NUR 3810 Exam 2 Practice Test Answers
and Rationale:
1. Which information given by a patient admitted with chronic stable angina will help the
nurse confirm this diagnosis?
a. The patient states that the pain “wakes me up at night.”
b. The patient rates the pain at a level 3 to 5 (0 to 10 scale).
c. The patient states that the pain has increased in frequency over the last week.
d. The patient states that the pain “goes away” with one sublingual nitroglycerin tablet.
Rationale: Chronic stable angina is typically relieved by rest or nitroglycerin administration. The
level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with
increased frequency is typical of unstable angina.
2. After the nurse has finished teaching a patient about the use of sublingual nitroglycerin,
which patient statement indicates that the teaching has been effective?
a. “I can expect some nausea as a side effect of nitroglycerin.”
b. “I should only take the nitroglycerin if I start to have chest pain.”
c. “I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart.”
d. “Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.”
Rationale: The emergency medical services (EMS) system should be activated when chest pain
or other symptoms are not completely relieved after 3 sublingual nitroglycerin tablets taken 5
minutes apart. Nitroglycerin can be taken to prevent chest pain or other symptoms from
developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an expected side effect of
nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery
atherosclerosis.
3. After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing
anginal episodes, which statement by a patient indicates that the teaching has been effective?
a. “Carvedilol will help my heart muscle work harder.”
b. “It is important not to suddenly stop taking the carvedilol.”
c. “I can expect to feel short of breath when taking carvedilol.”
d. “Carvedilol will increase the blood flow to my heart muscle.”
Rationale: Patients who have been taking β-adrenergic blockers can develop intense and
frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases
myocardial contractility. Shortness of breath that occurs when taking β-adrenergic blockers for
angina may be due to bronchospasm and should be reported to the health care provider.
Carvedilol works by decreasing myocardial oxygen demand, not by increasing blood flow to the
coronary arteries.
4. A patient who has had chest pain for several hours is admitted with a diagnosis of rule out
myocardial infarction (MI). Which laboratory test should the nurse monitor to help
determine whether the patient has had an MI?
a. Myoglobin
, b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin
Rationale: Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction
(MI) and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but it
lacks specificity and its use is limited. The other laboratory data are useful in determining the
patient’s risk for developing coronary artery disease (CAD) but are not helpful in determining
whether an acute MI is in progress.
5. Heparin is ordered for a patient with a non–ST-segment-elevation myocardial
infarction (NSTEMI). What is the purpose of the heparin?
a. Heparin enhances platelet aggregation.
b. Heparin decreases coronary artery plaque size.
c. Heparin prevents the development of new clots in the coronary arteries.
d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.
Rationale: Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary
artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or
enhance platelet aggregation.
6. A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads
is admitted to the emergency department (ED) and diagnosed as having an ST-segment-
elevation myocardial infarction (STEMI). Which question should the nurse ask to determine
whether the patient is a candidate for thrombolytic therapy?
a. “Do you have any allergies?”
b. “Do you take aspirin on a daily basis?”
c. “What time did your chest pain begin?”
d. “Can you rate your chest pain using a 0 to 10 scale?”
Rationale: Thrombolytic therapy should be started within 6 hours of the onset of the myocardial
infarction (MI), so the time at which the chest pain started is a major determinant of the
appropriateness of this treatment. The other information will also be needed, but it will not be a
factor in the decision about thrombolytic therapy.
7. In preparation for discharge, the nurse teaches a patient with chronic stable angina how to
use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that
the teaching has been effective?
a. “I will check my pulse rate before I take any nitroglycerin tablets.”
b. “I will put the nitroglycerin patch on as soon as I get any chest pain.”
c. “I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.”
d. “I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin.”
Rationale: The patient should sit down before taking the nitroglycerin to decrease cardiac
workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically
rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin.
and Rationale:
1. Which information given by a patient admitted with chronic stable angina will help the
nurse confirm this diagnosis?
a. The patient states that the pain “wakes me up at night.”
b. The patient rates the pain at a level 3 to 5 (0 to 10 scale).
c. The patient states that the pain has increased in frequency over the last week.
d. The patient states that the pain “goes away” with one sublingual nitroglycerin tablet.
Rationale: Chronic stable angina is typically relieved by rest or nitroglycerin administration. The
level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with
increased frequency is typical of unstable angina.
2. After the nurse has finished teaching a patient about the use of sublingual nitroglycerin,
which patient statement indicates that the teaching has been effective?
a. “I can expect some nausea as a side effect of nitroglycerin.”
b. “I should only take the nitroglycerin if I start to have chest pain.”
c. “I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart.”
d. “Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.”
Rationale: The emergency medical services (EMS) system should be activated when chest pain
or other symptoms are not completely relieved after 3 sublingual nitroglycerin tablets taken 5
minutes apart. Nitroglycerin can be taken to prevent chest pain or other symptoms from
developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an expected side effect of
nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery
atherosclerosis.
3. After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing
anginal episodes, which statement by a patient indicates that the teaching has been effective?
a. “Carvedilol will help my heart muscle work harder.”
b. “It is important not to suddenly stop taking the carvedilol.”
c. “I can expect to feel short of breath when taking carvedilol.”
d. “Carvedilol will increase the blood flow to my heart muscle.”
Rationale: Patients who have been taking β-adrenergic blockers can develop intense and
frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases
myocardial contractility. Shortness of breath that occurs when taking β-adrenergic blockers for
angina may be due to bronchospasm and should be reported to the health care provider.
Carvedilol works by decreasing myocardial oxygen demand, not by increasing blood flow to the
coronary arteries.
4. A patient who has had chest pain for several hours is admitted with a diagnosis of rule out
myocardial infarction (MI). Which laboratory test should the nurse monitor to help
determine whether the patient has had an MI?
a. Myoglobin
, b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin
Rationale: Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction
(MI) and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but it
lacks specificity and its use is limited. The other laboratory data are useful in determining the
patient’s risk for developing coronary artery disease (CAD) but are not helpful in determining
whether an acute MI is in progress.
5. Heparin is ordered for a patient with a non–ST-segment-elevation myocardial
infarction (NSTEMI). What is the purpose of the heparin?
a. Heparin enhances platelet aggregation.
b. Heparin decreases coronary artery plaque size.
c. Heparin prevents the development of new clots in the coronary arteries.
d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.
Rationale: Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary
artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or
enhance platelet aggregation.
6. A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads
is admitted to the emergency department (ED) and diagnosed as having an ST-segment-
elevation myocardial infarction (STEMI). Which question should the nurse ask to determine
whether the patient is a candidate for thrombolytic therapy?
a. “Do you have any allergies?”
b. “Do you take aspirin on a daily basis?”
c. “What time did your chest pain begin?”
d. “Can you rate your chest pain using a 0 to 10 scale?”
Rationale: Thrombolytic therapy should be started within 6 hours of the onset of the myocardial
infarction (MI), so the time at which the chest pain started is a major determinant of the
appropriateness of this treatment. The other information will also be needed, but it will not be a
factor in the decision about thrombolytic therapy.
7. In preparation for discharge, the nurse teaches a patient with chronic stable angina how to
use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that
the teaching has been effective?
a. “I will check my pulse rate before I take any nitroglycerin tablets.”
b. “I will put the nitroglycerin patch on as soon as I get any chest pain.”
c. “I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.”
d. “I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin.”
Rationale: The patient should sit down before taking the nitroglycerin to decrease cardiac
workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically
rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin.
