Med-Surg Practice Test #1: Cardiovascular

Answer: B. Obtain a 12-lead ECG.

Rationale: This client has classic signs of acute coronary syndrome. ACC/AHA guidance calls for a 12-lead ECG within 10 minutes of arrival for anyone with suspected ACS, because an ST-elevation MI needs emergency reperfusion and every minute of delay means more heart muscle lost. Other early care (oxygen if the saturation is low, aspirin unless contraindicated, IV access, cardiac monitoring, troponin) happens alongside it, per the provider's orders and facility protocol. Option A is wrong because morphine is not the first step and is used selectively, only for pain not relieved by other treatment. Option C is wrong because a lipid panel does not change emergency care. Option D is wrong because a long history delays the ECG; a brief, focused history can be taken while the ECG is done.

Answer: D. Raise the client to high Fowler's position with the legs dependent and apply oxygen.

Rationale: Crackles throughout both lungs, pink frothy sputum and low oxygen saturation in a client with heart failure point to acute pulmonary edema, a life-threatening emergency. Sitting the client upright with the legs down eases breathing and reduces venous return (preload) to the failing heart, and oxygen treats the hypoxemia. The nurse then calls the provider or rapid response team, because IV diuretics and other treatment are usually needed quickly. Option A is wrong because coughing does not clear fluid from the alveoli. Option B is wrong because frothy sputum here is fluid, not infection, and a culture delays care. Option C is wrong because lying flat increases venous return and makes the pulmonary edema worse.

Answer: A. "I'll weigh myself every morning after I urinate and before breakfast, on the same scale, and write it down."

Rationale: Daily weight is the earliest and most reliable sign of fluid retention, because about 1 kg of weight gained overnight is about 1 liter of fluid. Weighing at the same time each day, after voiding, before eating, in similar clothing and on the same scale gives comparable numbers. The client should report a gain above the limit the provider sets; many plans use a gain of about 1 to 1.5 kg (2 to 3 lb) in a day or 2.5 kg (5 lb) in a week, but the client follows their own written plan. Option B is wrong because weekly weights miss rapid fluid gain. Option C is wrong because edema shows up later than weight gain; several liters can build up before swelling is obvious. Option D is wrong because an extra diuretic dose is taken only if the provider's written action plan says so, and the gain still needs to be reported.

Answer: C. "Walk until the cramping starts, rest until it goes away, then walk again, as part of a regular walking program."

Rationale: Cramping with walking that eases with rest is intermittent claudication. A structured walking program, in which the client walks to moderate discomfort, rests, then walks again, improves walking distance over time and is a core part of PAD treatment in the ACC/AHA PAD guideline. The provider may refer the client to supervised exercise therapy. Option A is wrong because raising the legs above the heart reduces arterial blood flow; clients with arterial disease often find the legs feel better slightly dependent. Option B is wrong because compression stockings can further reduce arterial flow and are not used for arterial disease unless the provider has evaluated the circulation and approves them. Option D is wrong because these clients often have reduced sensation and can be burned, and heat raises tissue oxygen demand in a limb that already has poor flow.

Answer: A. Notify the provider or rapid response team immediately.

Rationale: Sudden pain, pallor, coolness and pulselessness in one limb suggest acute arterial occlusion, most likely an embolus from the heart in a client with atrial fibrillation. The other signs to check are paresthesia and paralysis (the six Ps). This is a vascular emergency: muscle and nerve damage can become permanent within hours, so the provider must be told right away for urgent anticoagulation and possible clot removal or revascularization. Keep the leg flat or slightly dependent and protect it from pressure. Option B is wrong because elevation further reduces arterial flow and waiting an hour loses time. Option C is wrong because heat increases oxygen demand and can burn a limb with reduced sensation. Option D is wrong because massage is not appropriate and does nothing for a blocked artery.

Answer: D. New severe low back pain, blood pressure 94/58 mm Hg (down from 136/80) and heart rate 120/min

Rationale: Sudden severe back, flank or abdominal pain with falling blood pressure and a rising heart rate in a client with an aortic aneurysm suggests the aneurysm is leaking or rupturing. This is a surgical emergency with high mortality; the nurse calls the rapid response team and provider immediately and prepares for emergency surgery per protocol. Options A and B are wrong because a pulsating periumbilical mass and an abdominal bruit are expected findings with a known AAA; they should be documented, and the abdomen should not be palpated deeply or repeatedly. Option C is wrong because a stable blood pressure is the goal while the client waits for repair.

Answer: B. Blood pressure 82/60 mm Hg, distended neck veins and muffled heart sounds

Rationale: Pericarditis can cause fluid to build up in the pericardial sac. When the fluid squeezes the heart, the ventricles cannot fill, and cardiac output falls. Low blood pressure, distended neck veins and muffled heart sounds (Beck's triad), often with pulsus paradoxus and tachycardia, point to cardiac tamponade, which can be fatal and may need emergency pericardiocentesis. Option A is wrong because pleuritic chest pain that eases when leaning forward is a typical finding of pericarditis. Option C is wrong because a pericardial friction rub is also expected with pericarditis. Option D is wrong because a low-grade fever and fatigue are common with pericarditis; they are monitored but are not an emergency.

Answer: C. Sudden weakness of the right arm and slurred speech

Rationale: Vegetations on the heart valves can break off and travel as emboli. New one-sided weakness and slurred speech suggest an embolic stroke, which is time-critical: the nurse activates the stroke or rapid response team and notes the time last known well. Options A and D are wrong because Janeway lesions (painless red spots on the palms or soles) and splinter hemorrhages (dark lines under the nails) are known signs of endocarditis; they are documented and reported but are not an emergency. Option B is wrong because fatigue and poor appetite are common with endocarditis and its treatment.

Answer: D. The client says, "I skipped my apixaban most of last week because I ran out."

Rationale: In atrial fibrillation, blood pools in the left atrium and clots can form. When a normal rhythm returns, a clot can be pushed out and cause a stroke. For this reason, guidelines generally call for a period of uninterrupted anticoagulation before elective cardioversion, or an imaging study such as a transesophageal echocardiogram to look for clot. Missed doses must be reported so the provider can decide whether to delay the procedure or order imaging. Option A is wrong because fasting before the procedure is expected, as sedation is given. Option B is wrong because anxiety is normal and is managed with teaching and support. Option C is wrong because an irregular rhythm is the reason for the procedure.

Answer: A. Lower the blood pressure gradually to the provider's target, with frequent blood pressure and neurologic checks.

Rationale: Severe hypertension with new signs of organ damage (here, confusion and vision changes) is a hypertensive emergency and is treated with a titrated IV medication in a closely monitored setting. Blood pressure is lowered in a controlled way, because the brain, heart and kidneys have adapted to the high pressure and a sudden drop can cause ischemia or stroke. ACC/AHA guidance for most adults is to lower the pressure by no more than about 25% in the first hour, with exceptions such as aortic dissection; the nurse follows the provider's specific targets and facility protocol. Option B is wrong because dropping to a normal pressure quickly can cause organ ischemia. Option C is wrong because a hypertensive emergency needs prompt IV treatment. Option D is wrong because a titrated IV antihypertensive needs very frequent monitoring, often every few minutes at first or by arterial line, per protocol.