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Coronary Artery Disease and Hypertension
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Coronary Artery Disease and Hypertension NCLEX Review

1. A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the
following assessments is most critical before the procedure?

a. Intake and output

b. Baseline peripheral pulse rates
c. Height and weight
d. Allergy to iodine or shellfish

2. A client with no history of cardiovascular disease comes into the ambulatory clinic with
flulike symptoms. he client suddenly complains of chest pain. Which of the following
questions would best help a nurse to discriminate pain caused by a non!cardiac problem?

a. “Have you ever had this pain before?”

b. “Can you describe the pain to e?”
c. “!oes the pain get worse when you breathe in?”
d. “Can you rate the pain on a scale of "#"$% with "$ 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. A nurse plans to allow for
which of the following client activities?

a. &trict bed rest for '( hours after transfer

b. Bathroo privileges and self#care activities
c. )nsupervised hallway abulation with distances under '$$ feet
d. Ad lib activities because the client is onitored.

#. A nurse notes 2$ bilateral edema in the lower e%tremities of a client with myocardial
infarction who was admitted 2 days ago. he nurse would plan to do which of the
following ne%t?

a. *eview the intake and output records for the last ' days
b. Change the tie of diuretic adinistration fro orning to evening
c. *e+uest a sodiu restriction of " g,day fro the physician.
d. -rder daily weights starting the following orning.

&. A client is wearing a continuous cardiac monitor' which begins to sound its alarm. A
nurse sees no electrocardiogram comple%es on the screen. he first action of the nurse is to(

a. Check the client status and lead placeent

b. ress the recorder button on the electrocardiogra console.
c. Call the physician
d. Call a code blue

). A nurse is assessing the blood pressure of a client diagnosed with primary hypertension.
he nurse ensures accurate measurement by avoiding which of the following?

a. &eating the client with ar bared% supported% and at heart level.
b. /easuring the blood pressure after the client has been seated +uietly for 0 inutes.
c. )sing a cuff with a rubber bladder that encircles at least 1$2 of the lib.
d. 3aking a blood pressure within "0 inutes after nicotine or caffeine ingestion.

*. +, heparin therapy is ordered for a client. While implementing this order' a nurse
ensures that which of the following medications is available on the nursing unit?

a. 4itain 5
b. Ainocaporic acid
c. otassiu chloride
d. rotaine sulfate

-. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin
/oumadin0. he clients prothrombin time is 2 seconds' with a control of 11 seconds. he
nurse assesses that this result is(

a. 3he sae as the client6s own baseline level

b. 7ower than the needed therapeutic level
c. 8ithin the therapeutic range
d. Higher than the therapeutic range

3. A client who has been receiving heparin therapy also is started on warfarin. he client
asks a nurse why both medications are being administered. +n formulating a response' the
nurse incorporates the understanding that warfarin(

a. &tiulates the breakdown of specific clotting factors by the liver% and it takes '#9 days for this
to e:ert an anticoagulant effect.
b. Inhibits synthesis of specific clotting factors in the liver% and it takes 9#( days for this
edication to e:ert an anticoagulant effect.
c. &tiulates production of the body6s own throbolytic substances% but it takes '#( days for this
to begin.
d. Has the sae echanis of action as Heparin% and the crossover tie is needed for the seru
level of warfarin to be therapeutic.

1. A )!year!old male client comes into the emergency department with complaints of
crushing chest pain that radiates to his shoulder and left arm. he admitting diagnosis
is acute myocardial infarction. +mmediate admission orders include o%ygen by 4/ at
#56minute' blood work' chest %!ray' an 7/8' and 2mg of morphine given intravenously.
he nurse should first(

a. Adinister the orphine

b. -btain a "'#lead ;C<
c. -btain the lab work
d. -rder the chest :#ray

11. When administered a thrombolytic drug to the client e%periencing an 9+' the nurse
e%plains to him that the purpose of this drug is to(

a. Help keep hi well hydrated

b. !issolve clots he ay have
c. revent kidney failure
d. 3reat potential cardiac arrhythias.

