Myocardial Infarction and Heart Failure Practice Quiz (70 Questions)

Myocardial Infarction and Heart Failure
Practice Quiz (70 Questions)
Question 1
CORRECT
Which of the following types of angina is most closely related with an impending MI?
Angina decubitus
Chronic stable angina
Nocturnal angina
Unstable angina
Question 1 Explanation:
Unstable angina progressively increases in frequency, intensity, and duration and is related
to an increased risk of MI within 3 to 18 months.
Question 2
CORRECT
Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
Dilated aorta
Normally functioning heart
Decreased myocardial contractility
Failure of the ventricle to eject all of the blood during systole

An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction.
The increased resistance is related to decreased compliance of the ventricle. A dilated
aorta doesn’t cause an extra heart sound, though it does cause a murmur. Decreased
myocardial contractility is heard as a third heart sound. An S4 isn’t heard in a normally
functioning heart.
Question 3
CORRECT
Which of the following classes of drugs is most widely used in the treatment of
cardiomyopathy?
Antihypertensives
Beta-adrenergic blockers
Calcium channel blockers
Nitrates
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.
Question 4
WRONG
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
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.
Question 5
WRONG
If medical treatments fail, which of the following invasive procedures is necessary for
treating cardiomyopathy?
Cardiac catheterization
Coronary artery bypass graft (CABG)
Heart transplantation
Intra-aortic balloon pump (IABP)
The only definitive treatment for cardiomyopathy that can’t be controlled medically is a
heart transplant because the damage to the heart muscle is irreversible.
Question 6
WRONG
A nurse is preparing for the admission of a client with heart failure who is being sent
directly to the hospital from the physician’s office. The nurse would plan on having which of
the following medications readily available for use?
Diltiazem (Cardizem)
Digoxin (Lanoxin)
Propranolol (Inderal)
Metoprolol (Lopressor)
Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate
through a variety of mechanisms. Digoxin is the medication of choice to treat heart failure.
Diltiazem (calcium channel blocker) and propranolol and metoprolol (beta blockers) have a
negative inotropic effect and would worsen the failing heart.
Question 7
WRONG
Which of the following tests is used most often to diagnose angina?
Chest x-ray
Echocardiogram
Cardiac catheterization
12-lead electrocardiogram (ECG)
The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant
angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or
signs of heart failure, but isn’t used to diagnose angina.
Question 8
WRONG
Which of the following recurring conditions most commonly occurs in clients with
cardiomyopathy?
Heart failure
Diabetes
MI
Pericardial effusion
Because the structure and function of the heart muscle is affected, heart failure most
commonly occurs in clients with cardiomyopathy. MI results from prolonged myocardial
ischemia due to reduced blood flow through one of the coronary arteries. Pericardial
effusion is most predominant in clients with pericarditis.
Question 9
WRONG
An 18-year-old client who recently had an URI is admitted with suspected rheumatic fever.
Which assessment findings confirm this diagnosis?
Erythema marginatum, subcutaneous nodules, and fever
Tachycardia, finger clubbing, and a load S3
Dyspnea, cough, and palpitations
Dyspnea, fatigue, and syncope
Diagnosis of rheumatic fever requires that the client have either two major Jones criteria or
one minor criterion plus evidence of a previous streptococcal infection. Major criteria
include carditis, polyarthritis, Sydenham’s chorea, subcutaneous nodules, and erythema
marginatum (transient, non pruritic macules on the trunk or inner aspects of the upper
arms or thighs). Minor criteria include fever, arthralgia, elevated levels of acute phase
reactants, and a prolonged PR-interval on ECG.
Question 10
WRONG
A client with angina complains that the angina pain is prolonged and severe and occurs at
the same time each day, most often in the morning, On further assessment a nurse notes
that the pain occurs in the absence of precipitating factors. This type of anginal pain is best
described as:
Stable angina
Unstable angina
Variant angina
Nonanginal pain
Stable angina is induced by exercise and is relieved by rest or nitroglycerin tablets.
Unstable angina occurs at lower and lower levels of activity and rest, is less predictable,
and is often a precursor of myocardial infarction. Variant angina, or Prinzmetal’s angina, is
prolonged and severe and occurs at the same time each day, most often in the morning.
Question 11
WRONG
In which of the following disorders would the nurse expect to assess sacral edema in a
bedridden client?
Diabetes
Pulmonary emboli
Renal failure
Right-sided heart failure
The most accurate area on the body to assess dependent edema in a bed-ridden client is
the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.
Question 12
WRONG
Toxicity from which of the following medications may cause a client to see a green-yellow
halo around lights?
Digoxin
Furosemide (Lasix)
Metoprolol (Lopressor)
Enalapril (Vasotec)
One of the most common signs of digoxin toxicity is the visual disturbance known as the
“green-yellow halo sign.” The other medications aren’t associated with such an effect.
Question 13
WRONG
Which of the following symptoms is the most likely origin of pain the client described as
knifelike chest pain that increases in intensity with inspiration?
Cardiac
Gastrointestinal
Musculoskeletal
Pulmonary
Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only
increases with movement. Cardiac and GI pains don’t change with respiration.
Question 14
WRONG
A client with pulmonary edema has been on diuretic therapy. The client has an order for
additional furosemide (Lasix) in the amount of 40 mg IV push. Knowing that the client also
will be started on Digoxin (Lanoxin), a nurse checks the client’s most recent:
Digoxin level
Sodium level
Potassium level
Creatinine level
The serum potassium level is measured in the client receiving digoxin and furosemide.
Heightened digitalis effect leading to digoxin toxicity can occur in the client with
hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.
Question 15
WRONG
Septal involvement occurs in which type of cardiomyopathy?
Congestive
Dilated
Hypertrophic
Restrictive
In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle

