A blockage in which coronary artery is most likely to damage the front wall of the left ventricle and the front of the septum?
Left anterior descending artery
✓
Right coronary artery
Left circumflex artery
Posterior descending artery
Correct Answer
Left anterior descending artery
The left anterior descending artery supplies the anterior wall of the left ventricle and much of the septum, so its blockage causes an anterior infarction that can involve a large area of muscle. Right coronary artery supplies the right ventricle and the inferior wall. Left circumflex artery supplies the lateral and back walls of the left ventricle. Posterior descending artery supplies the inferior wall and the back portion of the septum.
Category: Cardiac Overview
Question 2
A telemetry strip shows a PR interval that stays the same from beat to beat, with QRS complexes dropped without warning. Which rhythm is this?
Second-degree AV block, Mobitz I
Second-degree AV block, Mobitz II
✓
First-degree AV block
Third-degree AV block
Correct Answer
Second-degree AV block, Mobitz II
In Mobitz II the PR interval is constant and impulses fail to reach the ventricles unpredictably; it is the more serious second-degree block because it can progress to complete heart block. Second-degree AV block, Mobitz I shows a PR interval that lengthens with each beat until a QRS is dropped. First-degree AV block has a long PR interval but no dropped beats. Third-degree AV block shows no relationship at all between P waves and QRS complexes.
Category: Dysrhythmias
Question 3
A patient in third-degree heart block is dizzy and hypotensive. Which intervention should the nurse prepare for?
Defibrillation
Synchronized cardioversion
Transcutaneous pacing
✓
Vagal maneuvers
Correct Answer
Transcutaneous pacing
In complete heart block, the ventricles beat on their own at a slow escape rate, so a symptomatic patient needs pacing with pads on the chest until a permanent pacemaker can be placed. Defibrillation is for ventricular fibrillation and pulseless ventricular tachycardia. Synchronized cardioversion treats fast rhythms such as atrial fibrillation. Vagal maneuvers slow the heart and would make the bradycardia worse.
Category: Dysrhythmias
Question 4
A patient on telemetry develops frequent new premature ventricular contractions. Which laboratory values should the nurse check?
Hemoglobin and hematocrit
BUN and creatinine
Glucose and albumin
Potassium and magnesium
✓
Correct Answer
Potassium and magnesium
Electrolyte disturbances, especially of potassium and magnesium, make the ventricles irritable and trigger PVCs, so these levels are checked and replaced as ordered. Hemoglobin and hematocrit reflect blood loss and anemia. BUN and creatinine reflect kidney function. Glucose and albumin reflect blood sugar and nutrition, not ventricular irritability.
Category: Dysrhythmias
Question 5
Which ECG finding describes a premature ventricular contraction?
An early, wide QRS with no P wave before it
✓
An early P wave followed by a normal QRS
A sawtooth baseline with no clear P waves
A flat line with no electrical activity
Correct Answer
An early, wide QRS with no P wave before it
A PVC starts in the ventricle, so it comes early, has a wide QRS, has no P wave before it, and is usually followed by a compensatory pause. An early P wave followed by a normal QRS describes a premature atrial contraction. A sawtooth baseline with no clear P waves describes atrial flutter. A flat line with no electrical activity describes asystole.
Category: Dysrhythmias
Question 6
Before elective cardioversion for atrial fibrillation, which test checks the atria for a blood clot?
Exercise stress test
Transesophageal echocardiogram
✓
Chest x-ray
Holter monitor
Correct Answer
Transesophageal echocardiogram
Blood that pools in fibrillating atria can form clots, and a shock that restores normal contraction could dislodge a clot and cause a stroke or other systemic embolism; a probe passed down the esophagus gives a close view of the atria to look for one first. Exercise stress test looks for ischemia during exertion. Chest x-ray shows heart size and lung fields but not clots inside the heart. Holter monitor records the rhythm over time but cannot see a clot.
Category: Dysrhythmias
Question 7
Which instruction should the nurse give a patient with heart failure about daily weights?
Weigh after dinner when fluid intake is highest
Weigh once a week in different clothing
Weigh each morning after voiding, on the same scale
✓
Weigh only when the ankles look swollen
Correct Answer
Weigh each morning after voiding, on the same scale
Weighing at the same time, after voiding, in similar clothing and on the same scale makes day-to-day changes meaningful, and a sudden gain signals fluid retention that should be reported. Weigh after dinner when fluid intake is highest adds variation from food and drink. Weigh once a week in different clothing misses rapid gains and adds error. Weigh only when the ankles look swollen detects fluid only after it has already built up.
Category: Heart Failure
Question 8
A patient hospitalized with heart failure becomes short of breath and tired during morning care. Which plan of care addresses this problem?
