ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
- ANS
1. A client complains of crushing chest pain that radiates to his left arm. He should be presented with the
following treatment:
1. Aspirin, oxygen, nitroglycerin, and morphine
2. Aspirin, oxygen, nitroglycerin, and codeine
3. Oxygen, nitroglycerin, meperidine, and thrombolytics
4. Aspirin, oxygen, nitroprusside, and morphine - ANSAnswer: 1. Aspirin, oxygen, nitroglycerin, and
morphine
1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology
of this disease process, the nurse would expect the patient to exhibit what heart rhythm?
A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia - ANSC
Feedback:
In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation.
Bradycardia, VF, and VT are not characteristic of this valvular disorder.
1. An older adult is newly diagnosed with primary hypertension and has just been started on a beta-
blocker. The nurse's health education should include which of the following?
A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure - ANSAns: C
Feedback:
Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension.
The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a
standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls
that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet
rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly
patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a
risk and activity should not normally be limited.
2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be
discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic
prophylaxis prior to which of the following?
A) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations - ANSC
Feedback:
Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures
involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa
(not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth).
There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital
admissions, or exposure to people who are immunosuppressed.
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision
and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could
be indicative of what?
A) Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency - ANSAns: A
Feedback:
Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel
damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma
and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would
have a more rapid onset.
2. The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of
the patient's heart?
A) P wave
B) T wave
C) U wave
D) QRS complex - ANSB
Feedback:
The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state.
Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
2. Which lifestyle changes should a client diagnosed with coronary artery disease consider?
1. Smoking cessation
2. Establishing a regular exercise routine
3. Weight reduction
4. All of the Above - ANSAnswer: 4. All of the Above
3. A client's cardiac monitor alarm sounds, indicating ventricular tachycardia. The nurse should:
1. perform immediate defibrillation.
2. Assess the client.
3. Call the physician.
4. Administer a precordial thump. - ANSAnswer: 2. Assess the client.
3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective
assessment data from a patient with hypertension, the nurse learns that the patient has a family history of
hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack
of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk
factor for hypertension?
A) Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen - ANSAns: C
Feedback:
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.
3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the
nurse's admission interview, the patient states that she takes over-the-counter water pills on a regular
basis. How should the nurse best respond to the fact that the patient has been taking diuretics?
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patient's oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patient's fluid balance is monitored vigilantly. - ANSC
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware.
Adjusting the patient's sodium or fluid intake or fluid monitoring does not address this important
contraindication.
4. *****************************************************************An adult patient with third-degree AV block is
admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic
will the ECG most likely show?
A) PP interval and RR interval are irregular.
B) PP interval is equal to RR interval.
C) Fewer QRS complexes than P waves
D) PR interval is constant. - ANSC
Feedback:
In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a
result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there
are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of
the heart. The other listed ECG changes are not consistent with this diagnosis.
4. A complication of peripheral vascular disease may be:
1. stasis ulcer.
2. Pressure ulcer.
3. Gastric ulcer.
4. Duodenal ulcer. - ANSAnswer: 1. stasis ulcer.
4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart
transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse
best respond?
A) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant. - ANSD
Feedback:
After heart transplant, patients are constantly balancing the risk of rejection with the risk of infection.
Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf), azathioprine (Imuran), or
mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to minimize rejection. Cyclosporine
does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.
4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain
that hypertensive urgency differs from hypertensive emergency in what way?
A) The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage. - ANSAns: D
Feedback:
Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an
intensive care setting because of the serious target organ damage that may occur. Blood pressures are
, ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in
hypertensive urgency. Extremely close hemodynamic monitoring of the patient's BP is required in both
situations. The medications of choice in hypertensive emergencies are those with an immediate effect,
such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents,
angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of
hypertensive urgencies.
5. ******************************************************** The nurse is writing a plan of care for a patient with a
cardiac dysrhythmia. What would be the most appropriate goal for the patient?
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. - ANSC
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening
complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not
appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than
with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
5. A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood
pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been
this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses
by the nursing instructor would be best?
A) "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine
examination."
B) "We will need to reevaluate your blood pressure because your age places you at high risk for
hypertension."
C) "A single elevated blood pressure does not confirm hypertension. You will need to have your blood
pressure reassessed several times before a diagnosis can be made."
D) "You have no need to worry. Your pressure is probably elevated because you are being tested." -
ANSAns: C
Feedback:
Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and
diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The
nurse should not tell the student that there is no need to worry.
5. A key diagnostic test for heart failure is:
1. serum potassium.
2. B-type natriuretic peptide.
3. Troponin I
4. cardiac enzymes. - ANSAnswer: 2. B-type natriuretic peptide.
5. A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis
when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the
patient knows the importance of taking which of the following drugs?
