1. A patient is diagnosed as having elevated cholesterol level.

The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of: A) Lipids and fibrous tissue C) Lipoproteins B) WBCs D) High-density cholesterol Ans: A Difficulty: Easy 2. The coronary arteries are susceptible to development of arteriosclerosis because coronary arteries: A) Are smaller in diameter B) Accumulate more low-density cholesterol C) Have numerous twist and turns D) Have a decreased pulse pressure Ans: C Difficulty: Easy 3. An adult patient who experiences angina pectoris with exertion is informed by the nurse that most often angina is caused by: A) Smoking C) Infarction of the myocardium B) Inadequate cardiac output D) Coronary arteriosclerosis Ans: D Difficulty: Moderate 4. The nurse is teaching a 45-year-old patient about ways to lower elevated cholesterol levels. One method to lower cholesterol levels is to exercise, which: A) Increases HDL and decreases triglycerides B) Increases LDL and decreases triglycerides C) Decreases HDL and increases LDL D) Decreases both HDL and LDL Ans: A Difficulty: Moderate 5. A patient angina with pectoris secondary to atherosclerotic disease asks why he experiences chest pain with exertion. The nurse informs him that exertion: A) Increases the heart's oxygen demands B) Causes vasoconstriction of the heart C) Increases blood flow to the mesenteric area D) Reduces the effectiveness of medications Ans: A Difficulty: Moderate 6. To relieve angina pectoris symptoms, the nurse administers nitroglycerin sublingual to the patient. Which of the following is an action of nitroglycerin? A) Decreases myocardial oxygen consumption B) Causes venous constriction C) Decreases collateral circulation in the heart D) Causes arterial constriction Ans: A Difficulty: Moderate
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7. An adult patient has symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is: A) Deficient knowledge about underlying disease and methods for avoiding complications B) Anxiety related to fear of death C) Ineffective cardiopulmonary tissue perfusion secondary to CAD, as evidenced by chest pain D) Noncompliance related to failure to accept necessary lifestyle changes Ans: C Difficulty: Moderate 8. The most appropriate intervention for the nurse to take when a patient develops chest pain related to angina is to: A) Discontinue oxygen if in use B) Ambulate the patient to see if the pain is relieved with activity C) Have the patient sit or rest immediately D) Remove the nitroglycerin patch immediately Ans: C Difficulty: Moderate 9. A 66-year-old male patient presents to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The nurse is aware that because of the length of time the patient has been experiencing symptoms, if they are due to an MI, the myocardium: A) May have developed an increased area of infarction B) Will probably not have more damage than if he came in immediately C) May be restored in the area of dead cells with proper treatment D) Has been damaged already, so immediate treatment is no longer necessary Ans: A Difficulty: Difficult 10. The nurse notes that there are changes in the ECG of a patient who experienced an MI. Changes may indicate that the occurring ischemia is: A) P wave inversion B) T wave inversion C) Q wave changes with no change in ST or T wave D) P wave enlargement Ans: B Difficulty: Difficult 11. A patient is suspected of experiencing an MI at approximately 6:00 AM, at which time laboratory results show an increase in troponin I. The nurse can expect troponin I to peak at what time: A) 6:00 PM B) 1:00 PM C) 8:00 PM the following day D) 10:00 AM Ans: A Difficulty: Moderate

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12. A patient is admitted with pale, cool skin, midsternal chest pain unrelieved with rest, and a history of CAD. The nurse is aware that: A) The symptoms indicate angina and should be treated as such. B) The symptoms indicate anxiety and should be treated as such. C) The symptoms indicate an acute coronary episode and should be treated as such. D) Treatment should be held until an ECG is completed. Ans: C Difficulty: Moderate 13. An adult male patient is admitted to emergency following a fall in which he sustained a large laceration to the occipital area of his head. Prior to the fall, he says he developed unrelieved chest pain that had been present for approximately 20 minutes and is still present. The doctor diagnoses the patient with an MI and deep laceration. To minimize cardiac damage, which of the following physician's order will the nurse expect to see for this patient? A) Thrombolytics, oxygen administration, and bed rest B) Morphine sulphate, oxygen administration, and bed rest C) Oxygen administration, anticoagulants and bed rest D) Bed rest, albuterol nebulizer treatments, and oxygen administration Ans: B Difficulty: Moderate 14. Forty minutes after arrival to the emergency room, a patient suffering an MI is to have emergent percutaneous transluminal coronary angioplasty (PTCA) to: A) Decrease cardiac workload B) Cure elevated cholesterol C) Reperfuse the area of myocardium deprived of oxygen D) Remove the area of ischemia from the myocardium Ans: C Difficulty: Moderate 15. The most appropriate expected patient outcome for the nursing diagnosis of deficient knowledge about post-MI self-care would be: A) Relief of angina B) Less anxiety C) Maintenance of adequate tissue perfusion D) Adherence to self-care program Ans: D Difficulty: Moderate 16. A patient admitted to the hospital for the first time in his life has experienced an MI and subsequently is found to have arteriosclerosis. The most appropriate intervention to initiate once the patient is symptom free to extend and improve his quality of life is: A) Cardiac rehabilitation phase I C) Cardiac rehabilitation phase III B) Cardiac rehabilitation phase II D) Anxiety reduction

