NCLEX-RN Practice Quiz Test Bank #3 (75 Questions)

NCLEX-RN Practice Quiz Test Bank #3 (75 Questions) 1. 1. Question A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which action must you intervene? o A. The NA assists the patient to ambulate to the bathroom and back to bed. o B. The NA reminds the patient not to look at his feet when he is walking. o C. The NA performs the patient’s complete bath and oral care. o D. The NA sets up the patient’s tray and encourages the patient to feed himself. Incorrect Correct Answer: C. The NA performs the patient’s complete bath and oral care. The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this patient as independent and mobile as possible. • Option A: Assisting the patient to ambulate prevents incidences of fall and injury. • Option B: Reminding the patient not to look at his feet while walking maintains the client’s independence while keeping him safe. • Option D: Encouraging the patient to feed himself is an appropriate goal of maintaining independence. 2. 2. Question The nurse is preparing to discharge a patient with chronic low back pain. Which statement by the patient indicates that additional teaching is necessary? • A. “I will avoid exercise because the pain gets worse.” • B. “I will use heat or ice to help control the pain.” • C. “I will not wear high-heeled shoes at home or work.” • D. “I will purchase a firm mattress to replace my old one.” Incorrect Correct Answer: A. “I will avoid exercise because the pain gets worse.” Exercises are used to strengthen the back, relieve pressure on compressed nerves and protect the back from re-injury. Doing exercises to strengthen the lower back can help alleviate and prevent lower back pain. It can also strengthen the core, leg, and arm muscles. According to researchers, exercise also increases blood flow to the lower back area, which may reduce stiffness and speed up the healing process. • Option B: Ice and heat application are appropriate interventions for back pain. Applying ice or a reusable gel pack constricts blood vessels and reduces swelling around the injury. This is particularly useful for conditions, like a sprained ankle, that cause significant swelling. Heat has the opposite effect, increasing blood flow to the area. This relaxes muscle fibers, which can help when the client experiences spasms or stiffness. • Option C: People with chronic back pain should avoid wearing high-heeled shoes at all times. The normal s-curve of the spine acts as a cushion or spring, reducing stress on the vertebrae. When wearing high heels, the shape of the spine is altered and the client doesn’t get that same shock absorption as she walks, which, over time, can lead to uneven wear on the cartilage discs, joints and ligaments of the back. • Option D: A firm mattress prevents lower back pain. Sleeping on a mattress that is too firm can cause aches and pains on pressure points. A medium-firm mattress may be more comfortable because it allows the shoulder and hips to sink in slightly. Patients who want a firmer mattress for back support can get one with thicker padding for greater comfort. 3. 3. Question A patient with a spinal cord injury (SCI) complains about a severe throbbing headache that suddenly started a short time ago. Assessment of the patient reveals increased blood pressure (168/94) and decreased heart rate (48/minute), diaphoresis, and flushing of the face and neck. What action should you take first? • A. Administer the ordered acetaminophen (Tylenol). • B. Check the Foley tubing for kinks or obstruction. • C. Adjust the temperature in the patient’s room. • D. Notify the physician about the change in status. Incorrect Correct Answer: B. Check the Foley tubing for kinks or obstruction. These signs and symptoms are characteristic of autonomic dysreflexia, a neurologic emergency that must be promptly treated to prevent a hypertensive stroke. The cause of this syndrome is noxious stimuli, most often a distended bladder or constipation, so checking for poor catheter drainage, bladder distention, or fecal impaction is the first action that should be taken. • Option C: Adjusting the room temperature may be helpful, since too cool a temperature in the room may contribute to the problem. • Option A: Tylenol will not decrease the autonomic dysreflexia that is causing the patient’s headache. • Option D: Notification of the physician may be necessary if nursing actions do not resolve symptoms. 4. 4. Question Which patient should you, as charge nurse, assign to a new graduate RN who is orienting to the neurologic unit? • A. A 28-year-old newly admitted patient with spinal cord injury. • B. A 67-year-old patient with stroke 3 days ago and left-sided weakness. • C. An 85-year-old dementia patient to be transferred to long-term care today. • D. A 54-year-old patient with Parkinson’s who needs assistance with bathing. Incorrect Correct Answer: B. A 67-year-old patient with stroke 3 days ago and left-sided weakness. The new graduate RN who is oriented to the unit should be assigned stable, non-complex patients, such as the patient with stroke. • Option A: The newly admitted SCI should be assigned to experienced nurses. Most cases of SCI take place when trauma breaks and squeezes the vertebrae, or the bones of the back. This, in turn, damages the axons—the long nerve cell “wires” that pass through vertebrae, carrying signals between the brain and the rest of the body. The axons might be crushed or completely severed by this damage. Someone with injury to only a few axons might be able to recover completely from their injury. On the other hand, a person with damage to all axons will most likely be paralyzed in the areas below the injury. • Option C: A patient for transfer should be assigned to a nurse who has experience in the process of transferring patients. • Option D: The patient with Parkinson’s disease needs assistance with bathing, which is best delegated to the nursing assistant. 5. 5. Question A patient with a spinal cord injury at level C3-4 is being cared for in the ED. What is the priority assessment? • A. Determine the level at which the patient has intact sensation. • B. Assess the level at which the patient has retained mobility. • C. Check blood pressure and pulse for signs of spinal shock. • D. Monitor respiratory effort and oxygen saturation level. Incorrect Correct Answer: D. Monitor respiratory effort and oxygen saturation level. The first priority for the patient with an SCI is assessing respiratory patterns and ensuring an adequate airway. The patient with a high cervical injury is at risk for respiratory compromise because the spinal nerves (C3 – 5) innervate the phrenic nerve, which controls the diaphragm. • Option A: Determining this data can be done after addressing the concerns on the respiratory status of the patient. • Option B: This data can be assessed after monitoring the respiratory effort and oxygen saturation level of the patient. • Option C: Vital signs checking is also necessary, but not as high priority. Vital signs can be quite abnormal following SCI. In addition to the usual causes in trauma such as pain, bleeding, and distress, this can be due to loss of autonomic control, which occurs particularly in cervical or high thoracic injuries. The autonomic nervous system controls our HR, BP temperature, etc. Autonomic instability is most acute in the first few days to weeks of the injury. 