Cardiovascular system MCQ-1

• 1) Which of the below is NOT a function of the

fibrous skeleton of the heart?
A) Conducts the impulses from atria to ventricles
B) Acts as a point of insertion for cardiac muscle
fibers
C) Prevents overstretching of the valves
D) Forms a structural foundation for the heart
valves
C) Prevents overstretching of the valves
• 2) Gate keeper of the heart is
• A) SA Node
• B)AV node
• D) Purkinjee fibers
• E) Bundle of His
• The SA node generates electrical impulses at 60
to 100 times per minute and is controlled by the
sympathetic and parasympathetic nervous
system
• If the SA node fails, the AV node can initiate and
sustain a heart rate of 40 to 60 beats/minute.
• Purkinje fibers can act as the pacemaker with a
rate between 20 and 40 beats/minute when
higher pacemakers (such as the SA and AV nodes)
fail.
3) “Heart of heart” is ________
a) SA node
b) AV node
c) Bundle of HIS
d) Purkinji fibers
• 4) Inner most layer of heart
• A) Myocardium
• B) Pericardium
• C) Epicaridum
• D) Endocardium
5) Egg on side appearance is characteristic of?
• A. Tetralogy of fallot
• B. Total anomalous pulmonary venous
connection
• C. Patent ductus arteriosus
• D. Transposition of great arteries
 X ray signs and
conditions
X ray signs/ diagnostic Disease condition
signs
Boot shaped heart TOF
Egg on side appearance Transposition of Great arteries

Ground glass appearance RDS/HMD

Cottage- loaf sign/‘snow man’ or ‘ Total Anomalous Pulmonary Venous

figure of 8’ sign Connection

Box Shaped Heart Ebstein’s anomaly

Steeple sign Croup

Cherry red epiglottis on laryngoscopy Croup

Honey comb appearance Bronchiectasis

Flask shaped/pear shaped/money Pericardial effusion
bag/leather
bottle shaped heart
Jug handle appearance Primary pulmonary artery hypertension

3 like appearance Coarctation of aorta

Egg in cup appearance Constrictive pericarditis

Pericardial calcification Constrictive pericarditis

Bat’s wing appearance Pulmonary edema

Pruned tree appearance(of pulmonary Pulmonary artery hypertension

circulation)

Step ladder or stair case pattern in X ray Intussusception

5) A client is admitted to the emergency department with chest
pain that is consistent with myocardial infarction based on
elevated troponin levels. Heart sounds are normal and vital
signs are noted on the client’s chart. The nurse should alert
the health care provider because these changes are most
consistent with which complication? Refer to chart

