HA: Cardiovascular Practice Questions

Multiple Choice

A nurse is explaining the difference between atherosclerosis and arteriosclerosis to a patient during a health education session. Which statement by the patient indicates correct understanding?

• "Atherosclerosis is the thickening of the artery walls, while arteriosclerosis involves plaque buildup in the arteries."

• "Atherosclerosis involves the formation of plaque in the arteries, while arteriosclerosis refers to the general thickening and loss of elasticity of arterial walls."

• "Both atherosclerosis and arteriosclerosis mean the same thing and involve narrowing of the arteries due to cholesterol."

• "Arteriosclerosis specifically refers to plaque buildup in the arteries, while atherosclerosis is a type of blood clot in the arteries."

​Rationale

Arteriosclerosis is a broad term referring to the general thickening, stiffening, and loss of elasticity of arterial walls, which can occur with aging. Atherosclerosis is characterized by the formation of plaque along the arterial walls, leading to narrowed and potentially blocked arteries. The other options are incorrect.

Multiple Choice

A patient is recovering from a cardiac catheterization that was performed via the right groin.  Which assessment requires the nurse to notify the healthcare provider immediately?

• Pain at the insertion site

• Urine output of

  250 mL over 2 hours

• Oozing serosanguinous drainage at the puncture site

• Decreased pulses in the right foot

​Rationale

Pain may occur at insertion site, but this is expected.  Urine output is adequate.  Some oozing is normal and should be monitored, but is not priority.  Decreased pulses distal to insertion site for procedure may indicate occlusion of the femoral artery by a hematoma and should immediately be reported.

Multiple Select

The nurse correlates which assessment finding to activation of the renin-angiotensin-aldosterone system?  Select all that apply.

• Increased blood pressure

• Increased heart rate

• Increased sodium reabsorption

• Increased urine output

• Increased oxygen saturation

​Rationale

Angiotensin II is a potent vasoconstrictor so BP will increase.  Angiotensin II also acts on adrenal glands to release aldosterone which promotes sodium and water reabsorption in kidneys.  This system will not increase HR, urine output or oxygen saturation.

Multiple Choice

A patient’s blood pressure is 148/92 mm Hg; however, previous measurements have been within normal limits.  The patient denies any other complaints.  Which intervention would be appropriate for this patient?

• Refer the patient to the emergency department for treatment

• Prepare teaching on antihypertensive medications

• Schedule an additional measurement in a few weeks

• Instruct on the effects of hypertension on major body organs

​Rationale

Definitive diagnosis of hypertension requires two or more elevated readings on two or more different dates.  This BP does not required referral to the ED.  Since we do not yet have a definitive diagnosis of hypertension, it is too early to start teaching on antihypertensive medications or the effects of hypertension on major body organs.

Multiple Choice

The nurse is preparing teaching material to help a patient with atherosclerosis manage lifestyle changes.  What should the nurse emphasize in this teaching?

• "You need to limit cigarette smoking."

• "You need to follow a low-fat, low-cholesterol diet."

• "You should consider adopting an active lifestyle."

• "You may have dizziness at times which is expected."

​Rationale

The patient should be encouraged to quit smoking, not just limit smoking, as smoking makes atherosclerosis worse.  A low fat/cholesterol diet helps manage risk factors and slows the progression of atherosclerosis.  Patients with atherosclerosis should be encouraged to increase activity, not just consider adding activity.  Patients with atherosclerosis have increased risk of stroke, so neurologic changes should be reported immediately.

Multiple Choice

In a patient with coronary artery disease with elevated liver function test results, it is a priority for the nurse to follow up with the healthcare provider about which prescription?

• Aspirin

• Atorvastatin

• Metoprolol

• Cholestyramine

​Rationale

Atorvastatin (Lipitor), a statin used to reduce cholesterol, is contraindicated for patients with active liver disease. Therefore, the nurse needs to follow up with the healthcare provider about this medication.

Multiple Choice

A patient is being evaluated for chest pain in the emergency department.  Which laboratory test is best to determine if this patient has experienced an acute myocardial infarction?

• Troponin

• Creatinine Kinase

• CK-MB

• Serum lactate level

​Rationale

Troponins are expressed almost exclusively by the heart and are a specific marker of cardiac muscle damage.  This is the best blood test to diagnose acute MI.  CK is a general marker of cellular injury in body, not specific to the heart.  CK-MB is released from heart, but troponin is still the gold standard.  Oxygen deprivation leads to excessive production of lactic acid, though this is not diagnostically definitive for acute MI.

Multiple Choice

The nurse is preparing medications for a patient experiencing an acute myocardial infarction.  Which medication will dilate the patient’s coronary arteries?