6. 6. Question You are pulled from the ED to the neurologic floor. Which action should you delegate to the nursing assistant when providing nursing care for a patient with SCI? • A. Assess the patient's respiratory status every 4 hours. • B. Take the patient’s vital signs and record them every 4 hours. • C. Monitor nutritional status including calorie counts. • D. Have the patient turn, cough, and deep breathe every 3 hours. Incorrect Correct Answer: B. Take the patient’s vital signs and record them every 4 hours. The nursing assistant’s training and education include taking and recording the patient’s vital signs. • Option A: Assessing the patient’s respiratory status would require the knowledge of a registered nurse. • Option C: Monitoring patients requires additional education and is appropriate for the scope of practice for professional nurses. • Option D: The nursing assistant may assist with turning and repositioning the patient and may remind the patient to cough and deep breathe but does not teach the patient how to perform these actions. 7. 7. Question You are helping the patient with an SCI to establish a bladder-retraining program. What strategies may stimulate the patient to void? Select all that apply. • A. Stroke the patient’s inner thigh. • B. Pull on the patient’s pubic hair. • C. Initiate intermittent straight catheterization. • D. Pour warm water over the perineum. • E. Tap the bladder to stimulate detrusor muscle. Incorrect Correct Answers: A, B, D, & E All of the strategies, except straight catheterization, may stimulate voiding in patients with SCI. • Option C: Intermittent bladder catheterization can be used to empty the patient’s bladder, but it will not stimulate voiding. 8. 8. Question The patient with a cervical SCI has been placed in fixed skeletal traction with a halo fixation device. When caring for this patient the nurse may delegate which action (s) to the LPN/LVN? Select all that apply. • A. Check the patient’s skin for pressure from the device. • B. Assess the patient’s neurologic status for changes. • C. Observe the halo insertion sites for signs of infection. • D. Clean the halo insertion sites with hydrogen peroxide. Incorrect Correct Answer: A, C, & D • Option A: Checking for signs of pressure within the scope of practice of the LPN/LVN. • Option C: Observing for signs of an infection is within the scope of practice of the LPN/LVN. • Option D: The LPN/LVN also has the appropriate skills for cleaning the halo insertion sites with hydrogen peroxide. • Option B: Neurologic examination requires additional education and skill appropriate to the professional RN. 9. 9. Question You are preparing a nursing care plan for the patient with SCI including the nursing diagnosis Impaired Physical Mobility and Self-Care Deficit. The patient tells you, “I don’t know why we’re doing all this. My life’s over.” What additional nursing diagnosis takes priority based on this statement? • A. Risk for Injury related to altered mobility • B. Imbalanced Nutrition, Less Than Body Requirements • C. Impaired Adjustment to Spinal Cord Injury • D. Poor Body Image related to immobilization Incorrect Correct Answer: C. Impaired Adjustment to Spinal Cord Injury The patient’s statement indicates impairment of adjustment to the limitations of the injury and indicates the need for additional counseling, teaching, and support. • Option A: The patient may have a risk for injury due to SCI, but it is not related to the statement. The spinal cord can be injured by transection, distraction, compression, bruising, hemorrhage or ischemia of the cord or by injury to blood vessels supplying it. These injuries can all result in permanent cord injury and may be complete or incomplete. • Option B: A client with SCI may have imbalanced nutrition because of a lesser appetite for eating, but it is not directly related to the statement. Refer to a Dietician early to ensure adequate nutrition, fluid & fiber in the feeds. • Option D: This nursing diagnosis may be appropriate to the patient with SCI, but it is not related to the patient’s statement. 10. 10. Question Which patient should be assigned to the traveling nurse, new to neurologic nursing care, who has been in the neurologic unit for 1 week? • A. A 34-year-old patient newly diagnosed with multiple sclerosis (MS). • B. A 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS). • C. A 56-year-old patient with Guillain-Barre syndrome (GBS) in respiratory distress. • D. A 25-year-old patient admitted with CA level spinal cord injury (SCI). Incorrect Correct Answer: B. A 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS) The traveling nurse is relatively new to neurologic nursing and should be assigned to patients whose conditions are stable and not complex. • Option A: The newly diagnosed patient will need to be transferred to the ICU. Multiple sclerosis (MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees and producing significant physical disability within 20–25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur months or years apart and affect different anatomic locations. • Option C: The patient with GBS is in respiratory distress and should be assigned to an experienced neurological nurse. Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that usually last for a few weeks. • Option D: The patient with C4 SCI is at risk for respiratory arrest. A C4 spinal cord injury occurs when damage is dealt about mid-way down the cervical spinal cord — the topmost portion of the spinal cord that is located in the neck and upper shoulders. 11. 11. Question The patient with multiple sclerosis tells the nursing assistant that after physical therapy she is too tired to take a bath. What is your priority nursing diagnosis at this time? • A. Fatigue related to disease state • B. Activity Intolerance due to generalized weakness • C. Impaired Physical Mobility related to neuromuscular impairment • D. Self-care Deficit related to fatigue and neuromuscular weakness Incorrect Correct Answer: D. Self-care Deficit related to fatigue and neuromuscular weakness At this time, based on the patient’s statement, the priority is Self-Care Deficit related to fatigue after physical therapy. Fatigue is described as an overwhelming feeling of lassitude or lack of physical or mental energy that interferes with activities. • Option A: The patient might be experiencing fatigue, but it might be due to the activities at physical therapy. Fatigue is one of the most common symptoms of MS, reported by at least 75% of patients with the disease. • Option B: Activity intolerance in a patient with MS is appropriate, but not related to the statement. An estimated 50–60% of persons with MS describe fatigue as one of their most bothersome symptoms, and it is a major reason for unemployment among MS patients. • Option C: Impaired physical mobility is appropriate to a patient with MS, but it is not related to the patient’s statement. Spasticity in MS is characterized by increased muscle tone and resistance to movement; it occurs most frequently in muscles that function to maintain an upright posture. The muscle stiffness greatly increases the energy expended to perform activities of daily living (ADLs), which in turn contributes to fatigue. 