THE HEART AND CIRCULATORY SYSTEM PART 2

1. Which is a true statement concerning the administration of topical nitroglycerin ointment?
   a. The ointment should be applied on the chest over the heart.
   b. The ointment should be used only in the case of a mild angina episode.
   c. The old ointment should be removed before the new ointment is applied.
   d. The ointment should be massaged gently into the skin and then covered with plastic wrap.

c. The old ointment should be removed before the new ointment is applied.

2. The nurse is administering intravenous nitroglycerin to a patient who has just been admitted for an acute myocardial infarction. Which statement is true in regard to the administration of this medication?
   a. It must be contained in special non–polyvinyl chloride (non-PVC) intravenous
   (IV) bags.
   b. It is stable for only 24 hours after preparation.
   c. It can be given in infusions with other medications.
   d. An IV filter should be attached to the infusion tubing.

a. It must be contained in special non–polyvinyl chloride (non-PVC) intravenous
(IV) bags.

3. A 53-year-old male patient has been admitted for evaluation of chest pain. He has been diagnosed with angina and prescribed sublingual nitroglycerin tablets. What important instructions for using this medication should the nurse give the patient?
   a. Take up to five doses at 15-minute intervals after an anginal attack.
   b. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
   c. If the chest pain is not relieved, go to hospital immediately.
   d. Sit or lie down when taking a tablet; change positions slowly to avoid falling or
   fainting.

d. Sit or lie down when taking a tablet; change positions slowly to avoid falling or
fainting.

4. A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away after he takes one or two sublingual nitroglycerin tablets and rests. What type of angina does he have?
   a. Classic angina
   b. Variant angina
   c. Unstable angina
   d. Prinzmetal’s angina

a. Classic angina

5. A female patient arrives in the emergency department with severe chest pain. She has had pain off and on for a week. Which assessment finding indicates a need for cautious use of nitrates and nitrites?
   a. Blood pressure of 110/78 mm Hg
   b. History of liver disease
   c. History of heart failure
   d. Anemia

d. Anemia

6. A patient is taking a calcium channel blocker as part of his therapy after a myocardial infarction. What important information or instructions should the nurse give the patient about this medication?
   a. The tablet should be chewed for faster release of the medication.
   b. A frequent adverse effect is hypertension, which should be reported immediately.
   c. If adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
   d. A high-fibre diet with plenty of fluids will help to prevent the constipation that may occur.

d. A high-fibre diet with plenty of fluids will help to prevent the constipation that may occur.

7. A patient has been prescribed transdermal nitroglycerin patches. What important instructions for applying these patches should the nurse give the patient?
   a. Use the patches on any nonhairy area on the body.
   b. Use the patches only on the chest area.
   c. Temporarily remove the patch while swimming.
   d. Apply the patch to the same site consistently.

a. Use the patches on any nonhairy area on the body.

8. A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is the best one for the nurse to give the patient?
   a. Omit one dose once a week.
   b. Leave the patch on for 2 days at a time.
   c. Use only half of a patch until the tolerance subsides.
   d. Remove the patch at bedtime, then apply a new one in the morning.

d. Remove the patch at bedtime, then apply a new one in the morning.

1. A person who is experiencing chest pain while playing tennis has brought along a bottle of sublingual nitroglycerin. In this situation, which action is appropriate for this person to take? (Select all that apply.)
   a. Stop the activity and lie down or sit down.

   b. Call 911 immediately.

   c. Place a tablet under the tongue.

   d. Place a tablet in the space between the gum and cheek.

   e. If chest pain is not relieved after 1 minute, take another sublingual tablet.

   f. Take another sublingual tablet if chest pain is not relieved after 5 minutes.

   g. Take a sip of liquid to help dissolve the pill.

   h. Call 911 if the pain is not relieved within 5 minutes after taking one sublingual

   tablet.