chambers—is apparent. This abnormality isn’t seen in other types of cardiomyopathy.
Question 16
WRONG
Which of the following is the most common symptom of myocardial infarction (MI)?
Chest pain
Dyspnea
Edema
Palpitations
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.
Question 17
WRONG
Which of the following is a compensatory response to decreased cardiac output?
Decreased BP
Alteration in LOC
Decreased BP and diuresis

Increased BP and fluid retention
The body compensates for a decrease in cardiac output with a rise in BP, due to the
stimulation of the sympathetic NS and an increase in blood volume as the kidneys retain
sodium and water. Blood pressure doesn’t initially drop in response to the compensatory
mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output
persists.
Question 18
WRONG
Which of the following blood gas abnormalities is initially most suggestive of pulmonary
edema?
Anoxia
Hypercapnia
Hyperoxygenation
Hypocapnia
In an attempt to compensate for increased work of breathing due to hyperventilation,
carbon dioxide decreases, causing hypocapnea. If the condition persists, CO2 retention
occurs and hypercapnia results.
Question 19
WRONG
Which of the following symptoms is most commonly associated with left-sided heart
failure?
Crackles
Arrhythmias
Hepatic engorgement
Hypotension
Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused
by fluid backing up into the pulmonary system. Arrhythmias can be associated with both
right- and left-sided heart failure. Left-sided heart failure causes hypertension secondary to
an increased workload on the system.
Question 20
WRONG
Myocardial oxygen consumption increases as which of the following parameters increase?
Preload, afterload, and cerebral blood flow
Preload, afterload, and renal blood flow
Preload, afterload, contractility, and heart rate
Preload, afterload, cerebral blood flow, and heart rate.
Myocardial oxygen consumption increases as preload, afterload, renal contractility, and
heart rate increase. Cerebral blood flow doesn’t directly affect myocardial oxygen
consumption.
Question 21
WRONG
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
Canned foods and juices, such as tomato juice, are typically high in sodium and should be
avoided in a sodium-restricted diet.
Question 22
WRONG
Acute pulmonary edema caused by heart failure is usually a result of damage to which of
the following areas of the heart?
Left atrium
Right atrium
Left ventricle
Right ventricle
The left ventricle is responsible for the majority of force for the cardiac output. If the left
ventricle is damaged, the output decreases and fluid accumulates in the interstitial and
alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to
heart failure but wouldn’t affect cardiac output or, therefore, the onset of pulmonary
edema. If the right atrium and right ventricle were damaged, right-sided heart failure would
result.
Question 23
WRONG
In which of the following types of cardiomyopathy does cardiac output remain normal?
Dilated
Hypertrophic
Obliterative
Restrictive
Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the
ventricle remains relatively unchanged. All of the rest decrease cardiac output.
Question 24
WRONG
Which of the following types of cardiomyopathy can be associated with childbirth?
Dilated
Hypertrophic
Myocarditis
Restrictive
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.
Question 25
WRONG
Which of the following classes of medications protects the ischemic myocardium by