Complete bathing, dressing and a hallway walk back to back
Keep the patient flat in bed between tasks
Withhold all activity until discharge
Schedule rest periods between care activities
✓
Correct Answer
Schedule rest periods between care activities
A failing heart cannot raise its output enough to meet the demand of several tasks in a row, so spacing care with rest periods conserves energy and limits dyspnea and fatigue. Complete bathing, dressing and a hallway walk back to back stacks up oxygen demand with no time to recover. Keep the patient flat in bed between tasks increases fluid return to the lungs and worsens dyspnea. Withhold all activity until discharge leads to deconditioning; activity is increased gradually once the patient is stable.
Category: Heart Failure
Question 9
Why does a patient with heart failure retain sodium and water?
Reduced kidney perfusion activates the renin-angiotensin-aldosterone system
✓
The heart releases a hormone that blocks all urine output
High blood glucose draws water into the cells
The lungs absorb extra fluid from inhaled air
Correct Answer
Reduced kidney perfusion activates the renin-angiotensin-aldosterone system
A failing heart lowers blood flow to the kidneys, which respond by releasing renin; the resulting angiotensin II and aldosterone cause the body to hold on to sodium and water, worsening congestion. The heart releases a hormone that blocks all urine output is wrong because the natriuretic peptides from a stretched heart actually promote sodium loss. High blood glucose draws water into the cells is not the mechanism. The lungs absorb extra fluid from inhaled air is not how fluid overload develops.
Category: Heart Failure
Question 10
A patient with heart failure suddenly develops severe dyspnea, crackles throughout both lungs and frothy sputum. What should the nurse do first?
Lower the head of the bed to rest the heart
Raise the patient to high Fowler's position and give oxygen
✓
Encourage the patient to drink more fluids
Walk the patient in the hallway to clear the lungs
Correct Answer
Raise the patient to high Fowler's position and give oxygen
These are signs of acute pulmonary edema, and oxygenation is the top priority: sitting upright eases breathing and reduces venous return, and oxygen supports saturation while the provider is notified. Lower the head of the bed to rest the heart increases fluid return to the lungs and worsens dyspnea. Encourage the patient to drink more fluids adds to the fluid overload. Walk the patient in the hallway to clear the lungs raises oxygen demand in a patient who is already hypoxic.
Category: Heart Failure
Question 11
What effect does a blood pressure cuff that is too small for the patient's arm have on the reading?
The reading will be falsely low
The reading will be unaffected
The reading will be falsely high
✓
Only the pulse rate will change
Correct Answer
The reading will be falsely high
A cuff that is too narrow must be inflated to a higher pressure to compress the artery, so it gives a falsely high reading; choosing the correct cuff size is necessary for accuracy. The reading will be falsely low is the error caused by a cuff that is too large. The reading will be unaffected is wrong because cuff size directly affects the measurement. Only the pulse rate will change is wrong because cuff size does not alter heart rate.
Category: Hypertension
Question 12
Which patient position gives the most accurate blood pressure reading in a clinic?
Seated with legs crossed and the arm hanging down
Standing with the arm raised above the head
Lying flat right after walking into the room
Seated with feet flat, legs uncrossed and the arm supported
✓
Correct Answer
Seated with feet flat, legs uncrossed and the arm supported
Sitting with both feet on the floor, legs uncrossed and the arm supported on a table or lap, after a brief rest, prevents falsely elevated or lowered values. Seated with legs crossed and the arm hanging down can raise the reading. Standing with the arm raised above the head lowers the reading in the arm. Lying flat right after walking into the room skips the rest period and uses a nonstandard position.
Category: Hypertension
Question 13
Which finding distinguishes a hypertensive emergency from hypertensive urgency?
Signs of acute damage to organs such as the kidneys or heart
✓
A headache that began within the past day
An elevated reading at a single clinic visit
A systolic value higher than the diastolic value
Correct Answer
Signs of acute damage to organs such as the kidneys or heart
Both involve severely elevated blood pressure, but a hypertensive emergency includes target organ damage, such as kidney failure or pulmonary edema, and needs immediate inpatient treatment. A headache that began within the past day can occur in either condition. An elevated reading at a single clinic visit does not define either one. A systolic value higher than the diastolic value is true of every blood pressure reading.
Category: Hypertension
Question 14
A patient has chest pain and a rising troponin level, but the ECG shows no ST-segment elevation. Which condition does the nurse anticipate?
Stable angina
Non-ST-elevation myocardial infarction
✓
Unstable angina
ST-elevation myocardial infarction
Correct Answer
Non-ST-elevation myocardial infarction
A rising troponin shows that heart muscle has been damaged, and the absence of ST elevation classifies the event as a non-ST-elevation MI. Stable angina is predictable chest pain that resolves with rest and causes no muscle damage. Unstable angina also lacks a troponin rise. ST-elevation myocardial infarction requires ST-segment elevation on the ECG.
