NURS 341 COMPREHENSIVE EXAM ACTUAL QUESTIONS
AND SOLUTIONS GRADED A+
✔✔Which statement made by a patient with coronary artery disease indicates
that further diet teaching is needed?
a. "I willswitch from whole milk to 1% milk."
b. "I like salmon and I will plan to eat it more often."
c. "I can have a glass of wine with dinner if I want one."
d. "I will miss being able to eat peanut butter sandwiches." - ✔✔D. "I will miss being
able to eat peanut butter sandwiches."
Although only 30% of the daily calories should come from fats, most of the fat in the diet
should come from monounsaturated fats such as are found in nuts, olive oil, and canola
oil. The patient can include peanut butter sandwiches as part of the diet. The other
patient comments indicate a good understanding of the recommended diet
✔✔Which patient statement indicates that the nurse's teaching about
carvedilol (Coreg) for preventing anginal episodes 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 feelshort of breath when taking carvedilol."
d. "Carvedilol will increase the blood flow to my heart muscle." - ✔✔B. "It is important
not to suddenly stop taking the carvedilol."
Patients who have been taking -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 -adrenergic blockers for angina may be due to bronchospasm and should
be reported to the health care provider. Carvedilol works by decreasing myocardial O2
demand, not by increasing blood flow to the coronary arteries
✔✔A patient who has had chest pain for several hours is admitted with a
diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test
is most specific for the nurse to monitor in determining whether the patient
has had an AMI?
a. Myoglobin
b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin - ✔✔D. cardiac-specific troponin
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 but are not helpful in determining whether an acute MI is in
progress.
✔✔Diltiazem is prescribed for a patient newly diagnosed with Prinzmetal's
(variant) angina.
Which action of diltiazem is accurate for the nurse to include in the teaching
plan?
a. Reduces heart palpitations.
b. Prevents coronary artery plaque.
c. Decreases coronary artery spasms.
d. Increases contractile force of the heart. - ✔✔C. decreases coronary artery spasms
Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers
(e.g., diltiazem, amlodipine) are a first-line therapy for this type of angina. Lipid-lowering
drugs help reduce atherosclerosis (i.e., plaque formation), and -adrenergic blockers
decrease sympathetic stimulation of
the heart (i.e., palpitations). Medications or activities that increase myocardial
contractility will increase the incidence of angina by increasing O2 demand.
✔✔Which data indicates to the nurse that the patient with stable angina is
experiencing a side effect of metoprolol?
a. Patient is restless and agitated.
b. Patient reports feeling anxious.
c. Blood pressure is 90/54 mm Hg.
d. Heart monitor shows normal sinus rhythm. - ✔✔C. blood pressure is 90/54 mm Hg
Patients taking -adrenergic blockers should be monitored for hypotension and
bradycardia. Because this class of medication inhibits the sympathetic nervous system,
restlessness, agitation, hypertension, and anxiety will not
be side effects. Normal sinus rhythm is a normal and expected heart rhythm.
✔✔Nadolol (Corgard) is prescribed for a patient with chronic stable angina
and left ventricular dysfunction. Which data would indicate to the nurse that
the drug is effective?
a. Decreased blood pressure and heart rate
b. Improvement in the strength of the distalpulses
c. Fewer complaints of having cold hands and feet
d. Participation in daily activities without chest pain - ✔✔D. participation in daily
activities without chest pain
Because the drug is ordered to improve the patient's angina, effectiveness is indicated if
the patient is able to accomplish daily activities without chest pain. Blood pressure and
heart rate may decrease, but these data do not indicate that the goal of decreased
angina has been met. The non-cardio selective -adrenergic blockers can cause
peripheral vasoconstriction, so the nurse would not expect an
improvement in distal pulse quality or skin temperature.
, ✔✔Heparin is ordered for a patient with a non-ST-segment-elevation
myocardial infarction (NSTEMI). How should the nurse explain the purpose of
the heparin to the patient?
a. "Heparin enhances platelet aggregation at the plaque site."
b. "Heparin decreases the size of the coronaryartery plaque."
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." - ✔✔C. "Heparin prevents the development of new clots in the coronary
arteries."
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.
✔✔Which action will the nurse take to evaluate the effectiveness of IV
nitroglycerin for a patient with a myocardial infarction (MI)?
a. Monitor heart rate.
b. Ask about chest pain.
c. Check blood pressure.
d. Observe for dysrhythmias. - ✔✔B. ask about chest pain
The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the
balance between myocardial oxygen supply and demand. The nurse will also monitor
heart rate and blood pressure and observe for dysrhythmias, but these parameters will
not indicate whether the medication
is effective.
✔✔A patient is admitted to the emergency department and diagnosed as
having an ST-segment-elevation myocardial infarction (STEMI). Which
question would the nurse ask to determine whether the patient is a
candidate for thrombolytic therapy?
a. "Do you have anyallergies?"
b. "Did you take aspirin today?"
c. "What time did your pain begin?"
d. "Can you rate the pain on a 0 to 10 scale?" - ✔✔C. "what time did your pain begin"
Thrombolytic therapy criteria include chest pain for less than 12 hours with 12-lead ECG
findings consistent with an acute STEMI. The other information is not a factor in the
decision about thrombolytic therapy
✔✔A patient who has recently had an acute myocardial infarction (AMI)
ambulates in the hospital hallway. Which data would indicate to the nurse
that the patient should stop and rest?
a. O2 saturation drops from 99% to95%.