a) Cardiogenic shock
b) Cardiac tamponade
c) Pulmonary embolism
d) Dissecting thoracic aortic
aneurysm
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 the chest pain. Dissecting
aortic aneurysms usually are accompanied by back
pain
6) 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?
a. Glipizide
b.Metformin
c. Repaglinide
d.Regular insulin
7) True about stone heart syndrome?
A. Global ischemic contracture of the heart
B. Was more frequent in the early era of
cardiopulmonary bypass
C. Moderate hypothermia is useful in
prevention
D. All of the above
• Global ischemic contracture of the heart
resulting in a firm myocardium and loss of
intracavitary volume is termed stone heart
syndrome.
• It was described in the early years of open
heart surgery with cardiopulmonary bypass
• 8) The action of Furosemide in acute
pulmonary edema due acute left ventricular
failure is by:
• a) Pulmonary venodilation
• b) Increasing urine formation
• c) Decreases blood volume
• d) All of the above
• Frusemide is a loop diuretic.  It is also a
pulmonary venodilator.
•  In left ventricular failure, frusemide is given
intravenously.
•  It causes pulmonary venodilation and
relieves pulmonary congestion.
• Also by increasing urine formation, it
decreases blood volume and venous return
thus decreasing preload of the heart
• 9) Aclient in sinus bradycardia, with a heart
rate of 45 beats/minute, complains of
dizziness and has a blood pressure of 82/60
mm Hg. Which prescription should the nurse
anticipate will be prescribed?
• A) Administer digoxin.
• B) Defibrillate the client.
• C) Continue to monitor the client.
• D) Prepare for transcutaneous pacing
• Sinus bradycardia is noted with a heart rate less than 60 beats
per minute.
• This rhythm becomes a concern when the client becomes
symptomatic.
• 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.
• Defibrillation is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation.
• Digoxin will further decrease the client’s heart rate.
Continuing to monitor the client delays necessary
intervention
11) X-ray appearance of calcification of patent
ductus arteriosus is?
A) Y shaped
B) Inverted Y shaped
C) V shaped
D) Inverted V shaped
13) client with myocardial infarction suddenly
becomes tachycardic, shows signs of air hunger,
and begins coughing frothy, pink-tinged sputum.
Which finding would the nurse anticipate when
auscultating the client’s breath sounds?
a) Stridor
b)Crackles
c) Scattered rhonchi
d)Diminished breath sounds
• Pulmonary edema is characterized by extreme
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
obstruction
14) A client with myocardial infarction is
developing cardiogenic shock. Because of the
risk of myocardial ischemia, what condition
should the nurse carefully assess the client
for?
a)Bradycardia
b) Ventricular dysrhythmias
c) Rising diastolic blood pressure
d) Falling central venous pressure
• Classic signs of cardiogenic shock as they
relate to myocardial ischemia include low
blood pressure and tachycardia.
• The central venous pressure would rise as the
backward effects of the severe left ventricular
failure.
• Dysrhythmias commonly occur as a result of
decreased oxygenation and severe damage to
greater than 40% of the myocardium
• 15) The nurse is evaluating the condition of a
client after pericardiocentesis performed to
treat cardiac tamponade. Which observation
would indicate that the procedure was
effective?
• a) Muffled heart sounds
• b) A rise in blood pressure
• c) Jugular venous distention
• d)Client expressions of dyspnea
• Following pericardiocentesis, the client usually
expresses immediate relief.
• Heart sounds are no longer muffled or distant
and blood pressure increases
• Distended neck veins are a sign of increased
venous pressure, which occurs with cardiac
tamponade
• 16) The nurse is monitoring an infant with
congenital heart disease closely for signs of
heart failure (HF). The nurse should assess the
infant for which early sign of HF?
• A) Pallor
• B) Cough
• c) Tachycardia
• D) Slow and shallow breathing
• HF is the inability of the heart to pump a
sufficient amount of blood to meet the oxygen
and metabolic needs of the body.
• The early signs of HF include tachycardia,
tachypnea, profuse scalp sweating, fatigue and
irritability, sudden weight gain, and respiratory
distress.
• A cough may occur in HF as a result of mucosal
swelling and irritation, but is not an early sign.
• Pallor may be noted in an infant with HF, but is
not an early sign
17) The nurse reviews the laboratory results for
a child with a suspected diagnosis of
rheumatic fever, knowing that which
laboratory study would assist in confirming
the diagnosis?
a)Immunoglobulin
b) Red blood cell count
c) White blood cell count
d) Anti–streptolysin O tite
18) On assessment of a child admitted with a
diagnosis of acute-stage Kawasaki disease, the
nurse expects to note which clinical
manifestation of the acute stage of the
disease?
a)Cracked lips
b)Normal appearance
c) Conjunctival hyperemia
d) Desquamation of the skin
• Kawasaki disease, also known as mucocutaneous lymph node
syndrome, is an acute systemic inflammatory illness.
• The cause is unknown, but may be associated with an infection from
an organism or toxin.
• Cardiac involvement is the most serious complication; aneurysms
can develop.
• Acute stage
a. Fever b. Conjunctival hyperemia c. Red throat d. Swollen hands,
rash, and enlargement of cervical lymph nodes
• Subacute stage
• a. Cracking lips and fissures b. Desquamation of the skin on the tips
of the fingers and toes c. Joint pain d. Cardiac manifestations e.
Thrombocytosis
• 3. Convalescent stage: Child appears normal, but signs of
inflammation may be present
• 19) A health care provider has prescribed
oxygen as needed for an infant with heart
failure. In which situation should the nurse
administer the oxygen to the infant?
• A) During sleep
• B) When changing the infant’s diapers.
• C) When the mother is holding the infant
• D) When drawing blood for electrolyte level
testing
• Heart failure (HF) is the inability of the heart to pump a
sufficient amount of blood to meet the oxygen and
metabolic needs of the body.
• Crying exhausts the limited energy supply, increases the
workload of the heart, and increases the oxygen demands.
• Oxygen administration mayHeart failure (HF) is the
inability of the heart to pump a sufficient amount of blood
to meet the oxygen and metabolic needs of the body.
• Crying exhausts the limited energy supply, increases the
workload of the heart, and increases the oxygen demands.
Oxygen administration may
• 20) The following features are true for
tetralogy of Fallot, except:
A. Ventricular septal defect
B. Right ventricular hypertrophy
C. Atrial septal defect
D. Pulmonary stenosis
• 21) Blalock and Taussig shunt is done
between:
A. Aorta to pulmonary artery
B. Aorta to pulmonary vein
C. Subclavian artery to pulmonary vein
D. Subclavian vein to artery
• Blalock and Taussig shunt is used in the
surgical management of tetralogy of fallot.
• It is shunts blood from the subclavian artery
to the pulmonary artery
• As subclavian artery is a branch of aorta, the
best answer would be ‘aorta to pulmonary
artery.’
• 22) 1. Which of the following statements are
true of Coarctation of the aorta?
• (a) It usually presents with cyanosis and can be
detected with a drop in oxygen saturations from
pre to post ductal measurements
• (b) It typically presents with hypertension in the
legs in newborn babies
• (c) It can present with renal failure and lactic
acidosis as the duct closes
• (d) It is the commonest form of congenital heart
defect
• Coarctation of the aorta is localized narrowing near the
insertion of the ductus arteriosus.
• As the duct closes the blood flow to the descending
aorta beyond the constriction is dramatically reduced
resulting in poor organ perfusion and build up of tissue
hypoxia leading to lactic acidosis.
• With coarctation of the aorta, the blood pressure is
higher in the upper extremities than in the lower
extremities.
• In addition, bounding pulses in the arms, weak or
absent femoral pulses, and cool lower extremities may
be present
• 23) Reverse e sign seen in
• A) Coarctation of Aorta
• B) VSD
• C) ASD
• D) Patent ductus arteriosus
• 24) Double Shadow is seen in
a. Mitral Stenosis
b. IBD
c. Pinealoma
d. None of the above
• The double-density sign, also known as the double
right heart border, is seen on frontal chest radiographs
in the presence of left atrial enlargement, and occurs
when the right side of the left atrium extends behind
the right cardiac shadow, indenting the adjacent lung
and forming its own distinct silhouette 
• If large enough, the left atrium can actually reach
beyond the border of the right atrium; this is known
as atrial escape.
•  The right superior pulmonary vein can lead to a similar
appearance 
• 25) Hilar dance on fluoroscopy is seen in
cases of
a. ASD
b. Bronchiectasis
c. Both
d. None
26) A nurse caring for a client in one room is told
by another nurse that a second client has
developed severe pulmonary edema. On
entering the 2nd client’s room, the nurse
would expect the client to be:
A. Slightly anxious
B. Mildly anxious
C. Moderately anxious
D. Extremely anxious
 Pulmonary edema causes the client
to be extremely agitated and
anxious.
 The client may complain of a sense
of drowning, suffocation, or
smothering.

D. Extremely anxious
27) 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 IV push. Knowing that the client also
will be started on digoxin (Lanoxin), a nurse
checks the client’s most recent:
A. Digoxin level
B. Sodium level
C. Potassium level
D. Creatinine level
• The serum potassium level is measured in the
client receiving digoxin and furosemide.

