

The home health nurse makes a home visit to a client who has an implantable cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary?
1. "If I feel an internal defibrillator shock, I should sit down."
2. "I won't be able to have a magnetic resonance imaging test (MRI)."
3. "My wife knows how to call the emergency medical services (EMS) if I need it."
4. "I can stop taking my antidysrhythmic medicine now because I have a pacemaker."

A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point?
1. Before each P wave
2. Just after each P wave
3. Just after each T wave
4. Before each QRS complex

A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding?
1. Bilateral edema
2. Increased calf circumference
3. Diminished distal peripheral pulses
4. Coolness and pallor of the affected limb

The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's prescriptions?Select all that apply.
1. Elevation of the right leg
2. Ambulation in the hall every 4 hours
3. Application of moist heat to the right leg
4. Administration of acetaminophen (Tylenol)
5. Monitoring for signs of pulmonary embolism

A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team?
1. Dietitian
2. Medical social worker
3. Pain management clinic
4. Smoking-cessation program

The home health nurse is visiting a client who has had a prosthetic valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this surgery?
1. "I need to count my pulse every day."
2. "I have to do deep breathing exercises every 2 hours."  
3. "I threw away my straight razor and bought an electric razor."
4. "I have to go to the bathroom frequently because of my medication."

The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply.
1. Soak the feet in hot water daily.
2. Be careful not to injure the legs or feet.
3. Use a heating pad on the legs to aid vasodilation.
4. Walk each day to increase circulation to the legs.
5. Cut down on the amount of fats consumed in the diet.

The home health nurse visits a client recovering from cardiogenic shock secondary to an anterior myocardial infarction and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures?
1. "I exercise every day after breakfast."
2. "I've gained 8 pounds since discharge."
3. "I take an antacid when I experience epigastric pain."
4. "I have planned periods of rest at 10:00 am and 3:00 pm daily."

A client who had coronary artery bypass surgery states to the home health nurse: "get so frustrated. I can't even do my gardening." The nurse then assesses the client for activity level since the surgery. Which client statement indicates a need for further teaching?
1. "I pace my activities throughout the day."
2. "I plan regular rest periods during the day."
3. "I avoid outdoor physical activity during the heat of the day."
4. "I try to walk immediately after lunch, after I've finished my morning housecleaning."

The nurse notes that a client's cardiac rhythm shows absent P waves and no PR interval. How should the nurse interpret this rhythm?
1. Bradycardia
2. Tachycardia
3. Atrial fibrillation
4. Normal sinus rhythm (NSR)

The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving intravenous doses of furosemide (Lasix). The client is attached to cardiac telemetry, and the nurse is monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has changed to this pattern. The nurse determines that the most likely cause of this cardiac rhythm in the client is which problem?

1. Pacemaker dysfunction
2. The presence of hypokalemia
3. The effectiveness of the furosemide
4. An impending myocardial infarction (MI)

A client is attached to a cardiac monitor, and the nurse notes the presence of this cardiac rhythm on the monitor. The nurse quickly assesses the client, knowing that this rhythm is indicative of which rhythm?

1. Atrial fibrillation
2. Ventricular fibrillation (VF)
3. Ventricular tachycardia (VT)
4. Premature ventricular complexes

A nurse is assessing a client's legs for the presence of edema. The nurse notes that the client has mild pitting with slight indentation and no perceptible swelling of the leg. How should the nurse define and document this finding?
1. 1+ edema
2. 2+ edema
3. 3+ edema
4. 4+ edema

The postmyocardial infarction client is scheduled for a technetium 99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure?
1. A Foley catheter
2. Signed informed consent
3. A central venous pressure (CVP) line
4. Notation of allergies to iodine or shellfish

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety?
1. Assessing pain
2. Administering vasodilators
3. Avoiding over-the-counter medications
4. Moving slowly from a sitting to a standing position

A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. Which nursing action should be included in the client's plan of care?
1. Limiting oral and intravenous fluids
2. Measuring the client's pulse each shift
3. Providing the client with short, frequent walks
4. Eliminating sources of caffeine from meal trays

The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription?
1. 50 to 100 joules
2. 150 to 300 joules
3. 300 to 350 joules
4. 350 to 400 joules

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment?
1. Flat neck veins
2. Nausea and vomiting
3. Hypotension and dizziness
4. Clubbed fingertips and headache

The nurse has provided self-care activity instructions to a client after insertion of an automatic internal cardioverter-defibrillator (AICD). The nurse determines that further instruction is needed if the client makes which statement?
1. "I can perform activities such as swimming, driving, or operating heavy equipment as I need to."
2. "I need to avoid doing anything that could involve rough contact with the AICD insertion site."
3. "I should try to avoid doing strenuous things that would make my heart rate go up to or above the rate cutoff on the AICD."
4. "I should keep away from electromagnetic sources such as transformers, large electrical generators, metal detectors, and I shouldn't lean over running motors."