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Ans: A Difficulty: Moderate 17. The operating room (OR) nurse often assists with coronary artery bypass graft surgery (CABG). The OR nurse is aware that the vessel most commonly used as source for a CABG is: A) Brachial artery C) Femoral artery B) Brachial vein D) Greater saphenous vein Ans: D Difficulty: Moderate 18. A patient has returned to the unit after PTCA. The nurse monitors the patient for: A) Hypocalcemia C) Left ventricular hypertrophy B) Bleeding at insertion site D) Congestive heart failure Ans: B Difficulty: Moderate 19. During PTCA, a patient who received a coronary artery stent is informed that she will need to take aspirin for the rest of her life. The nurse informs her that aspirin is prescribed to prevent: A) Thrombus formation C) The onset of pain B) Dysrhythmias D) Hemorrhage at the stent site Ans: A Difficulty: Moderate 20. To allow the cardiac surgeon to work in a bloodless surgical field during cardiac surgical procedures and to maintain perfusion of body organs and tissues, a technique often used is: A) CABG B) PTCA C) Atherectomy D) Cardiopulmonary bypass Ans: D Difficulty: Easy 21. In the preoperative phase of the patient awaiting cardiac surgery, a nurse should: A) Clarify medication regimen preoperatively B) Not alter medication regimen preoperatively C) Save teaching material until after the surgery D) Not discuss fears with the patient to avoid worsening them Ans: A Difficulty: Moderate 22. A 66-year-old patient is admitted for cardiac surgery. The patient states that he is afraid of dying while undergoing the surgery. The nurse is aware that: A) A further assessment of anxiety is required. B) A more complete physical examination is required. C) Preoperative fears are normal and if ignored will be alleviated independently. D) Teaching should be initiated immediately to alleviate the fears.

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Ans: A Difficulty: Moderate 23. During the postoperative assessment of a patient who has undergone cardiac surgery, the nurse assesses the peripheral pulses, nail beds, mucosa, and skin temperature. These assessments focus on the patient's: A) Renal function C) Peripheral vascular status B) Cardiac status D) Fluid and electrolyte status Ans: C Difficulty: Easy 24. The nurse notes that the patient who has undergone cardiac surgery is now nauseated, restless, confused, and experiencing peaked tall T waves in the ECG. The nurse suspects the patient may be experiencing symptoms of: A) Hypocalcemia B) Hypercalcemia C) Hyperkalemia D) Hypermagnesemia Ans: C Difficulty: Moderate 25. The nurse notes a decrease in urine output to less than 25 mL/h and a decrease in blood pressure. These changes in patient condition may indicate: A) Fluid volume overload C) Decreased cardiac output B) Impaired gas exchange D) Impaired cerebral circulation Ans: C Difficulty: Moderate 26. When a patient has been extubated from the ventilator after cardiac surgery, the nurse encourages the patient to: A) Deep breathe and cough at least every 1 to 2 hours B) Deep breathe and cough once every 6 hours C) Lie flat as often as possible D) Avoid taking deep breaths to minimize pain Ans: A Difficulty: Easy 27. During the immediate postoperative period following cardiac surgery, a patient is mechanically ventilated. Which of the following symptoms may indicate impaired gas exchange? A) Bradycardia B) Edema C) Restlessness D) Warm, moist skin Ans: C Difficulty: Moderate 28. The nurse who is administering sublingual nitroglycerin informs the patient that immediately after administration the patient may experience: A) Nervousness or paresthesia C) Drowsiness or blurred vision B) Throbbing headache or dizziness D) Tinnitus or diplopia Ans: B