• C. Potassium level
• 28) A client who had cardiac surgery 24 hours ago
has a urine output averaging 19 ml/hr for 2 hours.
The client received a single bolus of 500 ml of IV
fluid. Urine output for the subsequent hour was 25
ml. Daily laboratory results indicate the blood urea
nitrogen is 45 mg/dL and the serum creatinine is 2.2
mg/dL. A nurse interprets the client is at risk for:
A. Hypovolemia
B. UTI
C. Glomerulonephritis
D. Acute renal failure
• 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 BUN and creatinine levels.
• The client may need medications such as
dopamine (Intropin) to increase renal perfusion
and possibly could need peritoneal dialysis or
hemodialysis.
D. Acute renal failure
• 29) A nurse is preparing to ambulate a client on
the 3rd day after cardiac surgery. The nurse
would plan to do which of the following to
enable the client to best tolerate the
ambulation?
•  A. Encourage the client to cough and deep
breathe.
•  B. Premedicate the client with an analgesic.
•  C. Provide the client with a walker.
•  D. Remove telemetry equipment because it
weighs down the hospital gown.
• The nurse should encourage regular use of
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.
B. Premedicate the client with an analgesic
• 30) A client’s electrocardiogram strip shows
atrial and ventricular rates of 80 complexes
per minute. The PR interval is 0.14 second,
and the QRS complex measures 0.08 second.
The nurse interprets this rhythm is:
A.Normal sinus rhythm
B.Sinus bradycardia
C.Sinus tachycardia
D. Sinus dysrhythmia
• A. Normal sinus rhythm
31) A client has frequent bursts of ventricular
tachycardia on the cardiac monitor. A nurse
is most concerned with this dysrhythmia because:
•  A. It is uncomfortable for the client, giving a
sense of impending doom.
•  B. It produces a high cardiac output that quickly
leads to cerebral and myocardial ischemia.
•  C. It is almost impossible to convert to a normal
sinus rhythm.
•  D. It can develop into ventricular fibrillation at
any time.
•  D. It can develop into ventricular fibrillation
at any time.
32) A home care nurse is making a routine visit
to a client receiving digoxin (Lanoxin) in the
treatment of heart failure. The nurse would
particularly assess the client for:
A. Thrombocytopenia and weight gain
B. Anorexia, nausea, and visual disturbances
C. Diarrhea and hypotension
D. Fatigue and muscle twitching
• The first signs and symptoms of digoxin toxicity in adults
include abdominal pain, N/V, visual disturbances
(blurred, yellow, or green vision, halos around lights),
bradycardia, and other dysrhythmias. Symptoms may
be mild and include nausea, vomiting, and anorexia.
• Visual side effects might include color changes, also
known as xanthopsia.
• But yellow or green-tinted vision is usually associated
with digoxin toxicity.
• Patients may also highlight blurry vision or photopsia.
• At toxic levels, digoxin is proarrhythmic.
• B. Anorexia, nausea, and visual disturbances
• 33) A client with angina complains that the
angina pain is prolonged and severe and
occurs at the same time each day, most often
in the morning, On further assessment a nurse
notes that the pain occurs in the absence of
precipitating factors. This type of anginal pain
is best described as:
 A. Stable angina
B. Unstable angina
C. Variant angina
D. Nonanginal pain
• Variant angina, or Prinzmetal’s angina, is prolonged
and severe and occurs at the same time each day,
most often in the morning.
 