blocking catecholamines and sympathetic nerve stimulation?
Narcotics
Nitrates
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).
Question 26
WRONG
What is the primary reason for administering morphine to a client with an MI?
To sedate the client
To decrease the client’s pain
To decrease the client’s anxiety
To decrease oxygen demand on the client’s heart
Morphine is administered because it decreases myocardial oxygen demand. Morphine will
also decrease pain and anxiety while causing sedation, but it isn’t primarily given for those
reasons.
Question 27
WRONG
What is the most common complication of an MI?
Cardiogenic shock
Heart failure
Arrhythmias
Pericarditis
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.
Question 28
WRONG
After an anterior wall myocardial infarction, which of the following problems is indicated by
auscultation of crackles in the lungs?
Left-sided heart failure
Pulmonic valve malfunction
Tricupsid valve malfunction
The left ventricle is responsible for most of the 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. Pulmonic and tricuspid valve malfunction
causes right sided heart failure.
Question 29
WRONG
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.
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.
Question 30
WRONG
Furosemide is administered intravenously to a client with HF. How soon after

administration should the nurse begin to see evidence of the drugs desired effect?
5 to 10 minutes
30 to 60 minutes
2 to 4 hours
6 to 8 hours
After IV injection of furosemide, diuresis normally begins in about 5 minutes and reaches
its peak within about 30 minutes. Medication effects last 2 to 4 hours.
Question 31
WRONG
Which of the following blood tests is most indicative of cardiac damage?
Lactate dehydrogenase
Complete blood count (CBC)
Troponin I
Creatine kinase (CK)
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.
Question 32
WRONG
Which of the following actions is the first priority of care for a client exhibiting signs and
symptoms of coronary artery disease?
Decrease anxiety
Enhance myocardial oxygenation
Administer sublingual nitroglycerin
Educate the client about his symptoms
Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or
symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers
damage. Sublingual nitroglycerin is administered to treat acute angina, but administration
isn’t the first priority. Although educating the client and decreasing anxiety are important in
care delivery, neither are priorities when a client is compromised.
Question 33
WRONG
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
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.
Question 34
WRONG
Which of the following positions would best aid breathing for a client with acute pulmonary
edema?
Lying flat in bed
Left side-lying
In high Fowler’s position
In semi-Fowler’s position
A high Fowler’s position promotes ventilation and facilitates breathing by reducing venous
return. Lying flat and side-lying positions worsen the breathing and increase workload of
the heart. Semi-Fowler’s position won’t reduce the workload of the heart as well as the
Fowler’s position will.
Question 35
WRONG
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
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.
Question 36
WRONG
A home care nurse is making a routine visit to a client receiving digoxin (Lanoxin) in the
treatment of heart failure. The nurse would particularly assess the client for:
Thrombocytopenia and weight gain
Anorexia, nausea, and visual disturbances
Diarrhea and hypotension
Fatigue and muscle twitching
The first signs and symptoms of digoxin toxicity in adults include abdominal pain, N/V,
visual disturbances (blurred, yellow, or green vision, halos around lights), bradycardia, and
other dysrhythmias.
Question 37
WRONG
The physician orders continuous intravenous nitroglycerin infusion for the client with MI.
Essential nursing actions include which of the following?
Obtaining an infusion pump for the medication
Monitoring BP q4h
Monitoring urine output hourly
Obtaining serum potassium levels daily
IV nitro infusion requires an infusion pump for precise control of the medication. BP
monitoring would be done with a continuous system, and more frequently than every 4
hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is
not associated with nitroglycerin infusion.
Question 38
WRONG
Which of the following actions is the appropriate initial response to a client coughing up
pink, frothy sputum?
Call for help
Call the physician
Start an I.V. line

Suction the client
Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the
client is at high risk for decompensation, the nurse should call for help but not leave the
room. The other three interventions would immediately follow.
Question 39
WRONG
A client comes into the E.R. with acute shortness of breath and a cough that produces pink,
frothy sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of
122 BPM, and a respiratory rate of 38 breaths/minute. The client’s medical history included
DM, HTN, and heart failure. Which of the following disorders should the nurse suspect?
Pulmonary edema
Pneumothorax
Cardiac tamponade
Pulmonary embolus
SOB, tachypnea, low BP, tachycardia, crackles, and a cough producing pink, frothy sputum
are late signs of pulmonary edema.
Question 40
WRONG
Which of the following complications is indicated by a third heart sound (S3)?
Ventricular dilation
Systemic hypertension
Aortic valve malfunction
Increased atrial contractions
Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial
contraction or systemic hypertension can result in a fourth heart sound. Aortic valve
malfunction is heard as a murmur.
Question 41
WRONG
What is the first intervention for a client experiencing MI?
Administer morphine
Administer oxygen
Obtain an ECG
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. Morphine and nitro are
also used to treat MI, but they’re more commonly administered after the oxygen. An ECG is
the most common diagnostic tool used to evaluate MI.
Question 42
WRONG
Which of the following nursing diagnoses would be appropriate for a client with heart
failure? Select all that apply.
Ineffective tissue perfusion related to decreased peripheral blood flow secondary to

