CARDIO WORKBOOK
1. A nurse is evaluating the blood pressure (BP) results for multiple clients with cardiac problems on a
telemetry unit. Which BP reading suggests to the nurse that the client’s mean arterial pressure (MAP) is
abnormal and warrants notifying the physician?
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a. 110/50 mm Hg
b. 94/60 mm Hg
c. 98/36 mm Hg
d. 140/78 mm Hg
2. A nurse assesses a patient who has just returned to the ward after having a coronary angiogram
through the left femoral artery. The client’s baseline blood pressure (BP) during the procedure was
130/70 mm Hg and the cardiac rhythm was a normal sinus throughout. Which assessment finding
should indicate to the nurse that the client may be experiencing a complication?
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a. BP 135/75 mmHg
b. Apical pulse 142 bpm with an irregular-irregular rhythm
c. Pedal pulses +1
d. Left groin soft with 1cm ecchymoses
3. In a health teaching session with a client newly diagnosed with chronic stable angina, the nurse
should incorporate which of the following measures that would prevent recurrence of angina? i. Wear a
face mask when outdoors in cold weather ii. Increase isometric arm exercises iii. Avoid straining at stool
iv. Perform most exertional activities in the morning v. Take nitroglycerin before a stressful situation
even when there is no pain present vi. Eliminate tobacco use.
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a. I, II, III, IV, VI
b. III, IV, V, VI
c. I, III, IV, V
d. I, III, V, VI
4. A client is diagnosed with acute coronary syndrome. During the morning shift, he complains of sharp
chest pains radiating to the left shoulder. The nurse notes that the client has tachycardia with
premature ventricular contractions (PVCs). Admitting orders included all of the following interventions
for treating chest pain. Which should the nurse implement first?
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a. Obtain a stat 12-lead electrocardiogram (ECG).
b. Administer oxygen by nasal cannula.
c. Administer sublingual nitroglycerin.
d. Administer morphine sulfate intravenously.
5. The nurse admits a client who had an infarct in the inferior septal wall of the myocardium. Upon
assessment, the nurse noted jugular vein distention and ascites. Which among these is likely the
complication the client is experiencing?
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a. Pulmonic valve malfunction
b. Right-sided heart failure
c. Ruptured septum
d. Left-sided heart failure
6. A client with a history of myocardial infarction 3 days ago complains of unusual fatigue. Upon
assessment, the nurse finds that the client is dyspneic with activity, with HR: 110 bpm and generalized
edema. Which action by the nurse is most appropriate?
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a. Continue to monitor client’s cardiac rhythm
b. Administer high-flow oxygen
c. Encourage the client to increase rest
d. Compare baseline weight with his current weight
7. A client has developed atrial fibrillation and has a HR of 166 beats per minute. The nurse should
assess the client for which possible effect of this condition?
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a. Hypertension and headache
b. Flat neck veins
c. Nausea and vomiting
d. Hypotension and dizziness
8. A patient prescribed with nitroglycerin is being instructed by the nurse about its administration.
Which of these should not be included in the nurse’s instruction?
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a. Sit down for a few minutes when taking nitroglycerin.
b. If throbbing headache and flushing are experienced after taking nitroglycerin, immediately call the
emergency medical services.
c. Nitroglycerin supply is renewed every 6 months.
d. Never store nitroglycerin tablets in metal pillboxes.
9. While looking at the cardiac monitor, the nurse suddenly notes that her patient is having ventricular
tachycardia. Which action should she take first?
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a. Call a code.
b. Prepare for cardioversion.
c. Prepare for defibrillation.
d. Determine client’s responsiveness.
10. A PACU nurse is caring for a patient who just had coronary artery bypass graft. Which assessment
finding in the immediate postoperative period should be immediately referred by the nurse to the
physician?
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a. No chest tube output for 1 hour when previously it was copious
b. ABG results of pH 7.32; PCO2 48; HCO3 28; PO2 80
c. Urine output of 160cc in the last 4 hours
d. Temperature of 37.4°C
11. Which among the following patients with cardiac conditions should a nurse prioritize FIRST?
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a. A 56-year-old patient admitted a day ago, with chest pain, on IV heparin, and has a PTT due back in 30
minutes
b. A 65-year-old patient with end-stage cardiomyopathy, blood pressure (BP) of 78/50 mm Hg, 20 mL/ hr
urine output, and a “Do Not Resuscitate” order and whose family has just arrived
c. A 72-year-old client who was transferred 2 hours ago from the Medical ICU after his coronary artery
bypass graft and has new onset atrial fibrillation
d. A 42-year-old patient who underwent aortic valve replacement 2 days ago, with BP 114/72mmHg, HR
100bpm, RR 28 breaths/min, and temperature of 38.4°C
12. During the start of her AM shift, a nurse receives a verbal order for a cardiac catheterization to be
done on a client in the afternoon. Which action should the nurse do first?