C. Variant angina
• 34) The physician orders continuous
intravenous nitroglycerin infusion for the
client with MI. Essential nursing actions
include which of the following?
•  A. Obtaining an infusion pump for the
medication.
•  B. Monitoring BP q4h.
•  C. Monitoring urine output hourly.
•  D. Obtaining serum potassium levels daily.
• IV nitro infusion requires an infusion pump for
precise control of the medication. When
administered as a drip in the emergency room
or ICU, its effects are often very closely
monitored via an arterial line for real-time
blood pressure monitoring. This vigilance is
necessary to maximize the effectiveness of the
drip and provide rapid feedback on the
patient’s condition.
• Correct Answer: A. Obtaining an infusion
pump for the medication.
• 35) Aspirin is administered to the client
experiencing an MI because of its:
•  A. Antipyretic action
•  B. Antithrombotic action
•  C. Antiplatelet action
•  D. Analgesic action
• Aspirin does have antipyretic, antiplatelet, and
analgesic actions, but the primary reason ASA is
administered to the client experiencing an MI is its
antithrombotic action.
• Aspirin is a cyclooxygenase-1 (COX-1) inhibitor.
• It is a modifier of the enzymatic activity of
cyclooxygenase-2 (COX-2).
B. Antithrombotic action
• 36) Which of the following is an expected
outcome for a client on the second day of
hospitalization after an MI?
•  A. Has severe chest pain.
•  B. Can identify risk factors for MI.
•  C. Agrees to participate in a cardiac
rehabilitation walking program.
•  D. Can perform personal self-care activities
without pain.
• By day 2 of hospitalization after an MI, clients
are expected to be able to perform personal
care without chest pain. Pain is a subjective
experience and must be described by the
patient. Provides a baseline for comparison to
aid in determining the effectiveness of
therapy, resolution, and progression of the
problem.
• D. Can perform personal self-care activities
without pain.
• 37) Which of the following reflects the
principle on which a client’s diet
will most likely be based during the acute
phase of MI?
•  A. Liquids as ordered
•  B. Small, easily digested meals
•  C. Three regular meals per day
•  D. NPO
• Recommended dietary principles in the acute
phase of MI include avoiding large meals
because small, easily digested foods are better
tolerated. Fluids are given according to the
client’s needs, and sodium restrictions may be
prescribed, especially for clients with
manifestations of heart failure. Cholesterol
restrictions may be ordered as well.
• B. Small, easily digested meals
• 38) An older, sedentary adult may not
respond to emotional or physical stress as well
as a younger individual because of:
•  A. Left ventricular atrophy
•  B. Irregular heartbeats
•  C. Peripheral vascular occlusion
•  D. Pacemaker placement
• In older adults who are less active and do not exercise the
heart muscle, atrophy can result.
• Disuse or deconditioning can lead to abnormal changes in the
myocardium of the older adult.
• As a result, under sudden emotional or physical stress, the
left ventricle is less able to respond to the increased demands
on the myocardial muscle.
• While aging does not itself cause heart failure (HF), it does
lower the threshold for the manifestation of the disease.
• As the populations of most developed countries continue to
become older, on average, the importance of aging as a risk
factor for all cardiovascular diseases increases in kind.
• A. Left ventricular atrophy
• 39) Which of the following would be a priority
nursing diagnosis for the client with heart
failure and pulmonary edema?
•  A. Risk for infection related to stasis of
alveolar secretions.
•  B. Impaired skin integrity related to pressure.
•  C. Activity intolerance related to pump
failure.
•  D. Constipation related to immobility.
• Activity intolerance is a primary problem for clients
with heart failure and pulmonary edema.
• The decreased cardiac output associated with heart
failure leads to reduced oxygen and fatigue.
• Clients frequently complain of dyspnea and fatigue. As
heart failure becomes more severe, the heart is unable
to pump the amount of blood required to meet all of
the body’s needs
• To compensate, blood is diverted away from less-
crucial areas, including the arms and legs, to supply
the heart and brain.
• C. Activity intolerance related to pump failure
• 40) Captopril may be administered to a client
with HF because it acts as a:
•  A. Vasopressor
•  B. Volume expander
•  C. Vasodilator
•  D. Potassium-sparing diuretic
• ACE inhibitors have become the vasodilators of
choice in the client with mild to severe HF.
Vasodilator drugs are the only class of drugs clearly
shown to improve survival in overt heart failure.
• ACEi improves heart failure by decreasing afterload.
• Apart from decreasing the afterload, it also reduces
cardiac myocyte hypertrophy.
• The Heart Outcomes Prevention Evaluation (HOPE)
Study demonstrated better outcomes for those
prescribed ACE inhibitors.
• C. Vasodilator
• 41) Furosemide is administered intravenously
to a client with HF. How soon after
administration should the nurse begin to see
evidence of the drug’s desired effect?
•  A. 5 to 10 minutes
•  B. 30 to 60 minutes
•  C. 2 to 4 hours
•  D. 6 to 8 hours
• After IV injection of furosemide, diuresis
normally begins in about 5 minutes and
reaches its peak within about 30 minutes.
Medication effects last 2 to 4 hours. The
terminal half-life of furosemide is
approximately 2 hours, and the total time of
therapeutic effect is 6 to 8 hours. However,
the half-life of furosemide will prolong in
patients with chronic renal disease.
• A. 5 to 10 minutes
• 42) Which of the following foods should the
nurse teach a client with heart failure to avoid
or limit when following a 2-gram sodium diet?
•  A. Apples
•  B. Tomato juice
•  C. Whole wheat bread
•  D. Beef tenderloin
• B. Tomato juice
• Canned foods and juices, such as tomato juice, are
typically high in sodium and should be avoided on a
sodium-restricted diet.
• Canned and processed foods, such as gravies, instant
cereal, packaged noodles, and potato mixes, olives,
pickles, soups, and vegetables are high in salt.
• Choose the frozen item instead; or better yet, choose
fresh foods when you can. Cheeses, cured meats
(such as bacon, bologna, hot dogs, and sausages),
fast foods, and frozen foods also may contain a lot of
sodium.
• 43) The nurse finds the apical pulse below the
5th intercostal space. The nurse suspects:
•  A. Left atrial enlargement
•  B. Left ventricular enlargement
•  C. Right atrial enlargement
•  D. Right ventricular enlargement
• A normal apical impulse is found under over
the apex of the heart and is typically located
and auscultated in the left fifth intercostal
space in the midclavicular line. An apical
impulse located or auscultated below the fifth
intercostal space or lateral to the midclavicular
line may indicate left ventricular enlargement.
• B. Left ventricular enlargement
• 44) Which of the following arteries primarily
feeds the anterior wall of the heart?
•  A. Circumflex artery
•  B. Internal mammary artery
•  C. Left anterior descending artery
•  D. Right coronary artery
• The left anterior descending artery is the
primary source of blood for the anterior wall
of the heart. The left anterior descending
artery (LAD) supplies the anterior two-thirds
of the septum. The LAD is one of two major
branches of the LMCA, with the other being
the left circumflex (LCx) coronary arteries.
Combined, these two supply blood to the left
atrium and left ventricle.