• Heparin

• Fibrinolytics

• Nitroglycerin

• Beta-blockers

​Rationale

Heparin is given to prevent new clot formation.  Fibrinolytics work to dissolve clots.  Nitroglycerin dilates coronary arteries.  Beta-blockers decrease SNS response to MI, decreasing cardiac workload and oxygen consumption.

Multiple Choice

The nurse monitors for which clinical manifestation in a patient diagnosed with right-sided heart failure?

• Fatigue

• Shortness of breath

• Crackles with auscultation

• Edema in the lower extremities

​Rationale

Fatigue, shortness of breath, and crackles are associated with left-sided heart failure.  With right sided heart failure, blood backs up into the peripheral circulation, leading to edema, JVD, hepatomegaly, and ascites.

Multiple Select

In providing care to a patient with an acute exacerbation of heart failure, the nurse prepares to administer prescribed medication that provides which actions?  Select all that apply.

• Decrease preload

• Increase preload

• Decrease afterload

• Increase afterload

• Increase contractility

​Rationale

In patients with heart failure, we need to decrease preload and afterload and increase contractility.  If we increased preload/afterload and decreased contractility, their CHF would worsen.

Multiple Choice

The nurse is monitoring a patient with peripheral artery disease (PAD).  Which clinical manifestation does the nurse correlate to stage IV PAD?

• Pedal pulses are decreased

• Muscle pain experienced with exercise

• Numbness and tingling of the extremity

• Tissue that is blackened on the great toe

​Rationale

In stage one, the patient has no complaints of pain but does have decreased pedal pulses.  In stage II, the patient has muscle pain with exercise that is relieved with rest.  In stage III, the patient has pain at rest with numbness and burning in the distal extremities.  In stage IV, the patient has experienced ulcers or blackened tissue on the toes/foot (necrosis/gangrene).

Multiple Select

The nurse is preparing material about peripheral artery disease (PAD) for a community fair.  What should the nurse include about modifiable risk factors for the disease?  Select all that apply.

• History of COPD

• Smoking

• Hypertension

• Family history of CVD

• Sedentary lifestyle

​Rationale

COPD is not a risk factor for PAD.  Smoking, hypertension and sedentary lifestyles are modifiable risk factors for PAD.  Family history is a non-modifiable risk factor for PAD.

Multiple Select

Which statements by a 70-year-old patient about elective surgery for repair of an AAA indicate that teaching was effective?  Select all that apply.

• "The size of my aneurysm is not a factor."

• "I have a greater risk of rupture because I have hypertension."

• "Because my aneurysm is 7cm, the risk of rupture is greater than the risk of dying during surgery."

• "My risk of rupture is greater because my aneurysm is 7cm wide."

• "My age is really not a consideration at this time."

​Rationale

The greater the size of the aneurysm, the more likely rupture is to occur.  Hypertension increases the risk of rupture.  Rupture is likely with coexisting hypertension and with aneurysms more than 6cm wide.  At that point, risk of rupture is greater than the risk of death during surgical repair.  Age is always taken into consideration with surgery.  Also, most AAAs occur in patients between 60-90 years old.

Multiple Choice

A person with a venous leg ulcer should…

• Stand as much as possible to encourage more blood flow to the legs.

• Sit as much as possible to relieve strain on the legs.

• Elevate the legs as much as possible to encourage blood flow out of the legs.

• Elevated the head of the bed while sleeping to increase venous pressure in the legs.

​Rationale

Sitting/standing for long periods of time makes the issue worse.  Elevation is key to encourage venous return to the heart.  We want to decrease venous pressure in the legs, not increase it.

Multiple Choice

Which statement by the patient discharging on warfarin indicates the need for further teaching?

• "I can take acetaminophen for pain."

• "I need to limit my intake of green leafy vegetables."

• "It is okay if I see a little blood in my stool."

• "I need to take the medication at the same time every day."

​Rationale

Tylenol does not impact blood clotting and is safe to take for those on anticoagulants.  It is important to limit/remain consistent with foods high in vitamin K as they may counteract the action of warfarin.  It is not ok to see blood in stool.  This needs to be reported immediately (as well as blood in sputum, emesis, or urine).  The medication should be taken at same time every day.

Multiple Choice

In reviewing healthcare provider admission orders for a patient admitted for treatment of a DVT of the lower left leg, which order should the nurse question?

• Compression stockings on both legs

• SCDs on both legs

• Elevate the left leg above heart level

• Encourage fluid intake

​Rationale

Compression stockings are an appropriate order.  They promote venous return and decrease leg swelling.  SCDs should be questioned.  They may cause thrombus to break away and result in an embolus.  Elevation is appropriate to enhance venous return and reduce swelling.  Fluid intake is also appropriate as it prevent dehydration/sluggish blood flow (which exacerbates DVT growth).