Cardiovascular Management

1. A patient is admitted with acute chest pain and shortness of breath. The nurse anticipates that the physician will order which diagnostic test to confirm a myocardial infarction? • A. Electrocardiogram (ECG) • B. Chest X-ray • C. Arterial blood gas (ABG) • D. Magnetic resonance imaging (MRI) Correct Answer: A. Electrocardiogram (ECG) • Rationale: An ECG is the first diagnostic test used to confirm a myocardial infarction. It can identify ST-segment elevations or depressions, T-wave changes, and pathological Q waves indicative of ischemia or infarction. Chest X-ray and MRI are not immediate diagnostic tools for MI, and ABG measures oxygenation, not cardiac ischemia. ________________________________________ 2. Which laboratory value is the most specific for detecting myocardial damage? • A. Creatinine kinase (CK) • B. Lactate dehydrogenase (LDH) • C. Troponin • D. Myoglobin Correct Answer: C. Troponin • Rationale: Troponin is the most specific and sensitive biomarker for myocardial damage. Elevated troponin levels confirm myocardial injury. CK, LDH, and myoglobin are less specific to cardiac tissue and may be elevated in other conditions. ________________________________________ 3. A patient with a history of heart failure is prescribed furosemide (Lasix). The nurse should monitor for which potential side effect? • A. Hyperkalemia • B. Hypokalemia • C. Hypertension • D. Tachycardia Correct Answer: B. Hypokalemia • Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium, which can lead to hypokalemia. Hyperkalemia is less likely unless there is concurrent potassium-sparing diuretic therapy. Furosemide can cause hypotension due to volume depletion. ________________________________________ 4. A patient is recovering from coronary artery bypass graft (CABG) surgery. Which intervention is a priority for preventing postoperative complications? • A. Ambulate the patient as soon as possible • B. Maintain the patient on strict bed rest • C. Administer IV fluids to maintain hydration • D. Limit deep breathing exercises Correct Answer: A. Ambulate the patient as soon as possible • Rationale: Early ambulation is essential for preventing complications such as deep vein thrombosis (DVT) and pneumonia. Bed rest can increase the risk of these complications. Deep breathing exercises should be encouraged to promote lung expansion. ________________________________________ 5. A nurse is assessing a patient for signs of digoxin toxicity. Which of the following is an early indication of toxicity? • A. Bradycardia • B. Visual disturbances • C. Confusion • D. Nausea and vomiting Correct Answer: D. Nausea and vomiting • Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms like nausea and vomiting. Other signs, such as bradycardia, visual disturbances, and confusion, may occur later. ________________________________________ 6. A patient with atrial fibrillation is prescribed warfarin (Coumadin). What is the most important laboratory test to monitor during therapy? • A. Hemoglobin • B. Platelet count • C. International normalized ratio (INR) • D. Activated partial thromboplastin time (aPTT) Correct Answer: C. International normalized ratio (INR) • Rationale: The INR is used to monitor the effectiveness of warfarin therapy and ensure the patient is within the therapeutic range (typically 2.0–3.0 for atrial fibrillation). aPTT is used for heparin therapy. ________________________________________ 7. A patient with chronic heart failure reports a 5-pound weight gain over two days. What action should the nurse take? • A. Educate the patient on reducing caloric intake • B. Reassure the patient that this is normal for heart failure • C. Notify the healthcare provider • D. Instruct the patient to stop taking diuretics Correct Answer: C. Notify the healthcare provider • Rationale: A rapid weight gain in heart failure patients is often due to fluid retention and indicates worsening heart failure. The healthcare provider should be notified for potential adjustments in diuretic therapy or other interventions. ________________________________________ 8. The nurse is caring for a patient who just underwent a percutaneous coronary intervention (PCI) with stent placement. What is the priority nursing assessment? • A. Monitoring for signs of infection • B. Assessing the site for bleeding • C. Monitoring blood pressure hourly • D. Measuring urine output Correct Answer: B. Assessing the site for bleeding • Rationale: Bleeding at the insertion site is the most critical complication after PCI, as the femoral artery is often accessed. Monitoring for infection is important but is not the immediate concern post-procedure. ________________________________________ 9. A patient is receiving nitroglycerin IV for chest pain. Which vital sign is the most important for the nurse to monitor? • A. Respiratory rate • B. Blood pressure • C. Oxygen saturation • D. Heart rate Correct Answer: B. Blood pressure • Rationale: Nitroglycerin can cause vasodilation, leading to hypotension. Blood pressure must be closely monitored to prevent significant drops, which could lead to shock. ________________________________________ 10. The nurse is educating a patient with hypertension about dietary modifications. Which statement indicates the need for further teaching? • A. “I will reduce my salt intake.” • B. “I can drink coffee as it doesn’t affect my blood pressure.” • C. “I should avoid processed foods.” • D. “I will limit my alcohol consumption.” Correct Answer: B. “I can drink coffee as it doesn’t affect my blood pressure.” • Rationale: Caffeine can elevate blood pressure, so the patient should be aware of its potential effects. Salt reduction, avoiding processed foods, and limiting alcohol are correct interventions for managing hypertension.