ACFH

1. A patient about to receive his morning dose of digoxin (Lanoxin®) has an apical pulse of 70 beats per minute. What should the nurse do?
   a. Administer the dose
   b. Withhold the dose and notify the physician
   c. Notify the physician and monitor the patient’s vital signs
   d. Recheck the pulse, making sure to count for 1 full minute

a. Administer the dose

2. The nurse is assessing the patient before administration of a cardiac glycoside. Which condition can predispose a patient to digitalis toxicity?
   a. Hypokalemia
   b. Hyperkalemia
   c. Hypocalcemia
   d. Heart failure

a. Hypokalemia

3. The nurse who is assessing a patient who is receiving intravenous (IV) digitalis recognizes that the drug has a negative chronotropic effect. How is a negative chronotropic effect evident in a patient?
   a. By an increased heart rate
   b. By a decreased heart rate
   c. By decreased conduction
   d. By increased ectopic beats

b. By a decreased heart rate

4. A patient has been taking digoxin (Lanoxin) at home but has developed toxicity. The physician has ordered digoxin immune Fab. The patient asks the nurse why the medication has been changed. Which is the nurse’s best response?
   a. “It works faster than digoxin.”
   b. “It is safer than digoxin and can be taken orally.”
   c. “It helps to convert the fibrillating atria to a more normal rhythm.”
   d. “This new drug is an antidote to digoxin and will help to lower the blood levels.”

d. “This new drug is an antidote to digoxin and will help to lower the blood levels.”

5. A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risk should the nurse keep in mind while assessing this patient during the infusion?
   a. Hypotension
   b. Hyperkalemia
   c. Hypertension
   d. Decreased urine output

a. Hypotension

6. A patient with atrial fibrillation has been started on digoxin (Lanoxin), and 1 week later a digoxin level is drawn. Which result is within the normal therapeutic levels for digoxin?
   a. 0.6 ng/mL
   b. 1.5 ng/mL
   c. 2.5 ng/mL d. 3.0 ng/mL

The digoxin therapeutic window is between 0.8 and 2 ng/mL.

7. Which medication results in a drug interaction if given to a patient taking digitalis?
   a. acetylsalicylic acid (Aspirin®)
   b. acetaminophen (Tylenol®)
   c. quinidine sulphate
   d. Vitamin K

c. quinidine sulphate

7. Which medication results in a drug interaction if given to a patient taking digitalis?
   a. acetylsalicylic acid (Aspirin®)
   b. acetaminophen (Tylenol®)
   c. quinidine sulphate
   d. Vitamin K

c. quinidine sulphate

8. A patient is beginning digoxin (Lanoxin) therapy. Which food should the nurse tell this patient to avoid when taking the digoxin dose?
   a. Cooked vegetables
   b. Canned fruits
   c. Fried foods
   d. Bran muffins

d. Bran muffins

9. The nurse is assessing a patient before administration of a cardiac glycoside. Which laboratory result can increase the toxicity of the drug?
   a. Potassium level of 2.8 mmol/L
   b. Potassium level of 4.9 mmol/L
   c. Sodium level of 140 mmol/L
   d. Calcium level of 10 mmol/L

a. Potassium level of 2.8 mmol/L

10. The nurse is administering the phosphodiesterase inhibitor milrinone.
    What is the drug’s positive inotropic effect?
    a. Increased heart rate
    b. Increased blood vessel dilation
    c. Increased force of cardiac contraction
    d. Increased conduction of electrical impulses across the heart

c. Increased force of cardiac contraction

11. Which condition predisposes a patient to digitalis toxicity?
    a. Hypercalcemia and advanced age
    b. Hyperthyroidism and liver dysfunction
    c. Ventricular fibrillation and hyperkalemia
    d. Dysrhythmias and hypernatremia

a. Hypercalcemia and advanced age

12. Which assessment result is the most important indicator of an exacerbation of heart failure?
    a. Increased weight
    b. Hypokalemia
    c. Increased pulse
    d. Increased oxygen saturation

a. Increased weight

1. When a patient is experiencing digoxin toxicity, which clinical situations necessitate the use of digoxin immune Fab? (Select all that apply.)
   a. The patient reports seeing colourful halos around lights.