• C. Left anterior descending artery
• 45) The most important factor in regulating
the caliber of blood vessels, which determines
resistance to flow, is:
•  A. Hormonal secretion
•  B. Independent arterial wall activity.
•  C. The influence of circulating chemicals
•  D. The sympathetic nervous system
• The autonomic nervous system exerts influence
over the organ systems of the body to
upregulate and downregulate various functions.
The two aspects of the ANS operate as opposing
functions that act to achieve homeostasis. The
sympathetic nervous system, also known as the
“fight or flight” system, increases energy
expenditure and inhibits digestion.
• D. The sympathetic nervous system
46) With peripheral arterial insufficiency, leg
pain during rest can be reduced by:
•  A. Elevating the limb above heart level.
•  B. Lowering the limb so it is dependent.
•  C. Massaging the limb after application of
cold compresses.
•  D. Placing the limb in a plane horizontal to
the body.
• The cornerstone of treatment of PAD is
exercise to improve peripheral circulation,
walking economy, cardiopulmonary function,
and functional capacity.
• B. Lowering the limb so it is dependent
• 47) Buerger’s disease is characterized by all of
the following except:
•  A. Arterial thrombosis formation and
occlusion.
•  B. Lipid deposits in the arteries.
•  C. Redness or cyanosis in the limb when it is
dependent.
•  D. Venous inflammation and occlusion.
• Buerger disease, also known as
Thromboangiitis obliterans (TAO) is a
progressive, nonatherosclerotic, segmental,
inflammatory disease that most often affects
small and medium arteries of the upper and
lower extremities. The typical age range for
occurrence is 20 to 50 years, and the disorder
is more frequently found in males who smoke.
• B. Lipid deposits in the arteries
• 48) A significant cause of venous thrombosis
is:
•  A. Altered blood coagulation
•  B. Stasis of blood
•  C. Vessel wall injury
•  D. All of the above
• A deep-vein thrombosis (DVT) is a blood clot
that forms within the deep veins, usually of
the leg, but can occur in the veins of the arms
and the mesenteric and cerebral veins. Deep-
vein thrombosis is a common and important
disease. It is part of the venous
thromboembolism disorders which represent
the third most common cause of death from
cardiovascular disease after heart attacks and
stroke.
• D. All of the above
• 49) When caring for a patient who has started
anticoagulant therapy with warfarin
(Coumadin), the nurse knows not to expect
therapeutic benefits for:
•  A. At least 12 hours
•  B. The first 24 hours
•  C. 2-3 days
•  D. 1 week
• The onset of action is typically 24 to 72 hours.
• A peak therapeutic effect is seen 5 to 7 days after initiation.
• However, the patient’s international normalized ratio (INR)
may increase within 36 to 72 hours after initiating treatment.
• Warfarin is a once-daily oral medication. Warfarin
administration can be at any time during the day, but
recommendations are for administration in the afternoon or
evening. By instructing patients to take warfarin later in the
day, healthcare providers can have the opportunity to
individualize a patient’s warfarin dose the same day based
on their most current lab values.
C. 2-3 days
50) Mike, a 43-year old construction worker, has a history of
hypertension. He smokes two packs of cigarettes a day, is
nervous about the possibility of being unemployed, and has
difficulty coping with stress. His current concern is calf pain
during minimal exercise that decreased with rest. The nurse
assesses Mike’s symptoms as being associated with
peripheral arterial occlusive disease. The nursing diagnosis is
probably:
•  A. Alteration in tissue perfusion related to compromised
circulation.
•  B. Dysfunctional use of extremities related to muscle spasms.
•  C. Impaired mobility related to stress associated with pain.
•  D. Impairment in muscle use is associated with pain on
exertion.
• Insufficient arterial blood flow causes
decreased nutrition and oxygenation at the
cellular level. Decreased tissue perfusion can
be temporary, with few or minimal
consequences to the health of the patient, or
it can be more acute or protracted, with
potentially destructive effects on the patient
• A. Alteration in tissue perfusion related to
compromised circulation
• 51) 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.
The nurse would next assess the client for:
•  A. Familial tendency toward peripheral
vascular disease.
•  B. Smoking history.
•  C. Recent exposures to allergens.
•  D. History of insect bites.
• The mixture of arterial and venous manifestations
(claudication and phlebitis, respectively) in the
young male client suggests Buerger’s disease. This is
an uncommon disorder characterized by
inflammation and thrombosis of smaller arteries and
veins. This disorder typically is found in young adult
males who smoke. The cause is not known precisely
but is suspected to have an autoimmune
component.
• B. Smoking history
• 52) Intravenous heparin therapy is ordered for
a client. While implementing this order, a
nurse ensures that which of the following
medications is available in the nursing unit?
•  A. Vitamin K
•  B. Aminocaproic acid
•  C. Potassium chloride
•  D. Protamine sulfate
• The antidote to heparin is protamine sulfate and
should be readily available for use if excessive
bleeding or hemorrhage should occur.
Protamine is a medication used to reverse and
neutralize the anticoagulant effects of heparin.
Protamine is the specific antagonist that
neutralizes heparin-induced anticoagulation.
When appropriately dosed, this neutralization
reduces the risk of postoperative bleeding.
• D. Protamine sulfate
• 53) A client who has been receiving heparin therapy also is started
on warfarin sodium (coumadin). The client asks the nurse why both
medications are being administered. In formulating a response, the
nurse incorporates the understanding that warfarin sodium:
•  A. Stimulates the breakdown of specific clotting factors by the
liver, and it takes 2-3 days for this to exhibit an anticoagulant
effect.
•  B. Inhibits synthesis of specific clotting factors in the liver, and it
takes 3 to 4 days for this medication to exert an anticoagulation
effect.
•  C. Stimulates production of the body’s own thrombolytic
substances, but it takes 2-4 days for it to begin.
•  D. Has the same mechanism action of heparin, and the crossover
time is needed for the serum level of warfarin sodium to be
therapeutic.
• Warfarin sodium works in the liver and inhibits synthesis of
four vitamin K-dependent clotting factors (X, IX, VII, and II),
but it takes 3 to 4 days before the therapeutic effect of
warfarin is exhibited. Heparin is generally continued for seven
to ten days. During this time warfarin is generally begun, and
it is important to continue the patient on warfarin for five to
seven days while the patient is receiving intravenous heparin
therapy. After stopping heparin, oral anticoagulation with
warfarin should be continued for six weeks.
• B. Inhibits synthesis of specific clotting factors in the liver,
and it takes 3 to 4 days for this medication to exert an
anticoagulation effect.
• 54) A nurse has the order to begin administering
warfarin sodium (Coumadin) to a client. While
implementing this order, the nurse ensures that
which of the following medications is available on
the nursing unit as the antidote for Coumadin?
•  A. Vitamin K
•  B. Aminocaproic acid
•  C. Potassium chloride
•  D. Protamine sulfate
•
• The antidote to warfarin (Coumadin) is Vitamin K and
