CARDIOVASCULAR Test Questions/Blueprint
Question
1. Hypertension
1.
When the nurse is developing a teaching plan to
prevent the development of heart failure in a
patient with stage 1 hypertension, the information
that needs to be emphasized with antihypertensive
medication therapy is that
a. Hypertension is silent and if untreated can
cause irreversible damage to the kidneys.
b. Hypertension eventually will lead to heart
failure by overworking the left ventricle
c. High BP increases risk for rheumatic heart
disease.
d. High systemic pressure precipitates papillary
muscle rupture
e. a & b
2.
The nurse obtains the following information about
hypertension risk factors from a patient with
prehypertension. The modifiable risk factor that will
be the highest priority to change with your patient
is:
a. Gets no regular exercise
b. Is 10 pounds over their ideal weight
c. Has a high sodium intake
d. Drinks wine with dinner daily
e. Smokes ½ pack per day
The nurse is planning patient teaching for a patient
who has just been diagnosed with hypertension
and has a new prescription for Captopril
(Capoten). Which information is important to
include when teaching the patient?
a. To increase fluid intake if dryness of the mouth
is a problem
b. To check heart rate daily before taking the
3.
©2011 Keith Rischer/www.KeithRN.com
Course
Objective
Step in the
Nursing Process
implementation
Cognitive Level
(Blooms)
Apply
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Response
Level
Discrim.
.679
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medication
c. To include high-potassium foods such as citrus
fruits in the diet
d. To change position slowly to help prevent
dizziness and falls
4.
Laboratory testing is ordered for a patient during a
clinic visit for routine assessment of hypertension.
When monitoring for target organ damage as a
consequence of hypertension, the nurse will be
most concerned about
a. Blood urea nitrogen (BUN) of 15 mg/dl
b. Alanine aminotransferase (ALT) 40 u/L
c. Aspartate aminotransferase (AST) 38 u/L
d. Serum creatinine of 1.8 mg/dl
5.
In teaching a patient with hypertension, the nurse
emphasizes that even though you have no
symptoms, hypertension needs to be controlled
because it can quietly damage many organs in the
body. The damage that occurs is primarily related
to which effect of hypertension?
a.
b. Arterial wall changes with progressive
development of atherosclerosis
c. Hypoxia of organ systems caused by
thickening of capillary membranes, which
impairs gas exchange.
d. Increased viscosity of the blood contributing to
intravascular coagulation with necrosis of
tissue distal to occlusions.
6. Angina-Coronary Artery Disease
6.
Which of the following conditions causes the chest
pain seen with angina?
a. Increased preload
b. Decreased afterload
c. Decreased contractility
d. Decreased oxygen supply to the myocardium
7.
7. N1120-V-2 Your patient presents to the
©2011 Keith Rischer/www.KeithRN.com
assessment
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emergency department with complaints of
substernal chest pain. 12 hours later, it is noted on
the laboratory assessment that troponin levels
have not risen. What conclusion can be drawn
from this information?
a. Your patient has not experienced a myocardial
infarction.
b. Your patient is experiencing an evolving
myocardial infarction.
c. Your patient most likely had a myocardial
infarction several days ago.
d. Your patient has experienced a myocardial
infarction within the last 24 hours.
8.
Why is the administration of aspirin recommended
along with nitroglycerin when a client is
experiencing angina-like chest pain?
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a. Aspirin has analgestic properties without
sedation
b. Aspirin can trigger vasodilation and improve
blood plow.
c. Aspirin inhibits platelet aggregation and clot
information
d. Aspirin has cardiotonic properties and
improves contraction
9.
Nitroglycerin is indicated as one of the first
medications given for chest pain in angina
because it:
a. Decreases workload of the heart through
decreasing preload and dilates the coronary
©2011 Keith Rischer/www.KeithRN.com
arteries
b. Decreases workload of the heart through
increasing preload and dilates the coronary
arteries
c. Decreases workload of the heart through
decreasing afterload and constricts the
coronary arteries
d. Decreases workload of the heart through
decreasing heartrate and decreasing cardiac
contractility
10.
A client who has experienced a myocardial
infarction develops left ventricular heart failure.
Which sign of poor organ perfusion should the
nurse remain alert for?
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a. Alanine aminotransferase (ALT) 122 u/L
b. Serum creatinine of 1.7 mg/dl
c. Urine output less than 30mL/hour
d. b & c
e. a, b, c
11.