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a. Initiate NPO status for the patient.
b. Start an IV infusion of 0.9 NaCl
c. Ask the client to sign the consent form.
d. Teach the patient about the procedure.
13. A client with acute chest pain is receiving morphine sulfate via IV. Which of the following results are
the intended effects of this drug? Select all that apply. i. Reduces myocardial oxygen consumption ii.
Prevents ventricular remodeling iii. Reduces BP and HR iv. Reduces fear and anxiety v. Decreases
respiratory rate
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a. I, III, IV
b. I, II, III, IV
c. I, III, IV, V
d. I, III
14. After a myocardial infarction, the admitted patient is instructed to move his legs while resting in bed.
This exercise is to:
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a. Prepare the client for ambulation
b. Promote urinary and intestinal elimination
c. Prevent thrombophlebitis and formation of blood clots
d. Decrease the likelihood of pressure ulcer formation
15. After administering tissue plasminogen activator (t-PA) to a patient, what should the nurse do?
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a. Observe client for chest pain
b. Monitor for fever
c. Review the 12-lead ECG
d. Auscultate breath sounds
16. Following diagnosis of angina pectoris, the patient reports inability to walk up two flights of stairs
without experiencing pain. What measure should the nurse instruct the client to do to prevent this
problem?
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a. Climb the steps early in the day.
b. Rest for at least an hour before climbing the stairs
c. Take a nitroglycerin tablet before climbing the stairs
d. Lie down after climbing the stairs
17. What is the reason a nurse teaches a client with heart failure to take oral furosemide in the morning?
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a. To prevent electrolyte imbalances
b. To retard rapid drug absorption
c. To help excrete excessive fluids accumulated during the night
d. To prevent sleep disturbances during the night
18. A client is scheduled for cardiac catheterization. Which among these should the nurse perform
before the procedure? Select all that apply. I. Verify that written consent has been obtained II.
Administer all prescribed oral medications III. Check for iodine sensitivity IV. Insert a urinary drainage
catheter V. Withhold food and oral fluids prior to the procedure
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A.I,III,V
B.II,III,IV
C.II,IV,V
D,III,I,V
19. A patient taking digoxin should report which of the following indications of its toxicity
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a. Rashes over chest and back
b. Increased appetite
c. Elevated blood pressure
d. Visual disturbances
20. A client who recently experienced a myocardial infarction is scheduled to have a percutaneous
transluminal coronary angioplasty (PTCA). The nurse should plan to teach the client about which aspect
of a balloon-tipped catheter?
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a. A meshlike device will be inflated that will spring open.
b. The catheter will be used to compress the plaque against the coronary blood vessel wall.
c. The catheter will cut away the plaque from the coronary vessel wall using a cutting blade.
d. The catheter will be positioned in a coronary artery to take pressure measurements in the vessel
21. A cardiac catheterization, using the femoral artery approach, is performed to assess the degree of
coronary artery thrombosis in a client. Which of these actions should the nurse not include in caring
during the post-procedure period?
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a. Checking the client’s groin for bleeding
b. Encouraging the client to increase fluid intake
c. Placing the client’s bed in the high-Fowler’s position
d. Instructing the client to move the toes when checking circulation, motion, and sensation
II. Modified True or False Write TRUE if the statement is correct. If the statement is false, replace the
underlined word/s with the answer that will make the statement correct.
