Cardiovascular Health Review Questions and Answers Rated A+
A nurse is reviewing the medical record of a client who is receiving heparin therapy for treatment of
deep-vein thrombosis. Which of the following interventions should the nurse anticipate taking if the
client's aPTT is 96 seconds?
-increase the heparin infusion flow rate by 2mL/hr
-continue to monitor the heparin infusion as prescribed
-request a prothrombin time (PT)
-stop the heparin infusion. - Answers Stop the heparin infusion
- The aPTT level is above the therapeutic range of 1.5 to 2 times the control value. The nurse should
discontinue the heparin infusion immediately and notify the provider to prevent harm to the client.
A nurse providing teaching for a client who is 2 days postoperative following a heart transplant. Which
of the following statements should the nurse include in the teaching?
-"You may no longer be able to feel chest pain."
-"Your level of activity intolerance will not change"
-"After 6 months, you will no longer need to restrict your sodium intake."
-"You will be able to stop taking immunosuppressants after 12 months." - Answers "You may no longer
be able to feel chest pain"
Heart transplant clients usually are no longer able to feel chest pain due to denervation of the heart.
A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when
evaluating the point of maximal impulse. - Answers Apex
the point of maximal impulse is located at the left 5th intercostal space in the midclavicular line.
a nurse is caring for a client who has a history of deep vein thrombosis and is receiving warfarin. which
of the following client findings provides the nurse with the best evidence regarding the effectiveness of
the warfarin therapy?
,-hemoglobin 14 g/dL
-minimal bruising of extremities
-reduced circumference of affected extremity
-INR 2.5 - Answers INR 2.5
the nurse should determine that an INR of 2.5 is within the desired therapeutic range and is the best
evidence of effective warfarin therapy.
a nurse is assessing a client in the emergency room who has a bradydysrhythmia. which of the following
findings should the nurse expect?
-confusion
-friction rub
-hypertension
-dry skin - Answers confusion
bradydysrhythmia can cause decreased tissue perfusion, which can lead to confusion. therefore, the
nurse should monitor the client's mental status.
a nurse is providing discharge teaching for a client who has prescription for the transdermal
nitroglycerin patch. which of the following instructions should the nurse include in the teaching?
-apply the new patch to the same site as the previous patch
-place the patch on an area of skin away from skin folds and joints
-keep the patch on 24hr per day
-replace the patch at the onset of angina - Answers place the patch on an area of skin away from skin
folds and joints
,the client should apply the patch to an area of skin that is not prone to movement or wrinkling
a nurse is caring for a client in the first hour following an aortic aneurysm repair. which of the following
findings can indicate shock and should be reported to the provider?
-serosanguineous drainage on dressing
-severe pain with coughing
-urine output of 20 mL/hr
-increase in temperature from 36.8 C (98.2 F) to 37.5 C (99.5) - Answers urine output of 20 mL/hr
urine output less than 30mL/hr can indicate shock because it reflects decreased blood flow to the
kidneys, possible from graft rupture and hemorrhage.
a nurse is providing discharge teaching for a client who has heart failure. the nurse should instruct the
client to report which of the followings immediately to the provider?
-weight gain of 0.9 kg (2lb) in 24 hr
-increase of 10 mm Hg in systolic blood pressure
-dyspnea with exertion
-dizziness when rising quickly - Answers weight gain of 0.9 kg (2 lb) in 24 hr
when using the urgent vs. nonurgent approach to client care, the nurse should determine that the
priority finding is a weight gain of 0.5-0.9 kg (1-2 lb) in 1 day. this weight gain is an indication of fluid
retention resulting from worsening heart failure. the client should report this finding immediately.
a nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal
sinus rhythm to a supraventricular tachycardia. the client is conscious with a heart rate of 200 to
210/min and has a faint radial pulse. the nurse should anticipate assisting with which of the following
interventions?
-delivery of a precordial thump
-vagal stimulation
, -administration of atropine IV
-Defibrillation - Answers vagal stimulation
vagal stimulation can help the client's heart return to a normal sinus rhythm temporarily
a nurse is caring for a client following an abdominal aortic aneurysm resection. which of the following is
the priority assessment for this client?
-neck vein distention
-bowel sounds
-peripheral edema
-urine output - Answers urine output
the greatest risk to this client is graft occlusion or rupture. therefore, monitoring urine output, which
reflects blood flow to the kidneys, is the priority assessment.
a nurse is caring for a client following insertion of a permanent pacemaker. which of the following client
statements indicates a potential complication of the insertion procedure?
-"i cant get rid of these hiccups"
-"i feel dizzy when i stand"
-"my incision site stings"
-"i have a headache" - Answers " I cant get rid of these hiccups"
hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can indicate a
complication such as lead wire perforation.
a nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. which
of the following client findings should the nurse report to the provider?