Category: Myocardial Infarction
Question 15
For a patient whose ECG shows ST-segment elevation during crushing chest pain, which treatment should the nurse be ready for?
An exercise stress test later in the day
Discharge home with outpatient follow-up
Emergent coronary angiography with possible stent placement
✓
A scheduled bypass surgery after recovery
Correct Answer
Emergent coronary angiography with possible stent placement
ST elevation signals a complete coronary blockage, and because heart muscle dies the longer the artery stays closed, the patient is taken emergently for angiography and reopening of the vessel. An exercise stress test later in the day is unsafe during an active infarction. Discharge home with outpatient follow-up ignores a life-threatening event. A scheduled bypass surgery after recovery delays reperfusion; bypass is reserved for patterns such as multiple blockages.
Category: Myocardial Infarction
Question 16
After a cardiac catheterization through the femoral artery, the nurse finds blood soaking the dressing over the puncture site. What is the nurse's first action?
Raise the head of the bed
Help the patient walk to the bathroom
Remove the dressing and leave the site open
Apply firm, direct pressure over the puncture site
✓
Correct Answer
Apply firm, direct pressure over the puncture site
Bleeding from an arterial puncture can be rapid, so the nurse first applies direct pressure to stop it, then checks vital signs and distal pulses and notifies the provider. Raise the head of the bed bends the hip and can increase bleeding at the groin. Help the patient walk to the bathroom adds pressure on the site and can worsen bleeding. Remove the dressing and leave the site open does nothing to control the bleeding.
Category: Myocardial Infarction
Question 17
A patient with a known abdominal aortic aneurysm reports sudden, severe back and abdominal pain, and the nurse finds a falling blood pressure and a rising heart rate. What should the nurse do?
Keep the patient on bed rest and call the rapid response team
✓
Encourage walking to ease the back pain
Apply a heating pad to the lower back
Offer oral fluids and recheck later
Correct Answer
Keep the patient on bed rest and call the rapid response team
Sudden severe pain with hypotension and tachycardia signals rupture with internal bleeding, so the patient stays on bed rest, the rapid response team is activated and the patient is prepared for emergency surgery. Encourage walking to ease the back pain raises blood pressure and delays care. Apply a heating pad to the lower back treats the pain as muscular and wastes time. Offer oral fluids and recheck later delays treatment and the patient may need to stay NPO for surgery.
Category: Aortic and Carotid Disease
Question 18
Which symptom suggests reduced blood flow to the brain from carotid artery disease?
Calf pain that occurs only with walking
Sudden numbness and weakness on one side of the body
✓
A pulsating mass in the abdomen
Swelling of both ankles by evening
Correct Answer
Sudden numbness and weakness on one side of the body
Narrowed carotid arteries reduce blood flow to the brain and can release emboli, causing visual changes, confusion, and numbness or weakness on the side of the body opposite the affected artery, warning signs of a possible stroke. Calf pain that occurs only with walking is intermittent claudication from peripheral arterial disease. A pulsating mass in the abdomen suggests an abdominal aortic aneurysm. Swelling of both ankles by evening suggests venous insufficiency or heart failure.
Category: Aortic and Carotid Disease
Question 19
A patient has a shallow ulcer with an irregular shape near the inner ankle, surrounding brown discoloration and leg edema. Which type of ulcer is this?
Arterial ulcer
Pressure injury
Venous stasis ulcer
✓
Diabetic neuropathic ulcer
Correct Answer
Venous stasis ulcer
Venous stasis ulcers form on the lower leg near the ankle, are shallow and irregular, may be fairly painless, and come with edema and brown skin changes from pooled blood. Arterial ulcer is round, has little drainage and forms on the toes, heels and other bony prominences. Pressure injury forms over a bony prominence from sustained pressure. Diabetic neuropathic ulcer typically forms on the sole of the foot under pressure points.
Category: Peripheral Vascular Disease
Question 20
What does the ankle-brachial index compare?
Pulse rate in the foot with pulse rate at the wrist
Skin temperature of the foot with that of the hand
Leg circumference with arm circumference
Blood pressure in the ankle with blood pressure in the arm
✓
Correct Answer
Blood pressure in the ankle with blood pressure in the arm
The ankle-brachial index compares systolic pressure at the ankle with pressure in the arm; a lower ankle pressure points to arterial narrowing in the leg, and testing after treadmill walking can reproduce the problem. Pulse rate in the foot with pulse rate at the wrist would be the same heartbeat at both sites. Skin temperature of the foot with that of the hand is part of a physical exam, not this test. Leg circumference with arm circumference measures swelling or muscle size, not blood flow.
Category: Peripheral Vascular Disease