NAME:_____________________ 4.

Start range of motion exercises

immediately.

SCORE:_____________
Cardiovascular Practice Exams

1. The nurse is caring for an adult who has a

clotting time of 20 minutes. What should the 5. The nurse is caring for an adult who is
nurse do because of the lab values? admitted with a history of angina pectoris.
1. Observe the client carefully for thrombus He calls the nurse and says he has just taken
formation. a nitroglycerin tablet sublingually for
2. Protect the client from sources of anginal pain. What action should the nurse
infection. take next?
3. Assure the client has adequate rest. *1. Monitor ECG. If the pain does not
*4. Avoid giving the client injections. subside within five minutes, place a second
tablet under his tongue.
2. A client who is receiving heparin asks the 2. Assist him into bed and position him in
nurse why it cannot be given by mouth. The Trendelenburg position. Record vital signs
nurse’s reply is based on which knowledge? every five minutes.
Heparin is given parenterally because: 3. Notify the physician immediately. Start an
*1. It is destroyed by gastric secretions. IV so there will be a route for cardiac
2. It irritates the gastric mucosa. medications.
3. It irritates the intestinal lining. 4. Administer xylocaine (Lidocaine) IV.
4. Therapeutic levels can be achieved more Prepare for defibrillation.
quickly.
6. A low sodium, low cholesterol weight
3. An adult is admitted for a cardiac reducing diet is prescribed for an adult
catheterization. The client asks the nurse if client. The nurse knows the client
she will be asleep during the cardiac understands his diet when he chooses which
catheterization. What is the best answer for of the following meals?
the nurse to give? *1. Baked chicken and mashed potatoes.
1. “You will be given a light general 2. Stir-fried Chinese vegetables and rice.
anesthesia.” 3. Tuna fish salad with celery sticks.
*2. ” You will be sedated but not asleep.” 4. Lean steak with carrots.
3. “The doctor will give you an anesthetic if
you are having too much pain.” 7. A 70-year-old is admitted to the intensive
4. “Is it important for you to be asleep?” care unit with cardiogenic shock. The nurse
prepares an infusion of dobutamine as
4. An adult has just returned following a left prescribed by the physician. The nurse
heart catheterization. What is it essential for recognizes an essential safety measure to be
the nurse to do? taken with this drug is to
*1. Check her peripheral pulses. 1. Obtain a 12 lead electrocardiograph.
2. Maintain her NPO. 2. Assess electrolyte levels.
3. Apply heat to the insertion site. 3. Administer the drug through a large vein.
4. Monitor for increase in temperature.
8. A client with atrial fibrillation is receiving and finds them to be: B.P. 150/94; P 60; R.
warfarin sodium (coumadin) daily. What is 28. What is the most appropriate initial
the action of this drug? action for the nurse to take at this time?
1. Inactivates protamine sulfate. 1. Record the findings on the client’s chart.
2. Prevents new clots from forming. 2. Withhold the digoxin and report the
3. Dissolves existing clots. findings.
4. Slows the heart rate. 3. Request an appointment with the
ophthalmologist.
9. A client is receiving enalapril (Vasotec) 5 4. Reassure the client he is experiencing a
mg po daily for hypertension. Other normal reaction to his medication.
medications include estrogen, lithium
carbonate, and lorazepam. Which 13. The nurse is caring for an adult who
complaints should alert the nurse that underwent a mitral valve replacement.
medication interactions are present? Following cardiac surgery, clients often
1. Recent memory loss, muscle weakness, experience periods of disorientation. Which
and hyperreflexia. of the following nursing actions may help
2. Blood pressure 140/90, reports of mood prevent this disorientation?
swings, and restful night sleep. 1. Keep the client heavily sedated.
3. Slight kyphosis, occasional hot flashes, 2. Keep the ICU well lighted 24 hours a day.
and menstrual cramps. 3. Restrict visitors to 5 minutes at a time.
4. Feelings of panic and anxiety, retrograde 4. Position the cardiac monitor so that it is
amnesia, and sleepiness. out of the client’s view.