You are caring for your patient who had coronary
angioplasty (PTCA) 1 hour ago. Which
complications of this procedure should the nurse
remain alert for at this time?
a. Hypertensive crisis
b. Hyperkalemia
c. Infection
©2011 Keith Rischer/www.KeithRN.com
d. Bleeding
12.
13.
Your patient who is scheduled for
echocardiography today asks why this test is being
performed. What is the nurse’s best response?
a. To assess the structure of the heart and
determine left ventricular function
b. To assess for abnormal electrical impulses
within the heart
c. To evaluate the decrease in the cardiac output
when the client has PVCs
d. To evaluate the coronary arteries for any
blockages that may be present
You are taking the history of your patient who has
chest pain. Recently, he has had episodes of chest
discomfort while mowing the lawn with a push
mower. The chest discomfort subsides when the
patient rests. What conclusion can the nurse draw
from this information?
implementation
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a. The patient likely has unstable angina.
b. The patient likely has stable angina.
c. The patient likely has had a myocardial
infarction.
d. The patient need not be concerned about this
pain, because it relieved with rest.
14. The nurse is admitting a patient who is complaining
of chest pain to the emergency department (ED).
Which information collected by the nurse suggests
that the pain is caused by an acute myocardial
infarction (AMI)?
a. The pain onset was while he was watching TV.
b. The pain increases with deep breathing.
c. The pain is relieved after the patient takes
nitroglycerin.
d. The pain has persisted longer than 30 minutes.
e. a & d
©2011 Keith Rischer/www.KeithRN.com
15. Which information given by a patient admitted with
chronic stable angina will help the nurse confirm
this diagnosis?
a. The patient rates the pain at a level 3 to 5 (0–
10 scale).
b. The patient states that the pain “wakes me up
at night.”
c. The patient indicates that the pain is resolved
after taking one sublingual nitroglycerin tablet.
d. The patient says that the frequency of the pain
has increased over the last few weeks.
16.
16. Three risk factors that influence the
development and progression of coronary artery
disease include:
a. Smoking, family history of heart disease and
diabetes.
b. Smoking, active life style, and high density
lipoproteins (HDL) of 25.
c. Smoking, diabetes and high density
lipoproteins (HDL) of 80.
d. Obesity, smoking, and low density lipoproteins
(LDL) of 80.
Heart Failure
The initial compensatory mechanism of the body
that maintains cardiac output when the heart is in
failure is:
a. Increased parasympathetic nervous system
stimulation
b. Increased sympathetic nervous system
stimulation
c. Decreased sympathetic nervous system
stimulation
d. Renin-Angiotensin-Aldosterone System
18. An elderly patient with a 40-pack-year history of
smoking and a recent myocardial infarction is
admitted to the medical unit with acute shortness
of breath; the nurse needs to rule out pneumonia
versus heart failure. The diagnostic test that the
nurse will monitor to help in determining whether
the patient has heart failure is:
a. 12-lead electrocardiogram (ECG).
assessment
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17.
©2011 Keith Rischer/www.KeithRN.com
19.
b. Troponin
c. B-type natriuretic peptide (BNP).
d. Creatinine phosphokinase (CPK-MB)
Which nursing diagnosis would be considered a
priority for the client with left sided heart failure?
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a. Anxiety
b. Activity Intolerance
c. Impaired Gas Exchange
d. Fatigue
20.
ACE inhibitors such as Lisinopril are often the first
drug used to manage heart failure. What aspects
of cardiac output are influenced by this medication
to decrease the workload of the heart?
a. Increases preload and decreases afterload
b. Decreases preload and decreases afterload
c. Increases preload and increases afterload
d. Decreases heart rate and decreases
contractility
21.
Your patient with left sided heart failure has an
ejection fraction of 25%. What pathophysiologic
changes would the nurse expect to see?
a. An increase in stroke volume
b. A decrease in tissue /organ perfusion
c. An increase in oxygen saturation
d. A decrease in arterial vasoconstriction
22. Questions: 22-26: Ms. Camp, age 65 was
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discharged from the hospital 2 weeks ago after a 5day stay for severe dyspnea and congestive heart
failure. She now has 2+ pitting edema in lower
extremities and a nonproductive cough. Her vital
signs are:
T-98.9 P-112, R-28 BP 170/110 O2 sats 88% on
room air. Ms. Camp has shortness of breath with
exertion and used 3 pillows to sleep last night
because she became very short of breath after
lying flat. Standing or sitting up relieved her
shortness of breath.