12. 12. Question The LPN/LVN, under your supervision, is providing nursing care for a patient with GBS. What observation would you instruct the LPN/LVN to report immediately? • A. Complaints of numbness and tingling. • B. Facial weakness and difficulty speaking. • C. Rapid heart rate of 102 beats per minute. • D. Shallow respirations and decreased breath sounds. Incorrect Correct Answer: D. Shallow respirations and decreased breath sounds The priority interventions for the patient with GBS are aimed at maintaining adequate respiratory function. These patients are at risk for respiratory failure, which is urgent. Upon presentation, 40% of patients have a respiratory or oropharyngeal weakness. Ventilatory failure with required respiratory support occurs in up to one-third of patients at some time during the course of their disease. • Option A: These findings should be reported to the nurse but it is not an urgent matter. The typical patient with Guillain-Barré syndrome (GBS), which in most cases will manifest as acute inflammatory demyelinating polyradiculoneuropathy (AIDP), presents 2-4 weeks following a relatively benign respiratory or gastrointestinal illness with complaints of finger dysesthesias and proximal muscle weakness of the lower extremities. • Option B: Facial weakness and difficulty of speaking are common signs of GBS and must be reported, but it is not a priority. The classic clinical picture of weakness is ascending and symmetrical in nature. The lower limbs are usually involved before the upper limbs. Proximal muscles may be involved earlier than the more distal ones. Trunk, bulbar, and respiratory muscles can be affected as well. • Option C: A rapid heart rate is important and should be reported to the nurse, but it is not life-threatening. Autonomic nervous system involvement with dysfunction in the sympathetic and parasympathetic systems can be observed in patients with GBS. 13. 13. Question The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent of urine and stool. What is your best first action at this time? • A. Administer an acetaminophen suppository • B. Notify the physician immediately • C. Recheck vital signs in 1 hour • D. Reschedule patient’s physical therapy session Incorrect Correct Answer: B. Notify the physician immediately. The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient’s respiratory status. The patient may need intubation and mechanical ventilation. • Option A: The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. • Option C: This patient’s vital signs need to be re-checked sooner than 1 hour. • Option D: Rescheduling the physical therapy can be delegated to the unit clerk and is not urgent. Focus: Prioritization 14. 14. Question You are providing care for a patient with an acute hemorrhage stroke. The patient’s husband has been reading a lot about strokes and asks why his wife did not receive alteplase. What is your best response? • A. “Your wife was not admitted within the time frame that alteplase is usually given.” • B. “This drug is used primarily for patients who experience an acute heart attack.” • C. “Alteplase dissolves clots and may cause more bleeding into your wife’s brain.” • D. “Your wife had gallbladder surgery just 6 months ago and this prevents the use of alteplase.” Incorrect Correct Answer: C. “Alteplase dissolves clots and may cause more bleeding into your wife’s brain.” Alteplase is a clot buster. With a patient who has experienced a hemorrhagic stroke, there is already bleeding into the brain. A drug like alteplase can worsen the bleeding. • Option A: This statement is correct, but it does not address the relevance of the drug to the patient’s diagnosis. • Option B: This is an accurate statement, but it does not clearly explain the effects of the drug on the patient. • Option D: This statement is also accurate about the use of alteplase, but it is not pertinent to this patient’s diagnosis. 15. 15. Question You are supervising a senior nursing student who is caring for a patient with a right hemisphere stroke. Which action by the student nurse requires that you intervene? • A. The student instructs the patient to sit up straight, resulting in the patient’s puzzled expression. • B. The student moves the patient’s tray to the right side of her over-bed tray. • C. The student assists the patient with passive range-of-motion (ROM) exercises. • D. The student combs the left side of the patient’s hair when the patient combs only the right side. Incorrect Correct Answer: A. The student instructs the patient to sit up straight, resulting in the patient’s puzzled expression. Patients with right cerebral hemisphere stroke often present with neglect syndrome. They lean to the left and when asked, respond that they believe they are sitting up straight. They often neglect the left side of their bodies and ignore food on the left side of their food trays. The nurse would need to remind the student of this phenomenon and discuss the appropriate interventions. • Option B: They often ignore the food on the left side of their food trays, so reminding them is a correct action. • Option C: Passive range of motion exercises help keep the left side of the patient’s body from atrophy as a result of unuse. • Option D: This is a correct action of the student nurse, as the patient may neglect the left side of the body. 16. 16. Question Which of the following arteries primarily feeds the anterior wall of the heart? • A. Circumflex artery • B. Internal mammary artery • C. Left anterior descending artery • D. Right coronary artery Incorrect Correct Answer: C. Left anterior descending artery The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart. • Option A: The circumflex artery supplies the lateral wall. The circumflex artery, fully titled as the circumflex branch of the left coronary artery, is an artery that branches off from the left coronary artery to supply portions of the heart with oxygenated blood. The circumflex artery itself divides into smaller arterial systems. • Option B: The internal mammary artery supplies the mammary. The internal thoracic artery (ITA), previously commonly known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts. • Option D: The right coronary artery supplies the inferior wall of the heart. The right coronary artery supplies blood to the right ventricle and then supplies the underside (inferior wall) and backside (posterior wall) of the left ventricle. 17. 