1
VASCULAR CONDITIONS
1. When assessing the lower extremities of a client with peripheral vascular disease (PVD), the nurse
notes bilateral ankle edema. This edema is primarily caused by:
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a. Increased venous pressure
b. Competent venous valves
c. Increased muscular activity
d. Decreased blood volume
2. A client who has been diagnosed with peripheral vascular disease (PVD) is being discharged. The client
needs more teaching if she states that she will:
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a. Avoid heating pads
b. Avoid crossing the legs
c. Wear leather shoes
d. Use iodine on an injured site
3. The client has aching, weakness, and a cramping sensation in both of the lower extremities while
walking. To promote health and maintain the client's level of activity, the nurse should suggest that the
client try:
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a. Riding a stationary bike
b. Skiing
c. Jogging
d. Golfing
4. The doctor prescribed a client with pentoxifylline for his intermittent claudication. To be able to
determine its effectiveness, the nurse should ask if the client:
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a. Can wiggle the toes
b. Has improved circulation in the legs
c. Is urinating more frequently
d. Is less dizzy
5. A client who has undergone an amputation of three toes and a femoral-popliteal bypass asks you
which leg positions can he assume while sitting. A nurse would give an incorrect answer if she suggest
the patient to:
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a. Flex his ankles
b. Cross his legs
c. Elevate his legs
d. Extend his knees
6. A nurse admits a client with a diagnosis of severe cellulitis in his left leg. The nurse anticipates the
prescribed treatment will include:
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a. Debriding the left leg
b. Obtaining baseline coagulation laboratory tests and initiating anticoagulation therapy
c. Applying sequential compression devices
d. Administering IV antiobiotics
7. A patient had a femoral-popliteal artery bypass graft surgery 48 hours ago. A priority nursing action at
this time should be to:
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a. Monitor the dorsalis pedis and posterior tibial pulses bilaterally every 4 hours.
b. Monitor intake and output.
c. Maintain the client at a 60-degree sitting position when resting in bed.
d. Report any edema that develops in the operative leg.
8. A new nurse reads presence of lymphedema in the chart of his patient who had undergone surgery
for breast cancer. He then asks his senior nurse what lymphedema. Which statement to the new nurse
regarding lymphedema is correct?
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a. Lymphedema frequently signifies that there is a recurrence of the malignancy.
b. Lymphedema usually resolves after the cancer treatment is completed when collateral lymph
circulation develops.
c. Lymphedema is characterized by severe swelling in the arm and hand on the affected side.
d. Lymphedema is mainly controlled by encouraging women to keep their arm elevated.
9. An 85-year-old female client is brought to the emergency department due to chest pains. She tells a
nurse that the chest pain is stabbing through the chest into her back. Her blood pressure is 220/140 mm
Hg. The nurse expects the diagnosis to be:
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a. Acute arterial occlusion
b. Pulmonary embolism
c. Aortic dissection
d. Subclavian steal syndrome
10. Which assessment findings in a patient with thoracic aneurysm suggest occurrence of rupture?
Select all that apply. i. Severe chest pain radiating to the back ii. Abdominal distention iii. Hypotension iv.
Dyspnea v. Oliguria
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a. II, III, IV, V
b. I, III, IV
c. I, III, IV, V
d. I, II, III, IV, V
11. A male client seeks care at a vascular clinic and is diagnosed with Buerger’s disease (thromboangiitis
obliterans). A nurse is teaching the client ways to prevent progression of the disease. Which prevention
measure should be the nurse’s initial focus when teaching the client?
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a. Abstaining from all tobacco products in all forms
b. Avoiding exposure to cold
c. Maintaining meticulous hygiene practices
d. Following a low-fat diet
12. A nurse is completing a health history on a client admitted to a hospital with recurrent lower
extremity cellulitis. The client tells the nurse that he has tinea pedis. The nurse concludes that this is
significant because:
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a. The loss of skin integrity that occurs with tinea pedis allows bacteria to enter the tissue.
b. The cellulitis is commonly caused by a fungus.
c. The cellulitis should resolve with topical fungicide therapy.
d. The client is at risk for developing a painful neuralgia after the infection has resolved.
13. The nurse has completed giving medication instructions to a client receiving enalapril to treat
hypertension. What statement made by the client is an indication that he was not able to fully
understand the teaching?
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a. “Change positions slowly.”
b. “Monitor the blood pressure every week.”
c. “Use salt moderately in cooking and on foods.”
d. “Report signs and symptoms of infection to the health care provider.”
14. A client is taking clonidine for treatment of his hypertension. The nurse should teach the client about
which of the following common adverse effects of this drug? Select all that apply i. Hyperkalemia ii. Dry
mouth. iii. Pancreatitis. iv. Impotence. v. Sleep disturbance
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a. II, IV, V
b. I, III, V
c. I, II, IV
d. II, III, V
15. A client who has diabetes is taking metoprolol for hypertension. Which of the following information
should the nurse include in the teaching plan? Select all that apply. i. Have a blood glucose level drawn
every 6 to 12 months during therapy. ii. Use an appropriate decongestant if needed. iii. These tablets
should be taken with food at same time each day. iv. Report any fainting spells to the health care
provider v. Do not crush or chew the tablets. vi. Notify the health care provider if pulse is 82 per minute.