should be readily available for use if excessive
bleeding or hemorrhage should occur. When
managing warfarin toxicity, the initial step would be
to discontinue warfarin and then administer vitamin
K (phytonadione). The vitamin K may administration
can be either via the oral, intravenous, or
subcutaneous route. However, the initial
administration of oral vitamin K is often preferable in
patients without major bleeding or extremely
elevated INR.
• A. Vitamin K
• 55) A nurse is assessing the neurovascular status of a client
who returned to the surgical nursing unit 4 hours ago after
undergoing an aortoiliac bypass graft. The affected leg is
warm, and the nurse notes redness and edema. The pedal
pulse is palpable and unchanged from admission. The nurse
interprets that the neurovascular status is:
•  A. Normal because of the increased blood flow through the
leg.
•  B. Slightly deteriorating and should be monitored for another
hour.
•  C. Moderately impaired, and the surgeon should be called.
•  D. Adequate from the arterial approach, but venous
complications are arising.
• An expected outcome of surgery is warmth, redness,
and edema in the surgical extremity because of
increased blood flow. Aortofemoral bypass surgery is
a procedure utilized commonly for the treatment of
aortoiliac occlusive disease, sometimes referred to as
Leriche syndrome. Aortoiliac occlusive disease can
contribute to lower extremity ischemic symptoms
necessitating intervention.
•  A. Normal because of the increased blood flow
through the leg.
• 56) A client is admitted with a venous stasis
leg ulcer. A nurse assesses the ulcer, expecting
to note that the ulcer:
•  A. Has a pale colored base.
•  B. Is deep, with even edges.
•  C. Has little granulation tissue.
•  D. Has brown pigmentation around it.
• Venous leg ulcers, also called stasis ulcers,
tend to be more superficial than arterial
ulcers, and the ulcer bed is pink. The edges of
the ulcer are uneven, and granulation tissue is
evident. The skin has a brown pigmentation
from the accumulation of metabolic waste
products resulting from venous stasis. The
client also exhibits peripheral edema.
•  D. Has brown pigmentation around it.
• 57) In preparation for the discharge of a client
with arterial insufficiency and Raynaud’s
disease, client teaching instructions should
include:
•  A. Walking several times each day as an
exercise program.
•  B. Keeping the heat up so that the environment
is warm.
•  C. Wearing a TED hose during the day.
•  D. Using hydrotherapy for increasing
oxygenation.
• The client’s instructions should include keeping the
environment warm to prevent vasoconstriction. In
response to cold temperatures, the body adapts by
restricting blood flow to the skin. This is done as a
thermoregulatory mechanism to prevent further loss
of body heat and to sustain the core body
temperature. In Raynaud’s phenomenon, blood-flow
restriction occurs during cold temperatures and
emotional stress.
• B. Keeping the heat up so that the environment is
warm.
• 58) A client comes to the outpatient clinic and tells
the nurse that he has had leg pains that begin
when he walks but cease when he stops walking.
Which of the following conditions would the nurse
assess for?
•  A. An acute obstruction in the vessels of the legs.
•  B. Peripheral vascular problems in both legs.
•  C. Diabetes
•  D. Calcium deficiency
Intermittent claudication is a condition that indicates
vascular deficiencies in the peripheral vascular
system. Intermittent claudication (IC) typically refers
to lower extremity skeletal muscle pain that occurs
during exercise. IC presents when there is insufficient
oxygen delivery to meet the metabolic requirements
of the skeletal muscles. Pain within these muscle
groups is reproducibly induced by walking and
relieved with rest.
B. Peripheral vascular problems in both legs
• 59) Which of the following characteristics is
typical of the pain associated with DVT?
•  A. Dull ache
•  B. No pain
•  C. Sudden onset
•  D. Tingling
• DVT is associated with deep leg pain of sudden
onset, which occurs secondary to the occlusion.
A deep-vein thrombosis (DVT) is a blood clot
that forms within the deep veins, usually of the
leg, but can occur in the veins of the arms and
the mesenteric and cerebral veins. Deep-vein
thrombosis is a common and important
disease.
• C. Sudden onset
60) Cancer can cause changes in what
component of Virchow’s triad?
•  A. Blood coagulability
•  B. Vessel walls
•  C. Blood flow
•  D. Blood viscosity
• Charles Emile Troisier later recognized the
further association of other abdominal
cancers as well as testicular cancer with the
presence of Virchow’s node.
• Virchow sought to explain the causation of
pulmonary thromboembolism and theorized
that pulmonary arterial embolus arises from
peripheral/distant thrombosis.
• A. Blood coagulability
• 61) Which of the following actions is
the first priority of care for a client exhibiting
signs and symptoms of coronary artery disease?
•  A. Decrease anxiety.
•  B. Enhance myocardial oxygenation.
•  C. Administer sublingual nitroglycerin.
•  D. Educate the client about his symptoms.
• Enhancing myocardial oxygenation is always the first
priority when a client exhibits signs or symptoms of
cardiac compromise. Without adequate oxygenation,
the myocardium suffers damage. The desired effect
is to decrease myocardial oxygen demand by
decreasing ventricular stress. Drugs with negative
inotropic properties can decrease perfusion to the
already ischemic myocardium. A combination of
nitrates and beta-blockers may have cumulative
effects on cardiac output.
• B. Enhance myocardial oxygenation.
62) Medical treatment of coronary artery
disease includes which of the following
procedures?
•  A. Cardiac catheterization
•  B. Coronary artery bypass surgery
•  C. Oral medication therapy
•  D. Percutaneous transluminal coronary
angioplasty
• C. Oral medication therapy
• Oral medication administration is a noninvasive, medical
treatment for coronary artery disease. Nitrates should
be given for pain relief after making sure there are no
contraindications to nitrates like hypotension, RV failure,
and consumption of phosphodiesterase inhibitors in the
past 24-48 hours. High-dose statin therapy and beta-
blockers should also be initiated early. P2Y12 inhibitors
(prasugrel, ticagrelor, or prasugrel) should be started
based on the patient profile.
63) Which of the following is the most common
symptom of myocardial infarction (MI)?
•  A. Chest pain
•  B. Dyspnea
•  C. Edema
•  D. Palpitations
• A. Chest pain
• The most common symptom of an MI is chest pain,
resulting from deprivation of oxygen to the heart.
Myocardial ischemia can present as chest pain, upper
extremity pain, mandibular, or epigastric discomfort
that occurs during exertion or at rest. The chest pain
is usually retrosternal and is sometimes described as
the sensation of pressure or heaviness. The pain
often radiates to the left shoulder, neck, or arms with
no obvious precipitating factors, and it may be
intermittent or persistent. The pain usually lasts for
more than 20 minutes. It is usually not affected by
positional changes or active movement of the region.
64) 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. The nurse determines that the client
is experiencing:
 A. Premature ventricular contractions
B. Ventricular tachycardia
C. Ventricular fibrillation
D. Sinus tachycardia
Ventricular tachycardia is characterized by the absence
of P waves, wide QRS complexes (usually greater than
0.14 second), and a rate between 100 and 250 impulses
per minute.