10. A 68-year-old is admitted with a 14. An adult had open heart surgery today
diagnosis of right-sided congestive heart for a mitral valve replacement. He has a
failure. What assessment findings would the central venous pressure catheter. The CVP is
nurse expect in this client? recorded every 15 minutes. The nurse has
1. Distended neck veins. observed a marked increase in the CVP over
2. Slight ankle edema. the last 2 hours. The latest reading is above
3. Hypotension. normal. Which nursing action would be
4. Premature ventricular contractions. appropriate before the surgeon is called?
1. Increase the IV slightly to improve
11. Digoxin and Lasix (Furosemide) are cardiac output.
ordered for an adult client. Which of the 2. Elevate the client’s feet to increase venous
following would the nurse expect to be return.
ordered for this client? 3. Decrease the IV to a “keep open” rate.
1. Potassium. 4. Check the specific gravity of the urine.
2. Calcium.
3. Aspirin. 15. For which of the following surgical
4. Warfarin. procedures is it essential for the nurse to
note the presence or absence of the dorsalis
12. An adult client is receiving digoxin. One pedis and posterior tibial pulses?
morning when the nurse goes to give the 1. Carotid endartarectomy.
client his digoxin he says, “I think I need to 2. Iliofemoral bypass.
see the eye doctor. Things seem to look 3. Vein ligation.
green today.” The nurse takes his vital signs 4. Pacemaker implantation.
16. The nurse knows that the reason a client 20. A 48-year-old is found on a routine
who has had a myocardial infarction is physical examination to have a blood
getting heparin is to: pressure of 170/98. Follow up studies
1. Prevent extension of a thrombus. confirm a diagnosis of hypertension. He is
2. Dissolve small thrombi that have lodged prescribed hydrochlorothiazide. What
in the coronary arteries. nursing instruction is it essential for him to
3. Enhance the action of thrombin in the receive?
bloodstream. 1. Use a calcium based salt substitute.
4. Decrease the amount of time it takes the 2. Avoid hard cheeses.
blood to clot. 3. Drink orange juice or eat a banana daily.
4. Do not take aspirin.
17. The nurse is caring for a client receiving
heparin sodium. Which medication should 21. A low sodium diet has been ordered for
the nurse have readily available because the an adult client. Which menu is the lowest in
client is receiving heparin? sodium?
1. Vitamin K. 1. Tossed salad, carrot sticks, steak.
2. Magnesium sulfate. 2. Baked chicken, mashed potatoes, green
3. Warfarin sodium. beans.
4. Protamine sulfate. 3. Hot dog, roll, coleslaw.
4. Chicken noodle soup, applesauce, cottage
18. A 60-year-old client is admitted to the cheese.
hospital with peripheral vascular disease of
the lower extremities. He has had diabetes 22. An adult client was admitted to the
mellitus for 22 years. He smokes two packs coronary care unit following a
of cigarettes per day and is employed in a subendocardial myocardial infarction. A
job where he must stand for 7 or more hours balloon-tipped pulmonary artery catheter
each day. Which of the following would the was inserted when the client began to
nurse expect to elicit when assessing this exhibit signs of cardiogenic shock. The
client? nurse measures the client’s pulmonary
1. Diminished pedal pulses. capillary wedge pressure and finds it to be
2. Warm tender calves. 27 mm Hg. The nurse knows that this
3. Tremors of the feet bilaterally. pressure is
4. Difference in blood pressure when sitting 1. Within normal limits.
and standing. 2. Elevated above normal.
3. Less than normal.
19. A 60-year-old man has several ischemic 4. Life threatening.
ulcers on each ankle and lower leg area.
Other parts of his skin are shiny and taut 23. An elderly client with a long history of
with loss of hair. A primary nursing goal for heart disease was brought to the emergency
this client should be to department of a local hospital following a 30
1. Increase activity tolerance. minute episode of chest pain unrelieved by
2. Relieve anxiety. nitroglycerin. The client’s
3. Protect from injury. electrocardiograph has an inverted T wave.
4. Help build a positive body image. The nurse caring for the client knows this
finding indicates
1. First-degree heart block.
2. Second-degree heart block.
3. Atrial flutter.
4. Myocardial ischemia.

24. A client is admitted with

thrombophlebitis of the right leg. Which
findings would the nurse expect when
assessing this client?
1. Diminished pedal pulses.
2. Color changes in the extremities when
elevated.
3. Red, shiny skin.
4. Pain when the leg is elevated.

