N1120 Test Blueprint

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CARDIOVASCULAR Test Questions/Blueprint

|Question |Course Objective |Step in the Nursing Process |Cognitive Level |Difficulty Level|Item |Response |

| | | |(Blooms) | |Discrim. | |

|1. Hypertension | |implementation |Apply |.679 |0.2 | |

| | | | | | | |

|When the nurse is developing a teaching plan to prevent the development of heart | | | | | | |

|failure in a patient with stage 1 hypertension, the information that needs to be | | | | | | |

|emphasized with antihypertensive medication therapy is that | | | | | | |

|Hypertension is silent and if untreated can cause irreversible damage to the | | | | | | |

|kidneys. | | | | | | |

|Hypertension eventually will lead to heart failure by overworking the left | | | | | | |

|ventricle | | | | | | |

|High BP increases risk for rheumatic heart disease. | | | | | | |

|High systemic pressure precipitates papillary muscle rupture | | | | | | |

|a & b | | | | | | |

|The nurse obtains the following information about hypertension risk factors from a| |assessment |Apply |0.808 |0.4 | |

|patient with prehypertension. The modifiable risk factor that will be the highest | | | | | | |

|priority to change with your patient is: | | | | | | |

|Gets no regular exercise | | | | | | |

|Is 10 pounds over their ideal weight | | | | | | |

|Has a high sodium intake | | | | | | |

|Drinks wine with dinner daily | | | | | | |

|Smokes ½ pack per day | | | | | | |

|The nurse is planning patient teaching for a patient who has just been diagnosed | |intervention |apply |0.744 |0.2 | |

|with hypertension and has a new prescription for Captopril (Capoten). Which | | | | | | |

|information is important to include when teaching the patient? | | | | | | |

|To increase fluid intake if dryness of the mouth is a problem | | | | | | |

|To check heart rate daily before taking the medication | | | | | | |

|To include high-potassium foods such as citrus fruits in the diet | | | | | | |

|To change position slowly to help prevent dizziness and falls | | | | | | |

|Laboratory testing is ordered for a patient during a clinic visit for routine | |assessment |Understand/apply |0.962 |0.1 | |

|assessment of hypertension. When monitoring for target organ damage as a | | | | | | |

|consequence of hypertension, the nurse will be most concerned about | | | | | | |

|Blood urea nitrogen (BUN) of 15 mg/dl | | | | | | |

|Alanine aminotransferase (ALT) 40 u/L | | | | | | |

|Aspartate aminotransferase (AST) 38 u/L | | | | | | |

|Serum creatinine of 1.8 mg/dl | | | | | | |

|In teaching a patient with hypertension, the nurse emphasizes that even though you| |Assess/intervention |Understand/apply |0.679 |0.1 | |

|have no symptoms, hypertension needs to be controlled because it can quietly | | | | | | |

|damage many organs in the body. The damage that occurs is primarily related to | | | | | | |

|which effect of hypertension? | | | | | | |

| | | | | | | |

|Arterial wall changes with progressive development of atherosclerosis | | | | | | |

|Hypoxia of organ systems caused by thickening of capillary membranes, which | | | | | | |

|impairs gas exchange. | | | | | | |

|Increased viscosity of the blood contributing to intravascular coagulation with | | | | | | |

|necrosis of tissue distal to occlusions. | | | | | | |

|6. Angina-Coronary Artery Disease | |assessment |remember |0.885 |0.3 | |

| | | |understand | | | |

|Which of the following conditions causes the chest pain seen with angina? | | | | | | |

|Increased preload | | | | | | |

|Decreased afterload | | | | | | |

|Decreased contractility | | | | | | |

|Decreased oxygen supply to the myocardium | | | | | | |

|7. N1120-V-2 Your patient presents to the emergency department with complaints of | |assessment |Understand |0.897 |0.1 | |

|substernal chest pain. 12 hours later, it is noted on the laboratory assessment | | |apply | | | |

|that troponin levels have not risen. What conclusion can be drawn from this | | | | | | |

|information? | | | | | | |

|Your patient has not experienced a myocardial infarction. | | | | | | |

|Your patient is experiencing an evolving myocardial infarction. | | | | | | |

|Your patient most likely had a myocardial infarction several days ago. | | | | | | |