A client with a history of hypertension has been prescribed triamterene (Dyrenium). The nurse determines that the client understands the effect of this medication on the diet if the client states to avoid which fruit?
1. Apples
2. Pears
3. Bananas
4. Cranberries

A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems?
1. Anterior chest pain
2. Pericardial friction rub
3. Weakness and irritability
4. Chest pain that worsens on inspiration

Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse most anticipate in this client if PVCs are occurring?
1. A P wave preceding every QRS complex
2. QRS complexes that are short and narrow
3. Inverted P waves before the QRS complexes
4. Premature beats followed by a compensatory pause

The nurse is developing a plan of care for a client with pulmonary edema. The nurse establishes a goal to have the client participate in activities that reduce cardiac workload. The nurse should identify which client action as contributing to this goal?
1. Using a bedside commode
2. Sleeping in the supine position
3. Elevating the legs when in bed
4. Using seasonings to improve the taste of food

The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease?
1. Checking for a rash on the digits
2. Observing for softening of the nails or nail beds 
3. Palpating for a rapid or irregular peripheral pulse
4. Palpating for diminished or absent peripheral pulses

The health care provider prescribes bedrest for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply.
1. Place in Fowler's position for eating.
2. Encourage coughing with deep breathing.
3. Encourage increased oral intake of water daily.
4. Place thigh-length elastic stockings on the client.
5. Place sequential compression boots on the client.
6. Encourage the intake of dark green, leafy vegetables.

Spironolactone (Aldactone) is prescribed for a client with heart failure. In providing dietary instructions to the client, the nurse identifies the need to avoid foods that are high in which electrolyte?
1. Calcium
2. Potassium
3. Magnesium
4. Phosphorus

A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value came back elevated?
1. Myoglobin
2. Cardiac troponin
3. C-reactive protein
4. Creatine kinase (CK)

The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do?
1. Walk for as long as possible each day.
2. Cross the legs at the ankle only, not at the knee.
3. Lie down with the legs elevated and avoid sitting.
4. Sit in a chair 3 times a day for 3 hours at a time.

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 question should best help a nurse discriminate pain caused by a noncardiac problem?
1. "Can you describe the pain to me?"
2. "Have you ever had this pain before?"
3. "Does the pain get worse when you breathe in?"
4. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"

A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. The nurse should plan to allow for which client activity?
1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Ad lib activities because the client is monitored
4. Unsupervised hallway ambulation with distances under 200 feet

A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? Select all that apply.
1. Emotional stress
2. Atrial fibrillation
3. Nutritional anemia
4. Peptic ulcer disease
5. Recent upper respiratory infection

The nurse should recognize that a client who has developed severe pulmonary edema would most likely exhibit which symptom?
1. Mild anxiety
2. Slight anxiety 
3. Extreme anxiety
4. Moderate anxiety

A client with pulmonary edema has been receiving diuretic therapy. The client has a prescription for additional furosemide (Lasix) in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin (Lanoxin), which laboratory result should the nurse review as the priority?
1. Sodium level
2. Digoxin level
3. Creatinine level
4. Potassium level

A nurse is caring for a client with unstable ventricular tachycardia. The nurse should instruct the client to take which action, if prescribed, during an episode of ventricular tachycardia?
1. Lie down flat in bed.
2. Remove any metal jewelry.
3. Breathe deeply, regularly, and easily.
4. Inhale deeply and cough forcefully every 1 to 3 seconds.

A nurse employed in a cardiac unit determines that which client is the least likely to have implantation of an automatic internal cardioverter-defibrillator (AICD)?
1. A client with syncopal episodes related to ventricular tachycardia
2. A client with ventricular dysrhythmias despite medication therapy
3. A client with an episode of cardiac arrest related to myocardial infarction
4. A client with three episodes of cardiac arrest unrelated to myocardial infarction

A nurse is caring for a client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. Which activity will assist with preventing dislodgement of the pacing catheter?
1. Limiting both movement and abduction of the left arm
2. Limiting both movement and abduction of the right arm
3. Assisting the client to get out of bed and ambulate with a walker
4. Having the physical therapist do active range-of-motion exercises to the right arm

A client seeks treatment in a health care provider'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 statement would reflect accurate teaching by the nurse?
1. "The varicosity is surgically removed."
2. "The vein is tied off at the upper end to prevent stasis from occurring."
3. "The vein is tied off at the lower end to prevent stasis from occurring."
4. "An agent is injected into the vein to damage the vein wall and close the vein off."

