Cardiovascular Questions - Lippincot

122 ❍ Cardiovascular disorders
Review questions
1. While auscultating the heart sounds of a patient with mitral insufficiency, the nurse hears an extra heart
sound immediately after the second heart sound (S2). The nurse should document this extra heart sound as:
A. a first heart sound (S1).
B. a third heart sound (S3).
C. a fourth heart sound (S4).
D. a mitral murmur.
Correct answer: B An S3 is heard following an S2, indicating that the patient is experiencing heart failure
and results from increased filling pressures. Option A (S1) is a normal heart sound made by the closing of
the mitral and tricuspid valves. Option C (S4) is heard before S1 and is caused by resistance to ventricular
filling. Option D (murmur of mitral insufficiency) occurs during systole and is heard when there’s turbu-
lent blood flow across the valve.
2. A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work site health
screening. What should the nurse do?
A. Consider this to be a normal finding for his age and race.
B. Recommend he have his blood pressure rechecked in 1 year.
C. Recommend he have his blood pressure rechecked within 2 weeks.
D. Recommend he go to the emergency department for further evaluation.
Correct answer: C A blood pressure of 150/90 mm Hg should be rechecked within 2 weeks according to
current recommendations. If confirmed, assessment and treatment should be initiated by the practitioner.
Option A is incorrect because although hypertension is more prevalent among blacks, a blood pressure
of 150/90 mm Hg isn’t considered normal. Option B is incorrect because a person with a blood pressure
of 150/90 mm Hg shouldn’t wait as long as 1 year to have it rechecked. Option D is incorrect because he
doesn’t need to be treated on an emergency basis, but he should have his blood pressure monitored.
3. The nurse is administering warfarin (Coumadin) to a patient with deep vein thrombophlebitis. Which labo-
ratory value indicates warfarin is at therapeutic levels?
A. PTT 1½ to 2 times the control
B. PT 1½ to 2 times the control
C. INR of 3 to 4
D. Hematocrit of 32%
Correct answer: B Warfarin is at therapeutic levels when the patient’s PT is 1½ to 2 times the control.
Higher values indicate increased risk of bleeding and hemorrhage, and lower values indicate increased
risk of blood clot formation. Option A is incorrect because heparin, not warfarin, prolongs PTT. Option
C is incorrect because although the INR may also be used to determine if warfarin is at a therapeutic
level, an INR of 2 to 3 is considered therapeutic. Option D is incorrect because hematocrit doesn’t provide
information on the effectiveness of warfarin; however, a falling hematocrit in a patient taking warfarin
may be a sign of hemorrhage.
Review questions ❍ 123
4. A patient is receiving captopril for heart failure. The nurse should notify the practitioner that the
medication therapy is ineffective if an assessment reveals:
A. a skin rash.
B. peripheral edema.
C. a dry cough.
D. postural hypotension.
Correct answer: B Peripheral edema is a sign of fluid volume overload and worsening heart failure. The
other options (a skin rash, dry cough, and postural hypotension) are adverse reactions to captopril, but
they don’t indicate that therapy isn’t effective.
5. A 60-year-old male patient is suspected of having coronary artery disease. Which noninvasive diagnostic
method would the nurse expect to be ordered to evaluate cardiac changes?
A. Cardiac biopsy
B. Cardiac catheterization
C. MRI
D. Pericardiocentesis
Correct answer: C MRI is a noninvasive procedure that aids in the diagnosis and detection of thoracic
aortic aneurysm and evaluation of coronary artery disease, pericardial disease, and cardiac masses. Car-
diac biopsy (Option A), cardiac catheterization (Option B), and pericardiocentesis (Option D) are invasive
techniques used to evaluate cardiac changes.
6. When evaluating an ECG strip of a patient on a telemetry unit, the nurse notices the patient is having pre-
mature ventricular contractions (PVCs). What criterion on the ECG strip does the nurse use to evaluate the pres-
ence of PVCs?
A. An indiscernible PR interval
B. P waves that appear erratic
C. P waves that have a sawtooth configuration
D. A QRS complex followed by a compensatory pause
Correct answer: D In PVCs, the ECG shows a QRS complex followed by a compensatory pause that
ends when the underlying rhythm resumes. Options A and B are ECG criteria used to evaluate atrial
fibrillation. Option C is used to describe criteria for atrial flutter.
7. When locating Erb’s point to hear aortic and pulmonic sounds, the nurse should place the stethoscope at the:
A. fifth intercostal space near the midclavicular line.
B. fifth intercostal space along the left sternal border.
C. second intercostal space at the left sternal border.
D. third intercostal space at the left sternal border.
Correct answer: D Erb’s point is located at the third intercostal space at the left sternal border. The fifth
intercostal space near the midclavicular line (Option A) is used to listen to the mitral area. The fifth
intercostal space along the left sternal border (Option B) is the location for the tricuspid area. The second
intercostal space at the left sternal border (Option C) is the location for the pulmonic area.
124 ❍ Cardiovascular disorders
8. When caring for a patient with arterial occlusive disease, which of the following home health care
instructions is most appropriate for the nurse to give to the patient?
A. “You should massage your legs to relieve pain.”
B. “It’s best to sit and rest for several hours a day.”
C. “Make sure the head of your bed is slightly elevated when sleeping.”
D. “It’s best to wear tight socks instead of no socks.”
Correct answer: C The patient should make sure the head of the bed is slightly elevated to aid perfu-
sion to the lower extremities. The patient shouldn’t massage his legs (Option A) because doing so could
further damage tissue. Sitting for several hours a day (Option B) isn’t recommended. The patient should
wear loose clothing, not constrictive clothing such as socks with tight elastic (Option D), to avoid com-
pressing the vessels in the legs.
9. The nurse prepares to administer an ACE inhibitor to a patient with an acute MI for which reason?
A. To minimize platelet aggregation
B. To reduce preload and afterload
C. To reduce myocardial oxygen consumption
D. To decrease myocardial oxygen demand
Correct answer: B ACE inhibitors reduce preload and afterload. Antiplatelet drugs minimize platelet
aggregation (Option A). Nitrates reduce myocardial oxygen consumption (Option C). Beta-adrenergic
blockers reduce the workload of the heart and myocardial oxygen demand (Option D).
10. Which of the following conditions can cause right-sided heart failure?
A. A ventricular septal defect
B. An anterior MI
C. An atrial septal defect
D. Constrictive pericarditis
Correct answer: C An atrial septal defect can lead to right-sided heart failure. Left-sided heart failure
can result from a ventricular septal defect (Option A), an anterior MI (Option B), or constrictive pericardi-
tis (Option D).

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122 ❍ Cardiovascular disorders

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