22.
23.
24.
25.
26.
Which nursing diagnostic statement(s) are relevant
to her current status and will guide your plan of
care:
a. Impaired gas exchange
b. Excess fluid volume
c. Fluid volume deficit
d. a & b
What is the most important assessment for the
nurse to accomplish next for Ms. Camp?
a. Auscultate the lung sounds.
b. Assess the orientation.
c. Check the capillary refill.
d. Insert an IV.
Which assessment finding would most likely
indicate that Ms. Camp who has a history of left
sided heart failure is now in right-sided heart
failure?
a. 2+ pitting edema in lower extremities.
b. Crackles in lungs.
c. Orthopnea.
d. Non-productive cough.
The physician orders Furosemide (Lasix) 40 mg IV
stat. The primary rationale for this medication is to
decrease the workload of the heart by:
a. Lowering afterload through arterial vasodilation
b. Lowering preload through venous vasodilation
c. Lowering preload through diuresis
d. Lowering preload through diuresis and venous
vasodilation
When evaluating the effectiveness of your nursing
©2011 Keith Rischer/www.KeithRN.com
implement
analyze
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MODIFY
intervention, what nursing assessment data
supports that Furosemide has been effective to
decrease the workload of the heart?
a. Urine output of 800 mL in the past hour
b. Heart rate 120/minute
c. Respiratory rate 16/minute
d. a & c
e. a,b,c
MODIFY 26. N1120-V-2 When evaluating the
effectiveness of your nursing intervention, what
nursing assessment data supports that
Furosemide has been effective?
a. Urine output of 800 mL in the past hour
b. Heart rate 120/minute
c. Respiratory rate 16/minute
d. a & c
a,b,c
PVD-PAD
Apply
Analyze
Evaluate
27.
During an assessment of a 63-year-old patient at
the clinic, the patient says, “I have always taken an
evening walk, but lately my leg cramps and hurts
after just a few minutes of walking. The pain goes
away after I stop walking, though.” The nurse
should:
a. Ask about any skin color changes that occur in
response to cold.
b. Check for the presence of tortuous veins
bilaterally on the legs.
c. Assess for unilateral swelling, redness, and
tenderness of either leg.
d. Attempt to palpate the dorsalis pedis and
posterial tibial pulses.
29. The nurse performing an assessment with a patient
who has chronic peripheral arterial disease (PAD)
of the legs would expect to find
a. Swollen, dry, scaly ankles.
b. A positive Homans’ sign.
c. Little to no hair on lower legs
d. A draining ulcer on the heel.
30. The health care provider orders a continuous IV
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28.
©2011 Keith Rischer/www.KeithRN.com
31.
32.
33.
heparin infusion for a patient with swelling and
pain of the upper leg caused by a DVT. While the
patient is receiving the heparin infusion, the nurse
should
a. Assess for any signs of GI bleeding or unusual
bruising.
b. Notify the physician if platelets have dropped
significantly
c. Have vitamin K available in case reversal of
the heparin is needed.
d. Monitor posterior tibial and dorsalis pedis
pulses with the Doppler.
e. a&b
30. Your 72-year-old patient is hospitalized for an
aortic dissection of the abdominal aorta that
stabilizes with treatment. The nurse develops a
teaching plan for the patient’s discharge that
includes information about
a. gradually increasing exercise to improve
cardiac function and BP control.
b. appropriate use of nonsteroidal
antiinflammatory agents (NSAIDs) to control
any abdominal pain.
c. holding prescribed beta-blockers if systolic
blood pressure is <110 mm/Hg.
d. the use of antihypertensive medications to
lower the risk of further dissection
31. Your patient with a left calf DVT is at high risk
of developing a pulmonary embolism. Which
physical complaints would be suggestive that this
complication has occurred?
a. Shortness of breath
b. Pleuritic chest pain
c. Tachycardia
d. All of the above
32. A patient with a DVT is started on IV heparin
and oral warfarin (Coumadin). The patient asks the
nurse why two medications are necessary. The
nurse’s best response to the patient is,
a. “Heparin will start to dissolve the clot, and
Coumadin will prevent any more clots from
occurring.”
©2011 Keith Rischer/www.KeithRN.com
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b. “Because of the potential for a pulmonary
embolism, it is important for you to have more
than one anticoagulant.”
c. “The heparin will work immediately, but the
Coumadin takes at least 2-3 days to have an
effect on coagulation.”
d. “Administration of two anticoagulants reduces
the risk for recurrent deep vein thrombosis.”
