1. A client is scheduled to have a percutaneous transluminal coronary angioplasty (PTCA).

What information about the balloon-tipped catheter should the nurse plan to include when
providing client education concerning the procedure?
a. A mesh like device within the catheter will be inflated causing it to spring open
b. The catheter will be used to compress the plaque against the coronary blood
vessel wall
c. The catheter will cut away the plaque from the coronary vessel wall using
embedded blade
d. The catheter will be positioned in a coronary artery to take pressure measurements
in the vessels.
Answer: b
Rationale: In PTCA, a balloon tipped catheter is used to compress the plaque against the
coronary blood vessel wall.
2. A clinic nurse is assessing a prenatal client who has been diagnosed with heart disease.
The nurse carefully assesses the client’s VS, weight and fluid and nutritional status to
detect for complications caused by which pregnancy related concern?
a. Rh incompatibility
b. Fetal cardiomegaly
c. The increase in circulating blood volume
d. Hypertrophy and increased contractility of the heart
Answer: c
Rationale: Pregnancy taxes the circulating system of every woman because the blood volume
increases, which causes the cardiac output to increase.
3. A client has developed atrial defibrillation resulting in a ventricular rate of 150 bpm. The
nurse should assess the client for which effects of this cardiac occurrence? Select all that
apply.
a. Dyspnea
b. Flat neck veins
c. Nausea and vomiting
d. Chest pain or discomfort
e. Hypotension and dizziness
f. Hypertension and headache
Answer: a, d, e
Rationale: The nurse should assess the client for palpitations, chest pain or discomfort,
hypotension, pulse deficit, fatigue, weakness, dizziness, syncope.
4. As part of cardiac assessment, to palpate the apical pulse, the nurse places the fingertips
at which location?
 a. At the left midclavicular line at the fifth intercostal space
b. At the left midclavicular line at the third intercostal space.
c. To the right of the left midclavicular line at the fifth intercostal space.
d. To the right of the left midclavicular line at the third intercostal space.
Answer: a
Rationale: The point of maximal impulse, is where the apical pulse palpated is normally located
in the fourth or fifth intercostal space at the left midclavicular line.
5. The nurse is assessing a client who is being treated with beta-adrenergic blocker. Which
assessment findings would indicate that the client may be experiencing dose-related side
effects of this medication? Select all that apply.
a. Dizziness
b. Bradycardia
c. Chest pain
d. Reflex tachycardia
e. Sexual dysfunction
f. Cardiac dysrhythmias
Answer: a, b, e
Rationale: Beta adrenergic blockers, commonly called beta blockers are useful in treating cardiac
dysrhythmias, mild hypertension, mild tachycardia and angina pectoris. Side effects commonly
include dizziness, bradycardia, hypotension and sexual dysfunction.
6. A client admitted to the hospital for evaluation of recurrent runs of ventricular
tachycardia, is scheduled for electrophysiology studies (EPS). Which statement should
the nurse include in a teaching plan for this client?
a. “You will continue to take your medications until the morning of the test”.
b. “You will be sedated during the procedure and will not remember what has happened”.
c. “This test is a noninvasive method of determining the effectiveness of your medication
regimen”.
d. “The test uses a special wire to increase the heart rate and produce the irregular beats that
cause your signs and symptoms”.
Answer: d
Rationale: The purpose of EPS is to study the hearts electrical system. During the invasive
procedure, a special wire is introduced into the heart to produce dysrhythmias.
7. Acetylsalicylic acid (aspirin) is prescribed for the client diagnosed with coronary artery
disease before a percutaneous transluminal coronary angioplasty (PTCA). The nurse
administers the medication understanding that it is prescribed for what purpose?
a. Relieve post procedure plan.
b. Prevent thrombus formation.

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 c. Prevent post procedure hyperthermia.
d. Prevent inflammation of the puncture site.
Answer: b
Rationale: Before PTCA, the client is usually given an anticoagulant, commonly aspirin to help
reduce the risk of occlusion of the artery during the procedure because the aspirin inhibits
platelet aggregation.
8. The nurse notes an isolated ventricular isolated premature ventricular contraction (PVC)
on the cardiac monitor of a client recovering from anesthesia. Which action should the
nurse take?
a. Prepare for defibrillation
b. Continue to monitor the rhythm.
c. Prepare to administer lidocaine hydrochloride
d. Notify the primary health care provider immediately.
Answer: b
Rationale: The PVC is not life threatening. In this situation the nurse should continue to monitor
the client.
9. The nurse is caring for a client prescribed digoxin. Which manifestations correlate with a
digoxin level 2.3ng/dL? Select all that apply.
a. Nausea
b. Drowsiness
c. Photophobia
d. Increased appetite
e. Increased energy level
f. Seeing halos around bright objects
Answer: a, b, c, f
Rationale: The therapeutic range is 0.8 to 2.0ng/mL. Signs of toxicity include gastrointestinal
disturbances, including anorexia, nausea and vomiting, neurological abnormalities such as
fatigue, headache, depression, photophobia, halos around bright lights.
10. The nurse is planning care for a client with a chest tube attached to a Pleur-Evac drainage
system. The nurse should include which interventions in the plan? Select all that apply.
a. Changing the client’s position often
b. Clamping the chest tube intermittently.
c. Maintaining the collection chamber below the client’s waist
d. Adding water to the suction control chamber as it evaporates.
e. Taping the connection between the chest tube and the drainage system.
Answer: a, c, d, e