17. Question When do coronary arteries primarily receive blood flow? • A. During inspiration • B. During diastole • C. During expiration • D. During systole Incorrect Correct Answer: B. During diastole Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. • Option A: Breathing patterns are irrelevant to blood flow. It has been suggested that the diaphragm will preferentially steal blood flow from working locomotor muscles during increased activity (Bradley & Leith, 1978; Musch, 1993). In healthy adults, the cost of breathing is <5% of the total oxygen consumption at low-level exercise but approaches 15% during heavy exercise in young athletes or older fit subjects (Aaron et al. 1992; Dempsey & Johnson, 1992). Further, reflex vasoconstriction of the locomotor muscles is evident when a substantial respiratory load is applied sufficient to elicit diaphragm fatigue • Option C: Expiration is not related to the blood flow. The pulmonary system is intimately linked with the cardiovascular system anatomically and hemodynamically and plays a significant role in exercise intolerance through a number of mechanisms (Olson et al. 2006a,b;). • Option D: There is a little portion of the blood that the coronary arteries receive during systole. During systole, intramuscular blood vessels are compressed and twisted by the contracting heart muscle and blood flow to the left ventricle is at its lowest. The force is greatest in the subendocardial layers where it approximates to intramyocardial pressure. 18. 18. Question Which of the following illnesses is the leading cause of death in the US? • A. Cancer • B. Coronary artery disease • C. Liver failure • D. Renal failure Incorrect Correct Answer: B. Coronary artery disease Coronary artery disease accounts for over 50% of all deaths in the US. • Option A: Cancer accounts for approximately 20%. • Option C: Liver failure accounts for less than 10% of all deaths in the US. • Option D: Less than 10% of all deaths in the US can be attributed to renal failure. 19. 19. Question Which of the following conditions most commonly results in CAD? • A. Atherosclerosis • B. DM • C. MI • D. Renal failure Incorrect Correct Answer: A. Atherosclerosis Atherosclerosis, or plaque formation, is the leading cause of CAD. • Option B: DM is a risk factor for CAD but isn’t the most common cause. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes and is an independent cause of excess morbidity and mortality. • Option D: Renal failure doesn’t cause CAD, but the two conditions are related. Chronic kidney disease (CKD) accelerates the course of coronary artery disease, independent of conventional cardiac risk factors. In addition, CKD has been shown to confer inferior clinical outcomes following successful coronary revascularisation, which may be offset by arterial grafting. • Option C: Myocardial infarction is commonly a result of CAD. Myocardial infarction occurs when a coronary artery is so severely blocked that there is a significant reduction or break in the blood supply, causing damage or death to a portion of the myocardium (heart muscle). 20. 20. Question Atherosclerosis impedes coronary blood flow by which of the following mechanisms? • A. Plaques obstruct the vein • B. Plaques obstruct the artery • C. Blood clots form outside the vessel wall • D. Hardened vessels dilate to allow the blood to flow through Incorrect Correct Answer: B. Plaques obstruct the artery. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a lipoprotein-driven disease that leads to plaque formation at specific sites of the arterial tree through intimal inflammation, necrosis, fibrosis, and calcification. • Option A: Atherosclerosis is a direct result of plaque formation in the artery. Most often, the culprit morphology is plaque rupture with exposure of highly thrombogenic, red cell-rich necrotic core material. The permissive structural requirement for this to occur is an extremely thin fibrous cap, and thus, ruptures occur mainly among lesions defined as thin-cap fibroatheromas. • Option C: Blood clots form inside the vessel wall and impede circulation. Also common are thrombi forming on lesions without rupture (plaque erosion), most often on pathological intimal thickening or fibroatheromas. However, the mechanisms involved in plaque erosion remain largely unknown, although coronary spasm is suspected. • Option D: Hardened vessels can’t dilate properly and, therefore, constrict blood flow. During atherogenesis, the local vessel segment tends to remodel in such a way that the lumen area is usually not compromised until plaques are large (expansive remodeling). Thereafter stenosis formation may occur through continued plaque growth or shrinkage of the local vessel segment (constrictive remodeling) or a combination of the 2 processes. 21. 21. Question Which of the following risk factors for coronary artery disease cannot be corrected? • A. Cigarette smoking • B. DM • C. Heredity • D. HPN Incorrect Correct Answer: C. Heredity Because “heredity” refers to our genetic makeup, it can’t be changed. • Option A: Cigarette smoking cessation is a lifestyle change that involves behavior modification. Smoking raises the risk of getting CAD and dying early from CAD. Carbon monoxide, nicotine, and other substances in tobacco smoke can promote atherosclerosis and trigger symptoms of coronary artery disease. • Option B: Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Over time, high blood sugar can damage blood vessels and the nerves that control the heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease: High blood pressure increases the force of blood through your arteries and can damage artery walls. • Option D: Altering one’s diet, exercise, and medication can correct hypertension. British Hypertension Society (BHS) guidelines state that advice should be provided for prevention as well as treatment of hypertension and should be given to pre-hypertensives and those with a strong family history. They point out that effective lifestyle modification can lower blood pressure by at least as much as a single antihypertensive drug. 22. 22. Question Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease? • A. 100 mg/dl • B. 150 mg/dl • C. 175 mg/dl • D. 200 mg/dl Incorrect Correct Answer: D. 200 mg/dl Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD. The normal level of serum cholesterol is within 125 to 200 mg/dl. • Option A: 100mg/dl is an acceptable level of serum cholesterol. An elevated low-density lipoprotein cholesterol (LDL-C) level is a major risk factor for CAD, and several large, randomized, primary prevention trials have shown that lowering LDL-C levels with statins reduces the risk of major coronary events and coronary death. • Option B: 150 mg/dl is within the normal level of serum cholesterol. LDL is the particle that is responsible for transporting cholesterol to tissues. Cholesterol transportation is achieved by binding of the LDL receptor and apoB. • Option C: 175 mg/dl is still an acceptable level of serum cholesterol. HDL is a molecule that is antioxidant, antiinflammatory, antiapoptotic, and increases macrophage cholesterol excretion and endothelial healing. The removal of cholesterol from the body by the liver via HDL is called reverse cholesterol transport. 23. 