A nurse is reviewing the medical record of a client who is receiving heparin therapy for treatment of
deep-vein thrombosis. Which of the following interventions should the nurse anticipate taking if the
client's aPTT is 96 seconds?
-increase the heparin infusion flow rate by 2mL/hr
-continue to monitor the heparin infusion as prescribed
-request a prothrombin time (PT)
-stop the heparin infusion. - Answers Stop the heparin infusion
- The aPTT level is above the therapeutic range of 1.5 to 2 times the control value. The nurse should
discontinue the heparin infusion immediately and notify the provider to prevent harm to the client.
A nurse providing teaching for a client who is 2 days postoperative following a heart transplant. Which
of the following statements should the nurse include in the teaching?
-"You may no longer be able to feel chest pain."
-"Your level of activity intolerance will not change"
-"After 6 months, you will no longer need to restrict your sodium intake."
-"You will be able to stop taking immunosuppressants after 12 months." - Answers "You may no longer
be able to feel chest pain"
Heart transplant clients usually are no longer able to feel chest pain due to denervation of the heart.
A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when
evaluating the point of maximal impulse. - Answers Apex
the point of maximal impulse is located at the left 5th intercostal space in the midclavicular line.
a nurse is caring for a client who has a history of deep vein thrombosis and is receiving warfarin. which
of the following client findings provides the nurse with the best evidence regarding the effectiveness of
the warfarin therapy?
,-hemoglobin 14 g/dL
-minimal bruising of extremities
-reduced circumference of affected extremity
-INR 2.5 - Answers INR 2.5
the nurse should determine that an INR of 2.5 is within the desired therapeutic range and is the best
evidence of effective warfarin therapy.
a nurse is assessing a client in the emergency room who has a bradydysrhythmia. which of the following
findings should the nurse expect?
-confusion
-friction rub
-hypertension
-dry skin - Answers confusion
bradydysrhythmia can cause decreased tissue perfusion, which can lead to confusion. therefore, the
nurse should monitor the client's mental status.
a nurse is providing discharge teaching for a client who has prescription for the transdermal
nitroglycerin patch. which of the following instructions should the nurse include in the teaching?
-apply the new patch to the same site as the previous patch
-place the patch on an area of skin away from skin folds and joints
-keep the patch on 24hr per day
-replace the patch at the onset of angina - Answers place the patch on an area of skin away from skin
folds and joints
,the client should apply the patch to an area of skin that is not prone to movement or wrinkling
a nurse is caring for a client in the first hour following an aortic aneurysm repair. which of the following
findings can indicate shock and should be reported to the provider?
-serosanguineous drainage on dressing
-severe pain with coughing
-urine output of 20 mL/hr
-increase in temperature from 36.8 C (98.2 F) to 37.5 C (99.5) - Answers urine output of 20 mL/hr
urine output less than 30mL/hr can indicate shock because it reflects decreased blood flow to the
kidneys, possible from graft rupture and hemorrhage.
a nurse is providing discharge teaching for a client who has heart failure. the nurse should instruct the
client to report which of the followings immediately to the provider?
-weight gain of 0.9 kg (2lb) in 24 hr
-increase of 10 mm Hg in systolic blood pressure
-dyspnea with exertion
-dizziness when rising quickly - Answers weight gain of 0.9 kg (2 lb) in 24 hr
when using the urgent vs. nonurgent approach to client care, the nurse should determine that the
priority finding is a weight gain of 0.5-0.9 kg (1-2 lb) in 1 day. this weight gain is an indication of fluid
retention resulting from worsening heart failure. the client should report this finding immediately.
a nurse is watching a client's ECG monitor and notes that the client's rhythm has changed from a normal
sinus rhythm to a supraventricular tachycardia. the client is conscious with a heart rate of 200 to
210/min and has a faint radial pulse. the nurse should anticipate assisting with which of the following
interventions?
-delivery of a precordial thump
-vagal stimulation
, -administration of atropine IV
-Defibrillation - Answers vagal stimulation
vagal stimulation can help the client's heart return to a normal sinus rhythm temporarily
a nurse is caring for a client following an abdominal aortic aneurysm resection. which of the following is
the priority assessment for this client?
-neck vein distention
-bowel sounds
-peripheral edema
-urine output - Answers urine output
the greatest risk to this client is graft occlusion or rupture. therefore, monitoring urine output, which
reflects blood flow to the kidneys, is the priority assessment.
a nurse is caring for a client following insertion of a permanent pacemaker. which of the following client
statements indicates a potential complication of the insertion procedure?
-"i cant get rid of these hiccups"
-"i feel dizzy when i stand"
-"my incision site stings"
-"i have a headache" - Answers " I cant get rid of these hiccups"
hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can indicate a
complication such as lead wire perforation.
a nurse is caring for a client in the first 8 hr following coronary artery bypass graft (CABG) surgery. which
of the following client findings should the nurse report to the provider?
