1. A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in
the right leg. The nurse should notify the health care provider and immediately
1. keep the patient in bed in the supine position.
1. The patient’s history and clinical manifestations are consistent with acute arterial occlusion, and
resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until
circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood
flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.
b. The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous
thromboembolism. Which action by the nurse to elevate the patient’s feet is best?
1. One pillow is placed under the thighs and two pillows are placed under the lower legs.
1. The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium,
which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the
patient in the Trendelenburg position will lower the head below heart level, which is not indicated for
this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the
calf level.
1. The health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial thromboplastin time (PTT)
testing for a patient with venous thromboembolism (VTE). The nurse will plan to
1. avoid giving any IM medications to prevent localized bleeding.
1. IM injections are avoided in patients receiving anticoagulation. A PTT of 65 seconds is within the
therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.
1. A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is
most supportive of the diagnosis?
1. “I can’t get my shoes on at the end of the day.”
1. Because the edema associated with venous insufficiency increases when the patient has been
standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of
peripheral artery disease (PAD).
1. The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having
percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
1. Obtain vital signs.
1. Bleeding is a possible complication after catheterization of the femoral artery, so the nurse’s first
action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions
are also appropriate but can be done after determining that bleeding is not occurring.
1. The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient
with infective endocarditis (IE) based on which assessment finding(s)?
1. Fever, chills, and diaphoresis
2. Urine output less than 30 mL/hr
1. Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine
output. Petechiae, fever, chills, and diaphoresis are symptoms of IE, but are not caused by decreased
cardiac output. An increase in pulse rate of 15 beats/minute is normal with exercise.
ii. Petechiae on the inside of the mouth and conjunctiva
iii. Increase in heart rate of 15 beats/minute with walking
1. When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for
1. diastolic murmur.
2. peripheral edema.
3. shortness of breath on exertion.
1. The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in
hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not
indicators of possible hypoxemia.
ii. right upper quadrant tenderness.
1. A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which
information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?
1. Biologic valves will require immunosuppressive drugs after surgery.
2. Mechanical mitral valves need to be replaced sooner than biologic valves.
3. Lifelong anticoagulant therapy will be needed after mechanical valve replacement.
1. Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would
restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last
longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong
, health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not
needed.
ii. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.
1. While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse
determines that discharge teaching has been effective when the patient states that it will be necessary to
1. take antibiotics before any dental appointments.
2. limit physical activity to avoid stressing the heart.
3. take an aspirin a day to prevent clots from forming on the valve.
4. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.
1. Use of stimulant medications should be avoided by patients with MVP because these may
exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild
MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary
for this patient.
1. During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve, the
nurse instructs the patient on the
1. use of daily aspirin for anticoagulation.
2. correct method for taking the radial pulse.
3. need for frequent laboratory blood testing.
1. Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to
prevent clotting on the valve. This will require frequent international normalized ratio (INR) testing. Daily
aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse
is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.
ii. need to avoid any physical activity for 1 month.
1. When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for
the development of
1. flank pain.
2. splenomegaly.
3. shortness of breath.
1. Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain,
changes in mental status, and splenomegaly would be associated with embolization from the left-sided
valves.
ii. mental status changes.
1. The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for
which patient?
1. Patient admitted with a large acute myocardial infarction.
2. Patient being discharged after an exacerbation of heart failure.
3. Patient who had a mitral valve replacement with a mechanical valve.
1. Current American Heart Association guidelines recommend the use of prophylactic antibiotics
before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The
other patients are not at risk for IE.
ii. Patient being treated for rheumatic fever after a streptococcal infection.
1. The nurse is caring for a 78-year-old patient with aortic stenosis. Which assessment data obtained by the nurse would
be most important to report to the health care provider?
1. The patient complains of chest pressure when ambulating.
1. Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting
this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic
stenosis. A PMI at the left midclavicular line is normal.
ii. A loud systolic murmur is heard along the right sternal border.
iii. A thrill is palpated at the second intercostal space, right sternal border.
iv. The point of maximum impulse (PMI) is at the left midclavicular line.
1. Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis
are effective?
1. Assess for the presence of a paradoxical pulse.
2. Monitor for changes in the patient’s sedimentation rate.
3. Assess for the presence of jugular venous distention (JVD).
1. Because the most common finding on physical examination for a patient with chronic constrictive
pericarditis is jugular venous distention, a decrease in JVD indicates improvement. Paradoxical pulse, ST-
, segment ECG changes, and changes in sedimentation rates occur with acute pericarditis but are not
expected in chronic constrictive pericarditis.
1. Which statement by a patient with restrictive cardiomyopathy indicates that the nurse’s discharge teaching about self-
management has been most effective?
1. “I will avoid taking aspirin or other antiinflammatory drugs.”
2. “I will need to limit my intake of salt and fluids even in hot weather.”
3. “I will take antibiotics when my teeth are cleaned at the dental office.”
1. Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use
prophylactic antibiotics for any procedure that may cause bacteremia. The other statements indicate a
need for more teaching by the nurse. Dehydration and vigorous exercise impair ventricular filling in
patients with restrictive cardiomyopathy. There is no need to avoid salt (unless ordered), aspirin, or
NSAIDs.
ii. “I should begin an exercise program that includes things like biking or swimming.”
1. After receiving report on the following patients, which patient should the nurse assess first?
1. Patient with rheumatic fever who has sharp chest pain with a deep breath
2. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
1. Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse
should immediately assess this patient for other findings such as dyspnea or chest pain. The findings in
the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and
intervention.
ii. Patient with infective endocarditis who has a murmur and splinter hemorrhages
iii. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases
1. Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG)
technicians working on the cardiac unit?
1. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome.
2. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis
3. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy
4. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates
1. Under the supervision of registered nurses (RNs), UAP check the patient’s cardiac monitor and
obtain information about changes in heart rate and rhythm with exercise. Teaching and obtaining
information about home medications (prescribed or complementary) and selecting the best leads for
monitoring patients require more critical thinking and should be done by the RN.
the right leg. The nurse should notify the health care provider and immediately
1. keep the patient in bed in the supine position.
1. The patient’s history and clinical manifestations are consistent with acute arterial occlusion, and
resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until
circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood
flow to the leg. Exercise will increase oxygen demand for the tissues of the leg.
b. The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous
thromboembolism. Which action by the nurse to elevate the patient’s feet is best?
1. One pillow is placed under the thighs and two pillows are placed under the lower legs.
1. The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium,
which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the
patient in the Trendelenburg position will lower the head below heart level, which is not indicated for
this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the
calf level.
1. The health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial thromboplastin time (PTT)
testing for a patient with venous thromboembolism (VTE). The nurse will plan to
1. avoid giving any IM medications to prevent localized bleeding.
1. IM injections are avoided in patients receiving anticoagulation. A PTT of 65 seconds is within the
therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.
1. A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is
most supportive of the diagnosis?
1. “I can’t get my shoes on at the end of the day.”
1. Because the edema associated with venous insufficiency increases when the patient has been
standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of
peripheral artery disease (PAD).
1. The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having
percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
1. Obtain vital signs.
1. Bleeding is a possible complication after catheterization of the femoral artery, so the nurse’s first
action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions
are also appropriate but can be done after determining that bleeding is not occurring.
1. The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient
with infective endocarditis (IE) based on which assessment finding(s)?
1. Fever, chills, and diaphoresis
2. Urine output less than 30 mL/hr
1. Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine
output. Petechiae, fever, chills, and diaphoresis are symptoms of IE, but are not caused by decreased
cardiac output. An increase in pulse rate of 15 beats/minute is normal with exercise.
ii. Petechiae on the inside of the mouth and conjunctiva
iii. Increase in heart rate of 15 beats/minute with walking
1. When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for
1. diastolic murmur.
2. peripheral edema.
3. shortness of breath on exertion.
1. The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in
hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not
indicators of possible hypoxemia.
ii. right upper quadrant tenderness.
1. A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which
information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?