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Rationale: Changing the client’s position frequently is necessary to promote drainage and
ventilation. Maintaining the system below waist level is indicated to prevent fluid from
reentering the pleural space. Adding water to the suction control chamber is an appropriate
nursing action and is done as needed to maintain the full suction level prescribed. Taping
connection between the chest tube and system is also indicated to prevent accidental
disconnection.
11. A client is admitted to the cardiac intensive care unit after coronary artery bypass graft
surgery. The nurse notes that in the first hour after admission, the mediastinal chest tube
drainage was 75mL. During the second hour, the drainage has dropped to 5mL. The nurse
interprets this data and implements which intervention?
a. Identifies that the tube is draining normally.
b. Assess the tube to locate a possible occlusion
c. Auscultates the lungs for appropriate bilateral expansion
d. Assists the client with frequent coughing and deep breathing
Answer: b
Rationale: After CABG surgery, chest tube drainage should not exceed 100 to 150 mL per hour
during the first 2 hours postoperatively and approximately 500mL of drainage is expected in the
first 24 hours after CABG surgery. The sudden drop in drainage between the first and second
hour indicates that the tube is possibly occluded and requires further assessment by the nurse.
12. The home health care nurse is performing an initial assessment on a client who has been
discharged after an insertion of a permanent pacemaker. Which client statement indicates
that an understanding of self-care is evident?
a. “I will never be able to operate a microwave oven again”
b. “I should expect occasional feelings of dizziness and fatigue”
c. “I will take my pulse in the wrist or neck daily to record it In a log”
d. “Moving my arms and shoulders vigorously helps check pacemaker functioning
Answer: c
Rationale: Clients with permanent pacemakers must be able to take their pulse in the wrist or
neck accurately so as to note any variation in the pulse rate or rhythm that may need to be
reported to the primary health care provider.
13. The nurse providing diet teaching to a client experiencing heart failure instructs the client
to avoid which food item?
a. Sherbet
b. Steak sauce
c. Apple juice
d. Leafy green vegetables
Answer: b

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Rationale: Steak sauce is high in sodium. Clients with heart failure need to monitor sodium
intake. Causes the retention of fluid.
14. The nurse admitting a client diagnosed with myocardial infarction (MI) to the coronary
care unit (CCU) should plan care by implementing which intervention?
a. Beginning thrombolytic therapy
b. Placing the client on continuous cardiac monitoring
c. Infusing intravenous fluid at rate of 150 mL per hour
d. Administering oxygen at a rate of 6L per minute by nasal cannula
Answer: b
Rationale: The nurse should ensure that there is an adequate IV line insertion of an intermittent
lock. If an IV infusion is administered it is maintained at a keep vein open rate to prevent fluid
overload and heart failure. Oxygen should be administered at a rate of 2L to 4L per minute
unless otherwise prescribed.
15. A client who underwent peripheral arterial bypass surgery 16 hours ago reports that there
is increasing pain in the leg that worsens with the movement and is accompanied by
paresthesias. Based on these data which action should the nurse take?
a. Call the primary health care provider
b. Administer an opioid analgesics
c. Apply warm moist heat for comfort
d. Apply ice to minimize any developing swelling,.
Answer: a
Rationale: Compartment syndrome is characterized by increased pressure within the muscle
compartment caused by bleeding or excessive edema.
16. The nurse is encouraging the client to cough and deep breath after cardiac surgery. The
nurse ensures that which item is available to maximize the effectiveness of this
procedure?
a. Nebulizer
b. Ambu bag
c. Suction equipment
d. Incisional splinting pillow
Answer: d
Rationale: The use of incisional splint such as cough pillow can ease discomfort during coughing
and deep breathing.
17. The nurse is preparing to initiate an intravenous nitroglycerin drip on a client who has
experienced an acute myocardial infarction. In the absence of an invasive(arterial)

