1.       A nurse is describing the process by which blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorizes this action of the heart as what?

A)           Systole

B)            Diastole

C)            Repolarization

D)           Ejection fraction

Ans:       A

Feedback:

Systole is the action of the chambers of the heart becoming smaller and ejecting blood. This action of the heart is not diastole (relaxations), ejection fraction (the amount of blood expelled), or repolarization (electrical charging).

2.            During a shift assessment, the nurse is identifying the clients point of maximum impulse (PMI). Where will the nurse best palpate the PMI?

A)           Left midclavicular line of the chest at the level of the nipple

B)            Left midclavicular line of the chest at the fifth intercostal space

C)            Midline between the xiphoid process and the left nipple

D)           Two to three centimeters to the left of the sternum

Ans:       B

Feedback:

The left ventricle is responsible for the apical beat or the point of maximum impulse, which is normally palpated in the left midclavicular line of the chest wall at the fifth intercostal space.

3.            The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is 122/76 mm Hg, what is the patients pulse pressure?

A)           46 mm Hg

B)            99 mm Hg

C)            198 mm Hg

D)           76 mm Hg

Ans:       A

Feedback:

Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg.

4.            The nurse is caring for a patient admitted with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse should recognize what implication of this assessment finding?

A)           This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours.

B)            Because the patient has a history of unstable angina, this is a poor indicator of myocardial injury.

C)            This is an accurate indicator of myocardial injury.

D)           This result indicates muscle injury, but does not specify the source.

Ans:       C

Feedback:

Troponin I, which is specific to cardiac muscle, is elevated within hours after myocardial injury. Even with a diagnosis of unstable angina, this is an accurate indicator of myocardial injury.

5.            The nurse is conducting patient teaching about cholesterol levels. When discussing the patients elevated LDL and lowered HDL levels, the patient shows an understanding of the significance of these levels by stating what?

A)           Increased LDL and decreased HDL increase my risk of coronary artery disease.

B)            Increased LDL has the potential to decrease my risk of heart disease.

C)            The decreased HDL level will increase the amount of cholesterol moved away from the artery walls.

D)           The increased LDL will decrease the amount of cholesterol deposited on the artery walls.

Ans:       A

Feedback:

Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease.

6.            The physician has placed a central venous pressure (CVP) monitoring line in an acutely ill patient so right ventricular function and venous blood return can be closely monitored. The results show decreased CVP. What does this indicate?

A)           Possible hypovolemia

B)            Possible myocardial infarction (MI)

C)            Left-sided heart failure

D)           Aortic valve regurgitation

Ans:       A

Feedback:

Hypovolemia may cause a decreased CVP. MI, valve regurgitation and heart failure are less likely causes of decreased CVP.

7.            While auscultating a patients heart sounds, the nurse hears an extra heart sound immediately after the second heart sound (S2). An audible S3 would be considered an expected finding in what patient?

A)           An older adult

B)            A 20-year-old patient

C)            A patient who has undergone valve replacement

D)           A patient who takes a beta-adrenergic blocker

Ans:       B

Feedback:

S3 represents a normal finding in children and adults up to 35 or 40 years of age. In these cases, it is called a physiologic S3. It is an abnormal finding in a patient with an artificial valve, an older adult, or a patient who takes a beta blocker.