B. Ventricular tachycardia
65) Which of the following symptoms is
the most likely origin of pain the client
described as knifelike chest pain that
increases in intensity with inspiration?
•  A. Cardiac
•  B. Gastrointestinal
•  C. Musculoskeletal
•  D. Pulmonary
• D. Pulmonary
• Pulmonary pain is generally described by these
symptoms. Lung and breathing problems can
cause sudden, sharp chest pain. Some lung
problems can be serious. Lung conditions that
can cause chest pain include chest infection,
asthma attack, pneumonia, pleurisy, pulmonary
embolism, collapsed lung, or pulmonary
hypertension.
66) Which of the following blood tests
is most indicative of cardiac damage?
•  A. Lactate dehydrogenase
•  B. Complete blood count (CBC)
•  C. Troponin I
•  D. Creatine kinase (CK)
• C. Troponin I
• Troponin I levels rise rapidly and are detectable
within 1 hour of myocardial injury. Troponin I
levels aren’t detectable in people without
cardiac injury. Anything that causes damage to
cardiac muscle can cause troponin to spill into
the circulation. The most common cause of
injury is oxygen supply and demand mismatch,
which is seen in acute myocardial infarction
67) What is the primary reason for
administering morphine to a client with an
MI?
•  A. To sedate the client.
•  B. To decrease the client’s pain.
•  C. To decrease the client’s anxiety.
•  D. To decrease oxygen demand on the client’s
heart.
• D. To decrease oxygen demand on the client’s
heart
• Morphine is administered because it decreases
myocardial oxygen demand. Morphine can
decrease the heart rate, blood pressure, and
venous return. Morphine can also stimulate
local histamine-mediated processes. In theory,
the combination of these can reduce
myocardial oxygen demand.
68) Which of the following conditions
is most commonly responsible for myocardial
infarction?
•  A. Aneurysm
•  B. Heart failure
•  C. Coronary artery thrombosis
•  D. Renal failure
• C. Coronary artery thrombosis
• Coronary artery thrombosis causes an
inclusion of the artery, leading to myocardial
death. The pathogenesis of acute myocardial
infarction (AMI) and unstable angina is the
rupture of the coronary artery plaque
resulting in acute thrombotic occlusion of a
coronary artery. Thus, the thrombus forms an
integral part of the atherosclerotic coronary
plaques.
• 69) Which of the following complications is
indicated by a third heart sound (S3)?
•  A. Ventricular dilation
•  B. Systemic hypertension
•  C. Aortic valve malfunction
•  D. Increased atrial contractions
• A. Ventricular dilation
• Rapid filling of the ventricle causes vasodilation that is
auscultated as S3. The third heart sound (S3) is a low-
frequency, brief vibration occurring in early diastole at the
end of the rapid diastolic filling period of the right or left
ventricle. This sound is dull, much more so than the normal
sound. It is a shock, a perceptible elevation; it is hardly a
sound.
• A left-sided fourth heart sound is frequently present in
patients with systemic hypertension, aortic stenosis, or
hypertrophic cardiomyopathy. A left ventricular fourth heart
sound is common also in patients with coronary heart
disease. Here, the decrease in ventricular compliance can be
the result of prior myocardial infarction or acute ischemia.
70) A client is scheduled for a cardiac
catheterization 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
•  D. Allergy to iodine or shellfish
• 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. Allergic reactions can be
related to the use of local anesthetic, contrast
agents, heparin or other medications used during the
procedure. Reactions to the contrast agents can
occur in up to 1% of the patients, and people with
prior reactions are pretreated with corticosteroids
and antihistamines.
71) A client is wearing a continuous cardiac monitor,
which begins to sound its alarm. A nurse sees no
electrocardiogram complexes on the screen.
The first action of the nurse is to:
•  A. Check the client status and lead placement.
•  B. Press the recorder button on the
electrocardiogram console.
•  C. Call the physician.
•  D. Call a code blue.
• A. Check the client status and lead placement.
• Sudden 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. Unlike invasive
procedures, no preparation is needed, but the
patient should be advised to keep the monitor away
from other electrical devices while wearing the
device. Physicians should recommend not to put
lotion or moisturizer on the chest as it will affect the
attachment of leads.
72) IV heparin therapy is ordered for a client.
While implementing this order, a nurse
ensures that which of the following
medications is available in the nursing unit?
•  A. Vitamin K
•  B. Aminocaproic acid
•  C. Potassium chloride
•  D. Protamine sulfate
•  D. Protamine sulfate
• The antidote to heparin is protamine sulfate and
should be readily available for use if excessive
bleeding or hemorrhage should occur. Protamine is a
medication used to reverse and neutralize the
anticoagulant effects of heparin. Protamine is the
specific antagonist that neutralizes heparin-induced
anticoagulation. Protamine is a strongly alkaline
(nearly two-thirds of the amino acid composition is
arginine) polycationic low-molecular-weight protein
found in salmon sperm that is also currently available
in a recombinant form.
73) A client is at risk for pulmonary embolism
and is on anticoagulant therapy with warfarin
(Coumadin). The client’s prothrombin time is
20 seconds, with a control of 11 seconds. The
nurse assesses that this result is:
•  A. The same as the client’s own baseline level.
•  B. Lower than the needed therapeutic level.
•  C. Within the therapeutic range.
•  D. Higher than the therapeutic range.
• C. Within the therapeutic range.
• The therapeutic range for prothrombin time is
1.5 to 2 times the control for clients at risk for
thrombus. Based on the client’s control value,
the therapeutic range for this individual would