decreased cardiac output.
Activity intolerance related to increased cardiac output.
Decreased cardiac output related to structural and functional changes.
Impaired gas exchange related to decreased sympathetic nervous system activity.
HF is a result of structural and functional abnormalities of the heart tissue muscle. The
heart muscle becomes weak and does not adequately pump the blood out of the
chambers. As a result, blood pools in the left ventricle and backs up into the left atrium,
and eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle
after contraction thereby decreasing cardiac output. In addition, this pooling leads to
thrombus formation and ineffective tissue perfusion because of the decrease in blood flow
to the other organs and tissues of the body. Typically, these clients have an ejection
fraction of less than 50% and poorly tolerate activity. Activity intolerance is related to a
decrease, not increase, in cardiac output. Gas exchange is impaired. However, the decrease
in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic
nervous system activity.
Question 43
WRONG
Which of the following reflects the principle on which a client’s diet will most likely be based
during the acute phase of MI?
Liquids as ordered
Small, easily digested meals
Three regular meals per day
NPO
Recommended dietary principles in the acute phase of MI include avoiding large meals
because small, easily digested foods are better digested foods are better tolerated. Fluids
are given according to the client’s needs, and sodium restrictions may be prescribed,
especially for clients with manifestations of heart failure. Cholesterol restrictions may be
ordered as well. Clients are not prescribed a diet of liquids only or NPO unless their
condition is very unstable.
Question 44
WRONG
Which of the following terms describes the force against which the ventricle must expel
blood?
Afterload
Cardiac output
Overload
Preload
Afterload refers to the resistance normally maintained by the aortic and pulmonic valves,
the condition and tone of the aorta, and the resistance offered by the systemic and
pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per
minute. Overload refers to an abundance of circulating volume. Preload is the volume of

blood in the ventricle at the end of diastole.
Question 45
WRONG
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
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.
Question 46
WRONG
A nurse is conducting a health history with a client with a primary diagnosis of heart failure.
Which of the following disorders reported by the client is unlikely to play a role in
exacerbating the heart failure?
Recent URI
Nutritional anemia
Peptic ulcer disease
A-Fib
Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias,
infections, anemia, thyroid disorders, pregnancy, Paget’s disease, nutritional deficiencies
(thiamine, alcoholism), pulmonary disease, and hypervolemia.
Question 47
WRONG
Captopril may be administered to a client with HF because it acts as a:
Vasopressor
Volume expander
Vasodilator
Potassium-sparing diuretic
ACE inhibitors have become the vasodilators of choice in the client with mild to severe HF.
Vasodilator drugs are the only class of drugs clearly shown to improve survival in overt
heart failure.
Question 48
WRONG
When developing a teaching plan for a client with endocarditis, which of the following
points is most essential for the nurse to include?
“Report fever, anorexia, and night sweats to the physician.”
“Take prophylactic antibiotics after dental work and invasive procedures.”
“Include potassium rich foods in your diet.”
“Monitor your pulse regularly.”
The most essential teaching point is to report signs of relapse, such as fever, anorexia, and
night sweats, to the physician. To prevent further endocarditis episodes, prophylactic
antibiotics are taken before and sometimes after dental work, childbirth, or GU, GI, or
gynecologic procedures. A potassium-rich diet and daily pulse monitoring aren’t necessary
for a client with endocarditis.
Question 49
WRONG
Which of the following conditions is the predominant cause of angina?
Increased preload
Decreased afterload
Coronary artery spasm
Inadequate oxygen supply to the myocardium
Inadequate oxygen supply to the myocardium is responsible for the pain accompanying
angina. Increased preload would be responsible for right-sided heart failure. Decreased
afterload causes increased cardiac output. Coronary artery spasm is responsible for variant
angina.
Question 50
WRONG
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
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.
Question 51
WRONG
A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse
would plan to do which of the following to enable the client to best tolerate the
ambulation?
Encourage the client to cough and deep breathe
Premedicate the client with an analgesic