|Your patient has experienced a myocardial infarction within the last 24 hours. | | | | | | |

|Why is the administration of aspirin recommended along with nitroglycerin when a | |Assess |Understand |0.936 |0.1 | |

|client is experiencing angina-like chest pain? | |implementation |Apply | | | |

|Aspirin has analgestic properties without sedation | | | | | | |

|Aspirin can trigger vasodilation and improve blood plow. | | | | | | |

|Aspirin inhibits platelet aggregation and clot information | | | | | | |

|Aspirin has cardiotonic properties and improves contraction | | | | | | |

|Nitroglycerin is indicated as one of the first medications given for chest pain in| |implement |Understand |0.962 |0.1 | |

|angina because it: | | |apply | | | |

|Decreases workload of the heart through decreasing preload and dilates the | | | | | | |

|coronary arteries | | | | | | |

|Decreases workload of the heart through increasing preload and dilates the | | | | | | |

|coronary arteries | | | | | | |

|Decreases workload of the heart through decreasing afterload and constricts the | | | | | | |

|coronary arteries | | | | | | |

|Decreases workload of the heart through decreasing heartrate and decreasing | | | | | | |

|cardiac contractility | | | | | | |

|A client who has experienced a myocardial infarction develops left ventricular | |assessment |Understand |0.628 |0.4 | |

|heart failure. Which sign of poor organ perfusion should the nurse remain alert | | |Apply | | | |

|for? | | | | | | |

|Alanine aminotransferase (ALT) 122 u/L | | | | | | |

|Serum creatinine of 1.7 mg/dl | | | | | | |

|Urine output less than 30mL/hour | | | | | | |

|b & c | | | | | | |

|a, b, c | | | | | | |

|You are caring for your patient who had coronary angioplasty (PTCA) 1 hour ago. | |Assessment |Understand |0.590 |0.4 | |

|Which complications of this procedure should the nurse remain alert for at this | |implementation |Apply | | | |

|time? | | | | | | |

|Hypertensive crisis | | | | | | |

|Hyperkalemia | | | | | | |

|Infection | | | | | | |

|Bleeding | | | | | | |

|Your patient who is scheduled for echocardiography today asks why this test is | |implementation |Understand |0.628 |0.5 | |

|being performed. What is the nurse’s best response? | | |Apply | | | |

|To assess the structure of the heart and determine left ventricular function | | | | | | |

|To assess for abnormal electrical impulses within the heart | | | | | | |

|To evaluate the decrease in the cardiac output when the client has PVCs | | | | | | |

|To evaluate the coronary arteries for any blockages that may be present | | | | | | |

|You are taking the history of your patient who has chest pain. Recently, he has | |Assessment |Remember |0.987 |0.1 | |

|had episodes of chest discomfort while mowing the lawn with a push mower. The | | |Understand | | | |

|chest discomfort subsides when the patient rests. What conclusion can the nurse | | | | | | |

|draw from this information? | | | | | | |

|The patient likely has unstable angina. | | | | | | |

|The patient likely has stable angina. | | | | | | |

|The patient likely has had a myocardial infarction. | | | | | | |

|The patient need not be concerned about this pain, because it relieved with rest. | | | | | | |

|The nurse is admitting a patient who is complaining of chest pain to the emergency| |assessment |remember |0.872 |0.4 | |

|department (ED). Which information collected by the nurse suggests that the pain | | |understand | | | |

|is caused by an acute myocardial infarction (AMI)? | | | | | | |

|The pain onset was while he was watching TV. | | | | | | |

|The pain increases with deep breathing. | | | | | | |

|The pain is relieved after the patient takes nitroglycerin. | | | | | | |

|The pain has persisted longer than 30 minutes. | | | | | | |

|a & d | | | | | | |

|Which information given by a patient admitted with chronic stable angina will help| |assessment |Understand |0.910 |0.1 | |

|the nurse confirm this diagnosis? | | |apply | | | |

|The patient rates the pain at a level 3 to 5 (0–10 scale). | | | | | | |

|The patient states that the pain “wakes me up at night.” | | | | | | |

|The patient indicates that the pain is resolved after taking one sublingual | | | | | | |

|nitroglycerin tablet. | | | | | | |

|The patient says that the frequency of the pain has increased over the last few | | | | | | |