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Difficulty: Moderate 29. The nurse is providing teaching to a patient who's at risk for coronary artery disease (CAD). The nurse tells the patient that CAD has many risk factors that can be controlled or modified such as: A) Gender, obesity, family history, and smoking B) Inactivity, stress, gender, and smoking C) Obesity, inactivity, diet, and smoking D) Stress, family history, and obesity Ans: C Difficulty: Easy 30. A 48-year-old foreman at a local electric company comes to the hospital complaining of severe substernal chest pain radiating down his left arm. He's admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). Which of the following nursing assessments is a priority on admission to the CCU? A) Begin electrocardiogram (ECG) monitoring B) Obtain information about family history of heart disease C) Auscultate lung fields D) Determine if the patient smokes Ans: A Difficulty: Moderate 31. The nurse provides care for a patient who experienced an extensive myocardial infarction (MI). The patient exhibits behavior characteristic of the denial stage of the grieving process. How should the nurse approach the patient's denial? A) Reinforce and support the patient's denial. B) Let the patient know that the nurse is available to talk. C) Point out other patients with MIs who are doing well. D) Explain to the patient that he needs to accept his diagnosis. Ans: B Difficulty: Difficult 32. A patient comes to the emergency department with an acute myocardial infarction. An electrocardiogram shows a heart rate of 116 beats/minute with frequent premature ventricular contractions. The patient experiences ventricular tachycardia and becomes unresponsive. After resuscitation, the patient moves to the intensive care unit. What is the priority nursing diagnosis for this patient? A) Impaired physical mobility related to complete bed rest B) Deficient knowledge related to emergency interventions C) Social isolation related to restricted family visits D) Anxiety related to the threat of death Ans: D Difficulty: Difficult 33. The nurse in the emergency department is assessing a 64-year-old patient experiencing

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A) B) C) D)

substernal chest pain. The patient's electrocardiogram shows evidence of myocardial ischemia. Which statement indicates to the nurse that the patient may be a candidate for thrombolytic therapy? "I have had chest pain for 2 days." "My chest pain started 3 hours ago." "My chest pain stops when I take a nitroglycerin pill." "I have had chest pain on and off all week." Ans: B Difficulty: Difficult

34. The nurse is teaching a patient about the use of sublingual nitroglycerin. Which statement indicates understanding of the teaching plan? A) "I must swallow the tablet whole without chewing." B) "I should take a tablet about 45 minutes before initiating a strenuous activity that causes angina." C) "I'll keep the nitroglycerin in its original dark, airtight container." D) "I'll take a tablet every 5 minutes until my chest pain stops." Ans: C Difficulty: Moderate 35. The nurse is caring for a nonsmoking female patient with the diagnosis of coronary atherosclerosis who has been admitted to the hospital with angina. The patient states that she never experiences chest pain, the most common manifestation of myocardial ischemia. The nurse is not surprised at this statement and explains to the patient that: A) Women who have ischemia are usually totally asymptomatic. B) Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. C) Chest pain occurs only with strenuous exercise. D) Cigarette smoking is usually the contributing factor to chest pain. Ans: B Difficulty: Moderate 36. A patient is brought to the emergency room with chest pain. After interviewing the patient, the nurse discovers that the chest pain was precipitated by physical exertion and was relieved by nitroglycerin. Based on the patient's history, the nurse suspects which of the following medical diagnoses? A) Myocardial infarction C) Typical angina pectoris B) Atypical angina pectoris D) Unstable angina pectoris Ans: C Difficulty: Moderate 37. A patient is admitted through the emergency room with an acute MI. Upon review of the diagnostic testing results, the nurse would expect to see: A) Elevated CK isoenzymes, ie, CK-MB B) ECG changes at onset of chest pain C) Decrease in myoglobin protein

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D)

Enlarged heart seen on echocardiogram Ans: A Difficulty: Moderate

38. The nurse is doing health promotion and interviews a patient with a history of hypertension, who is currently smoking 1 pack of cigarettes per day. She has had no manifestations of coronary artery disease, but did have a recent LDL level of 154 mg/dL. Based on her assessment, the nurse would expect that the physician would treat this cholesterol level in which of the following ways? A) Drug therapy B) Diet and drug therapy C) Diet therapy only D) Cessation of cigarettes and diet therapy Ans: D Difficulty: Moderate 39. The nurse supervising a patient who had an MI and is now active in a cardiac rehabilitation program teaches him to self-monitor his activity and to stop exercising if he experiences: A) Chest pain, palpitations, or dyspnea B) An increase in systolic or diastolic blood pressure greater than 20 mm HG C) Oxygen saturation at 94% D) An increase in respiratory rate of 30 breaths/min Ans: A Difficulty: Moderate 40. The nurse caring for an elderly patient with CAD is teaching her about the clinical manifestations of an acute MI. The nurse emphasizes that she may not exhibit the typical pain profile because the presenting symptom in the elderly often is: A) Dyspnea B) Back pain C) Nausea D) Diaphoresis Ans: A Difficulty: Moderate 41. The nurse taking care of a patient with high cholesterol and triglyceride values teaches him about therapeutic lifestyle changes such as diet and exercise. The nurse is aware that the desired goal for cholesterol levels is: A) High HDL values and high triglyceride values B) Low soluble fiber C) Elevated blood lipids, fasting glucose less than 100 D) Low LDL values and high HDL values Ans: D Difficulty: Moderate 42. The nurse who is teaching about cardiovascular disease promotes cessation of cigarette smoking and healthy lifestyle, diet, and exercise to correct cholesterol abnormalities. In addition, the nurse explains that there are two modifiable conditions that have been

