Coronary Artery Disease & Hypertension Practice

Quiz (50 Questions)

Question 1
CORRECT
A client is scheduled for a cardiac catheterization 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
Allergy to iodine or shellfish

Question 1 Explanation: This procedure requires an informed consent because it involves injection of a
radiopaque dye into the blood vessel. The risk of allergic reaction and possible anaphylaxis is serious and
must be assessed before the procedure.

Question 2
CORRECT
A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like 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?”
“Does the pain get worse when you breathe in?”
“Can you rate the pain on a scale of 1-10, with 10 being the
D worst?”

Question 2 Explanation: Chest pain is assessed by using the standard pain assessment parameters. Options
1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropulmonary origin usually
worsens on inspiration.

Question 3
CORRECT
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

Bathroom privileges and self-care activities

C Unsupervised hallway ambulation with distances under 200 feet

D Ad lib activities because the client is monitored
Question 3 Explanation: On transfer from the CCU, the client is allowed self-care activities and bathroom
privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50,
100, 200 feet).

Question 4
CORRECT
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?
Review the intake and output records for the last 2 days
Change the time of diuretic administration from morning to
B evening

C Request a sodium restriction of 1 g/day from the physician

D Order daily weights starting the following morning
Question 4 Explanation: Edema, the accumulation of excess fluid in the interstitial spaces, can be
measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the
morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe
symptoms.

Question 5
CORRECT
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:
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
Question 5 Explanation: Sudden loss of electrocardiogram complexes indicates ventricular asystole or
possible electrode displacement. Accurate assessment of the client and equipment is necessary to determine
the cause and identify the appropriate intervention.

Question 6
CORRECT
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?
Seating the client with arm bared, supported, and at heart
A level.
 Measuring the blood pressure after the client has been seated
B quietly for 5 minutes.
Using a cuff with a rubber bladder that encircles at least 80%
C of the limb.
Taking a blood pressure within 15 minutes after nicotine or
caffeine ingestion.

Question 6 Explanation: BP should be taken with the client seated with the arm bared, positioned with
support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak
during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes
preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff
bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury
sphygmomanometer should be calibrated every 6 months to ensure accuracy.

Question 7
CORRECT
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 Aminocaproic acid
C Potassium chloride
Protamine sulfate

Question 7 Explanation: The antidote to heparin is protamine sulfate and should be readily available for
use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin.

Question 8
CORRECT
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
Within the therapeutic range

D Higher than the therapeutic range

Question 8 Explanation: The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients
at risk for thrombus. Based on the client’s control value, the therapeutic range for this individual would be
16.5 to 22 seconds. Therefore the result is within therapeutic range.

Question 9
CORRECT
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:
Stimulates the breakdown of specific clotting factors by the
A liver, and it takes 2-3 days for this to exert an anticoagulant
effect.
Inhibits synthesis of specific clotting factors in the liver,
and it takes 3-4 days for this medication to exert an
anticoagulant effect.
Stimulates production of the body’s own thrombolytic
C substances, but it takes 2-4 days for this to begin.
Has the same mechanism of action as Heparin, and the crossover
D time is needed for the serum level of warfarin to be
therapeutic.

Question 9 Explanation: Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent
clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is
exhibited

Question 10
CORRECT
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 2 mg of
morphine given intravenously. The nurse should first:
Administer the morphine

B Obtain a 12-lead ECG

C Obtain the lab work
D Order the chest x-ray
Question 10 Explanation: Although obtaining the ECG, chest x-ray, and blood work are all important, the
nurse’s priority action would be to relieve the crushing chest pain.

Question 11
CORRECT
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

Dissolve clots he may have

C Prevent kidney failure

D Treat potential cardiac arrhythmias
Question 11 Explanation: Thrombolytic drugs are administered within the first 6 hours after onset of a MI
to lyse clots and reduce the extent of myocardial damage.

