1. Magnesium is absorbed by what system of the body?

The answer is D: Prolonged QT interval on the EKG

6. An EKG shows a shortened QT interval. Which lab

●​ A. GI value below would be indicative of this change?

●​ B. Hepatic
●​ A. Calcium level of 8 mg/dL
●​ C. Renal
●​ D. Lymphatic ●​ B. Calcium level of 12 mg/dL
Answer is A: GI ●​ C. Calcium level of 8.7 mg/dL
●​ D. Calcium level of 9.2 mg/dL
2. A patient has a Magnesium level of 1.3 mg/dL. Which
of the following is NOT a sign or symptom of this The answer is B. Calcium level of 12 mg/dL
condition?

7. Which patient below is considered hypernatremic?

●​ A. Hypertension ●​ A. A patient with a sodium level of 155 mEq/L

●​ B. Torsades de pointes
●​ C. Positive Trousseau’s Sign
●​ B. A patient with a sodium level of 145 mEq/L
●​ D. Absent deep tendon reflexes
The answer is D: Absent deep tendon reflexes
●​ C. A patient with a sodium level of 120 mEq/L
●​ D. A patient with a sodium level of 136 mEq/L
3. Which of the following patients is MOST at risk for The answer is A: A patient with a sodium level of 155
hypermagnesemia? mEq/L.

8. A patient has a sodium level of 119 mEq/L. Which of the

●​ A. A patient with alcoholism following is NOT related to this finding?

●​ B. A patient taking a proton-pump inhibitor

●​ A. Oversecretion of ADH (antidiuretic hormone)
●​ C. A patient suffering from Crohn’s Disease
●​ B. Low salt diet
●​ D. A patient with a magnesium level of 0.6
mg/dL receiving IV magnesium sulfate ●​ C. Inadequate water intake

The answer is D: A patient with a magnesium level of 0.6

mg/dL receiving IV magnesium sulfate ●​ D. Hypotonic fluid infusion (overload)
The answer is C: Inadequate water intake
4. Stimulation of the facial nerve via the masseter
muscle causes twitching of the nose/lips in hypocalcemia
is known as?* 9. A patient’s blood tests show they have a critically low
parathyroid hormone (PTH). What effect would this have
●​ A. Trousseau's Sign on phosphate and calcium levels in the blood?

●​ A. Phosphate levels high, calcium levels low

●​ B. Chvostek's Sign
●​ C. Homan's Sign
●​ D. Goodell's Sign ●​ B. Phosphate and calcium levels high

The answer is B: Chvostek's Sign ●​ C. Phosphate and calcium levels low

●​ D. Phosphate levels low, calcium levels high
5. A patient has a calcium level of 7.2 mg/dL. What sign The answer is A: Phosphate levels high, calcium levels low
below is indicative of this lab value?

10. Which of the following would you NOT expect to see

with a phosphate level of 1.2 mg/dL?
●​ A. None, this is a normal calcium level
●​ B. Shortened ST segment ●​ A. Positive Trousseau’s Sign

●​ C. Hypoactive bowel sounds

●​ D. Prolonged QT interval on the EKG ●​ B. Anemia
 ●​ C. Confusion ●​ A. A 69 year old male with a history of alcohol
abuse and is recovering from a myocardial
●​ D. Osteomalacia
The answer is A: Positive Trousseau's Sign infarction.

●​ B. A 55 year old female with a health history of

11. A patient has a potassium level of 1.5 mEq/L. Which of asthma and hypoparathyroidism.
the following is NOT typically a sign with this condition?
●​ C. A 30 year old male with a history of
●​ A. None, this is a normal potassium level.
endocarditis and has severe mitral stenosis.

●​ D. A 45 year old female with lung cancer stage 2.

●​ B. Decreased respirations
●​ C. Decreased deep tendon reflexes
●​ D. Tall T-waves ●​ E. A 58 year old female with uncontrolled
The answer is D: Tall t-waves (this presents with hypertension and is being treated for influenza.
HYPERkalemia).

12. Which patient is at risk for hyperkalemia? The answers to this question are options: A, C, E. These
patients are at most risk for heart failure. Remember risks
●​ A. Patient taking a loop diuretic factor for developing heart failure include: remember the
mnemonic FAILURE: Faulty heart valves ( Option C mitral
●​ B. Patient with Cushing’s Syndrome stenosis in this case), Arrhythmias, Infarction (Option A),
Lineage, Uncontrolled hypertension (Option E),
Recreational drug usage, Evaders (Option E with influenza)
●​ C. Patient with Addison’s Disease
2. A patient is being discharged home after hospitalization
●​ D. Patient with nasogastric suction
of left ventricular systolic dysfunction. As the nurse
The answer is C: Addison's Disease providing discharge teaching to the patient, which
statement is NOT a correct statement about this condition?

13. Which of the following does Chloride NOT play a role ●​ A. "Signs and symptoms of this type of heart
in? failure can include: dyspnea, persistent cough,
difficulty breathing while lying down, and weight
●​ A. Digestion gain."