12. When interpreting an 7/8' the nurse would keep in mind which of the following about
the : wave? ;elect all that apply.

a. *eflects electrical ipulse beginning at the &A node

b. Indicated electrical ipulse beginning at the A4 node
c. *eflects atrial uscle depolari=ation
d. Identifies ventricular uscle depolari=ation
e. Has duration of norally $."" seconds or less.

1". A client has driven himself to the 7<. =e is & years old' has a history of hypertension'
and informs the nurse that his father died of a heart attack at ) years of age. he client is
presently complaining of indigestion. he nurse connects him to an 7/8 monitor and
begins administering o%ygen at 2 56minute per 4/. he nurses ne%t action would be to(

a. Call for the doctor

b. &tart an intravenous line
c. -btain a portable chest radiograph
d. !raw blood for laboratory studies

1#. he nurse receives emergency laboratory results for a client with chest pain and
immediately informs the physician. An increased myoglobin level suggests which of the
following?

a. Cancer
b. Hypertension
c. 7iver disease
d. /yocardial infarction

1&. When teaching a client about propranolol hydrochloride' the nurse should base the
information on the knowledge that propranolol hydrochloride(

null

a. Blocks beta#adrenergic stiulation and thus causes decreased heart rate% yocardial
contractility% and conduction.
b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance
andlowers blood pressure.
d. Is an angiotensin#converting en=ye inhibitor that reduces blood pressure by blocking the
conversion of angiotensin I to angiotensin II.

1). he most important long!term goal for a client with hypertension would be to(

a. 7earn how to avoid stress

b. ;:plore a >ob change or early retireent
c. /ake a coitent to long#ter therapy
d. Control high blood pressure

1*. =ypertension is known as the silent killer. his phrase is associated with the fact that
hypertension often goes undetected until symptoms of other system failures occur. his may
occur in the form of(

a. Cerebrovascular accident
b. 7iver disease
c. /yocardial infarction
d. ulonary disease

1-. >uring the previous few months' a &)!year!old woman felt brief twinges of chest pain
while working in her garden and has had frequent episodes of indigestion. ;he comes to the
hospital after e%periencing severe anterior chest pain while raking leaves. =er evaluation
confirms a diagnosis of stable angina pectoris. After stabilization and treatment' the client
is discharged from the hospital. At her follow!up appointment' she is discouraged because
she is e%periencing pain with increasing frequency. ;he states that she is visiting an invalid
friend twice a week and now cannot walk up the second flight of steps to the friends
apartment without pain. Which of the following measures that the nurse could suggest
would most likely help the client deal with this problem?

a. 4isit her friend earlier in the day.

b. *est for at least an hour before clibing the stairs.
c. 3ake a nitroglycerin tablet before clibing the stairs.
d. 7ie down once she reaches the friend6s apartent.

13. Which of the following symptoms should the nurse teach the client with unstable angina
to report immediately to her physician?

a. A change in the pattern of her pain

b. ain during se:
c. ain during an arguent with her husband
d. ain during or after an activity such as lawnowing

2. he physician refers the client with unstable angina for a cardiac catherization. he
nurse e%plains to the client that this procedure is being used in this specific case to(

a. -pen and dilate the blocked coronary arteries

b. Assess the e:tent of arterial blockage
c. Bypass obstructed vessels
d. Assess the functional ade+uacy of the valves and heart uscle

A4;W7<; and <A+4A570 @ /oronary Artery >isease and =ypertension 4/57

<eview

1. ANSWER D. This procedure requires an informed consent because it involves injection of a

radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is
serious and must be assessed before the procedure.

2. ANSWER C. Chest pain is assessed by using the standard pain assessment parameters.
Options A, , and ! may or may not help discriminate the origin of pain. "ain of pleuropulmonary
origin usually #orsens on inspiration.

3. ANSWER B. On transfer from the CC$, the client is allo#ed self%care activities and bathroom
privileges. &upervised ambulation for brief distances are encouraged, #ith distances gradually
increased '(), *)), +)) feet.