A) Enoxaparin (Lovenox)
B) Metoprolol (Lopressor)
C) Azathioprine (Imuran)
D) Amoxicillin (Amoxil) - ANSD
Feedback:
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
- ANS
1. A client complains of crushing chest pain that radiates to his left arm. He should be presented with the
following treatment:
1. Aspirin, oxygen, nitroglycerin, and morphine
2. Aspirin, oxygen, nitroglycerin, and codeine
3. Oxygen, nitroglycerin, meperidine, and thrombolytics
4. Aspirin, oxygen, nitroprusside, and morphine - ANSAnswer: 1. Aspirin, oxygen, nitroglycerin, and
morphine
1. A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology
of this disease process, the nurse would expect the patient to exhibit what heart rhythm?
A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia - ANSC
Feedback:
In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation.
Bradycardia, VF, and VT are not characteristic of this valvular disorder.
1. An older adult is newly diagnosed with primary hypertension and has just been started on a beta-
blocker. The nurse's health education should include which of the following?
A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure - ANSAns: C
Feedback:
Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension.
The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a
standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls
that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet
rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly
patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a
risk and activity should not normally be limited.
2. A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be
discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic
prophylaxis prior to which of the following?
A) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations - ANSC
Feedback:
Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures
involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa
(not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth).
There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital
admissions, or exposure to people who are immunosuppressed.
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision
and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could
be indicative of what?
A) Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency - ANSAns: A
Feedback:
Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel
damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma
and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would
have a more rapid onset.
2. The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of
the patient's heart?
A) P wave
B) T wave
C) U wave
D) QRS complex - ANSB
Feedback:
The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state.
Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
2. Which lifestyle changes should a client diagnosed with coronary artery disease consider?
1. Smoking cessation
2. Establishing a regular exercise routine
3. Weight reduction
4. All of the Above - ANSAnswer: 4. All of the Above
3. A client's cardiac monitor alarm sounds, indicating ventricular tachycardia. The nurse should:
1. perform immediate defibrillation.
2. Assess the client.
3. Call the physician.
4. Administer a precordial thump. - ANSAnswer: 2. Assess the client.
3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective
assessment data from a patient with hypertension, the nurse learns that the patient has a family history of
hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack
of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk
factor for hypertension?
A) Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen - ANSAns: C
Feedback:
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.
3. A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the
nurse's admission interview, the patient states that she takes over-the-counter water pills on a regular
basis. How should the nurse best respond to the fact that the patient has been taking diuretics?
,ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patient's oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patient's fluid balance is monitored vigilantly. - ANSC
Feedback:
Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware.
Adjusting the patient's sodium or fluid intake or fluid monitoring does not address this important
contraindication.
4. *****************************************************************An adult patient with third-degree AV block is
admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic
will the ECG most likely show?
A) PP interval and RR interval are irregular.
B) PP interval is equal to RR interval.
C) Fewer QRS complexes than P waves
D) PR interval is constant. - ANSC
Feedback:
In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a
result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there
are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of
the heart. The other listed ECG changes are not consistent with this diagnosis.
4. A complication of peripheral vascular disease may be:
1. stasis ulcer.
2. Pressure ulcer.
3. Gastric ulcer.
4. Duodenal ulcer. - ANSAnswer: 1. stasis ulcer.
4. The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart
transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse
best respond?
A) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant. - ANSD
Feedback:
After heart transplant, patients are constantly balancing the risk of rejection with the risk of infection.
Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf), azathioprine (Imuran), or
mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to minimize rejection. Cyclosporine
does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.
4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain
that hypertensive urgency differs from hypertensive emergency in what way?
A) The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage. - ANSAns: D
Feedback:
Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an
intensive care setting because of the serious target organ damage that may occur. Blood pressures are
, ATI ENGAGE ADULT MEDICAL SURGICAL RN-
ALTERATION IN HEALTHCARE- RN ALTERATION
IN CARDIOVASCULAR FUNCTION AND PERFUSION
ASSESSMENT.pdf
extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in
hypertensive urgency. Extremely close hemodynamic monitoring of the patient's BP is required in both
situations. The medications of choice in hypertensive emergencies are those with an immediate effect,
such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents,
angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of
hypertensive urgencies.
5. ******************************************************** The nurse is writing a plan of care for a patient with a
cardiac dysrhythmia. What would be the most appropriate goal for the patient?
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. - ANSC
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening
complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not
appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than
with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
5. A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood
pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been
this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses
by the nursing instructor would be best?
A) "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine
examination."
B) "We will need to reevaluate your blood pressure because your age places you at high risk for
hypertension."
C) "A single elevated blood pressure does not confirm hypertension. You will need to have your blood
pressure reassessed several times before a diagnosis can be made."
D) "You have no need to worry. Your pressure is probably elevated because you are being tested." -
ANSAns: C
Feedback:
Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and
diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The
nurse should not tell the student that there is no need to worry.
5. A key diagnostic test for heart failure is:
1. serum potassium.
2. B-type natriuretic peptide.
3. Troponin I
4. cardiac enzymes. - ANSAnswer: 2. B-type natriuretic peptide.
5. A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis
when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the
patient knows the importance of taking which of the following drugs?
A) Enoxaparin (Lovenox)
B) Metoprolol (Lopressor)
C) Azathioprine (Imuran)
D) Amoxicillin (Amoxil) - ANSD
Feedback:
