PRELIMS Practice Test 2

A client with pericarditis reports severe chest pain that becomes worse when lying flat and improves when sitting forward. Which condition does the nurse suspect? A. Myocardial infarction B. Pericarditis C. Heart failure D. Stable angina

B. Pericarditis — Pericarditis is inflammation of the pericardium. The characteristic pain is often relieved when the client sits up and leans forward and may worsen when lying down.

While assessing a client with pericarditis, the nurse hears a scratchy sound over the precordium. Which finding is this? A. S3 gallop B. Pericardial friction rub C. Murmur D. Pleural friction rub

B. Pericardial friction rub — A pericardial friction rub results from inflamed pericardial layers rubbing against each other. It is a classic assessment finding in pericarditis.

A client with pericarditis suddenly develops hypotension, muffled heart sounds, and jugular venous distention. Which complication should the nurse suspect? A. Cardiac tamponade B. Stable angina C. Chronic bronchitis D. Peripheral arterial disease

A. Cardiac tamponade — Cardiac tamponade occurs when fluid accumulates in the pericardial space and compresses the heart. Hypotension, muffled heart sounds, and jugular venous distention are classic findings.

The nurse is caring for a client with suspected cardiac tamponade. Which finding requires immediate attention? A. Mild fatigue B. Hypotension C. Mild headache D. Increased appetite

B. Hypotension — Tamponade restricts ventricular filling and decreases cardiac output. Severe hypotension indicates impaired cardiac function and requires immediate intervention.

A young adult develops chest discomfort and dysrhythmias after a recent viral illness. Which inflammatory cardiac condition should the nurse suspect? A. Myocarditis B. Varicose veins C. Pericarditis only D. Aortic aneurysm

A. Myocarditis — Myocarditis is inflammation of the myocardium and may occur following viral infections. It can impair myocardial contraction and cause dysrhythmias.

A client has a history of untreated streptococcal infection and later develops cardiac valve problems. Which condition is most likely responsible? A. Rheumatic fever B. Raynaud disease C. DVT D. Emphysema

A. Rheumatic fever — Rheumatic fever can develop after certain streptococcal infections and may cause inflammatory damage to the heart valves.

A client with infective endocarditis has fever, a new heart murmur, and abnormal lesions on the fingers. Which diagnostic test is especially important? A. Blood culture B. Urinalysis C. Spirometry D. Ankle-brachial index

A. Blood culture — Infective endocarditis involves infection of the endocardium and valves. Blood cultures help identify the causative organism and guide antibiotic treatment.

The nurse observes small, painful, reddish lesions on a client’s finger pads who has endocarditis. Which finding is this? A. Janeway lesions B. Osler nodes C. Varicose veins D. Cyanosis

B. Osler nodes — Osler nodes are painful, tender lesions associated with infective endocarditis. Janeway lesions are classically non-tender lesions on the palms and soles.

A client with infective endocarditis has non-tender hemorrhagic lesions on the palms and soles. Which finding should the nurse document? A. Osler nodes B. Janeway lesions C. Buerger lesions D. Raynaud lesions

B. Janeway lesions — Janeway lesions are non-tender hemorrhagic lesions found on the palms and soles and may occur with infective endocarditis.

A client has a blood pressure of 168/104 mmHg during repeated assessments. How should the nurse interpret this finding according to the lecture? A. Normal B. Prehypertension C. Stage 1 hypertension D. Stage 2 hypertension

D. Stage 2 hypertension — The lecture classifies blood pressure of approximately 160/100 mmHg or higher as stage 2 hypertension.

A patient with hypertension asks why controlling blood pressure is important. Which response is most appropriate? A. “It only prevents headaches.” B. “It reduces the workload on the heart and lowers the risk of complications.” C. “It prevents all infections.” D. “It eliminates the need for lifestyle changes.”

B. “It reduces the workload on the heart and lowers the risk of complications.” — Hypertension increases afterload and places additional stress on the cardiovascular system. Long-term uncontrolled hypertension can contribute to heart, brain, kidney, and vascular complications.

A client with hypertension is instructed to make lifestyle changes. Which choice demonstrates understanding? A. Increase sodium intake B. Stop exercising C. Follow a low-sodium diet and exercise regularly D. Increase cigarette smoking

C. Follow a low-sodium diet and exercise regularly — Lifestyle measures such as a DASH-style diet, reduced sodium intake, exercise, weight management, and smoking cessation help control hypertension.

A client with long-standing hypertension develops left ventricular hypertrophy. What is the primary reason? A. Increased workload against elevated arterial pressure B. Decreased blood viscosity C. Increased venous return only D. Decreased myocardial workload

A. Increased workload against elevated arterial pressure — Persistent hypertension increases afterload. The left ventricle must work harder to eject blood, which can eventually lead to hypertrophy.

A patient with coronary artery disease asks what atherosclerosis means. Which explanation is best? A. “It is a temporary narrowing caused by exercise.” B. “It is buildup of plaque within the arterial walls.” C. “It is inflammation of the veins.” D. “It is a complete absence of blood vessels.”

B. “It is buildup of plaque within the arterial walls.” — Atherosclerosis involves accumulation of lipid-containing plaque in arterial walls, progressively narrowing the vessel and reducing blood flow.

A patient with CAD develops chest pain while climbing stairs. Which medication would the nurse expect to be prescribed to relieve an episode of angina? A. Nitroglycerin B. Warfarin C. Protamine sulfate D. Iron

A. Nitroglycerin — Nitroglycerin is a potent vasodilator used to relieve anginal chest pain by improving coronary blood flow and reducing myocardial oxygen demand.

A patient prescribed sublingual nitroglycerin reports a headache after taking the medication. What should the nurse explain? A. “This always indicates an allergic reaction.” B. “Headache can occur because nitroglycerin causes vasodilation.” C. “The medication has caused an infection.” D. “You should immediately double the dose.”

B. “Headache can occur because nitroglycerin causes vasodilation.” — Headache and dizziness are recognized effects of nitroglycerin because of its vasodilating action.

A patient with angina is prescribed sublingual nitroglycerin. Before administering it, which assessment is especially important? A. Blood pressure B. Bowel sounds C. Skin turgor D. Pupillary response

A. Blood pressure — Nitroglycerin can cause vasodilation and hypotension. The nurse should assess blood pressure before administration.

A patient with coronary artery disease reports chest pain occurring at rest and becoming increasingly frequent. Which type of angina should the nurse suspect? A. Stable angina B. Unstable angina C. Exercise-induced normal pain D. Venous insufficiency

B. Unstable angina — Unstable angina is characterized by increasing frequency or severity of chest pain and may occur at rest. It is considered a pre-infarction condition.

A client reports episodes of chest pain that occur at rest because of coronary vasospasm. Which type of angina is most consistent with this finding? A. Stable angina B. Variant/Prinzmetal angina C. Exertional angina only D. Silent angina

B. Variant/Prinzmetal angina — Variant or Prinzmetal angina is associated with coronary artery vasospasm and can occur while the patient is at rest.

A client presents with severe substernal chest pressure lasting more than 15 minutes and describes it as an “elephant sitting on my chest.” What should the nurse suspect? A. Myocardial infarction B. Mild indigestion C. Stable angina only D. Varicose veins

A. Myocardial infarction — Prolonged severe chest pressure is concerning for myocardial infarction, particularly when it lasts longer than typical stable angina.

A patient is suspected of having an acute myocardial infarction. Which cardiac biomarker is considered highly specific for myocardial injury? A. Troponin B. Sodium C. Hemoglobin D. Albumin

A. Troponin — Troponin is a cardiac biomarker used to detect myocardial injury and is considered one of the most definitive biomarkers for MI.

A patient’s ECG shows ST-segment elevation during an acute coronary event. What does this finding indicate according to the lecture? A. Old infarction B. Site of injury C. Normal ventricular repolarization D. Venous obstruction

B. Site of injury — The lecture identifies ST-segment elevation as representing the site of myocardial injury.

A patient’s ECG shows a pathologic Q wave. Which interpretation is most appropriate? A. Acute oxygen saturation B. Old myocardial infarction C. Normal cardiac rhythm D. DVT

B. Old myocardial infarction — The lecture associates a pathologic Q wave with a previous or old myocardial infarction.

A client undergoing coronary artery bypass grafting asks which vessels may be used as grafts. Which response is correct? A. Saphenous vein B. Femoral vein only C. Jugular vein only D. Pulmonary artery only

A. Saphenous vein — The lecture identifies the saphenous vein as one of the vessels that may be used for CABG. Other possible grafts include the internal mammary artery and radial artery.

A patient has undergone CABG. Which nursing assessment is particularly important? A. Peripheral circulation and graft-related complications B. Hearing acuity only C. Visual acuity only D. Bowel elimination only

A. Peripheral circulation and graft-related complications — Following vascular/cardiac procedures, nursing assessment should focus on circulation, perfusion, vital signs, and signs of complications.

A patient with anemia asks why they feel exhausted after walking a short distance. Which explanation is best? A. Their blood carries less oxygen to tissues. B. Their veins are permanently enlarged. C. Their lungs have too much fluid. D. Their heart is always beating too slowly.

A. Their blood carries less oxygen to tissues. — Anemia involves decreased RBCs or hemoglobin, reducing the blood’s oxygen-carrying capacity. This can produce fatigue, weakness, and dyspnea with activity.

A client with anemia reports dizziness, fatigue, pallor, and dyspnea. Which nursing intervention is appropriate? A. Encourage activity beyond tolerance B. Schedule rest periods C. Restrict oxygen D. Encourage strenuous exercise immediately

B. Schedule rest periods — Reduced oxygen delivery can produce activity intolerance and fatigue. Rest periods help conserve energy and reduce oxygen demand.

A client receiving chemotherapy develops severe neutropenia. Which nursing action is most appropriate? A. Encourage exposure to sick visitors B. Use infection-prevention measures C. Encourage raw foods from outside sources D. Stop hand hygiene

B. Use infection-prevention measures — Neutropenia reduces the body’s ability to fight infection. Strict infection-prevention measures are therefore important.

A patient has a platelet count that is severely decreased. Which assessment finding should the nurse monitor for most closely? A. Bleeding B. Increased appetite C. Hypertension only D. Increased muscle mass

A. Bleeding — Platelets are essential for blood clot formation. Thrombocytopenia increases the risk for bleeding, including mucosal or internal bleeding.

A client with disseminated intravascular coagulation (DIC) has oozing blood from IV sites and mucous membranes. Which problem should the nurse recognize? A. Increased bleeding tendency B. Improved clotting ability C. Normal coagulation D. Isolated hypertension

A. Increased bleeding tendency — DIC involves widespread activation of coagulation with consumption of clotting factors and platelets. The patient may develop bleeding from IV sites, mucous membranes, and other areas.