Med-Surge Cardiac UPDATED ACTUAL
Exam Questions and CORRECT Answers
For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular
system, the nurse performs a thorough initial assessment to establish accurate baseline data.
Which of the following data is necessary to collect if the patient is experiencing chest pain?
a) Description of the pain
b) Pulse rate in upper extremities
c) Blood pressure in the left arm
d) Sound of the apical pulses - CORRECT ANSWER - a) Description of the pain
Explanation:
If the patient is experiencing chest pain, a history of its location, frequency, and duration is
necessary, as is a description of the pain, if it radiates to a particular area, what precipitates its
onset, and what brings relief. The nurse weighs the patient and measures vital signs. The nurse
may measure BP in both arms and compare findings. The nurse assesses apical and radial pulses,
noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.
Age-related changes associated with the cardiac system include which of the following? Select
all that apply.
a) Increased size of the left atrium
b) Myocardial thinning
c) Endocardial fibrosis
d) Increase in the number of SA node cells - CORRECT ANSWER - a) Increased size of
the left atrium, c) Endocardial fibrosis
Explanation:
Age-related changes associated with the cardiac system include endocardial fibrosis, increased
size of the left atrium, decreased number of SA node cells, and myocardial thickening.
Which of the following is the term for the normal pacemaker of the heart?
,a) Purkinje fibers
b) Atrioventricular (AV) node
c) Bundle of His
d) Sinoatrial (SA) node - CORRECT ANSWER - d) Sinoatrial (SA) node
Explanation:
The sinoatrial node is the primary pacemaker of the heart. The AV node coordinates the
incoming electrical impulses from the atria and, after a slight delay, relays the impulse to the
ventricles. The Purkinje fibers rapidly conduct the impulses through the thick walls of the
ventricles.
The ability of the cardiac muscle to shorten in response to an electrical impulse is termed which
of the following?
a) Diastole
b) Contractility
c) Depolarization
d) Repolarization - CORRECT ANSWER - b) Contractility
Explanation:
Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse.
Depolarization is the electrical activation of a cell caused by the influx of sodium into the cell
while potassium exits the cell. Repolarization is the return of the cell to the resting state, caused
by reentry of potassium into the cell while sodium exits the cell. Diastole is the period of
ventricular relaxation resulting in ventricular filling.
The nurse is caring for a patient with diabetes who is scheduled for a cardiac catheterization.
Prior to the procedure, it is most important for the nurse to ask which of the following questions?
a) "When was the last time you ate or drank?"
b) "Are you having chest pain?"
c) "Are you allergic to shellfish?"
,d) "What was your morning blood sugar reading?" - CORRECT ANSWER - c) "Are you
allergic to shellfish?"
Explanation:
Radiopaque contrast agents are used to visualize the coronary arteries. Some contrast agents
contain iodine, and the patient is assessed before the procedure for previous reactions to contrast
agents or allergies to iodine-containing substances (e.g., seafood). If the patient has a suspected
or known allergy to the substance, antihistamines or methylprednisolone (Solu-Medrol) may be
administered before the procedure. Although the other questions are important to ask the patient,
it is most important to ascertain if the patient has an allergy to shellfish.
The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart.
Which of the following actions should the nurse complete prior to the patient undergoing the
procedure? Select all that apply.
a) Remove the patient's Transderm Nitro patch.
b) Offer the patient a headset to listen to music during the procedure.
c) Sedate the patient prior to the procedure.
d) Remove the patient's jewelry.
e) Position the patient on his/her stomach for the procedure. - CORRECT ANSWER - a)
Remove the patient's Transderm Nitro patch., b) Offer the patient a headset to listen to music
during the procedure., d) Remove the patient's jewelry.
Explanation:
Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm,
Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to
prevent burning of the skin. A patient who is claustrophobic may need to receive a mild sedative
before undergoing an MRA. During an MRA, the patient is positioned supine on a table that is
placed into an enclosed imager or tube containing the magnetic field. Patients are instructed to
remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or
thumping that can be annoying is generated by the magnetic coils, so the patient may be offered
a headset to listen to music.
