NRSG 3420 EXAM 2d Questions with CORRECT
Answers (Grade A+)
Question 1:
A client with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should
inform the client about what potential adverse effects? A) Nervousness or paresthesia B)Throbbing
headache or dizziness C) Drowsiness or blurred vision D) Tinnitus or diplopia
Answer:
Throbbing headache or dizziness Explanation: Headache and dizziness commonly occur when
nitroglycerin is taken at the beginning of therapy. Nervousness, paresthesia, drowsiness, blurred vision,
tinnitus, and diplopia do not typically occur as a result of nitroglycerin therapy. Reference: Hinkle, J.L.,
& Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia,
Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Chart
27-3, p. 759. Chapter 27: Management of Patients with Coronary Vascular Disorders - Page 759
Question 2:
The physical therapist notifies the nurse that a client with coronary artery disease (CAD) experiences a
much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an
increase in heart rate in a client with CAD may result in what? A) Development of an atrial-septal
defect
Answer:
Myocardial ischemia Explanation: Unlike other arteries, the coronary arteries are perfused during
diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Clients,
particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not
usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are
congenital. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of
Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 25: Assessment of
Cardiovascular Function, Coronary B) Myocardial ischemia Arteries, p. 675. C) Formation of a pul-
Chapter 25: Assessment of Cardiovascular Function - Page 675 monary embolism D) Release of
potassium ions from cardiac cells
Question 3:
The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the
client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired
goal for cholesterol levels is which of the following? A) High HDL values and high triglyceride values
B) Absence of detectable total cholesterol levels C) Elevated blood lipids, fasting glucose less than 100
D) Low LDL values and high HDL values
Answer:
,Low LDL values and high HDL values Explanation: The desired goal for cholesterol readings is for a
client to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature
because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL
promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated
triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride
levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol. Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed.,
Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular
Disorders, Controlling Cholesterol Abnormalities, p. 753. Chapter 27: Management of Patients with
Coronary Vascular Disorders - Page 753
Question 4:
The health care provider has placed a central venous pressure (CVP) monitoring line in an acute-
Answer:
Possible hypovolemia Explanation: ly ill client so right ven- Hypovolemia may cause a decreased CVP.
MI, valve regurgitation and tricular function and veheart failure are less likely causes of decreased
CVP. nous blood return can Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook
be closely monitored. The of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, results
show decreased 2018, Chapter 25: Assessment of Cardiovascular Function, Central CVP. What does
this indi- Venous Pressure Monitoring, p. 706. cate? Chapter 25: Assessment of Cardiovascular
Function - Page 706 A) Possible hypovolemia B) Possible myocardial infarction (MI) C) Left-sided
heart failure D) Aortic valve regurgitation
Question 5:
The nursing instructor is teaching nursing students about myocardial contractility and ejection
fractions. What diagnostic tests can determine client ejection fractions? Select all that apply. A)
Echocardiogram B) Cardiac catheterization C) Magnetic resonance imaging D) Positron emission
tomography scan E) Troponin levels
Answer:
Echocardiogram Cardiac catheterization Magnetic resonance imaging Explanation: Echocardiogram,
cardiac catheterization, and magnetic resonance imaging can provide ejection fraction estimates. The
positron emission tomography scan reveals areas of decreased blood flow in the heart. Troponin levels
are cardiac markers and do not measure ejection fractions. Reference: Hinkle, J.L., & Cheever, K.H.,
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer,
2018, Chapter 25: Assessment of Cardiovascular Function, Effect of Stroke Volume on Cardiac
Output, p. 678. Chapter 25: Assessment of Cardiovascular Function - Page 678
Question 6:
, A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of
developing the disorder. Which is the best response by the nurse? A) "Moderation is the key to
everything." B) "Ask your physician to prescribe the new reverse lipid drug." C) "Increase the soy in
your diet." D) "Exercise, keep your blood sugar in check, and manage your stress."
