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1. The nursing instructor is explaining cardiac function to the senior nursing class. The

instructor explains that blood is ejected into circulation as the chambers of the heart
become smaller. The instructor categorizes this action of the heart as what?
A) Systole abirb.com/test
B) Diastole
C) Hypertension
D) Ejection fraction abirb.com/test

2. During a shift assessment, the nurse is assessing the point of maximum impulse (PMI).
Where will the nurse best palpate the PMI? abirb.com/test

A) Left midclavicular line of the chest wall at the seventh intercostal space
B) Left midclavicular line of the chest wall at the fifth intercostal space
C) Right midclavicular line of the chest wall at the sevaebnirtbh.cionmt/etersct ostal space
D) Right midclavicular line of the chest wall at the fifth intercostal space

3. The instructor is teaching the beginning nursing class hoawbirtbo.cocma/ltceustlate pulse

pressure. If the patient's systolic pressure was 122 mm Hg and the diastolic pressure was
75 mm Hg, what would the pulse pressure be?
A) 57 abirb.com/test
B) 60
C) 54
D) 47
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4. The nurse is caring for a patient admitted with unstable angina. The laboratory result for
the initial troponin I is elevated in this patient. The nurseabreirbc.ocogmn/itezset s what?
A) This is only an accurate indicator of myocardial damage when it reaches its peak in
24 hours.
B) Because the entry diagnosis is unstable angina, this is a poor indicator of
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myocardial injury.
C) This is an accurate indicator of myocardial
injury.
D) It is only an accurate indicator of skeletal muscle injury.
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5. You are conducting patient teaching about cholesterol levels in the body. When
discussing the patient's elevated LDL and lowered HDL levels, the patient shows an
understanding of the significance of these levels by statinagbirbw.choamt/?test
A) “Increased LDL and decreased HDL increase my risk of coronary artery disease.”
B) “Increased LDL and decreased HDL decrease my risk of coronary artery disease.”
C) “The decreased HDL level will increase the amountaboirfb.cchomo/lteesstterol
moved away from the artery walls.”
D) “The increased LDL will decrease the amount of cholesterol deposited on the
artery walls.”
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 6. The physician has placed a central venous pressure (CVP) monitoring line in your
patient so assessments can be made on right ventricular function and venous blood
return. The results show a decreased central venous pressaubirrbe..coWm/hteastt does this
indicate?
A) Possible hypovolemia
B) Possible hypervolemia
C) Right ventricular failure abirb.com/test
D) Left ventricular failure

7. The nurse is caring for a patient with heart failure. Whileabairubs.ccouml/tteastting heart
sounds of this patient, the nurse hears an extra heart sound immediately after the
second heart sound (S2). How would the nurse document this?
A) A first heart sound (S1) abirb.com/test
B) A third heart sound (S3)
C) A fourth heart sound (S4)
D) A murmur
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8. The physical therapist notifies the nurse that a patient with coronary artery disease
(CAD) experiences an increase in heart rate during physiacbairlb.tchomer/taepsty at the
bedside. The nurse recognizes that an increase in heart rate in a patient with CAD may
result in what?
A) Increased myocardial perfusion
B) Myocardial ischemia
C) Formation of a pulmonary embolism abirb.com/test

D) Electrolyte imbalances

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9. You are caring for an 82-year-old patient. You know that changes in the cardiac
structure and function occur in the heart of an older adult. What is a normal change
expected in the aging heart of an older adult?
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A) Decreased left ventricular ejection time
B) Decreased connective tissue in the SA and AV nodes and bundle branches
C) Thinning and flaccidity of the cardiac values
D) Widening of the aorta abirb.com/test

10. You are on triage duty in the emergency department (ED) when a patient presents to the
ED with symptoms indicative of a myocardial infarctiona(bMirb.Ic)o.mT/theset patient
informs you that these symptoms have been occurring over the last 4 to 5 days. Which
diagnostic study do you expect the physician to order to diagnosis an MI?
A) Myoglobin levels Page 2
B) Creatine kinase (CK) and its isoenzyme CK-MB
C) Troponin T and I
D) Lactic dehydrogenase and its isoenzymes
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11. The critical care nurse is caring for a patient with a central venous pressure (CVP)
monitoring system. The nurse notes that the patient's CVP is increasing. What may this
be indicative of? abirb.com/test
A) Hypovolemia
B) Hypervolemia
C) Hypermagnesemia abirb.com/test
D) Hypomagnesemia

12. The critical care nurse is caring for a patient with a pulmaobnirba.rcyoma/rtetsetry pressure
monitoring system. The nurse is aware that pulmonary artery pressure monitoring is
used to assess left ventricular function (cardiac output.) What else are pulmonary artery
pressure monitoring systems used for? abirb.com/test
A) To assess the patient's response to interventions such as fluid administration and
drug administration
B) To obtain specimens for arterial blood gas measurements
C) They have been determined to not be clinically usefaublirbf.ocormc/otensttinuous
monitoring of a patient with heart failure
D) To diagnose the etiology of chronic obstructive pulmonary disease
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13. The student nurses are studying the conduction system of the heart. The instructor
explains that the electrical conduction of the heart usually originates in the SA node.
Which sequence completes the conduction? abirb.com/test