Question 12
CORRECT
When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select
all that apply.
Reflects electrical impulse beginning at the SA node

B Indicated electrical impulse beginning at the AV node

Reflects atrial muscle depolarization

D Identifies ventricular muscle depolarization

Has duration of normally 0.11 seconds or less.

Question 12 Explanation: In a client who has had an ECG, the P wave represents the activation of the
electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave
represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is
0.11 seconds or less in duration and 2.5 mm or more in height.

Question 13
CORRECT
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

Start an intravenous line

C Obtain a portable chest radiograph

D Draw blood for laboratory studies
Question 13 Explanation: Advanced cardiac life support recommends that at least one or two intravenous
lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest
radiograph, and drawing blood are important but secondary to starting the intravenous line.

Question 14
CORRECT
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
Myocardial infarction

Question 14 Explanation: Detection of myoglobin is one diagnostic tool to determine whether myocardial
damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and
peaks within 4 to 6 hours after infarction (Note: less than 90 mg/L is normal).

Question 15
CORRECT
When teaching a client about propranolol hydrochloride, the nurse should base the information on the
knowledge that propranolol hydrochloride:
Blocks beta-adrenergic stimulation and thus causes decreased
heart rate, myocardial contractility, and conduction.
Increases norepinephrine secretion and thus decreases blood
B pressure and heart rate.
Is a potent arterial and venous vasodilator that reduces
C peripheral vascular resistance and lowers blood pressure.
Is an angiotensin-converting enzyme inhibitor that reduces
D blood pressure by blocking the conversion of angiotensin I to
angiotensin II

Question 15 Explanation: Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of

propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing
conduction.

Question 16
CORRECT
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
Make a commitment to long-term therapy

D Control high blood pressure

Question 16 Explanation: Compliance is the most critical element of hypertensive therapy. In most cases,
hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully
without drug therapy. Stress management and weight management are important components of
hypertension therapy, but the priority goal is related to compliance.

Question 17
CORRECT
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:
Cerebrovascular accident
B Liver disease
C Myocardial infarction
D Pulmonary disease
Question 17 Explanation: Hypertension is referred to as the silent killer for adults, because until the adult
has significant damage to other systems, the hypertension may go undetected. CVA’s can be related to
long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension.
Myocardial infarction is generally related to coronary artery disease.

Question 18
CORRECT
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
Take a nitroglycerin tablet before climbing the stairs

D Lie down once she reaches the friend’s apartment

Question 18 Explanation: Nitroglycerin may be used prophylactically before stressful physical activities
such as stair climbing to help the client remain pain free. Visiting her friend early in the day would have no
impact on decreasing pain episodes. Resting before or after an activity is not as likely to help prevent an
activity-related pain episode.

Question 19
CORRECT
Which of the following symptoms should the nurse teach the client with unstable angina to report
immediately to her physician?
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 lawn mowing
Question 19 Explanation: The client should report a change in the pattern of chest pain. It may indicate
increasing severity of CAD.
Question 20
CORRECT
The physician refers the client with unstable angina for a cardiac catheterization. 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

Assess the extent of arterial blockage

C Bypass obstructed vessels

D Assess the functional adequacy of the valves and heart muscle
Question 20 Explanation: Cardiac catheterization is done in clients with angina primarily to assess the
extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or
coronary artery bypass surgery will be based on the catheterization results.

Question 21
CORRECT
As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given
sublingually. This drug’s principal effects are produced by:

A Antispasmodic effect on the pericardium

B Causing an increased myocardial oxygen demand
Vasodilation of peripheral vasculature

D Improved conductivity in the myocardium

Question 21 Explanation: Nitroglycerin produces peripheral vasodilation, which reduces myocardial
oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase
blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand.
Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.

Question 22
CORRECT
The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
Headache

B High blood pressure

C Shortness of breath
D Stomach cramps
Question 22 Explanation: Because of the widespread vasodilating effects, nitroglycerin often produces
such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting.
Nitro does not cause shortness of breath or stomach cramps.
Question 23
CORRECT
Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client
to use the drug when chest pain occurs?