25. Heparin via IV infusion is ordered for a

client. Which of the following test results
should the nurse monitor frequently?
1. Hemoglobin and hematocrit.
2. Activated Partial Thromboplastin Time
(APTT)
3. Prothrombin time.
4. Platelet count.
 4. The nurse is caring for a client who
had a total thyroidectomy. Postoperative
nursing care after his return to the nursing
care unit should include observing for
Endocrine
1. Hoarseness.
1. The client is admitted with a 2. Signs of hypercalcemia.
tentative diagnosis of diabetes insipidus. 3. Loss of reflexes
What should the nurse assess for while 4. Mental confusion
taking a nursing history?
5. The nurse is teaching a client who
1. An increased appetite. had a total thyroidectomy in preparation for
2. Excessive urine output. discharge. Which is of highest priority in the
3. Recent rapid weight gain. teaching plan?
4. Gynecomastia.
1. “Report any signs of inflammation at
2. A client has a transphenoidal the incision site.”
hypophysectomy for a pituitary tumor. 2. “Take your thyroid medication every
When he returns to the nursing unit day.”
following surgery the head of his bed is 3. “Continue with coughing and deep
elevated 300. The primary purpose for this breathing exercises.”
position is to: 4. “Maintain strict bedrest for the first
week at home.”
1. Promote respiratory effort and
prevent atelectasis. 6. Which of the following is most likely
2. Reduce pressure on the sella turcica to develop if hyperthyroidism remains
and reduce headache. untreated?
3. Prevent acidosis and development of
cerebral edema. 1. Pulmonary embolism.
4. Promote oxygenation and prevent 2. Respiratory acidosis.
cerebral ischemia. 3. Cerebral vascular accident.
4. Heart failure
3. The nurse is discussing discharge
plans with a client who had a transphenoidal 7. A diagnosis of toxic hyperthyroidism
hypophysectomy. Which statement made by is made in the client. Propylthiouracil 100
the client indicates a need for more mg po tid is ordered. Which of the
teaching? following is the expected effect of this drug?

