Myocardial Infarction and Heart Failure Practice Quiz (70 Questions) Actual Real Exam Questions And Correct Answers.

Which of the following symptoms might a client with right-sided heart failure exhibit? Adequate urine output Polyuria Oliguria Polydipsia - correct answersC Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Which of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility? Beta-adrenergic blockers Calcium channel blockers Diuretics Inotropic agents - correct answersD Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? Beta-adrenergic blockers Calcium channel blockers Narcotics Nitrates - correct answersA 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 myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload). What is the most common complication of an MI? Cardiogenic shock Heart failure Arrhythmias Pericarditis - correct answersC Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? Antihypertensives Beta-adrenergic blockers Calcium channel blockers Nitrates - correct answersB By decreasing the heart rate and contractility, beta-blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in clients who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as effective as beta-blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium. Stimulation of the sympathetic nervous system produces which of the following responses? Bradycardia Tachycardia Hypotension Decreased myocardial contractility - correct answersB Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate. A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for: Hypovolemia UTI Glomerulonephritis Acute renal failure - correct answersD The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal insult is signaled by decreased urine output, and increased BUN and creatinine levels. The client may need medications such as dopamine (Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. Which of the following is the most common symptom of myocardial infarction (MI)? Chest pain Dyspnea Edema Palpitations - correct answersA The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias. Which of the following blood tests is most indicative of cardiac damage? Lactate dehydrogenase Complete blood count (CBC) Troponin I Creatine kinase (CK) - correct answersC 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. Lactate dehydrogenase (LDH) is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury. With which of the following disorders is jugular vein distention most prominent? Abdominal aortic aneurysm Heart failure MI Pneumothorax - correct answersB Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. JVD isn't a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure, however, in and of itself, an MI doesn't cause JVD. Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? Anxiety Stable angina Unstable angina Variant angina - correct answersB The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress. A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is: Normal sinus rhythm Sinus bradycardia Sinus tachycardia Sinus dysrhythmia - correct answersA An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: Left ventricular atrophy Irregular heartbeats Peripheral vascular occlusion Pacemaker placement - correct answersA In older adults who are less active and do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle. Which of the following is an expected outcome for a client on the second day of hospitalization after an MI? Has severe chest pain Can identify risks factors for MI Agrees to participate in a cardiac rehabilitation walking program Can perform personal self-care activities without pain - correct answersD By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Day 2 hospitalization may be too soon for clients to be able to identify risk factors for MI or begin a walking program; however, the client may be sitting up in a chair as part of the cardiac rehabilitation program. Severe chest pain should not be present. The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects: Left atrial enlargement Left ventricular enlargement Right atrial enlargement Right ventricular enlargement - correct answersB A normal apical impulse is found under over the apex of the heart and is typically located and auscultated in the left fifth intercostal space in the midclavicular line. An apical impulse located or auscultated below the fifth intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement. Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema? Risk for infection related to stasis of alveolar secretions Impaired skin integrity related to pressure Activity intolerance related to pump failure Constipation related to immobility - correct answersC Activity intolerance is a primary problem for clients with heart failure and pulmonary edema. The decreased cardiac output associated with heart failure leads to reduced oxygen and fatigue. Clients frequently complain of dyspnea and fatigue. The client could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the client with HF and pulmonary edema, nor is constipation related to immobility. Which of the following foods should the nurse teach a client with heart failure to avoid or limit when following a 2-gram sodium diet? Apples Tomato juice Whole wheat bread Beef tenderloin - correct answersB Canned foods and juices, such as tomato juice, are typically high in sodium and should be avoided in a sodium-restricted diet. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: It is uncomfortable for the client, giving a sense of impending doom. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. It is almost impossible to convert to a normal sinus rhythm. It can develop into ventricular fibrillation at any time. - correct answersD Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular fibrillation at any time. Which of the following types of cardiomyopathy can be associated with childbirth? Dilated Hypertrophic Myocarditis Restrictive - correct answersA Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? Angina pectoris