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 monitoring line, the nurse prepares to have which piece of equipment for use at the
bedsides to help assure the client’s safety?
a. Defibrillator
b. Pulse oximeter
c. Central venous pressure tray
d. Noninvasive blood pressure monitor
Answer: d
Rationale: Action accounts for the primary side effect of nitroglycerin which is hypotension. In
the absence of an arterial monitoring line the nurse should have a noninvasive bp monitor for use
at the bedside.
18. A client who is being treated for acute heart failure has the following Vital Signs:
BP85/50mmHg, PR 96bpm, RR 26bpm. The primary health care provider prescribes
digoxin to evaluate a therapeutic response to this medication, which changes in the
client’s VS should the nurse expect?
a. BP 85/50mmHg, PR 60bpm, RR26 bpm.
b. BP 98/60mmHg, PR 80bpm, RR 24bpm.
c. BP 130/70mmHg, PR 104bpm, RR 20bpm.
d. BP 110/40mmHg, PR 110bpm,20bpm
Answer: b
Rationale: The main function of digoxin is inotropic. It produces increased myocardial
contractility that is associated with an increased cardiac output. This causes a rise in the BP in a
client with heart failure. Digoxin also has an effect that decreases the heart rate and therefore
slowing pf the HR.
19. A client admitted to the hospital with chest pain and history of type 2 DM 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
Answer: b
Rationale: Metformin needs to be withheld 24 hours before and 48 hours after cardiac
catheterization because of the injection of contrast medium during the procedure.
20. A client in sinus bradycardia, with a heart rate of 45 bpm complains of dizziness and has
a BP of 82/60mmHg. Which prescription should the nurse anticipate will be prescribed?
a. Administer diogoxin
b. Defibrillate the client

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 c. Continue to monitor the client
d. Prepare for transcutaneous pacing
Answer: d
Rationale: Sinus bradycardia is noted with a heart rate less than 60 beats per min. this rhythm
becomes a concern when the client becomes sympthomatic. Hypotension and dizziness are signs
of decreased cardiac output
21. A client with myocardial infarction suddenly becomes tachycardic show 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
Answer: b
Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger and
the production of frothy, pink tinged sputum. Auscultation of the lungs reveals crackles.
22. 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 more consistent with which complication? Refer to chart.
a. Cardiogenic shock
b. Cardiac tamponade
c. Pulmonary embolism
d. Dissecting thoracic aortic aneurysm
Answer: a
Rationale: Cardiogenic shock occurs with severe damage to the left ventricle.classics signs
include hypotension; a rapid pulse that becomes weaker; decreased urine output and cool and
clammy skin.
23. A client is wearing a continuous cardiac monitor, which begins tpo sound uits alarm. The
nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing
action?
a. Call a code
b. Call the health care provider
c. Check the client’s status and lead placement
d. Press the recorder button on the electrocardiogram console
Answer: c

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Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or
possivbly electrode displacement.
24. A client is having a frequent premature ventricular contractions. The nurse should place
priority on assessment of which item?
a. Sensation of palpitations
b. Causative factors, such as caffeine
c. Blood pressure and oxygen saturation
d. Precipitating factors such as infection
Answer: c
Rationale: Premature ventricular contractions can cause hemodynamic compromise. Therefore
the priority is to monitor the blood pressure and oxygen saturation.
25. The nurse is evaluating a client’s response to cardioversion. Which assessment would be
the priority?
a. Blood pressure
b. Status of the airway
c. Oxygen flowrate
d. Level of consciousness
Answer: b
Rationale: Nursing responsibilities after cardioversion include maintenance first of a patent
airway, and then oxygen administration \, assessment of VS and level of consciousness and
dysrhythmia detection
26. 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
Answer: b
Rationale: Classic sign 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 became apparent.
27. A client in ventricular fibrillation is about to be fibrillated. To convert this rhythm
effectively, the monophasic defibrillator machine should be set at which energy levels (in
joules,J) for the first delivery?
a. 50 J
b. 120 J

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 c. 200 J
d. 360 J
Answer: d
Rationale: the energy level used for all defibrillation attempts with s monophasic defibrillator is
360 joules.
28. The nurse is watching the cardiac monitor and a client’s rhythm suddenly changes. There
are no P waves; instead there are fibrillatory waves before each QRS complex. Hpow
should the nurse correctly interpret the client’s heart rhythm?
a. Atrial fibrillation
b. Sinus Tachycardia
c. Ventricular fibrillation
d. Ventricular tachycardia
Answer: a
Rationale: Atrial fibrillation is characterized by loss of P waves and fibrillatory waves before
each QRS complex.
29. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What
should the nurse be most concerned about with this dysrhythmia?
a. It can develop into ventricular defibrillation at anytime
b. It is almost impossible to convert to an normal rhythm
c. It is uncomfortable to the client giving a sense of impending doom
d. It produces a high cardiac output that quickly leads to cerebral and myocardial
ischemia.
Answer: a
Rationale: Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable
ectopic focus that takes over as the pacemaker for the heart.
30. The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the
pad on the client’s chest and before discharge, which intervention is priority?
a. Ensure that the client has been intubated.
b. Set the defibrillator to the “synchronize” mode.
c. Administer an Amniodarone bolus intravenously.
d. Confirm that the rhythm is actually ventricular fibrillation.
Answer: d
Rationale: Until the defibrillator is attached and charged the client is resuscitated by using
cardiopulmonary resuscitation. Once the defibrillator has been attached the ECG is checked to
verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia.

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