|weeks. | | | | | | |

|16. Three risk factors that influence the development and progression of coronary | |Assessment |Understand |0.923 |0.1 | |

|artery disease include: | | | | | | |

|Smoking, family history of heart disease and diabetes. | | | | | | |

|Smoking, active life style, and high density lipoproteins (HDL) of 25. | | | | | | |

|Smoking, diabetes and high density lipoproteins (HDL) of 80. | | | | | | |

|Obesity, smoking, and low density lipoproteins (LDL) of 80. | | | | | | |

| Heart Failure | |assessment |Understand |0.846 |0.2 | |

|The initial compensatory mechanism of the body that maintains cardiac output when | | | | | | |

|the heart is in failure is: | | | | | | |

|Increased parasympathetic nervous system stimulation | | | | | | |

|Increased sympathetic nervous system stimulation | | | | | | |

|Decreased sympathetic nervous system stimulation | | | | | | |

|Renin-Angiotensin-Aldosterone System | | | | | | |

|An elderly patient with a 40-pack-year history of smoking and a recent myocardial | |assessment |Understand |0.474 |0.4 | |

|infarction is admitted to the medical unit with acute shortness of breath; the | | |Apply | | | |

|nurse needs to rule out pneumonia versus heart failure. The diagnostic test that | | | | | | |

|the nurse will monitor to help in determining whether the patient has heart | | | | | | |

|failure is: | | | | | | |

|12-lead electrocardiogram (ECG). | | | | | | |

|Troponin | | | | | | |

|B-type natriuretic peptide (BNP). | | | | | | |

|Creatinine phosphokinase (CPK-MB) | | | | | | |

|Which nursing diagnosis would be considered a priority for the client with left | |assessment |Understand |0.795 |0.2 | |

|sided heart failure? | | |Apply | | | |

|Anxiety | | | | | | |

|Activity Intolerance | | | | | | |

|Impaired Gas Exchange | | | | | | |

|Fatigue | | | | | | |

|ACE inhibitors such as Lisinopril are often the first drug used to manage heart | |assessment |Understand |0.936 |-0.2 | |

|failure. What aspects of cardiac output are influenced by this medication to | | |Apply | | | |

|decrease the workload of the heart? | | | | | | |

|Increases preload and decreases afterload | | | | | | |

|Decreases preload and decreases afterload | | | | | | |

|Increases preload and increases afterload | | | | | | |

|Decreases heart rate and decreases contractility | | | | | | |

|Your patient with left sided heart failure has an ejection fraction of 25%. What | |assessment |Understand |0.936 |0.1 | |

|pathophysiologic changes would the nurse expect to see? | | |Apply | | | |

|An increase in stroke volume | | | | | | |

|A decrease in tissue /organ perfusion | | | | | | |

|An increase in oxygen saturation | | | | | | |

|A decrease in arterial vasoconstriction | | | | | | |

|22. Questions: 22-26: Ms. Camp, age 65 was discharged from the hospital 2 weeks | |Assessment |Apply |0.423 |0.3 | |

|ago after a 5-day stay for severe dyspnea and congestive heart failure. She now | |implement |analyze | | | |

|has 2+ pitting edema in lower extremities and a nonproductive cough. Her vital | | | | | | |

|signs are: | | | | | | |

|T-98.9 P-112, R-28 BP 170/110 O2 sats 88% on room air. Ms. Camp has shortness of | | | | | | |

|breath with exertion and used 3 pillows to sleep last night because she became | | | | | | |

|very short of breath after lying flat. Standing or sitting up relieved her | | | | | | |

|shortness of breath. | | | | | | |

| | | | | | | |

|Which nursing diagnostic statement(s) are relevant to her current status and will | | | | | | |

|guide your plan of care: | | | | | | |

|Impaired gas exchange | | | | | | |

|Excess fluid volume | | | | | | |

|Fluid volume deficit | | | | | | |

|a & b | | | | | | |

|What is the most important assessment for the nurse to accomplish next for Ms. | |Assessment |Understand |0.859 |0.0 | |