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a. I, II, IV VI
b. I, III, IV, V
c. II, III, IV, V, VI
d. I, II, III, IV, V
SHOCK
1. The nurse suspects that a client who had a myocardial infarction is developing cardiogenic shock. The
nurse should assess for which peripheral vascular manifestation of this complication?
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a. Cool, clammy skin with weak or thread pedal pulses
b. Cool, dry skin with pulsus alternans
c. Flushed, dry skin with bounding pedal pulses
d. Warm, moist skin with irregular pedal pulses
2. What is the mean arterial pressure (MAP) of a person with a blood pressure 130/80 mmHg?
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a. 97
b. 50
c. 105
d. 113
3. What is the normal pulse pressure?
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a. 80-100 mmHg
b. 30-40 mmHg
c. 0-5 mmHg
d. 60-80 mmHg
4. What is the earliest manifestation of shock?
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a. Decreased oxygen saturation
b. Tachycardia
c. Bradypnea
d. Decreased urine output
5. Milrinone is indicated in the patient experiencing hypovolemic shock. The nurse knows that this drug
acts by:
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a. Increasing peripheral resistance while increasing venous return to the heart
b. Stimulating beta1 receptor sites on the heart and improving heart contractility
c. Dilating coronary arteries
d. Decreasing cardiac preload and increasing cardiac afterload
6. A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is
monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood
pressure has decreased significantly from the baseline value. The nurse suspects that the child is in
shock. Which is the most appropriate nursing action?
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a. Place the child in a supine position.
b. Place the child in Trendelenburg’s position.
c. Increase the flow rate of the intravenous fluids.
d. Notify the HCP.
7. A patient who sustained T6 injury from a vehicular accident manifests severe hypotension and
bradycardia. What should be the initial action of the nurse caring for the patient?
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a. Insert large-bore IV catheters.
b. Prepare to administer Lasix.
c. Place the patient on Trendelenburg.
d. Notify the physician.
8. Among the following goals, which is the most important in nursing care for a client who is in shock?
(Billings, 104)
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a. Manage vasoconstriction of vascular beds
b. Manage fluid overload
c. Manage increased cardiac output
d. Manage inadequate tissue perfusion
9. Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red
blood cells and normal saline solution? (Billings, 108)
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a. Fluid balance
b. Pain
c. Anaphylactic reaction
d. Altered LOC
10. The patient who does not respond adequately to fluid replacement was prescribed with Dopamine
HCl via IV infusion. What would the nurse assess the client for in determining the effectiveness of the
drug?
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a. Reduced preload and afterload
b. Increased renal and mesenteric blood flow
c. Increased cardiac output
d. Vasoconstriction
11. In caring for the client above, who is receiving dopamine for shock treatment, what should the nurse
do?
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a. Monitory blood pressure continuously.
b. Administer pain medication concurrently
c. Evaluate ABGs at least every 2 hours
d. Monitor for infection.
12. Which among the following nursing interventions is the most important in preventing septic shock?
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a. Maintaining asepsis of indwelling urinary catheters
b. Administering IV fluid replacement therapy as prescribed
c. Obtaining vital signs q4h for all clients
d. Monitoring red blood cell counts for elevation
13. Which of the following is an indication of a complication of septic shock?
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a. Acute respiratory distress syndrome
b. Mitral valve prolapse
c. Anaphylaxis
d. Chronic obstructive pulmonary disease
14. The nurse considers which of the following as the best indication that fluid replacement for a client
in hypovolemic shock is adequate?
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a. Systolic BP > 110mmHg
b. Diastolic BP >90 mmHg
c. Urine output greater than 30mL/hr
d. RR of 20 breaths/min
15. Which of the following indicates that a client who has had a 15% blood loss has developed
hypovolemic shock?
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a. Unequally dilated pupils
b. Systolic BP 75mmHg
c. Pulse rate 50 bpm
d. RR 4 cycles/min
16. Which of the fosllowing is a risk factor for hypovolemic shock?
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a. Antigen-antibody reaction
b. Gram-negative bacteria
c. Hemorrhage
d. Vasodilation