4. ANSWER A. -dema, the accumulation of excess fluid in the interstitial spaces, can be
measured by intake greater than output and by a sudden increase in #eight. !iuretics should be
given in the morning #henever possible to avoid nocturia. &trict sodium restrictions are reserved for
clients #ith severe symptoms.

5. ANSWER A. &udden loss of electrocardiogram complexes indicates ventricular asystole or

possible electrode displacement. Accurate assessment of the client and equipment is necessary to
determine the cause and identify the appropriate intervention.

6. ANSWER D. " should be taken #ith the client seated #ith the arm bared, positioned #ith
support and at heart level. The client should sit #ith the legs on the floor, feet uncrossed, and not
speak during the recording. The client should not have smoked tobacco or taken in caffeine in the )
minutes preceding the measurement. The client should rest quietly for ( minutes before the reading
is taken. The cuff bladder should encircle at least /)0 of the limb being measured. 1auges other
than a mercury sphygmomanometer should be calibrated every 2 months to ensure accuracy.

7. ANSWER D. The antidote to heparin is protamine sulfate and should be readily available for
use if excessive bleeding or hemorrhage should occur. 3itamin 4 is an antidote for #arfarin.

8. ANSWER C. The therapeutic range for prothrombin time is *.( to + times the control for clients
at risk for thrombus. ased on the client5s control value, the therapeutic range for this individual
#ould be *2.( to ++ seconds. Therefore the result is #ithin therapeutic range.

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9. ANSWER B. 6arfarin #orks in the liver and inhibits synthesis of four vitamin 4%dependent
clotting factors '7, 87, 388, and 88, but it takes  to 9 days before the therapeutic effect of #arfarin is
exhibited.

10. ANSWER A. Although obtaining the -C1, chest x%ray, and blood #ork are all important, the
nurse5s priority action #ould be to relieve the crushing chest pain.

11. ANSWER B. Thrombolytic drugs are administered #ithin the first 2 hours after onset of a :8 to
lyse clots and reduce the extent of myocardial damage.

12. ANSWERS A, C, E. 8n a client #ho has had an -C1, the " #ave represents the activation of
the electrical impulse in the &A node, #hich is then transmitted to the A3 node. 8n addition, the "
#ave represents atrial muscle depolari;ation, not ventricular depolari;ation. The normal duration of
the " #ave is ).** seconds or less in duration and +.( mm or more in height.

13. ANSWER B. Advanced cardiac life support recommends that at least one or t#o intravenous
lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable
chest radiograph, and dra#ing blood are important but secondary to starting the intravenous line.

14. ANSWER D. !etection of myoglobin is one diagnostic tool to determine #hether myocardial
damage has occurred. :yoglobin is generally detected about one hour after a heart attack is
experienced and peaks #ithin 9 to 2 hours after infarction '<emember, less than =) mg>? is normal.

15. ANSWER A. "ropranolol hydrochloride is a beta%adrenergic blocking agent. Actions of

propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and
slo#ing conduction.

16. ANSWER C. Compliance is the most critical element of hypertensive therapy. 8n most cases,
hypertensive clients require lifelong treatment and their hypertension cannot be managed
successfully #ithout drug therapy. &tress management and #eight management are important
components of hypertension therapy, but the priority goal is related to compliance.

17. ANSWER A. @ypertension is referred to as the silent killer for adults, because until the adult
has significant damage to other systems, the hypertension may go undetected. C3A5s can be related
to long%term hypertension. ?iver or pulmonary disease is generally not associated #ith hypertension.
:yocardial infarction is generally related to coronary artery disease.

18. ANSWER C. itroglycerin may be used prophylactically before stressful physical activities
such as stair climbing to help the client remain pain free. 3isiting her friend early in the day #ould

have no impact on decreasing pain episodes. <esting before or after an activity is not as likely to
help prevent an activity%related pain episode.

19. ANSWER A. The client should report a change in the pattern of chest pain. 8t may indicate
increasing severity of CA!.

20. ANSWER B. Cardiac catheri;ation is done in clients #ith angina primarily to assess the extent
and severity of the coronary artery blockage, A decision about medical management, angioplasty, or
coronary artery bypass surgery #ill be based on the catheri;ation results

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