A client is having a follow-up health care provider (HCP) office visit after vein ligation and stripping. The client describes a sensation of "pins and needles" in the affected leg. Which would be an appropriate action by the nurse based on evaluation of the client's comment?
1. Report the complaint to the HCP.
2. Instruct the client to apply warm packs.
3. Reassure the client that this is only temporary.
4. Advise the client to take acetaminophen (Tylenol) until it is gone.

A client is scheduled for a cardiac catheterization using a radiopaque dye. Which assessments are most critical before the procedure?
1. Intake and output
2. Height and weight
3. Allergy to iodine or shellfish
4. Baseline peripheral pulse rates

A nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is most likely unrelated to the aneurysm?
1. Pulsatile abdominal mass
2. Hyperactive bowel sounds in the area
3. Systolic bruit over the area of the mass
4. Subjective sensation of "heart beating" in the abdomen

A nurse is providing postoperative care for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should be most concerned about monitoring for which potential complications?
1. Bleeding and infection
2. Thrombosis and infection
3. Bleeding and wound dehiscence
4. Wound dehiscence and evisceration

A client with angina has a 12-lead electrocardiogram taken during an episode of chest pain. The nurse should examine the tracing for which electrocardiographic (ECG) change caused by myocardial ischemia?
1. Tall, peaked T waves
2. Prolonged PR interval
3. Widened QRS complex
4. ST segment elevation or depression

A nurse is preparing to ambulate a client on the third day after cardiac surgery. What should the nurse plan to do to enable the client to best tolerate the ambulation?
1. Remove telemetry equipment.
2. Provide the client with a walker.
3. Premedicate the client with an analgesic.
4. Encourage the client to cough and breathe deeply.

A client with rapid-rate atrial fibrillation asks a nurse why the health care provider is going to perform carotid sinus massage. Which is a correct explanation?
1. The vagus nerve slows the heart rate.
2. The diaphragmatic nerve slows the heart rate.
3. The diaphragmatic nerve overdrives the rhythm.
4. The vagus nerve increases the heart rate, overdriving the rhythm.

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 non-reddened, with no apparent drainage. The client's temperature is 99° F orally. The white blood cell count is 7500 cells/mm³. How should the nurse interpret these findings?
1. Incision is slightly edematous but shows no active signs of infection.
2. Incision shows early signs of infection, although the temperature is nearly normal.
3. Incision shows no sign of infection, although the white blood cell count is elevated.
4. Incision shows early signs of infection, supported by an elevated white blood cell count.

A nurse notes bilateral 2+ edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. Based on this observation, what should the nurse plan to do next?
1. Review intake and output records for the last 2 days.
2. Prescribe daily weights starting on the following morning.
3. Request a sodium restriction of 1 g/day from the health care provider.
4. Change the time of diuretic administration from morning to evening.

The nurse is teaching adult cardiopulmonary resuscitation (CPR) guidelines to a group of laypeople. The nurse tells the group that how many chest compressions should be delivered with every two rescue breaths?
1. 10
2. 15
3. 20
4. 30

The nurse is evaluating a client's cardiac rhythm strip to determine if there is proper function of the VVI mode pacemaker. Which denotes proper functioning?
1. Spikes precede all P waves and QRS complexes.
2. There are consistent spikes before each P wave.
3. Spikes occur before QRS complexes when intrinsic ventricular beats do not occur.
4. Spikes occur before all QRS complexes regardless of intrinsic ventricular activity.

The nurse determines that a client requires further teaching after permanent pacemaker insertion if which statement is made?
1. "My pulse rate should be less than what my pacemaker is set at."
2. "I'll need to call my health care provider if I feel tired or dizzy."
3. "I'll have to avoid carrying the grocery bags into the house for the next 6 weeks."
4. "It's safe to use my microwave as long it is properly grounded and well shielded."

Which locations is the correct position for the V₁ lead when performing a 12-lead electrocardiogram?
1. Fourth intercostal space left sternal border
2. Fourth intercostal space right sternal border
3. Fifth intercostal space left midaxillary line
4. Fifth intercostal space left midclavicular line

After instruction on the application of antiembolism stockings, the nurse determines that the client requires further teaching if which of these actions is performed?
1. The client puts on the stockings before getting out of bed.
2. The client bunches up the stockings for easier application.
3. The client ensures that stockings are pulled all the way up.
4. The client makes sure the rough seams of the stockings are on the outside.