A Take one tablet every 2 to 5 minutes until the pain stops.

Take one tablet and rest for 10 minutes. Call the physician if
B pain persists after 10 minutes.
Take one tablet, then an additional tablet every 5 minutes for
a total of 3 tablets. Call the physician if pain persists after
three tablets.
Take one tablet. If pain persists after 5 minutes, take two
D tablets. If pain still persists 5 minutes later, call the
physician.

Question 23 Explanation: The correct protocol for nitroglycerin used involves immediate administration,
with subsequent doses taken at 5-minute intervals as needed, for a total dose of 3 tablets. Sublingual
nitroglycerin appears in the bloodstream within 2 to 3 minutes and is metabolized within about 10 minutes.

Question 24
CORRECT
Which of the following arteries primarily feeds the anterior wall of the heart?

A Circumflex artery
B Internal mammary artery
Left anterior descending artery

D Right coronary artery

Question 24 Explanation: The left anterior descending artery is the primary source of blood flow for the
anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary supplies the
mammary, and the right coronary artery supplies the inferior wall of the heart.

Question 25
CORRECT
When do coronary arteries primarily receive blood flow?

A During inspiration
During diastolic

C During expiration
D During systole
Question 25 Explanation: Although the coronary arteries may receive a minute portion of blood during
systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are
irrelevant to blood flow.
Question 26
WRONG
Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of
the heart?

A Anterior
Apical
Inferior

D Lateral
Question 26 Explanation: The right coronary artery supplies the right ventricle, or the inferior portion of
the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery
doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left
atrium), or the apical portion (left ventricle) of the heart.

Question 27
CORRECT
A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?

A Aortic
B Mitral
Pulmonic

D Tricuspid
Question 27 Explanation: Abnormalities of the pulmonic valve are auscultated at the second left intercostal
space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to
the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the
midclavicular line. Tricupsid valve abnormalities are heard at the 3rd and 4th intercostal spaces along the
sternal border.

Question 28
CORRECT
Which of the following blood tests is most indicative of cardiac damage?

A Lactate dehydrogenase
B Complete blood count (CBC)
Troponin I

D Creatine kinase (CK)

Question 28 Explanation: Troponin I levels rise rapidly and are detectable within 1 hour of myocardial
injury. Troponin levels aren’t detectable in people without cardiac injury.
Question 29
CORRECT
Which of the following diagnostic tools is most commonly used to determine the location of myocardial
damage?

A Cardiac catheterization
B Cardiac enzymes
C Echocardiogram
Electrocardiogram (ECG)

Question 29 Explanation: The ECG is the quickest, most accurate, and most widely used tool to determine
the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the
location. An echocardiogram is used most widely to view myocardial wall function after an MI has been
diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also
indicate the location of myocardial damage, but the study may not be performed immediately.

Question 30
CORRECT
Which of the following types of pain is most characteristic of angina?

A Knifelike
B Sharp
C Shooting
Tightness

Question 30 Explanation: The pain of angina usually ranges from a vague feeling of tightness to heavy,
intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest,
neck, and arms.

Question 31
CORRECT
Which of the following parameters is the major determinant of diastolic blood pressure?

A Baroreceptors
B Cardiac output
C Renal function
Vascular resistance

Question 31 Explanation: Vascular resistance is the impedance of blood flow by the arterioles that most
predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.
Question 32
CORRECT
Which of the following factors can cause blood pressure to drop to normal levels?

A Kidneys’ excretion of sodium only

B Kidneys’ retention of sodium and water
Kidneys’ excretion of sodium and water

D Kidneys’ retention of sodium and excretion of water

Question 32 Explanation: The kidneys respond to a rise in blood pressure by excreting sodium and excess
water. This response ultimately affects systolic pressure by regulating blood volume.