1. I won’t brush my teeth until the 1. Increased perspiration and decreased

doctor removes the stitches. appetite.
2. I will wear loafers instead of tie 2. Increased basal metabolic rate.
shoes. 3. Increase in protein bound iodine.
3. Where can I get a Medic Alert 4. Weight gain and reduced pulse.
bracelet?
4. I will take all these new medicines 8. A client, who has just had a
until I feel better. thyroidectomy, returns to the unit in stable
condition. What equipment is it essential for 1. Shock can occur in clients who have
the nurse to have readily available? decreased amounts of adrenocortical
steroids.
1. Tracheostomy set. 2. Increased aldosterone levels cause
2. Thoracotomy tray. sodium retention and potassium excretion in
3. Sphygmomanometer. the kidneys.
4. Ice collar. 3. Excessive cortisone production
causes hypertension.
9. The client develops 4. Decreased amounts of
hypoparathyroidism after a total corticosteroids cause electrolyte imbalances.
thyroidectomy. What treatment should the
nurse anticipate? 13. The nurse is caring for a client who
is on a low sodium, high potassium diet.
1. Emergency tracheostomy. Which foods, if selected by the client,
2. Administration of calcium. indicate an understanding of the prescribed
3. Oxygen administration. diet?
4. IV potassium.
1. Baked macaroni and cheese, carrot
10. Which of the following diets would and raisin salad, and chocolate layer cake.
most likely be ordered for the client with 2. Shrimp salad, spinach salad, and
hypothyroidism? strawberries.
3. Cheese omelet, buttermilk biscuits
1. High protein, high calorie. and chocolate pudding.
2. Restricted fluids, low protein. 4. Fresh asparagus spears, broiled
3. High roughage, low calorie. chicken breast, and lettuce and tomato salad.
4. High carbohydrate, low roughage.
14. Diagnostic tests indicate that a 54-
11. A woman with myxedema is started year-old woman has bilateral adrenal
on thyroid replacement therapy and hyperplasia. She undergoes a bilateral
discharged. She returns to clinic one week adrenalectomy. The postoperative nursing
later. Which statement she makes is most care plan states to observe for adrenal crisis.
indicative of an adverse reaction to the Which of the following symptoms, if
medication? observed, would be most critical and need to
be reported immediately?
1. “My chest hurt when I was sweeping
the floor this morning.” 1. Pitting edema of the ankles.
2. “I had severe cramps last night.” 2. Lowering of the blood pressure.
3. “I am loosing weight.” 3. Oliguria.
4. “My pulse rate has been more rapid 4. Glucosuria.
lately.”
15. Fludrocortisone acetate (Florinef) 0.1
12. A client with Cushing’s syndrome is mg daily po has been ordered for a client
on a low sodium, high potassium diet for following bilateral adrenalectomy for which
which of the following reasons? of the following purposes?
1. To restore sodium and potassium You should ask your physician.”
balance. 3. “After surgery your appearance
2. To prevent hypertension. should gradually return to normal.”
3. To stimulate protein catabolism. 4. “Electrolysis and plastic surgery
4. To replace deficient adrenocortical should make your appearance normal.”
androgens.
19. The client is ready for discharge
16. The nurse is doing discharge following a unilateral adrenalectomy. Which
teaching with a client who has had a statement she makes indicates the best
bilateral adrenalectomy. What should be understanding of her condition?
included in the teaching plan?
1. “I will continue on a low sodium,
1. Telling her that after 1-2 years she low potassium diet.”
will likely not need to take medication. 2. “My husband has arranged for a
2. Explaining that she will need to take marriage counselor because of our fights.”
corticosteroids for the rest of her life. 3. “I will stay out of the sun so I will
3. Reinforcing that steroids should be not turn splotchy brown.”
slowly tapered if she decides to stop taking 4. “I will take all of those pills every
them. day.”
4. Teaching her urine and blood testing
to help in the regulation of steroid dosages. 20. The nurse’s next door neighbor
calls. He says he cannot awaken his 21-
17. A client who has had an year-old wife. The nurse notes that the
adrenalectomy is being discharged on client is unconscious and is having deep
Florinef 0.1 mg daily and prednisone 7.5 mg respirations. Her breath has a fruity smell to
daily. What instruction must be given to the it. The husband says that his wife has been
client? eating and drinking a lot and that last night
she vomited before lying down. Which of
1. Increase salt intake to prevent salt the following is the most appropriate initial
deprivation. action for the nurse to take?
2. Take the medication on an empty
stomach to aid in absorption. 1. Start cardiopulmonary resuscitation.
3. Expect a 3 to 5 pound weight 2. Get her to a hospital immediately.
increase for about 6 weeks. 3. Try to rouse her by giving her coffee.
4. Avoid exposure to infection, because 4. Give her sweetened orange juice.
she is susceptible.
21. An adolescent with newly diagnosed
18. A woman with a tumor of the adrenal IDDM asks the nurse if he can continue to
cortex says to the nurse, “Will I always look play football. What is the best answer for the
this ugly? I hate having a beard.” What is nurse to give?
the best response for the nurse to make?
1. “Now that you have diabetes, you
1. “After surgery you will not develop should not play football as you may get a cut
any more symptoms, but the changes you which will not heal.”
now have will linger.” 2. “If you work with your physician to
2. “That varies from person to person. regulate the insulin dosage and your diet you
should be able to play football.” 3. Eructation.
3. “It would be better for you to work 4. Singultus.
as equipment manager so you will not be
under as much stress. Stress can aggravate 25. An elderly client with NIDDM
diabetes.” develops an ingrown toenail. What is the
4. “You can probably continue to play best action for the nurse to take?
football if you can regulate it so that you
have the same amount of exercise each day.” 1. Put cotton under the nail and clip the
nail straight across.
22. An adolescent with IDDM is 2. Elevate the foot immediately.
learning about a diabetic diet. He asks the 3. Apply warm, moist soaks.
nurse if he will ever be able to go out to eat 4. Notify the physician.
with his friends again. What is the best
response for the nurse to make?

1. “You can go out with them but you

should take your own snack.”
2. “Yes. You will learn to use the
exchange lists so you can eat with your
friends.”
3. “When you get food out in a
restaurant be sure to order diet soft drinks.”
4. “Eating out will not be possible on a
diabetic diet. Why don’t you plan to invite
your friends to your house?”