Answer:
"Exercise, keep your blood sugar in check, and manage your stress." Explanation: Although
moderation is the key, this does not provide specific options for this client such as regular exercise and
managing stress and cholesterol levels. The reverse lipid drug sounds good but is not available or
approved by the FDA. Soy products have limited benefits for cholesterol control. Reference: Hinkle,
J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed.,
Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular
Disorders, Chart 27-1: Risk factors, Coronary Artery Disease, p. 752. Chapter 27: Management of
Patients with Coronary Vascular Disorders - Page 752
Question 7:
A client who has undergone valve replacement surgery is being prepared for discharge home. Because
the client will be discharged with a prescription for warfarin, the nurse should educate the client about
which of the following?
Answer:
The need for regularly scheduled testing of the client's International Normalized Ratio (INR)
Explanation: Clients who take warfarin after valve replacement have individualized target INRs;
usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement.
Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping
upright is unnecessary. A) The need for regularly Reference: Hinkle, J.L., & Cheever, K.H., Brunner &
Suddarth's Textbook scheduled testing of the of Medical-Surgical Nursing, 14th ed., Philadelphia,
Wolters Kluwer, client's International Nor- 2018, Chapter 28: Management of Patients with Structural,
Infectious malized Ratio (INR) and Inflammatory Cardiac Disorders, Nursing Management: Valvulo-
B) The need to learn to plasty and Valve Replacement, p. 801. sleep in a semi-Fowler po- Chapter 28:
Management of Patients with Structural, Infectious and sition for the first 6 to 8 Inflammatory Cardiac
Disorders - Page 801 weeks to prevent emboli C) The need to avoid foods that contain vitamin K D)
The need to take enteric-coated ASA on a daily basis
Question 8:
The nurse is writing a plan of care for a client with a cardiac dysrhythmia. What would be the priority
goal for the client? A) Maintain a resting heart rate below 70 bpm. B) Maintain adequate control of
chest pain. C) Maintain adequate cardiac output. D) Maintain normal cardiac structure.
Answer:
Maintain adequate cardiac output. Explanation: For client safety, the most appropriate goal is to
maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A
Answers (Grade A+)
Question 1:
A client with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should
inform the client about what potential adverse effects? A) Nervousness or paresthesia B)Throbbing
headache or dizziness C) Drowsiness or blurred vision D) Tinnitus or diplopia
Answer:
Throbbing headache or dizziness Explanation: Headache and dizziness commonly occur when
nitroglycerin is taken at the beginning of therapy. Nervousness, paresthesia, drowsiness, blurred vision,
tinnitus, and diplopia do not typically occur as a result of nitroglycerin therapy. Reference: Hinkle, J.L.,
& Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia,
Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular Disorders, Chart
27-3, p. 759. Chapter 27: Management of Patients with Coronary Vascular Disorders - Page 759
Question 2:
The physical therapist notifies the nurse that a client with coronary artery disease (CAD) experiences a
much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an
increase in heart rate in a client with CAD may result in what? A) Development of an atrial-septal
defect
Answer:
Myocardial ischemia Explanation: Unlike other arteries, the coronary arteries are perfused during
diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Clients,
particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not
usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are
congenital. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of
Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 25: Assessment of
Cardiovascular Function, Coronary B) Myocardial ischemia Arteries, p. 675. C) Formation of a pul-
Chapter 25: Assessment of Cardiovascular Function - Page 675 monary embolism D) Release of
potassium ions from cardiac cells
Question 3:
The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the
client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired
goal for cholesterol levels is which of the following? A) High HDL values and high triglyceride values
B) Absence of detectable total cholesterol levels C) Elevated blood lipids, fasting glucose less than 100
D) Low LDL values and high HDL values
Answer:
,Low LDL values and high HDL values Explanation: The desired goal for cholesterol readings is for a
client to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature
because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL
promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated
triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride
levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol. Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed.,
Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular
Disorders, Controlling Cholesterol Abnormalities, p. 753. Chapter 27: Management of Patients with
Coronary Vascular Disorders - Page 753
Question 4:
The health care provider has placed a central venous pressure (CVP) monitoring line in an acute-
Answer:
Possible hypovolemia Explanation: ly ill client so right ven- Hypovolemia may cause a decreased CVP.