23. Question Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease? • A. Decrease anxiety • B. Enhance myocardial oxygenation • C. Administer sublingual nitroglycerin • D. Educate the client about his symptoms Incorrect Correct Answer: B. Enhance myocardial oxygenation Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. • Option A: Decreasing the client’s anxiety is also important, but it is not the priority. When someone is anxious, their body reacts in ways that can put an extra strain on their heart. The physical symptoms of anxiety can be especially damaging among individuals with existing cardiac disease. • Option C: Sublingual nitroglycerin is administered to treat acute angina, but its administration isn’t the first priority. Although nitroglycerin has a vasodilatory effect in both arteries and veins, the profound desired effects caused by nitroglycerin are primarily due to venodilation. Venodilation causes pooling of blood within the venous system, reducing preload to the heart, which causes a decrease in cardiac work, reducing anginal symptoms secondary to demand ischemia. • Option D: Although educating the client is important in care delivery, it is not a priority when a client is compromised. Patient education promotes patient-centered care and increases adherence to medication and treatments. An increase in compliance leads to a more efficient and cost-effective healthcare delivery system. Educating patients ensures continuity of care and reduces complications related to the illness. 24. 24. Question Medical treatment of coronary artery disease includes which of the following procedures? • A. Cardiac catheterization • B. Coronary artery bypass surgery • C. Oral medication administration • D. Percutaneous transluminal coronary angioplasty Incorrect Correct Answer: C. Oral medication administration Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Nitroglycerin is the most common vasodilator used for acute cases of angina. It works to dilate or widen the coronary arteries, increasing blood flow to the heart muscle and to relax the veins, lessening the amount of blood that returns to the heart from the body. This combination of effects decreases the amount of work for the heart. • Option A: Cardiac catheterization isn’t a treatment but a diagnostic tool. Cardiac catheterization (cardiac cath or heart cath) is a procedure to examine how well the heart is working. A thin, hollow tube called a catheter is inserted into a large blood vessel that leads to the heart. • Option B: Coronary artery bypass surgery is an invasive procedure. Coronary artery bypass grafting (CABG) is a procedure to improve poor blood flow to the heart. It may be needed when the arteries supplying blood to heart tissue, called coronary arteries, are narrowed or blocked. This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, a type of ischemic heart disease. CABG may also be used in an emergency, such as a severe heart attack. • Option D: Percutaneous transluminal coronary angioplasty is an invasive, surgical treatment. Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. 25. 25. Question Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? • A. Anterior • B. Apical • C. Inferior • D. Lateral Incorrect Correct Answer: C. Inferior The right coronary artery supplies the right ventricle or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. • Option A: The right coronary artery doesn’t supply the anterior portion (left ventricle) of the heart. The right coronary artery supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm. The right coronary artery divides into smaller branches, including the right posterior descending artery and the acute marginal artery. • Option B: The right coronary artery does not supply to the apical portion or left ventricle of the heart. Together with the left anterior descending artery, the right coronary artery helps supply blood to the middle or septum of the heart. • Option D: The right coronary artery does not supply to the lateral portion (some of the left ventricle and the left atrium) of the heart. The left main coronary artery supplies blood to the left side of the heart muscle (the left ventricle and left atrium). 26. 26. Question Which of the following is the most common symptom of myocardial infarction? • A. Chest pain • B. Dyspnea • C. Edema • D. Palpitations Incorrect Correct Answer: A. Chest pain The most common symptom of an MI is chest pain, resulting from the deprivation of oxygen to the heart. The classic manifestation of ischemia is usually described as heavy chest pressure or squeezing, a “burning” feeling, or difficulty in breathing. The discomfort or pain often radiates to the left shoulder, neck, or arm. Chest pain may be atypical in a few cases. It builds in intensity over a period of a few minutes. • Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Despite variable prevalence estimates, dyspnea has been consistently associated with greater mortality in the general population. It is a more powerful predictor of clinical outcomes than objective physiologic measures such as pulmonary function testing in the general population, or angina in patients referred for cardiac evaluation. • Option C: Edema is a later sign of heart failure, often seen after an MI. All the factors which contribute to increased pressure in the left side and pooling of blood on the left side of the heart can cause cardiogenic pulmonary edema. The result of all these conditions will be increased pressure on the left side of the heart: increased pulmonary venous pressure–> increased capillary pressure in lungs–> pulmonary edema. • Option D: Palpitations may result from the reduced cardiac output, producing arrhythmias. In patients who describe the palpitations as a brief flip-flopping in the chest, the palpitations are thought to be caused by extrasystoles such as supraventricular or ventricular premature contractions. The flip-flop sensation is thought to result from the forceful contraction following the pause and the sensation that the heart is stopped results from the pause. The sensation of rapid fluttering in the chest is thought to result from a sustained ventricular or supraventricular arrhythmia. 27. 27. Question Which of the following landmarks is the correct one for obtaining an apical pulse? • A. Left intercostal space, midaxillary line • B. Left fifth intercostal space, midclavicular line • C. Left second intercostal space, midclavicular line • D. Left seventh intercostal space, midclavicular line Incorrect Correct Answer: B. Left fifth intercostal space, midclavicular line The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. • Option A: Normally, heart sounds aren’t heard in the midaxillary line. During systolic contraction of the heart, a high amplitude wave of blood gets ejected through the aortic valve out towards the periphery. This high-pressure wave distends the arteries, especially compliant “elastic” or “conducting” arteries, which tend to be larger and closer to the heart. The subsequent release of that distention somewhat sustains the systolic wave of blood throughout the body, creating a spike followed by a downward sloping plateau in pulse waveform. • Option C: The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. The intensity of the pulse is determined by blood pressure as well as other physiological factors such as ambient temperature. For example, colder temperatures cause vasoconstriction leading to decreased intensity. Besides the normal variation in a rhythm that occurs with the respiratory cycle, the heart rate should be regular in the absence of pathology. • Option D: Heart sounds are not heard in the seventh intercostal space in the midclavicular line. Pulses are accurately measured when the clinician places their fingertips onto the skin overlying the vessel (locations, see below) and focuses on different aspects of the pulse. (NB: although one often hears that utilization of the thumb for measuring pulses is less accurate secondary to increased perception of the clinician’s own pulsation during palpation, the author could not find data to support or refute this claim). If possible, the limb under evaluation should have support throughout palpation. 