Question 33
CORRECT
Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?
Changes in blood pressure

B Changes in arterial oxygen tension

C Changes in arterial carbon dioxide tension
D Changes in heart rate
Question 33 Explanation: Baroreceptors located in the carotid arteries and aorta sense pulsatile pressure.
Decreases in pulsatile pressure cause a reflex increase in heart rate. Chemoreceptors in the medulla are
primarily stimulated by carbon dioxide. Peripheral chemoreceptors in the aorta and carotid arteries are
primarily stimulated by oxygen.

Question 34
CORRECT
Which of the following terms describes the force against which the ventricle must expel blood?
Afterload

B Cardiac output
C Overload
D Preload
Question 34 Explanation: Afterload refers to the resistance normally maintained by the aortic and
pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and
pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload
refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of
diastole.
Question 35
CORRECT
Which of the following terms is used to describe the amount of stretch on the myocardium at the end of
diastole?

A Afterload
B Cardiac index
C Cardiac output
Preload

Question 35 Explanation: Preload is the amount of stretch of the cardiac muscle fibers at the end of
diastole. The volume of blood in the ventricle at the end of diastole determines the preload. Afterload is the
force against which the ventricle must expel blood. Cardiac index is the individualized measurement of
cardiac output, based on the client’s body surface area. Cardiac output is the amount of blood the heart is
expelling per minute.

Question 36
CORRECT
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension.
Before administered propranolol, which of the following actions should the nurse take first?

A Monitor the apical pulse rate

B Instruct the client to take medication with food
Question the physician about the order

D Caution the client to rise slowly when standing

Question 36 Explanation: Propranolol and other beta-adrenergic blockers are contraindicated in a client
with asthma, so the nurse should question the physician before giving the dose. The other responses are
appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The
client’s apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low,
the nurse should withhold the drug and notify the physician.

Question 37
CORRECT
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular
tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse
suspect?

A Hypocalcemia
B Hypermagnesemia
Hypokalemia

D Hypernatremia
Question 37 Explanation: Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In
turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.

Question 38
CORRECT
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the
nurse provide?

A “Eat foods high in potassium.”

B “Take daily potassium supplements.”
C “Discontinue sodium restrictions.”
“Avoid salt substitutes.”

Question 38 Explanation: Because spironolactone is a potassium-sparing diuretic, the client should avoid
salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods
and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.

Question 39
CORRECT
When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:

A Impulse to begin atrial contraction

B Impulse to transverse the atria to the AV node
C SA node to discharge the impulse to begin atrial depolarization
Impulse to travel to the ventricles

Question 39 Explanation: The P-R interval is measured on the ECG strip from the beginning of the P wave
to the beginning of the QRS complex. It is the time it takes for the impulse to travel to the ventricle.

Question 40
CORRECT
Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease,
which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says
that he doesn’t understand why he needs to be there because there is nothing that can be done to make him
better. The best nursing response is:
“Cardiac rehabilitation is not a cure but can help restore you
to many of your former activities.”
“Here we teach you to gradually change your lifestyle to
B accommodate your heart disease.”
“You are probably right but we can gradually increase your
C activities so that you can live a more active life.”
 “Do you feel that you will have to make some changes in your
D life now?”
Question 40 Explanation: Such a response does not have false hope to the client but is positive and realistic.
The answer tells the client what cardiac rehabilitation is and does not dwell upon his negativity about it.

Question 41
CORRECT
To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:

A In all extremities
B At the insertion site
Distal to the catheter insertion

D Above the catheter insertion

Question 41 Explanation: Palpating pulses distal to the insertion site is important to evaluate for
thrombophlebitis and vessel occlusion. They should be bilateral and strong.

Question 42
CORRECT
A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The purpose
of injecting radioisotope into the bloodstream is to detect:

A Normal vs. abnormal tissue

B Damage in areas of the heart
C Ventricular function
Myocardial scarring and perfusion

Question 42 Explanation: This scan detects myocardial damage and perfusion, an acute or chronic MI. It is
a more specific answer than (1) or (2). Specific ventricular function is tested by a gated cardiac blood pool
scan.

