CARDIOVASCULAR Test Questions/Blueprint

Question / Course Objective / Step in the Nursing Process / Cognitive Level
(Blooms) / Difficulty Level / Item
Discrim. / Response
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 / implementation / Apply / .679 / 0.2
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 / assessment / Apply / 0.808 / 0.4
3.  The nurse is planning patient teaching for a patient who has just been diagnosed with hypertension and has a new prescription forCaptopril (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 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 / intervention / apply / 0.744 / 0.2
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 / assessment / Understand/apply / 0.962 / 0.1
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?
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. / Assess/intervention / Understand/apply / 0.679 / 0.1
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 / assessment / remember
understand / 0.885 / 0.3
7.  7. N1120-V-2 Your patient presents to the 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. / assessment / Understand
apply / 0.897 / 0.1
8.  Why is the administration of aspirin recommended along with nitroglycerin when a client is experiencing angina-like chest pain?
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 / Assess
implementation / Understand
Apply / 0.936 / 0.1
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 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 / implement / Understand
apply / 0.962 / 0.1
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?
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 / assessment / Understand
Apply / 0.628 / 0.4
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
d.  Bleeding / Assessment
implementation / Understand
Apply / 0.590 / 0.4
12.  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 / implementation / Understand
Apply / 0.628 / 0.5
13.  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?
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. / Assessment / Remember
Understand / 0.987 / 0.1
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 / assessment / remember
understand / 0.872 / 0.4
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. / assessment / Understand
apply / 0.910 / 0.1
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. / Assessment / Understand / 0.923 / 0.1
Heart Failure
17.  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 / assessment / Understand / 0.846 / 0.2
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).
b. Troponin
c.  B-type natriuretic peptide (BNP).
d. Creatinine phosphokinase (CPK-MB) / assessment / Understand
Apply / 0.474 / 0.4
19.  Which nursing diagnosis would be considered a priority for the client with left sided heart failure?
a.  Anxiety
b.  Activity Intolerance
c.  Impaired Gas Exchange
d.  Fatigue / assessment / Understand
Apply / 0.795 / 0.2
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 / assessment / Understand
Apply / 0.936 / -0.2
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 / assessment / Understand
Apply / 0.936 / 0.1
22. Questions: 22-26: Ms. Camp, age 65 was discharged from the hospital 2 weeks ago after a 5-day 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.  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 / Assessment
implement / Apply
analyze / 0.423 / 0.3
23.  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. / Assessment
implement / Understand
Apply / 0.859 / 0.0
24.  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. / assessment / Understand
Apply / 0.859 / 0.3
25.  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 / implement / Understand
Apply / 0.821 / 0.1
26.  When evaluating the effectiveness of your nursing 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
27.  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 / evaluation / Understand
Evaluate / 0.564 / 0.4 / MODIFY
28.  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. / Assess
implement / Understand
Apply / 0.538 / 0.3
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. / assess / Understand
Evaluate / 0.962 / 0.2
30.  The health care provider orders a continuous IV 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 / Assess
implement / Understand
analyze / 0.846 / 0.2
31.  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 / implement / Understand
Apply / 0.705 / 0.5
32.  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 / assess / Understand
Analyze / 0.949 / 0.1
33.  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.”
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.” / implement / Understand
apply / 0.897 / 0.2