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A) B)

cited as major risk factors for CAD and its complications. These two conditions receive much attention in health promotion and control. They are: Obesity and hypertension C) Bradycardia and hypertension Diabetes mellitus and hypertension D) Depression and hypertension Ans: B Difficulty: Moderate

43. The nurse caring for a patient with cardiovascular disease is aware of the many types of pharmacologic therapy used of treat CAD that decrease the oxygen demand of the myocardium and increase the oxygen supply. The doctor has ordered Norvasc, a calcium channel blocking agent, for this patient. The nurse knows that calcium channel blockers have a variety of effects. One of the therapeutic effects is: A) Decrease in sinoatrial node and atrioventricular node conduction and decrease in workload of the heart B) Prevention of platelet aggregation and subsequent thrombosis C) Reduction of myocardial oxygen consumption by blocking beta-adrenergic stimulation to the heart D) Reduction of myocardial oxygen consumption, thus decreasing ischemia and relieving pain Ans: A Difficulty: Moderate 44. The nurse is caring for a patient with cardiovascular disease who has a nursing diagnosis of anxiety related to perceived threat of death. Stress reduction methods and providing information about the illness, its treatment, and prevention of its progression have been implemented by the nurse. The nurse evaluates her goal in reducing anxiety and determines that the goal has been met when the patient states: A) I know you are doing everything possible to save my life and help me. B) When can I resume all my normal activities again? C) I am going to take my recovery one day at a time. D) I feel fine now and I am ready to go on with my previous life activities. Ans: C Difficulty: Moderate 45. The nurse teaching the patient about risk factors that contribute to angina identifies the triggers that can cause anginal pain. Which of the following triggers can precipitate anginal pain? A) Exposure to warm temperatures B) Stress or any emotion-provoking situation C) Five light meals per day D) Forgetting to take the antihypertensive medication Ans: B Difficulty: Moderate 46. The nurse is caring for a patient who has recently been admitted with a myocardial infarction. Based on clinical manifestations and nursing assessment, the patient has a

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A) B) C) D)

nursing diagnosis of ineffective cardiac tissue perfusion related to decreased coronary blood flow from coronary thrombus and atherosclerotic plaque. In order to promote adequate tissue perfusion, the nurse is aware that in the initial phase of treatment a nursing intervention that is particularly helpful in reducing myocardial oxygen consumption is: Relieving anxiety Bed or chair rest Frequent assessment of peripheral pulses Scrupulous attention to fluid volume status Ans: B Difficulty: Moderate

47. The nurse is caring for a patient post-PTCA (percutaneous transluminal coronary angioplasty) who has returned to the nursing unit with a large peripheral vascular access sheath in place. An immediate nursing intervention includes: A) Instructing the patient to lie flat in bed and keep the affected leg straight until the sheath is removed B) Pressure dressing to the site and then resumption of ambulation C) Assisted ambulation for the first few hours after the procedure until hemostasis is achieved D) Removal of the pressure dressing with replacement of an adhesive bandage Ans: A Difficulty: Moderate 48. A nurse caring for a patient who has just been transferred from the PACU following coronary artery revascularization (CABG) performs frequent head-to-toe assessments for impending complications. The nurse finds the patient exhibits cyanosis of the mucous membranes, tachycardia, restlessness, and anxiety. The nurse is aware that these symptoms often are indicative of: A) Acute pain B) Infection C) Fluid volume and electrolyte imbalance D) Impaired gas exchange Ans: D Difficulty: Moderate 49. The nurse is caring for a patient post cardiac surgery. The patient manifests fever, pericardial pain, pleural pain, and dyspnea. The patient's lab studies show an elevated erythrocyte sedimentation rate and leukocytosis. The nurse is aware that these signs are indicative of: A) Acute incisional pain C) Pneumonia B) Post pericardiotomy syndrome D) Pulmonary embolus Ans: B Difficulty: Moderate

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