NUR 274: Exam 3 - Cardiac, Vascular, and Critical Care
Medgar Evers College
Commonly Occuring Health Problems I
NUR 274: Exam 3 - Cardiac, Vascular, and Critical Care
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Clinical Case: Acute Coronary Syndrome
A 62-year-old male presents to the Emergency Department complaining of heavy, crushing substernal chest pain that
radiates to his left jaw and shoulder. He is diaphoretic, nauseated, and appears anxious.
He has a history of smoking, hypertension, and hyperlipidemia.
Vital Signs:
- Blood Pressure: 158/94 mmHg
- Heart Rate: 108 bpm (Sinus Tachycardia)
- Respiratory Rate: 24 breaths/min
- SpO2: 91% on room air
An immediate 12-lead ECG is performed.
Based on the initial assessment, what is the nurse's immediate priority action?
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Section 1/5 120 total marks
Multiple Choice
Select the single best response for each of the following 60 questions.
Question 1 10 total marks
A Apply oxygen via nasal cannula at 2-4 L/min B
Administer 2 mg Morphine IV push
C Obtain a stat Troponin I level
D Administer 325 mg enteric-coated aspirin
B The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. The nurse identifies this as an injury in which
area of the heart?
A Septal wall
B Lateral wall
C Inferior wall
D Anterior wall
C The client is scheduled for an emergency Cardiac Catheterization. Which laboratory result is most critical for the
nurse to review prior to the procedure?
A White Blood Cell count
B Hemoglobin and Hematocrit
C Serum Potassium
D Serum Creatinine and BUN
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A
B
D The client is prescribed Nitroglycerin sublingual for chest pain. Which teaching point is accurate regarding
this medication?
A Expect a throbbing headache after administration.
B Take one tablet every 10 minutes until pain resolves.
C The medication remains potent for up to 2 years after opening.
D Swallow the tablet with a full glass of water.
E Following the cardiac catheterization, the nurse assesses the puncture site in the right groin. The site is firm
with no bleeding, but the right pedal pulse is weaker than the left. What is the nurse's first action?
A Check the temperature and color of both feet.
B Apply a pressure dressing to the site.
C Elevate the right leg on two pillows.
D Notify the physician immediately.
Question 2 10 total marks
Clinical Case: Heart Failure
A 75-year-old female is admitted with an exacerbation of Chronic Heart Failure. She reports sleeping in a recliner for
the past week because she 'can't breathe when lying flat.' She has significant swelling in her lower extremities.
Assessment Findings:
- Jugular Venous Distention (JVD) at 45 degrees
- 3+ pitting edema in bilateral ankles
- Crackles heard in the lung bases bilaterally
- S3 gallop noted on auscultation
- BNP: 1,200 pg/mL
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Which finding in the patient's assessment specifically indicates Right-Sided Heart Failure?
A S3 gallop
B Crackles in the lung bases
C Jugular Venous Distention
D Orthopnea
B The nurse identifies that the patient's 'crackles' and 'shortness of breath when lying flat' are manifestations of
which critical care complication?
Pulmonary Embolism
Pericarditis
C Pulmonary Edema
D Hypovolemic Shock
C The physician orders Digoxin 0.125 mg daily. Before administering, the nurse notes the patient's apical pulse
is 52 bpm. What is the correct nursing action?
A Hold the dose and notify the physician.
B Give half the dose and notify the physician.
C Administer the medication and document the heart rate.
D Administer a dose of Furosemide instead.
D The patient is prescribed Lisinopril. Which side effect is the most common reason for patients to discontinue
this ACE Inhibitor?
A Tachycardia
B Constipation
C Persistent dry cough
D Hypernatremia
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