|Camp? | |implement |Apply | | | |

|Auscultate the lung sounds. | | | | | | |

|Assess the orientation. | | | | | | |

|Check the capillary refill. | | | | | | |

|Insert an IV. | | | | | | |

|Which assessment finding would most likely indicate that Ms. Camp who has a | |assessment |Understand |0.859 |0.3 | |

|history of left sided heart failure is now in right-sided heart failure? | | |Apply | | | |

|2+ pitting edema in lower extremities. | | | | | | |

|Crackles in lungs. | | | | | | |

|Orthopnea. | | | | | | |

|Non-productive cough. | | | | | | |

|The physician orders Furosemide (Lasix) 40 mg IV stat. The primary rationale for | |implement |Understand |0.821 |0.1 | |

|this medication is to decrease the workload of the heart by: | | |Apply | | | |

|Lowering afterload through arterial vasodilation | | | | | | |

|Lowering preload through venous vasodilation | | | | | | |

|Lowering preload through diuresis | | | | | | |

|Lowering preload through diuresis and venous vasodilation | | | | | | |

|When evaluating the effectiveness of your nursing intervention, what nursing | |evaluation |Understand |0.564 |0.4 |MODIFY |

|assessment data supports that Furosemide has been effective to decrease the | | |Apply | | | |

|workload of the heart? | | |Analyze | | | |

|Urine output of 800 mL in the past hour | | |Evaluate | | | |

|Heart rate 120/minute | | | | | | |

|Respiratory rate 16/minute | | | | | | |

|a & c | | | | | | |

|a,b,c | | | | | | |

| | | | | | | |

|MODIFY 26. N1120-V-2 When evaluating the effectiveness of your nursing | | | | | | |

|intervention, what nursing assessment data supports that Furosemide has been | | | | | | |

|effective? | | | | | | |

|Urine output of 800 mL in the past hour | | | | | | |

|Heart rate 120/minute | | | | | | |

|Respiratory rate 16/minute | | | | | | |

|a & c | | | | | | |

|a,b,c | | | | | | |

|PVD-PAD | |Assess |Understand |0.538 |0.3 | |

|During an assessment of a 63-year-old patient at the clinic, the patient says, “I | |implement |Apply | | | |

|have always taken an evening walk, but lately my leg cramps and hurts after just a| | | | | | |

|few minutes of walking. The pain goes away after I stop walking, though.” The | | | | | | |

|nurse should: | | | | | | |

|Ask about any skin color changes that occur in response to cold. | | | | | | |

|Check for the presence of tortuous veins bilaterally on the legs. | | | | | | |

|Assess for unilateral swelling, redness, and tenderness of either leg. | | | | | | |

|Attempt to palpate the dorsalis pedis and posterial tibial pulses. | | | | | | |

|The nurse performing an assessment with a patient who has chronic peripheral | |assess |Understand |0.962 |0.2 | |

|arterial disease (PAD) of the legs would expect to find | | |Apply | | | |

|Swollen, dry, scaly ankles. | | |Evaluate | | | |

|A positive Homans’ sign. | | | | | | |

|Little to no hair on lower legs | | | | | | |

|A draining ulcer on the heel. | | | | | | |

|The health care provider orders a continuous IV heparin infusion for a patient | |Assess |Understand |0.846 |0.2 | |

|with swelling and pain of the upper leg caused by a DVT. While the patient is | |implement |Apply | | | |

|receiving the heparin infusion, the nurse should | | |analyze | | | |

|Assess for any signs of GI bleeding or unusual bruising. | | | | | | |

|Notify the physician if platelets have dropped significantly | | | | | | |

|Have vitamin K available in case reversal of the heparin is needed. | | | | | | |

|Monitor posterior tibial and dorsalis pedis pulses with the Doppler. | | | | | | |

|a&b | | | | | | |

|30. Your 72-year-old patient is hospitalized for an aortic dissection of the | |implement |Understand |0.705 |0.5 | |

|abdominal aorta that stabilizes with treatment. The nurse develops a teaching plan| | |Apply | | | |

|for the patient’s discharge that includes information about | | | | | | |

|gradually increasing exercise to improve cardiac function and BP control. | | | | | | |

|appropriate use of nonsteroidal antiinflammatory agents (NSAIDs) to control any | | | | | | |

|abdominal pain. | | | | | | |

|holding prescribed beta-blockers if systolic blood pressure is ................
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