23. One morning at 10 a.m. a client with

IDDM becomes very irritable and starts to
yell at the nurse. Which initial nursing
assessment should take priority?

1. Blood pressure and pulse.

2. Color and temperature of skin.
3. Reflexes and muscle tone.
4. Serum electrolytes.

24. An elderly client has been recently

diagnosed as having non-insulin dependent
diabetes mellitus (NIDDM). Which of the
following complaints she has is most likely
to be related to the diagnosis of diabetes
mellitus?

1. Pruritus vulvae.
2. Cough.
 unhindered by kinks.
4. Mark the time and level of drainage in the
collection chamber.

4. An adult client had a left thoracotomy. He

has portable water seal chest drainage. On
the first postoperative day the fluid in the
Respiratory Questions water seal chamber stops fluctuating. What
does this most likely indicate?
1. An adult client is admitted for diagnosis
1. The chest tube is clogged by fibrin or a
and treatment of a left lung lesion. A
clot.
bronchoscopy was performed under local
2. There is an air leak in the system.
anesthesia. What nursing action is of highest
3. Pulmonary edema has occurred due to
priority when he returns following the
increased blood volumes in remaining lung
bronchoscopy?
tissue.
1. Collect all sputum for examination.
4. The client’s left lung has reexpanded.
2. Assess level of consciousness frequently.
3. Withhold food and fluids until gag reflex
5. An adult client had a left lower
has returned.
lobectomy. Passive exercises are started on
4. Monitor blood pressure and pulse at 10
his left arm after surgery. The exercises are
minute intervals.
designed to prevent
1. Hyperflexion of the wrist.
2. A lower left lobectomy was performed on
2. Ankylosis of the shoulder.
an adult client. He was returned to his room
3. Flexion contractures of the elbow.
following an uneventful stay in the recovery
4. Spasticity of the intercostal muscle
room. It is most important for the nurse to
1. Encourage him to perform deep breathing
6. An adult client is admitted to the acute
and coughing exercises.
care hospital with bacterial pneumonia. On
2. Assist him with arm exercises to prevent
admission she was pale to dusky in color.
shoulder ankylosis.
Her respirations were 32, temperature 1030F
3. Help him perform leg exercises to prevent
and pulse 110. Auscultation revealed
thrombophlebitis.
decreased or absent lung sounds in both
4. Position him in semi-Fowler’s position on
bases and rhonchi in both upper lung fields.
his left side.
She was oriented to person, time and place,
but her responses were brief. Oxygen per
3. A client who has had a lobectomy returns
nasal cannula is started at 7 l / minute. IV
to the nursing unit. He has a chest tube
antibiotics were started. While checking the
attached to portable water seal drainage
client one hour after admission the nurse
system and oxygen per nasal cannula. The
notes that she is less responsive, answering
first nursing measure concerning the water
only yes or no questions. Her respirations
seal drainage is to
are somewhat more shallow and have
1. Milk the tubing to prevent accumulation
decreased to 27 per minute. What is the best
of fibrin and clots.
INITIAL action for the nurse to take?
2. Raise the drainage apparatus to bed height
1. Increase the IV infusion rate to increase
to accurately assess the meniscus level.
the amount of circulating antibiotics.
3. Attach the chest tubes to the bed linen to
2. Notify the physician of the client’s
assure that airflow and drainage are
changed mental status and await further suctioning.
orders. 4. Auscultate the lungs.
3. Increase the oxygen flow rate to 10 liters /
minute. 10. An adult is admitted to the hospital with
4. Continue to stimulate her until she progressive dyspnea on exertion, which has
responds appropriately. become increasingly severe during the last
six months. Physical examination reveals
7. A tracheostomy tube is inserted in a crackles at the base of the lung and clubbing
patient who is in respiratory distress as a of fingers. The client has asbestosis that has
result of pneumonia. The family asks why caused fibrosis in the alveoli. Soon after
the tube is inserted. What should the nurse admission, the nurse helps the client to the
include when explaining to the patient and bathroom. Before he returns to bed, he is
family? The purpose of a tracheostomy tube very short of breath. Considering the
is to severity of his symptoms, it is essential for
1. Decrease the client’s anxiety by the nurse to include which of the following
increasing the size of the airway. in the plan of care.
2. Provide increased cerebral oxygenation 1. Give continuous oxygen via nasal
thereby preventing further respiratory catheter.
depression. 2. Allow the client to move at his own pace.
3. Facilitate nursing care since tracheal tubes 3. Give bronchodilators to increase his
have fewer side effects than nasotracheal ability to breathe.
tubes. 4. Keep the client in bed to prevent further
4. Provide more controlled ventilation and episodes of dyspnea.
ease removal of secretions the client is
unable to handle. 11. An order is written for oxygen by nasal
cannula at 2 liters per minute. In assessing
8. An adult is about to have a tracheostomy the adequacy of the oxygen therapy, which
performed. Which action is of highest of the following is most effective?
priority for the nurse before the procedure is 1. Checking the respiratory rate.
done? 2. Checking the color of mucous
1. Establishing means of postoperative membranes.
communication. 3. Measurement of pulmonary functions.
2. Drawing blood for serum electrolytes and 4. Measurement of arterial blood gasses.
blood gases.
3. Inserting an indwelling catheter and 12. A client with asbestosis must see his
attaching it to dependent drainage. doctor regularly for a check up. What is the
4. Doing a surgical prep of the neck and primary reason for him to have frequent
upper chest wall. checkups?
1. Patients with asbestosis are at high risk
9. The nurse is performing tracheal for developing bronchogenic cancer.
suctioning. Which action is essential to 2. His doctor is monitoring him closely to
prevent hypoxemia during suctioning? look for signs of improvement.
1. Removal of oral and nasal secretions. 3. Patients who use low flow oxygen for
2. Encouraging the client to deep breathe long periods are at high risk for developing
and cough. neurological symptoms.
3. Administer 100% oxygen before
4. Periodic sputum samples are needed to 3. Assess for hypertension.
follow the progress of the disease. 4. Assess for blood streaked sputum.