Question 43
CORRECT
A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead
ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are
returned. All of the following will be included in the nursing care plan. Which activity has the highest
priority?

A Monitoring vital signs

B Completing a physical assessment
Maintaining cardiac monitoring
D Maintaining at least one IV access site
Question 43 Explanation: Even though initial tests seem to be within normal range, it takes at least 3 hours
for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia,
heart block, ventricular irritability, and other arrhythmias. Other activities can be accomplished around the
MI monitoring.

Question 44
CORRECT
A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom
is explained by which of the following statements?
The demand for oxygen is decreased because of pleural
A involvement
The inflammatory process causes the body to demand more oxygen
B to meet its needs
The heart has to pump faster to meet the demand for oxygen when
there is lowered arterial oxygen tension

D Respirations are labored

Question 44 Explanation: The arterial oxygen supply is lowered and the demand for oxygen is increased,
which results in the heart’s having to beat faster to meet the body’s needs for oxygen.

Question 45
CORRECT
A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94,
24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would
expect which cardiac enzyme to rise within the next 3 to 8 hours?
Creatine kinase (CK or CPK)

B Lactic dehydrogenase (LDH)

C LDH-1
D LDH-2
Question 45 Explanation: Creatine kinase (CK, formally known as CPK) rises in 3-8 hours if an MI is
present. When the myocardium is damaged, CPK leaks out of the cell membranes and into the bloodstream.
Lactic dehydrogenase rises in 24-48 hours, and LDH-1 and LDH-2 rises in 8-24 hours.

Question 46
CORRECT
A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse
understands that leg ulcers of this nature are usually caused by:
Decreased arterial blood flow secondary to vasoconstriction
B Decreased arterial blood flow leading to hyperemia
C Atherosclerotic obstruction of the arteries
D Trauma to the lower extremities
Question 46 Explanation: Decreased arterial flow is a result of vasospasm. The etiology is unknown. It is
more problematic in colder climates or when the person is under stress. Hyperemia occurs when the
vasospasm is relieved.

Question 47
CORRECT
Which of the following instructions should be included in the discharge teaching for a patient discharged
with a transdermal nitroglycerin patch?
“Apply the patch to a non hairy, nonfatty area of the upper
torso or arms.”
“Apply the patch to the same site each day to maintain
B consistent drug absorption.”
“If you get a headache, remove the patch for 4 hours and then
C reapply.”
“If you get chest pain, apply a second patch right next to the
D first patch.”

Question 47 Explanation: A nitroglycerin patch should be applied to a non hairy, nonfatty area for the best
and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should
be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to
treat chest pain.

Question 48
CORRECT
In order to prevent the development of tolerance, the nurse instructs the patient to:

A Apply the nitroglycerin patch every other day

Switch to sublingual nitroglycerin when the patient’s
B systolic blood pressure elevates to >140 mm Hg
Apply the nitroglycerin patch for 14 hours each and remove for
10 hours at night

D Use the nitroglycerin patch for acute episodes of angina only

Question 48 Explanation: Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period
each day.

Question 49
CORRECT
Direct-acting vasodilators have which of the following effects on the heart rate?

A Heart rate decreases

B Heart rate remains significantly unchanged
Heart rate increases

D Heart rate becomes irregular

Question 49 Explanation: Heart rate increases in response to decreased blood pressure caused by
vasodilation.

Question 50
CORRECT
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the
nurse bases teaching on the knowledge that:
Moderate doses of two different types of diuretics are more
A effective than a large dose of one type
This combination promotes diuresis but decreases the risk of
hypokalemia

C This combination prevents dehydration and hypovolemia

Using two drugs increases osmolality of plasma and the
D glomerular filtration rate
Question 50 Explanation: Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing
diuretic. Giving these together minimizes electrolyte imbalance.