Provide the client with a walker
Remove telemetry equipment because it weighs down the hospital gown
The nurse should encourage regular use of pain medication for the first 48 to 72 hours
after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen
consumption resulting from pain, and allow better participation in activities such as
coughing, deep breathing, and ambulation. Options 1 and 3 will not help in tolerating
ambulation. Removal of telemetry equipment is contraindicated unless prescribed.
Question 52
WRONG
A client admitted with angina complains of severe chest pain and suddenly becomes
unresponsive. After establishing unresponsiveness, which of the following actions should
the nurse take first?
Activate the resuscitation team
Open the client’s airway
Check for breathing
Check for signs of circulation
Immediately after establishing unresponsiveness, the nurse should activate the
resuscitation team. The next step is to open the airway using the head-tilt, chin-lift
maneuver and check for breathing (looking, listening, and feeling for no more than 10-
seconds). If the client isn’t breathing, give two slow breaths using a bag mask or pocket
mask. Next, check for signs of circulation by palpating the carotid pulse.
Question 53
WRONG
Which of the following conditions is most closely associated with weight gain, nausea, and a
decrease in urine output?
Angina pectoris
Cardiomyopathy
Left-sided heart failure
Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided
heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure.
Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones.
Angina pectoris doesn’t cause weight gain, nausea, or a decrease in urine output.
Question 54
WRONG
Medical treatment of coronary artery disease includes which of the following procedures?
Medical treatment of coronary artery disease includes which of the following

procedures?
Coronary artery bypass surgery
Oral medication therapy

Percutaneous transluminal coronary angioplasty
Oral medication administration is a noninvasive, medical treatment for coronary artery
disease. Cardiac catherization isn’t a treatment, but a diagnostic tool. Coronary artery
bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical
treatments.
Question 55
WRONG
Which of the following conditions is most commonly responsible for myocardial infarction?
Aneurysm
Heart failure
Coronary artery thrombosis
Renal failure
Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death.
An aneurysm is an outpouching of a vessel and doesn’t cause an MI. Renal failure can be
associated with MI but isn’t a direct cause. Heart failure is usually a result from an MI.
Question 56
WRONG
Which of the following arteries primarily feeds the anterior wall of the heart?
Circumflex artery
Internal mammary artery
Left anterior descending artery
Right coronary artery
Left anterior descending artery The left anterior descending artery is the primary source of
blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the
internal mammary artery supplies the mammary, and the right coronary artery supplies
the inferior wall of the heart.
Question 57
WRONG
Which of the following interventions should be the first priority when treating a client
experiencing chest pain while walking?
Sit the client down
Get the client back to bed
Obtain an ECG
The initial priority is to decrease the oxygen consumption; this would be achieved by sitting
the client down. An ECG can be obtained after the client is sitting down. After the ECGm
sublingual nitro would be administered. When the client’s condition is stabilized, he can be
returned to bed.
Question 58
WRONG
The nurse coming on duty receives the report from the nurse going off duty. Which of the
following clients should the on-duty nurse assess first?
The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76,
and a respiratory rate of 21 breaths a minute.
The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR
order.
The 62-year-old client who was admitted one day ago with thrombophlebitis and
receiving IV heparin.
A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and
is receiving IV diltiazem (Cardizem).
The client with A-fib has the greatest potential to become unstable and is on IV medication
that requires close monitoring. After assessing this client, the nurse should assess the
client with thrombophlebitis who is receiving a heparin infusion, and then go to the 58-
year-old client admitted 2-days ago with heart failure (her s/s are resolving and don’t
require immediate attention). The lowest priority is the 89-year-old with end stage right-
sided heart failure, who requires time consuming supportive measures.
Question 59
WRONG
Which of the following results is the primary treatment goal for angina?
Reversal of ischemia
Reversal of infarction
Reduction of stress and anxiety
Reduction of associated risk factors
Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption
and increasing oxygen supply. An infarction is permanent and can’t be reversed.
Question 60
WRONG
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
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.
Question 61
WRONG
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
Question 62
WRONG
With which of the following disorders is jugular vein distention most prominent?
Abdominal aortic aneurysm
Heart failure
MI
Pneumothorax
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.
Question 63
WRONG
Stimulation of the sympathetic nervous system produces which of the following responses?
Bradycardia
Tachycardia
Hypotension
Decreased myocardial contractility
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.
Question 64
WRONG
Which of the following symptoms might a client with right-sided heart failure exhibit?
Adequate urine output
Polyuria
Oliguria
Polydipsia
Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to
fluid retention, which causes oliguria.
Question 65
WRONG
A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the
admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago
because he was feeling better. Which of the following nursing diagnoses takes priority for
this client?
Anxiety
Ineffective tissue perfusion; cardiopulmonary
Acute pain
Ineffective therapeutic regimen management
MI results from prolonged myocardial ischemia caused by reduced blood flow through the
coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective
tissue perfusion (cardiopulmonary). Anxiety, acute pain, and ineffective therapeutic
regimen management are appropriate but don’t take priority.
Question 66
WRONG
Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
Cardiomyopathy
Coronary artery disease
Myocardial infarction
Pericardial effusion
Cardiomyopathy isn’t usually related to an underlying heart disease such as
atherosclerosis. The etiology in most cases is unknown. CAD and MI are directly related to
atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a
condition associated with Pericarditis and advanced heart failure.
Question 67
WRONG
Aspirin is administered to the client experiencing an MI because of its:
Antipyretic action
Antithrombotic action
Antiplatelet action
Analgesic action
Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason
ASA is administered to the client experiencing an MI is its antithrombotic action.
Question 68
WRONG
Which of the following classes of medications maximizes cardiac performance in clients