13. An adult male has had a hacking cough 17. The nurse is positioning an adult who
and shortness of breath for several months. has just returned to the surgical nursing care
He now has chest pain. His family has unit following a pneumonectomy. What is
pressured him into seeking medical the most appropriate position in which to
consultation. He continues to say, “It is just place the client?
a smoker’s cough.” The physician examines 1. Semi-Fowler’s on the unaffected side.
the client and arranges for hospital 2. Semi-Fowler’s on the affected side.
admission for a diagnostic work-up. The 3. Sims position on the unaffected side.
nurse is explaining several types of tests that 4. Semi-Fowler’s on his back.
are ordered. Which of these tests is most
definitive in the process of ruling out a 18. Which of the following nursing
malignancy? interventions should be instituted the day
1. Needle biopsy. after surgery for the client who has had a
2. Thoracentesis. pneumonectomy?
3. Bronchogram. 1. Provide range of motion exercises to
4. Sputum analysis. affected arm.
2. Strip chest tubes every hour.
14. Preoperative teaching for the client who 3. Force fluids to 3500 cc / day.
is to have a pneumonectomy should include 4. Monitor intermittent positive pressure
all of the following. Which is of highest breathing therapy.
priority?
1. Management of postoperative pain. 19. An adult has been diagnosed as having
2. Turning, coughing and deep breathing pulmonary tuberculosis. Which test(s)
exercises. would the nurse expect to be ordered before
3. How to move with the least pain. the client is started on Isoniazid (INH)
4. Leg exercises. therapy?
15. An adult client has just arrived in the 1. LDH, SGOT (AST)
recovery room following a pneumonectomy. 2. BUN, serum creatinine
What is the most appropriate initial action 3. Skin test for allergy
for the nurse? 4. Chest X-ray
1. Take his vital signs for baseline data.
2. Check the IV solution for rate and correct 20. A patient is admitted with
solution. histoplasmosis. Which item in the patient’s
3. Administer oxygen through an appropriate history is most likely related to the onset of
device. the disease?
4. Auscultate for the presence of breath 1. He works in a factory.
sounds. 2. He likes to explore caves.
3. He has three cats.
16. What action is essential because the 4. He smokes four packs of cigarettes a
client had a pneumonectomy? week.
1. Observe the tracheal position.
2. Auscultate bilateral breath sounds.