KEY:
Cognitive Level:
Remembering
Understanding
Applying
Analyzing
Evaluating
Creating
Item Discrimination = how well an item distinguishes between high and low scoring students.
 0 is OK if it’s info that everyone absolutely needs to know, i.e. key content.
 .2 to .3 is desirable for most
 .4 or higher is OK for just a few questions. If all were .4, most of our students would fail the test.
 Negative discrimination means a problem, like a poorly written question, mis-speaking in lecture, not fully clarifying a
topic, or an error on the answer key.
©2011 Keith Rischer/www.KeithRN.com
FINAL EXAM
Question
1. ALTERATIONS IN OXYGENATION
(CARDIOVASCULAR) (9)
1.
Which assessment data is relevant for the
nurse to monitor in a patient who is receiving
a thiazide diuretic (HCTZ) or a loop diuretic
(Furosemide) to manage hypertension?
a.
Assess most recent serum hemoglobin
b.
Assess for hypotension.
c.
Assess most recent serum potassium
d.
b&c
e.
a,b,c
2.
You are caring for a patient who had
symptoms of unstable angina and has been
admitted to the hospital. The most
appropriate nursing diagnosis for the
discomfort associated with angina is what?
a.
Deficient knowledge about underlying
disease and methods for avoiding
complications
b.
Anxiety related to fear of death
c.
Ineffective cardiopulmonary tissue
perfusion as evidenced by chest pain
d.
Noncompliance related to failure to
accept necessary lifestyle changes
A patient with an occluded coronary artery is
admitted and has an emergency
angiogram/PTCA. The patient is admitted to
the unit after the PTCA. What is the most
important complication to assess this patient
for?
a.
Infection
b.
Bleeding at insertion site
c.
Hypertensive crisis
d.
Congestive heart failure
3.
©2011 Keith Rischer/www.KeithRN.com
Course
Objective
Step in the
Nursing
Process
assess
Cognitive
Level
(Blooms)
Understand
apply
Difficulty Item
Response
Level
Discrim.
0.924
0.1
assessment
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0.911
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Assessment
implement
Understand
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0.759
0.5
4.
5.
6.
7.
8.
The nurse is assessing a client whose
condition is being stabilized after a
myocardial infarction (MI). What data
collected by the nurse would indicate likely
inadequate renal perfusion?
a.
Serum blood urea nitrogen (BUN) 20.
b.
Specific gravity of 1.010.
c.
Urine output of less than 30 ml/hr.
d.
Serum creatinine of 1.8 mg/dL
e.
c&d
When discussing angina pectoris secondary
to atherosclerotic disease with a patient, the
patient asks why he experiences chest pain
with exertion. The nurse informs the patient
that exertion:
a.
Increases the heart's oxygen demands
b.
Causes vasoconstriction of the
coronary arteries
c.
Increases blood flow to the coronary
arteries
d.
Decreases the workload of the heart
You are teaching your patient about coronary
artery disease (CAD) and its risk factors.
What risk factors would you identify that can
be controlled or modified?
a.
Gender, obesity, family history, and
smoking
b.
Inactivity, stress, gender, and smoking
c.
Obesity, inactivity, diet, and smoking
d.
Stress, family history, and obesity
You are doing discharge teaching with a
patient diagnosed with heart failure. What
would you teach this patient as the most
practical way to assess fluid balance?
a.
Monitor blood pressure daily
b.
Assess radial pulses daily
c.
Monitor weight daily
d.
Monitor urine output
Which assessment finding(s) would indicate
that your patient has biventricular heart
©2011 Keith Rischer/www.KeithRN.com
assess
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9.
failure?
a.
2+ pitting edema in lower extremities
b.
Crackles in bases of lungs bilaterally
c.
Labored respirations
d.
b&c
e.
a,b,c
Your patient has received intravenous
Heparin therapy for two days for treatment of
deep vein thrombophlebitis. He asks why he
is receiving Heparin. What is your best
response?
a.
“Heparin will dissolve the clots in your
legs.”
b.
“Heparin will prevent new clots from
forming.”
c.
“Heparin will thin your blood and
speeds clotting.”
d.
“Heparin will prevent the clots from
migrating to your lungs.”
©2011 Keith Rischer/www.KeithRN.com
Analyze
Evaluate
implement
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apply
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