28. 28. Question Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration? • A. Cardiac • B. Gastrointestinal • C. Musculoskeletal • D. Pulmonary Incorrect Correct Answer: D. Pulmonary Pulmonary pain is generally described by these symptoms. Pain may originate from several different structures within the chest, including the skin, ribs, intercostal muscles, pleura, esophagus, heart, aorta, diaphragm, or thoracic vertebrae. The pain may be transmitted by intercostal, sympathetic, vagus, and phrenic nerves. The innervations of the deep structures of the thorax follow common pathways to the central nervous system, making it difficult to localize the source of pain. • Option A: In cardiac pain, respirations are usually unaffected. Various schemes have been used to classify the etiologies of chest pain, but the most useful is to distinguish between acute and chronic patterns of pain. Patients with acute pain include those whose episodes are of recent onset or those who have had a recent increase in the intensity or frequency of recurrent pain. Patients with chronic pain include those who have recurrent episodes of pain occurring in a relatively stable pattern. • Option B: GI pains don’t change with respiration. The findings suggest that pain influences respiration by increasing its flow, frequency, and volume. Furthermore, paced slow breathing is associated with pain reduction in some of the studies, but evidence elucidating the underlying physiological mechanisms of this effect is lacking. • Option C: Musculoskeletal pain only increases with movement. The SNS is concerned with the regulation of vascular tone, blood flow, and blood pressure, as sympathetic nerves have stimulating effects on the heart (improving circulation) and respiratory system (increasing oxygen intake). Pain, therefore, increases heart rate, blood pressure, and respiratory rate. 29. 29. Question A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this? • A. Aortic • B. Mitral • C. Pulmonic • D. Tricuspid Incorrect Correct Answer: C. Pulmonic Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Murmurs of the cardiac system develop due to alterations in blood flow or mechanical operation. Murmurs develop from a multitude of mechanisms. Typical cases include low blood viscosity from anemia, septal defects, failure of the ductus arteriosus to close in newborns, excessive hydrostatic pressure on cardiac valves causing valve failure, hypertrophic obstructive cardiomyopathy, and valvular specific pathologies. • Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Aortic regurgitation, also known as aortic insufficiency, is a decrescendo blowing diastolic murmur heard best at the left lower sternal border, heard when blood flows retrograde into the left ventricle. This is most commonly seen in aortic root dilation and as sequelae of aortic stenosis. • Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Mitral stenosis is a diastolic murmur, best heard at the left 5th midclavicular line. It is associated with infective endocarditis and chronic rheumatic heart disease. Mitral regurgitation is a systolic murmur, best heard at the left 5th midclavicular line with possible radiation to the left axilla. It is commonly associated with infective endocarditis, rheumatic heart disease, congenital anomalies, and inferior wall myocardial infarctions. • Option D: Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border. Tricuspid stenosis is best heard at the lower left sternal border. Typical causes include infective endocarditis, seen in intravenous drug users, and carcinoid syndrome. Prolonged tricuspid stenosis may lead to right atrial enlargement and arrhythmias. Tricuspid regurgitation is systolic, auscultated at the lower left sternal border. It is also associated with intravenous drug users and carcinoid syndrome. 30. 30. Question Which of the following blood tests is most indicative of cardiac damage? • A. Lactate dehydrogenase • B. Complete blood count • C. Troponin I • D. Creatine kinase Incorrect Correct Answer: C. Troponin I Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren’t detectable in people without cardiac injury. The troponin complex consists of three subunits—troponin C, troponin I, and troponin T—and is located on the myofibrillar thin (actin) filament of striated (skeletal and cardiac) muscle. The cardiac isoforms troponin T and I are only expressed in cardiac muscle. Hence, cardiac troponin T (cTnT) and I (cTnI) are more specific than creatine kinase (CK) values for myocardial injury and, because of their high sensitivity, they may even be elevated when CK?MB concentrations are not. • Option A: Lactate dehydrogenase is present in almost all body tissues and not specific to the heart muscle. LDH isoenzymes are useful in diagnosing the cardiac injury. The function of the enzyme is to catalyze the reversible conversion of lactate to pyruvate with the reduction of NAD+ to NADH and vice versa. • Option B: CBC is obtained to review blood counts, and complete chemistry is obtained to review electrolytes. Obtain a complete blood cell (CBC) count if myocardial infarction (MI) is suspected in order to rule out anemia as a cause of decreased oxygen supply and prior to giving thrombolytic agents. • Option D: Because CK levels may rise with a skeletal muscle injury, CK isoenzymes are required to detect cardiac injury. In their current guidelines from 2000, the Joint European Society of Cardiology/American College of Cardiology committee redefined AMI as an elevation of cTn in blood above the 99th centile of a healthy reference population in conjunction with signs or symptoms of ischemia. This did expand the diagnostic capacity to detect micro?MI which was not evident by CK?MB measurements. 31. 31. Question What is the primary reason for administering morphine to a client with myocardial infarction? • A. To sedate the client • B. To decrease the client’s pain • C. To decrease the client’s anxiety • D. To decrease oxygen demand on the client’s heart Incorrect Correct Answer: D. To decrease oxygen demand on the client’s heart Morphine is administered because it decreases myocardial oxygen demand. Morphine to relieve pain during a myocardial infarction (MI) has been in use since the early 1900s. In 2005, an observational study raised some concerns, but there are very few effective alternatives. Morphine is a potent opioid; it decreases pain, which in turn leads to a decrease in the activation of the autonomic nervous system. These are desirable effects when a patient is having an MI. • Option A: Morphine can also cause sedation on the client, but it is not the main purpose of administering it. Morphine is rarely used for procedural sedation. However, for small procedures, physicians will sometimes combine a low dose of morphine with a low dose of benzodiazepine-like lorazepam. • Option B: Pain is decreased when morphine is given, but it is not the primary reason for administration. FDA-approved usage of morphine sulfate includes moderate to severe pain that may be acute or chronic. Most commonly used in pain management, morphine provides significant relief to patients afflicted with pain. • Option C: Morphine will also decrease anxiety, but isn’t primarily given for this reason. Morphine can decrease the heart rate, blood pressure, and venous return. Morphine can also stimulate local histamine-mediated processes. 