Coronary Artery Disease and Hypertension NCLEX Review

1. A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure?

a. Intake and output
b. Baseline peripheral pulse rates
c. Height and weight
d. Allergy to iodine or shellfish

2. A client with no history of cardiovascular disease comes into the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which of the following questions would best help a nurse to discriminate pain caused by a non-cardiac problem?

a. “Have you ever had this pain before?”
b. “Can you describe the pain to me?”
c. “Does the pain get worse when you breathe in?”
d. “Can you rate the pain on a scale of 1-10, with 10 being the worst?”

3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?

a. Strict bed rest for 24 hours after transfer
b. Bathroom privileges and self-care activities
c. Unsupervised hallway ambulation with distances under 200 feet
d. Ad lib activities because the client is monitored.

4. A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next?

a. Review the intake and output records for the last 2 days
b. Change the time of diuretic administration from morning to evening
c. Request a sodium restriction of 1 g/day from the physician.
d. Order daily weights starting the following morning.

5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to:

a. Check the client status and lead placement
b. Press the recorder button on the electrocardiogram console.
c. Call the physician
d. Call a code blue

6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following?

a. Seating the client with arm bared, supported, and at heart level.
b. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
c. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

7. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available on the nursing unit?

a. Vitamin K
b. Aminocaporic acid
c. Potassium chloride
d. Protamine sulfate

8. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:

a. The same as the client’s own baseline level
b. Lower than the needed therapeutic level
c. Within the therapeutic range
d. Higher than the therapeutic range

9. A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin:

a. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exert an anticoagulant effect.
b. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect.
c. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
d. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic.

10. A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first:

a. Administer the morphine
b. Obtain a 12-lead ECG
c. Obtain the lab work
d. Order the chest x-ray

11. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:

a. Help keep him well hydrated
b. Dissolve clots he may have
c. Prevent kidney failure
d. Treat potential cardiac arrhythmias.

12. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.

a. Reflects electrical impulse beginning at the SA node
b. Indicated electrical impulse beginning at the AV node
c. Reflects atrial muscle depolarization
d. Identifies ventricular muscle depolarization
e. Has duration of normally 0.11 seconds or less.

13. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to:

a. Call for the doctor
b. Start an intravenous line
c. Obtain a portable chest radiograph
d. Draw blood for laboratory studies

14. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?

a. Cancer
b. Hypertension
c. Liver disease
d. Myocardial infarction

15. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:

a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

16. The most important long-term goal for a client with hypertension would be to:

a. Learn how to avoid stress
b. Explore a job change or early retirement
c. Make a commitment to long-term therapy
d. Control high blood pressure

17. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:

a. Cerebrovascular accident
b. Liver disease
c. Myocardial infarction
d. Pulmonary disease

18. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?

a. Visit her friend earlier 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 once she reaches the friend’s apartment.

19. Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?

a. A change in the pattern of her pain
b. Pain during sex
c. Pain during an argument with her husband
d. Pain during or after an activity such as lawnmowing

20. The physician refers the client with unstable angina for a cardiac catherization. The nurse explains to the client that this procedure is being used in this specific case to:

a. Open and dilate the blocked coronary arteries
b. Assess the extent of arterial blockage
c. Bypass obstructed vessels
d. Assess the functional adequacy of the valves and heart muscle.

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