AND SOLUTIONS GRADED A+
✔✔Which statement made by a patient with coronary artery disease indicates
that further diet teaching is needed?
a. "I willswitch from whole milk to 1% milk."
b. "I like salmon and I will plan to eat it more often."
c. "I can have a glass of wine with dinner if I want one."
d. "I will miss being able to eat peanut butter sandwiches." - ✔✔D. "I will miss being
able to eat peanut butter sandwiches."
Although only 30% of the daily calories should come from fats, most of the fat in the diet
should come from monounsaturated fats such as are found in nuts, olive oil, and canola
oil. The patient can include peanut butter sandwiches as part of the diet. The other
patient comments indicate a good understanding of the recommended diet
✔✔Which patient statement indicates that the nurse's teaching about
carvedilol (Coreg) for preventing anginal episodes 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 feelshort of breath when taking carvedilol."
d. "Carvedilol will increase the blood flow to my heart muscle." - ✔✔B. "It is important
not to suddenly stop taking the carvedilol."
Patients who have been taking -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 -adrenergic blockers for angina may be due to bronchospasm and should
be reported to the health care provider. Carvedilol works by decreasing myocardial O2
demand, not by increasing blood flow to the coronary arteries
✔✔A patient who has had chest pain for several hours is admitted with a
diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test
is most specific for the nurse to monitor in determining whether the patient
has had an AMI?
a. Myoglobin
b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin - ✔✔D. cardiac-specific troponin
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 but are not helpful in determining whether an acute MI is in
progress.
✔✔Diltiazem is prescribed for a patient newly diagnosed with Prinzmetal's
(variant) angina.
Which action of diltiazem is accurate for the nurse to include in the teaching
plan?
a. Reduces heart palpitations.
b. Prevents coronary artery plaque.
c. Decreases coronary artery spasms.
d. Increases contractile force of the heart. - ✔✔C. decreases coronary artery spasms
Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers
(e.g., diltiazem, amlodipine) are a first-line therapy for this type of angina. Lipid-lowering
drugs help reduce atherosclerosis (i.e., plaque formation), and -adrenergic blockers
decrease sympathetic stimulation of
the heart (i.e., palpitations). Medications or activities that increase myocardial
contractility will increase the incidence of angina by increasing O2 demand.
✔✔Which data indicates to the nurse that the patient with stable angina is
experiencing a side effect of metoprolol?
a. Patient is restless and agitated.
b. Patient reports feeling anxious.
c. Blood pressure is 90/54 mm Hg.
d. Heart monitor shows normal sinus rhythm. - ✔✔C. blood pressure is 90/54 mm Hg
Patients taking -adrenergic blockers should be monitored for hypotension and
bradycardia. Because this class of medication inhibits the sympathetic nervous system,
restlessness, agitation, hypertension, and anxiety will not
be side effects. Normal sinus rhythm is a normal and expected heart rhythm.
✔✔Nadolol (Corgard) is prescribed for a patient with chronic stable angina
and left ventricular dysfunction. Which data would indicate to the nurse that
the drug is effective?
a. Decreased blood pressure and heart rate
b. Improvement in the strength of the distalpulses
c. Fewer complaints of having cold hands and feet
d. Participation in daily activities without chest pain - ✔✔D. participation in daily
activities without chest pain
Because the drug is ordered to improve the patient's angina, effectiveness is indicated if
the patient is able to accomplish daily activities without chest pain. Blood pressure and
heart rate may decrease, but these data do not indicate that the goal of decreased
angina has been met. The non-cardio selective -adrenergic blockers can cause
peripheral vasoconstriction, so the nurse would not expect an
improvement in distal pulse quality or skin temperature.
, ✔✔Heparin is ordered for a patient with a non-ST-segment-elevation
myocardial infarction (NSTEMI). How should the nurse explain the purpose of
the heparin to the patient?
a. "Heparin enhances platelet aggregation at the plaque site."
b. "Heparin decreases the size of the coronaryartery plaque."
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." - ✔✔C. "Heparin prevents the development of new clots in the coronary
arteries."
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.
✔✔Which action will the nurse take to evaluate the effectiveness of IV
nitroglycerin for a patient with a myocardial infarction (MI)?
a. Monitor heart rate.
b. Ask about chest pain.
c. Check blood pressure.
d. Observe for dysrhythmias. - ✔✔B. ask about chest pain
The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the
balance between myocardial oxygen supply and demand. The nurse will also monitor
heart rate and blood pressure and observe for dysrhythmias, but these parameters will
not indicate whether the medication
is effective.
✔✔A patient is admitted to the emergency department and diagnosed as
having an ST-segment-elevation myocardial infarction (STEMI). Which
question would the nurse ask to determine whether the patient is a
candidate for thrombolytic therapy?
a. "Do you have anyallergies?"
b. "Did you take aspirin today?"
c. "What time did your pain begin?"
d. "Can you rate the pain on a 0 to 10 scale?" - ✔✔C. "what time did your pain begin"
Thrombolytic therapy criteria include chest pain for less than 12 hours with 12-lead ECG
findings consistent with an acute STEMI. The other information is not a factor in the
decision about thrombolytic therapy
✔✔A patient who has recently had an acute myocardial infarction (AMI)
ambulates in the hospital hallway. Which data would indicate to the nurse
that the patient should stop and rest?
a. O2 saturation drops from 99% to95%.