The nurse is caring for a patient prescribed warfarin (Coumadin) orally. The nurse reviews the
patient's prothrombin time (PT) level to evaluate the effectiveness of the medication. The nurse
should also evaluate which of the following laboratory values?
, a) International normalized ratio (INR)
b) Partial thromboplastic time (PTT)
c) Complete blood count (CBC)
d) Sodium - CORRECT ANSWER - a) International normalized ratio (INR)
Explanation:
The INR, reported with the PT, provides a standard method for reporting PT levels and
eliminates the variation of PT results from different laboratories. The INR, rather than the PT
alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5,
although specific ranges vary based on diagnosis. The other laboratory values are not used to
evaluate the effectiveness of Coumadin.
The nurse is caring for a patient in the ICU who is being monitored with a central venous
pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse
understands that this finding indicates the patient is experiencing which of the following?
a) Excessive blood loss
b) Overdiuresis
c) Left-sided heart failure (HF)
d) Hypervolemia - CORRECT ANSWER - d) Hypervolemia
Explanation:
The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right
ventricular preload. Many problems can cause an elevated CVP, but the most common is
hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP
(<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.
A nurse is preparing to assess a patient for postural BP changes. Which of the following
indicates the need for further education?
a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR
b) Taking the patient's BP with the patient sitting on the edge of the bed with feet dangling
c) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)
Exam Questions and CORRECT Answers
For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular
system, the nurse performs a thorough initial assessment to establish accurate baseline data.
Which of the following data is necessary to collect if the patient is experiencing chest pain?
a) Description of the pain
b) Pulse rate in upper extremities
c) Blood pressure in the left arm
d) Sound of the apical pulses - CORRECT ANSWER - a) Description of the pain
Explanation:
If the patient is experiencing chest pain, a history of its location, frequency, and duration is
necessary, as is a description of the pain, if it radiates to a particular area, what precipitates its
onset, and what brings relief. The nurse weighs the patient and measures vital signs. The nurse
may measure BP in both arms and compare findings. The nurse assesses apical and radial pulses,
noting rate, quality, and rhythm. The nurse also checks peripheral pulses in the lower extremities.
Age-related changes associated with the cardiac system include which of the following? Select
all that apply.
a) Increased size of the left atrium
b) Myocardial thinning
c) Endocardial fibrosis
d) Increase in the number of SA node cells - CORRECT ANSWER - a) Increased size of
the left atrium, c) Endocardial fibrosis
Explanation:
Age-related changes associated with the cardiac system include endocardial fibrosis, increased
size of the left atrium, decreased number of SA node cells, and myocardial thickening.
Which of the following is the term for the normal pacemaker of the heart?
,a) Purkinje fibers
b) Atrioventricular (AV) node
c) Bundle of His
d) Sinoatrial (SA) node - CORRECT ANSWER - d) Sinoatrial (SA) node
Explanation:
The sinoatrial node is the primary pacemaker of the heart. The AV node coordinates the
incoming electrical impulses from the atria and, after a slight delay, relays the impulse to the
ventricles. The Purkinje fibers rapidly conduct the impulses through the thick walls of the
ventricles.
The ability of the cardiac muscle to shorten in response to an electrical impulse is termed which
of the following?
a) Diastole
b) Contractility
c) Depolarization
d) Repolarization - CORRECT ANSWER - b) Contractility
Explanation:
Contractility is the ability of the cardiac muscle to shorten in response to an electrical impulse.
Depolarization is the electrical activation of a cell caused by the influx of sodium into the cell
while potassium exits the cell. Repolarization is the return of the cell to the resting state, caused
by reentry of potassium into the cell while sodium exits the cell. Diastole is the period of
ventricular relaxation resulting in ventricular filling.
The nurse is caring for a patient with diabetes who is scheduled for a cardiac catheterization.