be 16.5 to 22 seconds. Therefore the result is
within the therapeutic range. PT measures the
time, in seconds, for plasma to clot after
adding thromboplastin, (a mixture of tissue
factor, calcium, and phospholipid) to a
patient’s plasma sample
74) When administered a thrombolytic drug to
the client experiencing an MI, the nurse
explains to him that the purpose of this drug is
to:
•  A. Help keep him well hydrated.
•  B. Dissolve clots he may have.
•  C. Prevent kidney failure.
•  D. Treat potential cardiac arrhythmias.
• B. Dissolve clots he may have.
• Thrombolytic drugs are administered within
the first 6 hours after onset of an MI to lyse
clots and reduce the extent of myocardial
damage. Thrombolytics or fibrinolytics are a
group of medications used in the management
and treatment of dissolving intravascular clots.
They are in the plasminogen activator class of
drugs.
75) Which of the following terms describes the
force against which the ventricle must expel
blood?
•  A. Afterload
•  B. Cardiac output
•  C. Overload
•  D. Preload
• Afterload refers to the resistance maintained by the aortic and
pulmonic valves, the condition and tone of the aorta, and the
resistance offered by the systemic and pulmonary arterioles. The
afterload of any contracting muscle is defined as the total force
that opposes sarcomere shortening minus the stretching force that
existed before contraction. Applying this definition to the heart,
afterload can be most easily described as the “load” against which
the heart ejects blood.
• A. Afterload
76) Acute pulmonary edema caused by heart
failure is usually a result of damage to which
of the following areas of the heart?
•  A. Left atrium
•  B. Right atrium
•  C. Left ventricle
•  D. Right ventricle
• C. Left ventricle
• The left ventricle is responsible for the majority of force for
the cardiac output. If the left ventricle is damaged, the output
decreases and fluid accumulates in the interstitial and
alveolar spaces, causing pulmonary edema. The resultant
pathology of increased extravascular fluid content in the lung
remains common to all forms of pulmonary edema. However,
the underlying mechanism leading to the edema arises from
the disruption of various complex physiologic processes,
maintaining a delicate balance of filtration of fluid and solute
across the pulmonary capillary membrane.
77) An 18-year-old client who recently had an
URI is admitted with suspected rheumatic
fever. Which assessment findings confirm this
diagnosis?
•  A. Erythema marginatum, subcutaneous
nodules, and fever
•  B. Tachycardia, finger clubbing, and a load S3
•  C. Dyspnea, cough, and palpitations
•  D. Dyspnea, fatigue, and syncope
•  A. Erythema marginatum, subcutaneous nodules,
and fever
• Diagnosis of rheumatic fever requires that the client
have either two major Jones criteria or one minor
criterion plus evidence of a previous streptococcal
infection. Major criteria include carditis, polyarthritis,
Sydenham’s chorea, subcutaneous nodules, and
erythema marginatum (transient, non pruritic
macules on the trunk or inner aspects of the upper
arms or thighs). Minor criteria include fever,
arthralgia, elevated levels of acute phase reactants,
and a prolonged PR-interval on ECG
78) A client admitted with angina complains of
severe chest pain and suddenly becomes
unresponsive. After establishing
unresponsiveness, which of the following
actions should the nurse take first?
•  A. Activate the resuscitation team.
•  B. Open the client’s airway.
•  C. Check for breathing.
•  D. Check for signs of circulation.
• A. Activate the resuscitation team.
• Immediately after establishing unresponsiveness, the
nurse should activate the resuscitation team. The
next step is to open the airway using the head-tilt,
chin-lift maneuver and check for breathing (looking,
listening, and feeling for no more than 10-seconds).
If the client isn’t breathing, give two slow breaths
using a bag mask or pocket mask. Next, check for
signs of circulation by palpating the carotid pulse.
79) A 55-year-old client is admitted with an acute
inferior-wall myocardial infarction. During the
admission interview, he says he stopped taking his
metoprolol (Lopressor) 5 days ago because he was
feeling better. Which of the following nursing
diagnoses takes priority for this client?
•  A. Anxiety
•  B. Ineffective tissue perfusion; cardiopulmonary
•  C. Acute pain
•  D. Ineffective therapeutic regimen management
• B. Ineffective tissue perfusion; cardiopulmonary
• MI results from prolonged myocardial ischemia
caused by reduced blood flow through the coronary
arteries. Therefore, the priority nursing diagnosis for
this client is Ineffective tissue perfusion
(cardiopulmonary). Cerebral perfusion is directly
related to cardiac output and is also influenced by
electrolyte and/or acid-base variations, hypoxia, and
systemic emboli.
80) A client comes into the E.R. with acute shortness of
breath and a cough that produces pink, frothy
sputum. Admission assessment reveals crackles and
wheezes, a BP of 85/46, a HR of 122 BPM, and a
respiratory rate of 38 breaths/minute. The client’s
medical history included DM, HTN, and heart failure.
Which of the following disorders should the nurse
suspect?
•  A. Pulmonary edema
•  B. Pneumothorax
•  C. Cardiac tamponade
•  D. Pulmonary embolism
• A. Pulmonary edema
• SOB, tachypnea, low BP, tachycardia, crackles, and a
cough producing pink, frothy sputum are late signs of
pulmonary edema. Progressively worsening dyspnea,
tachypnea, and rales (or crackles) on examination
with associated hypoxia are the clinical features
common to both cardiogenic and noncardiogenic
pulmonary edema. Cough with pink frothy sputum
noted due to hypoxemia from alveolar flooding and
auscultation of an S3 gallop could suggest cardiogenic
edema. Similarly, the presence of murmurs, elevated
jugular venous pressure, peripheral edema may point
towards a cardiac etiology.