MI, valve regurgitation and tricular function and veheart failure are less likely causes of decreased
CVP. nous blood return can Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook
be closely monitored. The of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, results
show decreased 2018, Chapter 25: Assessment of Cardiovascular Function, Central CVP. What does
this indi- Venous Pressure Monitoring, p. 706. cate? Chapter 25: Assessment of Cardiovascular
Function - Page 706 A) Possible hypovolemia B) Possible myocardial infarction (MI) C) Left-sided
heart failure D) Aortic valve regurgitation
Question 5:
The nursing instructor is teaching nursing students about myocardial contractility and ejection
fractions. What diagnostic tests can determine client ejection fractions? Select all that apply. A)
Echocardiogram B) Cardiac catheterization C) Magnetic resonance imaging D) Positron emission
tomography scan E) Troponin levels
Answer:
Echocardiogram Cardiac catheterization Magnetic resonance imaging Explanation: Echocardiogram,
cardiac catheterization, and magnetic resonance imaging can provide ejection fraction estimates. The
positron emission tomography scan reveals areas of decreased blood flow in the heart. Troponin levels
are cardiac markers and do not measure ejection fractions. Reference: Hinkle, J.L., & Cheever, K.H.,
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer,
2018, Chapter 25: Assessment of Cardiovascular Function, Effect of Stroke Volume on Cardiac
Output, p. 678. Chapter 25: Assessment of Cardiovascular Function - Page 678
Question 6:
, A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of
developing the disorder. Which is the best response by the nurse? A) "Moderation is the key to
everything." B) "Ask your physician to prescribe the new reverse lipid drug." C) "Increase the soy in
your diet." D) "Exercise, keep your blood sugar in check, and manage your stress."
Answer:
"Exercise, keep your blood sugar in check, and manage your stress." Explanation: Although
moderation is the key, this does not provide specific options for this client such as regular exercise and
managing stress and cholesterol levels. The reverse lipid drug sounds good but is not available or
approved by the FDA. Soy products have limited benefits for cholesterol control. Reference: Hinkle,
J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed.,
Philadelphia, Wolters Kluwer, 2018, Chapter 27: Management of Patients with Coronary Vascular
Disorders, Chart 27-1: Risk factors, Coronary Artery Disease, p. 752. Chapter 27: Management of
Patients with Coronary Vascular Disorders - Page 752
Question 7:
A client who has undergone valve replacement surgery is being prepared for discharge home. Because
the client will be discharged with a prescription for warfarin, the nurse should educate the client about
which of the following?
Answer:
The need for regularly scheduled testing of the client's International Normalized Ratio (INR)
Explanation: Clients who take warfarin after valve replacement have individualized target INRs;
usually between 2 and 3.5 for mitral valve replacement and 1.8 and 2.2 for aortic valve replacement.
Natural sources of vitamin K do not normally need to be avoided and ASA is not indicated. Sleeping
upright is unnecessary. A) The need for regularly Reference: Hinkle, J.L., & Cheever, K.H., Brunner &
Suddarth's Textbook scheduled testing of the of Medical-Surgical Nursing, 14th ed., Philadelphia,
Wolters Kluwer, client's International Nor- 2018, Chapter 28: Management of Patients with Structural,
Infectious malized Ratio (INR) and Inflammatory Cardiac Disorders, Nursing Management: Valvulo-
B) The need to learn to plasty and Valve Replacement, p. 801. sleep in a semi-Fowler po- Chapter 28:
Management of Patients with Structural, Infectious and sition for the first 6 to 8 Inflammatory Cardiac
Disorders - Page 801 weeks to prevent emboli C) The need to avoid foods that contain vitamin K D)
The need to take enteric-coated ASA on a daily basis
Question 8:
The nurse is writing a plan of care for a client with a cardiac dysrhythmia. What would be the priority
goal for the client? A) Maintain a resting heart rate below 70 bpm. B) Maintain adequate control of
chest pain. C) Maintain adequate cardiac output. D) Maintain normal cardiac structure.
Answer:
Maintain adequate cardiac output. Explanation: For client safety, the most appropriate goal is to
maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A