A) SA node to bundle of His to AV node to Purkinje fibers

B) SA node to AV node to Purkinje fibers to bundle of His
C) SA node to bundle of His to Purkinje fibers to AV naobidrbe.com/test
D) SA node to AV node to bundle of His to Purkinje fibers

14. Your patient has had a myocardial infarction and has beeanbirdb.icaogmn/toessted as having
damage to the layer of the heart responsible for the pumping action. You are aware that
the damage occurred where?
A) Endocardium abirb.com/test
B) Pericardium
C) Myocardium
D) Visceral pericardium
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15. The nurse working on a cardiac care unit is caring for a patient whose stroke volume has

increased. The nurse is aware that afterload influences a patient's stroke volume. The
nurse recognizes that afterload is increased when there is what?
A) Arterial vasoconstriction abirb.com/test
B) Venous vasoconstriction
C) Arterial vasodilatation
D) Venous vasodilatation abirb.com/test

16. In preparation for a transesophageal echocardiography, the nurse must

A) instruct the patient to drink 1 liter of water before thaebirtbe.csot.m/test
B) heavily sedate the patient.
C) inform the patient that blood pressure (BP) and electrocardiogram (ECG)
monitoring will occur throughout the test. abirb.com/test
D) inform the patient that an access line will be initiated in the femoral artery.

17. You are caring for a patient admitted with angina who isasbcirbh.ecodmu/lteesdt for a
cardiac catheterization. The patient is anxious and asks you about the reason for this
test. What is your best response?
A) “A cardiac catheterization is most commonly done
taobirabs.csoems/stesctoronary artery patency.”
B) “A cardiac catheterization is most commonly done to detect myocardial ischemia.”
C) “A cardiac catheterization is most commonly done to evaluate cardiovascular
response to stress.” abirb.com/test

D) “A cardiac catheterization is most commonly done to evaluate cardiac electrical

activity.”
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18. You are a critical care nurse caring for a patient who has suffered an MI. You know that
the most appropriate hemodynamic monitoring procedure to assess the left ventricular
function of a patient who has suffered an MI would be wahbairbt?.com/test
A) CVP monitoring
B) Pulmonary artery pressure monitoring (PAPM)
C) Systemic arterial pressure monitoring abirb.com/test
(SAPM)
D) Arterial blood gases (ABG)

19. A critically ill patient is admitted to the ICU. The physicaiabinrb.dcoemc/itdesets to use
intra-arterial pressure monitoring. What is the purpose of this?
A) To assess left ventricular function
B) To assess the pressure of the vena cava
C) To assess the pressure in the right atrium Page 4
D) To measure the patient's BP continually
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20. How is hemodynamic monitoring achieved?
A) Noninvasive monitoring systems
B) Extracorporeal monitoring systems
C) Direct pressure monitoring systems abirb.com/test
D) Partial pressure monitoring systems

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21. A patient is brought into the emergency department (ED) by family members who tell
the nurse the patient grabbed his chest and complained of substernal chest pain that feels
like something is sitting on his chest. The pain radiates to the jaw and the left shoulder.
The nurse notes the patient is diaphoretic and short of breabaitrbh..coWm/hteastt is the
nurse's priority action?
A) Notify the physician of a probable MI
B) Take vital signs abirb.com/test
C) Give sublingual nitroglycerin
D) Administer oxygen

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22. The nursing instructor is talking to her clinical group about taking an intake assessment
on a patient with coronary artery disease. What would be an important determination to
make during this intake assessment? abirb.com/test
A) If the patient and involved family members understand the discharge medications
and regimen
B) If the patient and involved family members understand nutrition
C) If the patient and involved family members are ableabtoirbr.ceocmo/tgenstize
symptoms of an acute cardiac problem, such as ACS or HF, and seek timely
treatment for these symptoms
D) If the patient and involved family members understaabnirdb.tchome /tteesat
ching done on exercise and dietary modifications

23. The synchronization of the atrial and ventricular events iasbtirhb.ecotmo/pteisct of the
prenursing physiology class today. What are the physiologic characteristics of the
nodal and Purkinje cells that provide this synchronization? (Mark all that apply.)
A) Loop connectivity
B) Excitability
C) Automaticity
D) Conductivity Page 5
E) Independence
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24. What is the terminal

point in the conduction
system of the heart? abirb.com/test

A) fibers abirb.com/test
B) AV node 25. You are caring for a 77-year-old
C) Bundle of HIS patient who was admitted to your
unit with vital fatigue
D) Nodal cells
and shortness of breath. What
could be a presumptive diagnosis
for this client?
A) Acute MI
B) A
c s
u y
t n
e d
r
c o
o m
r e
o D) S
n y
a n
r c
y o
p
s e
y
n
d
r
o
m
e
C) C
h
r
o
n
i
c