During assessment of a client newly diagnosed with hypertension, the nurse recognizes that which is a common occurrence?
1. Be asymptomatic
2. Be short of breath
3. Have visual disturbances
4. Have frequent nosebleeds

The nurse monitors the client for which condition as a complication of polycythemia vera?
1. Thrombosis
2. Hypotension
3. Cardiomyopathy
4. Pulmonary edema

A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action?
1. Check the blood pressure.
2. Call the health care provider.
3. Check the client and the chest leads.
4. Initiate cardiopulmonary resuscitation (CPR).

Which is the priority assessment in the care of a client who is newly admitted to the hospital for acute arterial insufficiency of the left leg and moderate chronic arterial insufficiency of the right leg?
1. Monitor oxygen saturation with pulse oximetry.
2. Assess activity tolerance before and after exercise.
3. Observe the client's cardiac rhythm with telemetry.
4. Assess peripheral pulses with an ultrasonic Doppler device.

A client's electrocardiogram shows that the atrial and ventricular rhythms are irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition?
1. Atrial flutter
2. Atrial fibrillation
3. Third-degree AV block
4. First-degree atrioventricular (AV) block

The nurse is preparing to care for a client who will be arriving from the recovery room after an above-the-knee amputation. The nurse ensures that which is in the client's hospital room as a priority item?
1. Over-bed trapeze
2. Dry sterile dressings
3. Surgical tourniquet
4. Incentive spirometer

A nurse is caring for a postoperative client who has lost a significant amount of blood because of complications during a surgical procedure. Which assessment finding would be indicative of further fluid volume deficit?
1. +4 Edema noted in lower extremities
2. Crackles auscultated from lung bases to apices
3. Blood pressure rises from 116/68 to 118/74 mm Hg
4. Pulse rate increases from 100 beats/min to 136 beats/min

A nurse reading the operative record of a client who had cardiac surgery notes that the client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac output results leads the nurse to make which conclusion?
1. The cardiac output is above the normal range.
2. The cardiac output is below the normal range.
3. The cardiac output is in the low-normal range.
4. The cardiac output is in the high-normal range.

A nurse is auscultating a 56 year old adult client's apical heart rate before giving digoxin (Lanoxin) and notes that the heart rate is 48 beats/minute. Which action should the nurse take?
1. Withhold the digoxin, and reevaluate the heart rate in 4 hours.
2. Administer half the prescribed dose to avoid a further decrease in heart rate.
3. Withhold the digoxin; assess for signs of decreased cardiac output and digoxin toxicity.
4. Administer the digoxin. The heart rate would be considered normal because of the client's age.

A nurse is assisting in admitting a client who has a diagnosis of hypothermia. The nurse anticipates that this client will exhibit which vital signs?
1. Increased heart rate and increased blood pressure
2. Increased heart rate and decreased blood pressure
3. Decreased heart rate and increased blood pressure
4. Decreased heart rate and decreased blood pressure

A client has been admitted with left-sided heart failure. When planning care for the client, interventions should be focused on reduction of which specific problem associated with this type of heart failure?
1. Ascites
2. Pedal edema
3. Bilateral lung crackles
4. Jugular vein distention

A client with angina complains that the anginal pain is prolonged, severe, and occurs at the same time each day, most often in the morning. On further assessment, the nurse notes that the pain occurs in the absence of precipitating factors. How would the nurse best describe this type of anginal pain?
1. Stable angina
2. Variant angina
3. Unstable angina
4. Nonanginal pain

A client's total cholesterol level is 344 mg/dL, low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL, and high-density lipoprotein cholesterol (HDL-C) level is 30 mg/dL. Based on analysis of the data, how should the nurse direct client teaching?
1. The client should maintain the current dietary regimen but increase activity level.
2. Results are inconclusive unless the triglyceride level is also screened, so teaching is not indicated at this time.
3. The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught.
4. The client is at low risk for cardiovascular disease, so the client should be encouraged to continue to follow the current regimen.

An ambulatory care nurse measures the blood pressure of a client and finds it to be 156/94 mm Hg. Which statement indicates the client needs additional education?
1. "It is important that I limit protein intake."
2. "I need to maintain a regular exercise program."
3. "I understand that I need to avoid adding salt to foods."
4. "It is important that I begin reducing and then maintaining weight."

A nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation?
1. Serum sodium level of 145 mEq/L
2. Serum chloride level of 98 mEq/L
3. Serum calcium level of 10 mg/dL
4. Serum potassium level of 2.8 mEq/L

A nurse notes that a client's serum calcium level is 6.0 mg/dL. Which assessment findings should be anticipated in this client? Select all that apply.
1. Tetany
2. Constipation
3. Renal calculi
4. Hypotension
5. Prolonged QT interval
6. Positive Chvostek's sign