NUR 313 Test 2 Cardiology Review Questions and Correct Answers
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Course
NUR 313
Institution
NUR 313
1. A client has chest pain rated at 8 on a 10 point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the highest priority for nursing management of this client at this time? ■ 1. Monitor daily weights and urine...
NUR 313 Test 2 Cardiology Review
Questions and Correct Answers
1. A client has chest pain rated at 8 on a 10 point
visual analog scale. The 12-lead electrocardiogram
reveals ST elevation in the inferior leads and Troponin levels are elevated. What is the
highest priority
for nursing management of this client at this time?
■ 1. Monitor daily weights and urine output.
■ 2. Permit unrestricted visitation by family and
friends.
■ 3. Provide client education on medications and
diet.
■ 4. Reduce pain and myocardial oxygen demand. ✅1. 4. Nursing management for a
client with a
myocardial infarction should focus on pain management and decreasing myocardial
oxygen demand.
Fluid status should be closely monitored. Client
education should begin once the client is stable and
amenable to teaching. Visitation should be based on
client comfort and maintaining a calm environment.
CN: Physiological adaptation;
CL: Synthesize
2. A client with chest pain is prescribed intravenous nitroglycerin (Tridil). Which
assessment is of
greatest concern for the nurse initiating the nitroglycerin drip?
■ 1. Serum potassium is 3.5 mEq/L.
■ 2. Blood pressure is 88/46.
■ 3. ST elevation is present on the
electrocardiogram.
■ 4. Heart rate is 61. ✅2. 2. Nitroglycerin is a vasodilator that will
lower blood pressure. The client is having chest
pain and the ST elevation indicates injury to the
myocardium, which may benefit from nitroglycerin.
The potassium and heart rate are within normal
range.
CN: Pharmacological and parenteral
therapies; CL: Analyze
3. The nurse is caring for a client diagnosed
with an anterior myocardial infarction 2 days ago.
Upon assessment, the nurse identifies a new systolic
,murmur at the apex. The nurse should first:
■ 1. Assess for changes in vital signs.
■ 2. Draw an arterial blood gas.
■ 3. Evaluate heart sounds with the client leaning
forward.
■ 4. Obtain a 12 Lead electrocardiogram. ✅3. 1. Infarction of the papillary muscles is a
potential complication of an MI causing ineffective
closure of the mitral valve during systole. Mitral
regurgitation results when the left ventricle contracts and blood flows backward into the
left atrium,
which is heard at the fifth intercostal space, left
midclavicular line. The murmur worsens during
expiration and in the supine or left-side position.
Vital sign changes will reflect the severity of the
sudden drop in cardiac output: decrease in blood
pressure, increase in heart rate, and increase in
respirations. A 12-lead ECG views the electrical
activity of the heart; an echocardiogram views valve
function.
CN: Physiological adaptation;
CL: Synthesize
4. A client with acute chest pain is receiving
I.V. morphine sulfate. Which of the following results
are intended effects of morphine in this client?
Select all that apply.
■ 1. Reduces myocardial oxygen consumption.
■ 2. Promotes reduction in respiratory rate.
■ 3. Prevents ventricular remodeling.
■ 4. Reduces blood pressure and heart rate.
■ 5. Reduces anxiety and fear. ✅4. 1, 4, 5. Morphine sulfate acts as an analgesic
and sedative. It also reduces myocardial oxygen consumption, blood pressure, and
heart rate. Morphine
also reduces anxiety and fear due to its sedative
effects and by slowing the heart rate. It can depress respirations; however, such an
effect may lead to
hypoxia, which should be avoided in the treatment
of chest pain. Angiotensin-converting enzyme-
inhibitor drugs, not morphine, may help to prevent
ventricular remodeling.
5. A client receives fibrinolytic therapy upon
admission following a myocardial infarction. He is
now receiving an I.V. infusion of heparin sodium at
1,200 units/hour. The dilution is 25,000 units/500 mL.
How many milliliters per hour will this client receive?
,________________________ mL/hour ✅5. 24 mL/hour
First, calculate how many units are in each milliliter
of the medication:
25,000 units 50 units
=
500 mL 1 mL
Next, calculate how many milliliters the client
receives per hour:
1,200 units
1 hour
50 units
1 mL
=
1,200
24
units
1 hour
1 mL
1
50
units
= 24 mL/hour.
÷
×
CN: Pharmacological and parenteral
therapies; CL: Apply
6. A 65-year-old client is admitted to the emergency department with a fractured hip.
The client
has chest pain and shortness of breath. The health
care provider orders nitroglycerin tablets. Which
should the nurse instruct the client to do?
■ 1. Put the tablet under the tongue until it is
absorbed.
■ 2. Swallow the tablet with 120 mL of water.
■ 3. Chew the tablet until it is dissolved.
■ 4. Place the tablet between his cheek and gums ✅6. 3. The client is having
symptoms of a myocardial infarction. The first action is to prevent
platelet formation and block prostaglandin synthesis. The nitroglycerin tablet will be
absorbed fastest
if the client chews the tablet.
CN: Physiological adaptation; CL: Apply
7. The nurse has completed an assessment on a
client with a decreased cardiac output. Which findings should receive the highest
priority?
, ■ 1. BP 110/62, atrial fibrillation with HR 82,
bibasilar crackles.
■ 2. Confusion, urine output 15 mL over the last
2 hours, orthopnea.
■ 3. SpO2 92 on 2 liters nasal cannula, respirations
20, 1+ edema of lower extremities.
■ 4. Weight gain of 1 kg in 3 days, BP 130/80,
mild dyspnea with exercise. ✅7. 2. A low urine output and confusion are signs
of decreased tissue perfusion. Orthopnea is a sign of
left-sided heart failure. Crackles, edema and weight
gain should be monitored closely, but the levels are
not as high a priority. With atrial fibrillation there is
a loss of atrial kick, but the blood pressure and heart
rate are stable.
CN: Physiological adaptation;
CL: Analyze
8. The nurse notices that a client's heart rate
decreases from 63 to 50 beats per minute on the
monitor. The nurse should first:
■ 1. Administer Atropine 0.5 mg I.V. push.
■ 2. Auscultate for abnormal heart sounds.
■ 3. Prepare for transcutaneous pacing.
■ 4. Take the client's blood pressure. ✅8. 4. The nurse should first assess the client's
tolerance to the drop in heart rate by checking the blood
pressure and level of consciousness and determine
if Atropine is needed. If the client is symptomatic,
Atropine and transcutaneous pacing are interventions for symptomatic bradycardia.
Once the client is
stable, further physical assessments can be done.
CN: Physiological adaptation;
CL: Synthesize
9. A client is admitted with a myocardial infarction and new onset atrial fibrillation. While
auscultating the heart, the nurse notes an irregular heart rate
and hears an extra heart sound at the apex after the
S2 that remains constant throughout the respiratory
cycle. The nurse should document these findings as:
■ 1. Heart rate irregular with S3.
■ 2. Heart rate irregular with S4.
■ 3. Heart rate irregular with aortic regurgitation.
■ 4. Heart rate irregular with mitral stenosis. ✅9. 1. An S3 heart sound occurs early in
diastole
as the mitral and tricuspid valves open and blood
rushes into the ventricles. To distinguish an S3
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