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Block 4 Advanced Cardiac

Total questions: 24

Worksheet time: 48mins

Name
Class
Date
1.
A patient with chronic heart failure is treated with hydrochlorothiazide, digoxin and lisinopril. To prevent the risk of digoxin toxicity with these drugs, it is most important the nurse monitor the patient's
a)
heart rate.
b)
blood pressure.
c)
gastrointestinal function.
d)
 potassium levels.
2.
When caring for a patient after cardiac catheterization with coronary angiography, which of the following findings would be of most concern to the nurse?
a)
swelling at the catheter insertion site
b)
development of raised wheals on the patient trunk
c)
Absence of pulses distal to the catheter insertion site
d)
Patient states pain at the insertion site as 4 out of 10
3.
A physical assessment finding that the nurse would expect to be present in the patient with acute left-sided heart failure is:
a)
 crackles, rales, and tachycardia
b)
hepato-splenomegaly and tachypnea
c)
peripheral edema and clammy, diaphoretic skin
d)
frothy blood tinged sputum and distended jugular veins
4.
The nurse assesses the patient with chronic bi-ventricular heart failure for paroxysmal nocturnal dyspnea by questioning the patient regarding:
a)
frequent awaking to void during the night.
b)
the presence of a dry hacking cough with exertion.
c)
The presence of difficulty breathing when lying flat.
d)
episodes of coughing and asphyxia while asleep.
5.
In the patient with dysrhythmia, the nurse identifies a nursing diagnosis of decrease cardiac output related to dysrhythmias when the patient experiences
a)
hypertension and bradycardia
b)
chest pain and decreased mentation
c)
abdominal distention and hepatomegaly
d)
bounding pules and a ventricular heave
6.
A patient with acute MI is having multifocal PVCs and ventricular couplets. He is alert and has a BP of 118/78 with an irregular pulse of 86 beats/min. The most appropriate action by the nurse at this time is to: 
a)
continue to assess the patient.
b)
be prepared to administer cardiopulmonary resuscitation (CPR).
c)
administer antidysrhythmic drugs per protocol.
d)
ask the patient to perform valsava maneuver.
7.
To detect a serious complication of acute heart failure post myocardial infarction, the nurse
a)
measures hourly urine output
b)
auscultates the chest for crackles
c)
uses continuous cardiac output monitoring
d)
takes vital signs for q 2 hours for the first 8 hours.
8.
A patient with chronic heart failure has atrial fibrillation and an LV ejection fraction of 18%. To decrease the risk of complications from these conditions, the nurse anticipates the administration of
a)
diuretics.
b)
anticoagulants.
c)
Beta-adrenergic blockers.
d)
potassium supplements.
9.
The diagnostic test that is most useful in differentiating the dyspnea related to heart failure from dyspnea of pulmonary disease is 
a)
exercise stress testing
b)
cardiac catheterization
c)
b-type natriuretic peptide (BNP) levels.
d)
determination of blood urea nitrogen (BUN)
10.
A patient with heart failure has tachypnea, severe dyspnea, and an SpO2 of 84%. The nurse identifies a nursing diagnosis of impaired gas exchange related to increased preload and mechanical failure.  An appropriate nursing intervention for this diagnosis is
a)
assist the patient to cough and deep breathe q2hr.
b)
assess intake and output q 8 hr and weigh the patient daily
c)
encourage rest periods to reduce cardiac workload
d)
Place the client in high Fowler's position and feet dangling
11.
The nurse determines that additional discharge teaching is needed when the patient with chronic heart failure says,
a)
"I will call the doctor if I have vomiting while on digoxin"
b)
"I will take my pulse every day and call the clinic if it is irregular or less than 50."
c)
"I will move my bedroom down stairs."
d)
"I will weigh myself every day and diet if I gain > 2-3 lbs.
12.

Three days after a mechanical mitral valve replacement surgery, the patient complains that she thinks she hears a clicking noise in her chest. The nurse teaches the patient:

a)

“That’s just your heart monitor.”

b)

“That’s the sound of your new valve opening and closing.”

c)

“Let me call your MD. Your valve shouldn’t make any noise.”

d)

“Your valve will make less noise as it becomes calcified.”

13.

Valve replacement causes a greater risk for endocarditis. What will the nurse teach the client on discharge?

a)

Will no longer be unable to do physical activities.

b)

Must take prophylactics for dental and anything invasive.

c)

You will be on anticoagulants for life.

d)

You will have to take antibiotics for life.

14.

Mitral valve stenosis causes ____ sided heart failure?

a)

Right

b)

Left

15.

An abdominal aneurysm will need to be repaired if it is greater than ______cms.

a)

5

b)

1

c)

0.5

d)

Any size

16.
The nurse is monitoring a client who has recently undergone pericardiocentisis. The nurse suspects cardiac tamponade after observing which of the following?
a)
A rapid increase in blood pressure and flushing
b)
Jugular vein distention and narrowing pulse pressure
c)
Bradycardia and bilateral crackles
d)
 Louder and harsher heart sounds
17.

A client has been admitted to the hospital with a diagnosis of suspected bacterial endocarditis. A complication the nurse will constantly observe for is

a)

Presence of aortic dissection

b)

Systemic emboli

c)

Liver Failure

d)

Congestive Heart Failure

18.
Which signs and symptoms are present with a diagnosis of pericarditis?
a)
Low grade fever, positional chest discomfort, ST segment changes
b)
Low urine output secondary to left ventricular dysfunction
c)
Lethargy, anorexia, and heart failure
d)
elevated troponin, ST elevation, heart failure
19.
Match the following areas on the precordium for best listening to each of the four heart valves with the valve -- 2RICS (2nd Right Intercostal Space)
a)
Aortic
b)
Pulmonic
c)
Mitral
d)
Tricuspid
20.

What valve disorder is most likely when you auscultate a diastolic murmur on the LLSB (Left Lower Sternal Boarder), 4th ICS

a)

Aortic stenosis

b)

Pulmonic regurgitation

c)

Mitral regurgitation

d)

Tricuspid stenosis

21.

The S2 heart sound results from closure of the ___ valves. Select all that apply!

a)

Outflow valves

b)

Aortic & Pulmonic valve

c)

AV valves

d)

Mitral and Tricuspid valves

22.

The nurse suspects a diagnosis of mitral valve regurgitation when what type of murmur is heard on auscultation?

a)

Valve "click" in the 4th ICS, lower left sternal border

b)

High pitched systolic murmur at the apex (5th ICS, midclavicular line)

c)

Low pitched diastolic murmur at the apex (5th ICS, midclavicular line)

d)

Diastolic murmur at the 2nd ICS, left sternal border

23.

A patient is being treated for pericarditis. Which medication would the nurse question?

a)

Colchicine

b)

Dopamine

c)

Ibuprofen

d)

Prednisone

24.

A complication after heart surgery, trauma, or pericarditis in which excess fluid accumulates in the pericardium obstructing ventricular filling and causing a decrease in cardiac output.

a)

angina

b)

pericarditis

c)

hypotension

d)

cardiac tamponade

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