   b. The patient’s serum potassium level is above 5 mmol/L.

   c. The patient is experiencing nausea and anorexia.

   d. The patient’s heart rhythm is atrial flutter with a rate of 115 per minute.

   e. The patient is experiencing long runs of ventricular tachycardia.

   f. The patient is experiencing severe sinus bradycardia that does not respond to

   cardiac pacing.

   g.The patient has taken an overdose of greater than 10 mg of digoxin.

   h. The patient reports fatigue and headaches.

BEFG

1. The Vaughan Williams classification categorizes amiodarone as a Class III drug. How does this drug work?
   a. By blocking slow calcium channels
   b. By prolonging action potential duration
   c. By blocking sodium channels and affecting phase 0
   d. By decreasing spontaneous depolarization and affecting phase 4

b. By prolonging action potential duration

2. Which is an adverse effect associated with the use of procainamide (Procan SR®)?
   a. Tinnitus
   b. Shortened QT interval
   c. Constipation
   d. Diarrhea

d. Diarrhea

3. Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics?
   a. Risk for infection
   b. Risk for injury to self
   c. Excess fluid volume
   d. Impaired skin integrity

b. Risk for injury to self

4. A patient will be discharged on quinidine sulphate (Apo-Quin-G®) extended-release tablets for the treatment of ventricular ectopy. What important information should the nurse give the patient about this medication?
   a. The medication should be stopped once the cardiac symptoms subside.
   b. Signs of cinchonism (such as tinnitus, loss of hearing, or slight blurring of vision)
   may occur.
   c. Because of increased photosensitivity, sunscreen products should be used when
   outside.
   d. Any tablet or capsule visible in the stool indicates an absorption problem and
   should be reported immediately.

b. Signs of cinchonism (such as tinnitus, loss of hearing, or slight blurring of vision)
may occur.

5. What is the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction (MI)?
   a. diltiazem (Cardizem®)
   b. metroprolol tartrate (Lopressor®)
   c. amiodarone hydrochloride (Cordarone®)
   d. adenosine (Adenocard®)

c. amiodarone hydrochloride (Cordarone®)

6. The nurse needs to administer adenosine (Adenocard) to a patient who is experiencing an acute episode of PSVT. What important information should the nurse remember when giving this medication?
   a. The onset of action occurs in 5 minutes.
   b. The medication must be given as a slow intravenous (IV) push.
   c. Asystole may occur for a few seconds after administration.
   d. The medication has a long half-life, and the duration of action is very long.

c. Asystole may occur for a few seconds after administration.

7. Which medication can cause a systemic lupus erythematosus–like syndrome in about 30% of patients?
   a. lidocaine
   b. procainamide hydrochloride
   c. atenolol
   d. propranolol

b. procainamide hydrochloride

8. A patient has been started on lidocaine (Xylocaine®). The nurse will monitor the patient for which adverse effect of this drug?
   a. Drowsiness
   b. Nystagmus
   c. Dry mouth
   d. Convulsions

d. Convulsions

9. What should be monitored closely in a patient who is taking Class IV antidysrhythmics?
   a. Urine output and specific gravity
   b. Temperature and skin turgor
   c. Heart rhythm and blood pressure
   d. Level of consciousness

c. Heart rhythm and blood pressure

1. Which instructions are appropriate for the nurse to give a patient who is taking an antidysrhythmic drug? (Select all that apply.)
   a. Do not chew or crush extended-release forms of medication.

   b. Capsules may be opened if they cannot be swallowed.

   c. Take the medication with food if gastrointestinal distress occurs.

   d. If a dose is missed, the missed dose should be taken with the next dose that is due.

   e. Take the medications with an antacid if gastrointestinal distress occurs.

   f. Limit or avoid the use of caffeine.

   g. The presence of a capsule in the stool should be reported to the physician

   immediately

ACF