1. Biologic valves will require immunosuppressive drugs after surgery.
2. Mechanical mitral valves need to be replaced sooner than biologic valves.
3. Lifelong anticoagulant therapy will be needed after mechanical valve replacement.
1. Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would
restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last
longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong
, health care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not
needed.
ii. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.
1. While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse
determines that discharge teaching has been effective when the patient states that it will be necessary to
1. take antibiotics before any dental appointments.
2. limit physical activity to avoid stressing the heart.
3. take an aspirin a day to prevent clots from forming on the valve.
4. avoid use of over-the-counter (OTC) medications that contain stimulant drugs.
1. Use of stimulant medications should be avoided by patients with MVP because these may
exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild
MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary
for this patient.
1. During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve, the
nurse instructs the patient on the
1. use of daily aspirin for anticoagulation.
2. correct method for taking the radial pulse.
3. need for frequent laboratory blood testing.
1. Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to
prevent clotting on the valve. This will require frequent international normalized ratio (INR) testing. Daily
aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse
is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.
ii. need to avoid any physical activity for 1 month.
1. When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for
the development of
1. flank pain.
2. splenomegaly.
3. shortness of breath.
1. Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain,
changes in mental status, and splenomegaly would be associated with embolization from the left-sided
valves.
ii. mental status changes.
1. The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for
which patient?
1. Patient admitted with a large acute myocardial infarction.
2. Patient being discharged after an exacerbation of heart failure.
3. Patient who had a mitral valve replacement with a mechanical valve.
1. Current American Heart Association guidelines recommend the use of prophylactic antibiotics
before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The
other patients are not at risk for IE.
ii. Patient being treated for rheumatic fever after a streptococcal infection.
1. The nurse is caring for a 78-year-old patient with aortic stenosis. Which assessment data obtained by the nurse would
be most important to report to the health care provider?
1. The patient complains of chest pressure when ambulating.
1. Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting
this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic
stenosis. A PMI at the left midclavicular line is normal.
ii. A loud systolic murmur is heard along the right sternal border.
iii. A thrill is palpated at the second intercostal space, right sternal border.
iv. The point of maximum impulse (PMI) is at the left midclavicular line.
1. Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis
are effective?
1. Assess for the presence of a paradoxical pulse.
2. Monitor for changes in the patient’s sedimentation rate.
3. Assess for the presence of jugular venous distention (JVD).
1. Because the most common finding on physical examination for a patient with chronic constrictive
pericarditis is jugular venous distention, a decrease in JVD indicates improvement. Paradoxical pulse, ST-
, segment ECG changes, and changes in sedimentation rates occur with acute pericarditis but are not
expected in chronic constrictive pericarditis.
1. Which statement by a patient with restrictive cardiomyopathy indicates that the nurse’s discharge teaching about self-
management has been most effective?
1. “I will avoid taking aspirin or other antiinflammatory drugs.”
2. “I will need to limit my intake of salt and fluids even in hot weather.”
3. “I will take antibiotics when my teeth are cleaned at the dental office.”
1. Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use
prophylactic antibiotics for any procedure that may cause bacteremia. The other statements indicate a
need for more teaching by the nurse. Dehydration and vigorous exercise impair ventricular filling in
patients with restrictive cardiomyopathy. There is no need to avoid salt (unless ordered), aspirin, or
NSAIDs.
ii. “I should begin an exercise program that includes things like biking or swimming.”
1. After receiving report on the following patients, which patient should the nurse assess first?
1. Patient with rheumatic fever who has sharp chest pain with a deep breath
2. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
1. Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse
should immediately assess this patient for other findings such as dyspnea or chest pain. The findings in
the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and
intervention.
ii. Patient with infective endocarditis who has a murmur and splinter hemorrhages
iii. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases
1. Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG)
technicians working on the cardiac unit?
1. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome.
2. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis
3. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy
4. Check the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates
1. Under the supervision of registered nurses (RNs), UAP check the patient’s cardiac monitor and
obtain information about changes in heart rate and rhythm with exercise. Teaching and obtaining
information about home medications (prescribed or complementary) and selecting the best leads for
monitoring patients require more critical thinking and should be done by the RN.