c
o
r
o
n
a
r
y
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a abir
bi b.c
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m .c est
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es m
t /t
es
t 27. When hemodynamic
monitoring is ordered for a
26. The nursing patient,aabircba.ctohme/tteesrt is
students are inserted into the appropriate
learning about blood vessel or heart chamber.
diagnostic tests It is then connected to a
for pressure monitoring system
cardiovascular that includes what? (Mark all
disease (CVD). that apply.)
One blood test A) A a
related to CVD tran bi
r
is a lipid profile. sdu b
When should a cer .c
o
lipid profile be B) A m
dra a flus /t
e
wn lar h st
to ge syst
get me em
acc al C) A
a
urat leve bi
e ler r
b
res D) A .c
ults pres o
m
? sure /t
A) After bag e
st
an E) An
8- osci
hou llat
r or
fast
B) After
a 28. The critical care nurse is
me caring for a client with
al bradycaardbiirba.caofmte/tersct
hig ardiovascular surgery. The
h in nurse knows that the heart rate
fat is determined by myocardial
C) After cells with the fastest inherent
a firing rate. Under normal
12- circumstances where are these
hou cells located?
r A) SA node
fast B) A e
D) After V nod C) Bu
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abi
ndl rb.
e co
m/t
of est
HI
S
D)Purki
nje
cel
ls

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29. The nurse is doing discharge teaching with a patient with coronary artery disease. The

patient asks why he has to take an aspirin every day if he doesn't have a headache. What
would be the nurse's best response?
A) “Taking an aspirin every day is an easy way to prevaebnirtb.pcolmaq/teuset
build-up in the arteries.”
B) “An aspirin a day is a common nonprescription medication that improves outcomes
in patients with CAD.” abirb.com/test
C) “Taking an aspirin every day really isn't necessary. It just makes some patients feel
like they are doing something to help themselves.”
D) “An aspirin a day is an easy way to help yourself feel better.”
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30. The physician has ordered an hs-CRP drawn on his patient. The results of the test are
1.75 mg/dL. The nurse would know that this patient has awbihrba.ctormis/tkesft or CVD?
A) High
B) Moderate
C) Low
D) None abirb.com/test

31. The patient has a homocysteine level ordered. What shoualbdirbt.hcoemn/teusrtse

know about laboratory results for homocysteine levels? (Mark all that apply.)
A) A 12-hour fast is necessary before drawing the blood sample.
B) A diet low in vitamin B6 can depress homocysteine levels.
C) Genetic factors can elevate homocysteine levels. abirb.com/test
D) A diet low in folic acid elevates homocysteine levels.
E) An 8-hour fast is necessary before drawing the blood sample.
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32. What part of an ECG is used to identify the presence of myocardial ischemia or injury?
A) ST segments
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B) QRS complex
C) Inverted P wave
D) D PVC
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33. A critical care nurse is caring for a patient with a hemodynamic monitoring system in
place. What complications should the nurse assess for? (Mark all that apply.)
A) Pneumothorax Page 7
B) Infection
C) Hemorrhage
D) Hemothorax
E) Air embolism
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34. Your patient has a CVP catheter in place. When you assess your patient, you find that

the pressure is 7 mm Hg. You know that normal pressure in the right atrium is what?
A) 2 to 3 mm Hg
B) 2 to 4 mm Hg abirb.com/test
C) 2 to 6 mm Hg
D) 2 to 7 mm Hg
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35. A critical care nurse is caring for a patient with a pulmonary artery catheter in place.
What does this catheter measure that is particularly important in critically ill patients?
A) Pulmonary artery systolic pressure abirb.com/test

B) Right ventricular afterload

C) Pulmonary artery pressure
D) Left ventricular preload abirb.com/test

36. A patient is brought to the emergency department by paramedics for a dysrhythmia.

When the patient is placed on the cardiac monitor, the pearbvirab.dcoinmg/tersht ythm is a
premature ventricular contraction (PVC) every other beat. The nurse knows that a PVC
is caused by what?
A) Late repolarizations of the atrium of ventricle abirb.com/test
B) Early depolarizations of the atrium or ventricle
C) Early firing of the AV node
D) Late firing of the SA node
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37. The student nurse is making a teaching plan for a patient being discharged status post
MI. What should the student include in the teaching plana?bi(rbM.coamrk/teastll that
apply.)
A) The need for careful monitoring
B) The need for exercise
C) The need for dietary modifications
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D) The need for psychological support groups
E) The need for daily weight loss

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38. You are caring for a patient admitted with a myocardial infarction. While you are doing
the admission assessment, the patient asks you for a laxative. The patient tells you he
suffers from constipation. What would you teach this patient to do to help his
constipation?
A) Take a mild laxative every day Page 8
B) Drink prune juice every day
C) Establish a nutritious diet
D) Don't strain during defecation

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Answer Key
Chapter 27

1. A
2. B Page 9
3. D
4. C
5. A
6. A
7. B
8. B
9. D
10. C
11. B
12. A
13. D
14. C
15. A
16. C
17. A
18. B
19. D
20. C
21. D
22. C
23. B, C, D
24. A
25. B
26. C
27. A, B, D
28. A
29. B
30. B
31. A, C, D
32. A
33. A, B, E
34. C
35. D
36. B
37. A, B, C
38. D
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