Prior to the procedure, it is most important for the nurse to ask which of the following questions?
a) "When was the last time you ate or drank?"
b) "Are you having chest pain?"
c) "Are you allergic to shellfish?"
,d) "What was your morning blood sugar reading?" - CORRECT ANSWER - c) "Are you
allergic to shellfish?"
Explanation:
Radiopaque contrast agents are used to visualize the coronary arteries. Some contrast agents
contain iodine, and the patient is assessed before the procedure for previous reactions to contrast
agents or allergies to iodine-containing substances (e.g., seafood). If the patient has a suspected
or known allergy to the substance, antihistamines or methylprednisolone (Solu-Medrol) may be
administered before the procedure. Although the other questions are important to ask the patient,
it is most important to ascertain if the patient has an allergy to shellfish.
The nurse is screening a patient prior to a magnetic resonance angiogram (MRA) of the heart.
Which of the following actions should the nurse complete prior to the patient undergoing the
procedure? Select all that apply.
a) Remove the patient's Transderm Nitro patch.
b) Offer the patient a headset to listen to music during the procedure.
c) Sedate the patient prior to the procedure.
d) Remove the patient's jewelry.
e) Position the patient on his/her stomach for the procedure. - CORRECT ANSWER - a)
Remove the patient's Transderm Nitro patch., b) Offer the patient a headset to listen to music
during the procedure., d) Remove the patient's jewelry.
Explanation:
Transdermal patches that contain a heat-conducting aluminized layer (e.g., NicoDerm,
Androderm, Transderm Nitro, Transderm Scop, Catapres-TTS) must be removed before MRA to
prevent burning of the skin. A patient who is claustrophobic may need to receive a mild sedative
before undergoing an MRA. During an MRA, the patient is positioned supine on a table that is
placed into an enclosed imager or tube containing the magnetic field. Patients are instructed to
remove any jewelry, watches, or other metal items (e.g., ECG leads). An intermittent clanking or
thumping that can be annoying is generated by the magnetic coils, so the patient may be offered
a headset to listen to music.
The nurse is caring for a patient prescribed warfarin (Coumadin) orally. The nurse reviews the
patient's prothrombin time (PT) level to evaluate the effectiveness of the medication. The nurse
should also evaluate which of the following laboratory values?
, a) International normalized ratio (INR)
b) Partial thromboplastic time (PTT)
c) Complete blood count (CBC)
d) Sodium - CORRECT ANSWER - a) International normalized ratio (INR)
Explanation:
The INR, reported with the PT, provides a standard method for reporting PT levels and
eliminates the variation of PT results from different laboratories. The INR, rather than the PT
alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5,
although specific ranges vary based on diagnosis. The other laboratory values are not used to
evaluate the effectiveness of Coumadin.
The nurse is caring for a patient in the ICU who is being monitored with a central venous
pressure (CVP) catheter. The nurse records the patient's CVP as 8 mm Hg. The nurse
understands that this finding indicates the patient is experiencing which of the following?
a) Excessive blood loss
b) Overdiuresis
c) Left-sided heart failure (HF)
d) Hypervolemia - CORRECT ANSWER - d) Hypervolemia
Explanation:
The normal CVP is 2 to 6 mm Hg. A CVP greater than 6 mm Hg indicates an elevated right
ventricular preload. Many problems can cause an elevated CVP, but the most common is
hypervolemia (excessive fluid circulating in the body) or right-sided HF. In contrast, a low CVP
(<2 mm Hg) indicates reduced right ventricular preload, which is most often from hypovolemia.
A nurse is preparing to assess a patient for postural BP changes. Which of the following
indicates the need for further education?
a) Positioning the patient supine for 10 minutes prior to taking the initial BP and HR
b) Taking the patient's BP with the patient sitting on the edge of the bed with feet dangling
c) Letting 30 seconds elapse after each position change before measuring BP and heart rate (HR)