with heart failure by increasing ventricular contractility?
Diuretics
Inotropic agents
Inotropic agents are administered to increase the force of the heart’s contractions, thereby
increasing ventricular contractility and ultimately increasing cardiac output.
Question 69
WRONG
A nurse caring for a client in one room is told by another nurse that a second client has
developed severe pulmonary edema. On entering the 2nd client’s room, the nurse would
expect the client to be:
Slightly anxious
Mildly anxious
Moderately anxious
Extremely anxious
Pulmonary edema causes the client to be extremely agitated and anxious. The client may
complain of a sense of drowning, suffocation, or smothering.
Question 70
WRONG
Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of
which of the following conditions?
Pericarditis
Hypertension
MI
Heart failure
These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the
chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by
headaches, visual disturbances, and a flushed face. MI causes heart failure but isn’t related
to these symptoms.

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Myocardial Infarction and Heart Failure

Practice Quiz (70 Questions)

Chronic stable angina

Normally functioning heart

Decreased myocardial contractility

Failure of the ventricle to eject all of the blood during systole

Calcium channel blockers

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

Coronary artery bypass graft (CABG)

Intra-aortic balloon pump (IABP)

Which of the following tests is used most often to diagnose angina?

12-lead electrocardiogram (ECG)

Erythema marginatum, subcutaneous nodules, and fever

Tachycardia, finger clubbing, and a load S3

Dyspnea, cough, and palpitations

Dyspnea, fatigue, and syncope

Right-sided heart failure

Septal involvement occurs in which type of cardiomyopathy?

In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle

Which of the following is a compensatory response to decreased cardiac output?

Decreased BP and diuresis

Increased BP and fluid retention

Myocardial oxygen consumption increases as which of the following parameters increase?

Preload, afterload, and cerebral blood flow

Preload, afterload, and renal blood flow

Preload, afterload, contractility, and heart rate

Preload, afterload, cerebral blood flow, and heart rate.

Whole wheat bread

Which of the following types of cardiomyopathy can be associated with childbirth?

Which of the following classes of medications protects the ischemic myocardium by

Calcium channel blockers

decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left

To sedate the client

To decrease the client’s pain

To decrease the client’s anxiety

To decrease oxygen demand on the client’s heart

What is the most common complication of an MI?

Left-sided heart failure

Pulmonic valve malfunction

Right-sided heart failure

Tricupsid valve malfunction

It is uncomfortable for the client, giving a sense of impending doom.

It is almost impossible to convert to a normal sinus rhythm.

It can develop into ventricular fibrillation at any time.

Furosemide is administered intravenously to a client with HF. How soon after

Which of the following blood tests is most indicative of cardiac damage?

Complete blood count (CBC)

Creatine kinase (CK)

Enhance myocardial oxygenation

Administer sublingual nitroglycerin

Educate the client about his symptoms

Lying flat in bed

In high Fowler’s position

Acute renal failure

Thrombocytopenia and weight gain

Anorexia, nausea, and visual disturbances