32. 32. Question Which of the following conditions is most commonly responsible for myocardial infarction? • A. Aneurysm • B. Heart failure • C. Coronary artery thrombosis • D. Renal failure Incorrect Correct Answer: C. Coronary artery thrombosis Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. Myocardial infarction occurs when a coronary artery is so severely blocked that there is a significant reduction or break in the blood supply, causing damage or death to a portion of the myocardium (heart muscle). • Option A: An aneurysm is an outpouching of a vessel and doesn’t cause an MI. On exertion, elevated blood pressure could cause expansion of the aneurysmal cavity, aggravating the coronary ischemia, and eventually would have produced myocardial infarction. However, this only occurs in very rare cases. • Option D: Renal failure can be associated with MI but isn’t a direct cause. All-cause mortality of dialysis patients with acute myocardial infarction (AMI) is 59% at 1 year and about 73% at 2 years. AMI in patients with nondialysis-dependent advanced CKD is also associated with poor long-term cardiovascular outcomes and survival. • Option B: Heart failure is usually the result of an MI. It produces both a vasculopathy and left ventricular dysfunction and fibrosis. It produces both a vasculopathy and left ventricular dysfunction and fibrosis. Endothelial dysfunction in the coronary arteries can lead to acute coronary events. Left ventricular dysfunction will cause the progression of heart failure, and left ventricular fibrosis and dysfunction provide an arrhythmic substrate. 33. 33. Question What supplemental medication is most frequently ordered in conjunction with furosemide (Lasix)? • A. Chloride • B. Digoxin • C. Potassium • D. Sodium Incorrect Correct Answer: C. Potassium Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Loop diuretics act at the ascending loop of Henle in the kidney and help the body push out extra fluid that could accumulate in the lungs or legs and ankles when the heart is unable to completely pump blood throughout the body. But they may also cause the body to eliminate excessive amounts of potassium, which might be expected to increase mortality from heart arrhythmias. As a precaution, therefore, many doctors prescribe potassium supplements to their patients receiving loop diuretics. • Option A: Chloride isn’t lost during diuresis. Continued use of diuretics, will cause some overall sodium and chloride loss. The body, however, has a natural way of compensating for these losses by reducing the excretion of sodium and chloride and stabilizing the amount of sodium, chloride, and water in the body. In this manner, fluid depletion usually is prevented. • Option B: Digoxin acts to increase contractility but isn’t given routinely with furosemide. People with heart failure who take digoxin are commonly given medicines called diuretics. These drugs remove excess fluid from the body. Many diuretics can cause potassium loss. A low level of potassium in the body can increase the risk of digitalis toxicity. • Option D: Sodium is not lost during diuresis. Diuretic drugs increase urine output by the kidney (i.e., promote diuresis). This is accomplished by altering how the kidney handles sodium. If the kidney excretes more sodium, then water excretion will also increase. 34. 34. Question After myocardial infarction, serum glucose levels and free fatty acids are both increased. What type of physiologic changes are these? • A. Electrophysiologic • B. Hematologic • C. Mechanical • D. Metabolic Incorrect Correct Answer: D. Metabolic Both glucose and fatty acids are metabolites whose levels increase after myocardial infarction. Acute myocardial infarction evokes a characteristic neurohumoral response: Catecholamine release is increased, plasma contents of free fatty acids and glucose are elevated and glucose tolerance is diminished. • Option A: Mechanical changes are those that affect the pumping action of the heart. The main mechanical complications (MC) of acute myocardial infarction are ventricular septal rupture(VSR), free wall rupture (FWR), and ischemic mitral regurgitation (IMR). In the chronic phase, negative remodeling and aneurysm formation may occur. • Option B: Hematologic changes would affect the blood. It has been documented that WBC associates through coronary atherosclerosis and ESR in myocardial infarction. Variations occur in hematological parameters such as hemoglobin, WBC, ESR, and platelet sedimentation rate, and fibrinogen in acute myocardial infarction. • Option C: Electrophysiologic changes affect conduction. When coronary blood flow is inadequate to support the oxygen needs of the myocardium (i.e., an ischemic state), tissue levels of oxygen fall, which leads to cellular hypoxia. Severe and prolonged hypoxia can ultimately lead to cellular death and total loss of electrical activity. Less severe hypoxia, or hypoxia of relatively short duration, will produce electrophysiological (and mechanical) changes in the heart. 35. 35. Question Which of the following complications is indicated by a third heart sound (S3)? • A. Ventricular dilation • B. Systemic hypertension • C. Aortic valve malfunction • D. Increased atrial contractions Incorrect Correct Answer: A. Ventricular dilation Rapid filling of the ventricles causes vasodilation that is auscultated as S3. The third heart sound (S3) is a low-frequency, brief vibration occurring in early diastole at the end of the rapid diastolic filling period of the right or left ventricle • Option B: Systemic hypertension can result in a fourth heart sound. The fourth heart sound is a low-pitched sound coincident with late diastolic filling of the ventricle due to atrial contraction. It thus occurs shortly before the first heart sound. Although it is also called the atrial sound, and its production requires an effective atrial contraction, the fourth heart sound is the result of vibrations generated within the ventricle. • Option C: Aortic valve malfunction is heard as a murmur. One in three elderly people have a heart murmur because of the scarring, thickening, or stiffening of their aortic valve. That’s aortic sclerosis. It’s usually not dangerous, since the valve can work for years after the murmur starts. • Option D: Increased atrial contractions can cause a fourth heart sound. Common theoretic mechanisms for this condition are based around abnormal automaticity of the cardiac myocytes, increased eliciting events from chemical or physical instigators, and reentry of a retrograde impulse. For these causes, structural heart damage or chemical use may be found during the history and physical examination. 36. 36. Question After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? • A. Left-sided heart failure • B. Pulmonic valve malfunction • C. Right-sided heart failure • D. Tricuspid valve malfunction Incorrect Correct Answer: A. Left-sided heart failure The left ventricle is responsible for the most cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn’t function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. • Option B: Pulmonic valve malfunction may cause right-sided heart failure. Pulmonary regurgitation (PR, also called pulmonic regurgitation) is a leaky pulmonary valve. This valve helps control the flow of blood passing from the right ventricle to the lungs. A leaky pulmonary valve allows blood to flow back into the heart chamber before it gets to the lungs for oxygen. • Option C: Right-sided heart failure can be caused by a pulmonic valve or tricuspid valve malfunction. This is the narrowing of the pulmonic valve that limits blood flow out of the right ventricle. • Option D: Tricuspid valve malfunction causes right-sided heart failure. The tricuspid valve doesn’t close properly. This causes blood in the right ventricle to flow back into the right atrium. 37. 37. Question Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? • A. Cardiac catheterization • B. Cardiac enzymes • C. Echocardiogram • D. Electrocardiogram Incorrect Correct Answer: D. Electrocardiogram The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. • Option A: Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately. • Option B: Cardiac enzymes are used to diagnose MI but can’t determine the location. • Option C: An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. 38. 38. Question What is the first intervention for a client experiencing myocardial infarction? • A. Administer morphine • B. Administer oxygen • C. Administer sublingual nitroglycerin • D. Obtain an electrocardiogram Incorrect Correct Answer: B. Administer oxygen Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. • Option A: Morphine may be given after administering supplemental oxygen first. As a potent opioid, morphine has seemed to be the ideal analgesic. It has innate hemodynamic effects that are beneficial during MI. It decreases heart rate, blood pressure, and venous return, and it may also stimulate local histamine-mediated processes. Theoretically, this reduces myocardial oxygen demand. • Option C: Sublingual nitroglycerin is also used to treat MI, but they’re more commonly administered after the oxygen. Nitroglycerin remains the first-line treatment for angina pectoris and acute myocardial infarction. Nitroglycerin achieves its benefit by giving rise to nitric oxide, which causes vasodilation and increases blood flow to the myocardium. • Option D: An ECG is the most common diagnostic tool used to evaluate MI. In a myocardial infarction transmural ischemia develops. In the first hours and days after the onset of myocardial infarction, several changes can be observed on the ECG. First, large peaked T waves (or hyperacute T waves), then ST elevation, then negative T waves, and finally pathologic Q waves develop. 39. 39. Question What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying? • A. “Tell me about your feelings right now.” • B. “When the doctor arrives, everything will be fine.” • C. “This is a bad situation, but you’ll feel better soon.” • D. “Please be assured we’re doing everything we can to make you feel better.” Incorrect Correct Answer: A. “Tell me about your feelings right now.” Validation of the client’s feelings is the most appropriate response. It gives the client a feeling of comfort and safety. • Option B: Option B may give the client false hope. • Option C: Telling the client that he will feel better soon would give him false hope. • Option D: No one can determine if a client experiencing MI will feel or get better and therefore, these responses are inappropriate. 40. 40. Question Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? • A. Beta-adrenergic blockers • B. Calcium channel blockers • C. Narcotics • D. Nitrates Incorrect Correct Answer: A. Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. • Option B: Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. • Option C: Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. • Option D: Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload). 41. 41. Question What is the most common complication of a myocardial infarction? • A. Cardiogenic shock • B. Heart failure • C. Arrhythmias • D. Pericarditis Incorrect Correct Answer: C. Arrhythmias Arrhythmia, caused by oxygen deprivation to the myocardium, is the most common complication of an MI. • Option A: Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. • Option B: Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. • Option D: Pericarditis most commonly results from a bacterial or viral infection but may occur after MI. 42. 42. Question With which of the following disorders is jugular vein distention most prominent? • A. Abdominal aortic aneurysm • B. Heart failure • C. Myocardial infarction • D. Pneumothorax Incorrect Correct Answer: B. Heart failure Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. • Option A: Jugular vein distention isn’t a symptom of an abdominal aortic aneurysm. The jugular vein is considered a central vein in the body. Central veins are thin-walled, distensible reservoirs and act as a conduit of blood in continuity with the right atrium. The jugular vein divides into external and internal. • Option C: An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention. In patients with acute inferior-wall MI with right ventricular involvement, distention of neck veins is commonly described as a sign of failure of the right ventricle. • Option D: Pneumothorax does not cause jugular vein distention. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. An increase in central venous pressure can result in distended neck veins, hypotension. 43. 43. Question What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention? • A. High-Fowler’s • B. Raised 10 degrees • C. Raised 30 degrees • D. Supine position Incorrect Correct Answer: C. Raised 30 degrees Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. • Option A: In high-Fowler’s position, the veins would be barely discernible above the clavicle. • Option B: Inclined pressure can’t be seen when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). • Option D: Inclined pressure cannot be seen when the client is in a supine position because the point that marks the pressure level is above the jaw. 44. 44. Question Which of the following parameters should be checked before administering digoxin? • A. Apical pulse • B. Blood pressure • C. Radial pulse • D. Respiratory rate Incorrect Correct Answer: A. Apical pulse An apical pulse is essential for accurately assessing the client’s heart rate before administering digoxin. The apical pulse is the most accurate point in the body. • Option B: Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. • Option C: The radial pulse can be affected by cardiac and vascular disease and therefore, won’t always accurately depict the heart rate. • Option D: Digoxin has no effect on respiratory function. Digoxin is used to treat heart failure, usually along with other medications. It is also used to treat a certain type of irregular heartbeat (chronic atrial fibrillation). 45. 45. Question Toxicity from which of the following medications may cause a client to see a green halo around lights? • A. Digoxin • B. Furosemide • C. Metoprolol • D. Enala