●​ B. Acid-base balance ●​ B. "It is important to monitor your daily weights,

fluid and salt intake."
●​ C. Fluid balance
●​ C. "Left-sided heart failure can lead to right-sided
heart failure, if left untreated."
●​ D. Bone health ●​ D. "This type of heart failure can build up pressure
in the hepatic veins and cause them to become
The answer is D: Bone health congested with fluid which leads to peripheral

14. A patient has a Chloride level of 70 mEq/L. Which edema."

condition below can cause this type of level?
Option D is the answer. This is a description of right-sided
heart failure NOT left ventricular systolic dysfunction.
●​ First A. None, this is a normal level. Left-sided systolic dysfunction is where the left side of the
heart is unable to CONTRACT efficiently which causes
blood to back-up into the lungs...leading to pulmonary
●​ B. Cystic Fibrosis edema.

●​ C. Metabolic acidosis
3. Which of the following are NOT typical signs and
●​ D. Hypertonic fluids symptoms of right-sided heart failure?
Select-all-that-apply:
The answer is B: Cystic Fibrosis

●​ A. Jugular venous distention

●​ B. Persistent cough
HEART FAILURE
1. Which of the following patients are MOST at risk for ●​ C. Weight gain
developing heart failure? Select-all-that-apply:
 ●​ F. Options A, B, and C are all correct.
●​ D. Crackles The answer is E. Options A and B are classic signs and
symptoms a patient may experience with heart failure
●​ E. Nocturia exacerbation.

●​ F. Orthopnea 7. Patients with heart failure can experience episodes of

exacerbation. All of the patients below have a history of
The answers are B, D, and F. Persistent cough, crackles heart failure. Which of the following patients are at MOST
(also called rales), and orthopnea are signs and symptoms risk for heart failure exacerbation?
of LEFT-sided heart failure...not right-sided heart failure.
●​ A. A 55 year old female who limits sodium and
fluid intake regularly.
4. A patient is diagnosed with left-sided systolic
dysfunction heart failure. Which of the following are ●​ B. A 73 year old male who reports not taking
expected findings with this condition? Amiodarone for one month and is experiencing

●​ A. Echocardiogram shows an ejection fraction of

38%. atrial fibrillation.

●​ B. Heart catheterization shows an ejection fraction ●​ C. A 67 year old female who is being discharged
of 65%. home from heart valve replacement surgery.

●​ C. Patient has frequent episodes of nocturnal ●​ D. A 78 year old male who has a health history of
paroxysmal dyspnea. eczema and cystic fibrosis.
Option B is the correct answer. Patients who are in an
●​ D. Options A and C are both expected findings
arrhythmia (especially a-fib) are at risk for developing heart
with left-sided systolic dysfunction heart failure.
failure because the heart is not contracting properly and
blood is pooling in the chambers.

The answer is D. Both Options A and C are correct. Option 8. A 74 year old female presents to the ER with complaints
B is a finding expected in left-sided DIASTOLIC of dyspnea, persistent cough, and unable to sleep at night
dysfunction heart failure because the issue is with the due to difficulty breathing. On assessment, you note
ability of the ventricle to FILL properly...therefore a patient crackles throughout the lung fields, respiratory rate of 25,
usually has a normal ejection fraction. Remember a normal and an oxygen saturation of 90% on room air. Which of the
EF is >60% in a healthy heart. following lab results confirm your suspicions of heart
failure?

5. True or False: Patients with left-sided diastolic

●​ A. K+ 5.6
dysfunction heart failure usually have a normal ejection
fraction. ●​ B. BNP 820

●​ True ●​ C. BUN 9
●​ D. Troponin <0.02
●​ False The answer is option B. BNP (b-type natriuretic peptide) is
a biomarker released by the ventricles when there is
The answer is TRUE. Patient with left-sided DIASTOLIC excessive pressure in the heart due to heart failure. <100 no
dysfunction heart failure normally have a normal ejection failure, 100-300 present, >300 pg/mL mild, >600 pg/mL
fraction. However, patients with left-sided SYSTOLIC >moderate, 900 pg/mL severe
dysfunction heart failure usually do not because the heart is
unable to CONTRACT efficiently rather than fill properly
as with diastolic dysfunction. 9. Which of the following tests/procedures are NOT used to
diagnose heart failure?

6. A patient has a history of heart failure. Which of the

following statements by the patient indicates the patient
●​ A. Echocardiogram
may be experiencing heart failure exacerbation? ●​ B. Brain natriuretic peptide blood test

●​ A. “I’ve noticed that I’ve gain 6 lbs in one week.” ●​ C. Nuclear stress test
●​ D. Holter monitoring
The answer is D. Options A, B, and C are all used to
●​ B. “While I sleep I have to prop myself up with a diagnose heart failure...however a holter monitor is not. A
pillow so I can breathe.” holter monitor is used to monitor a patient's heart rate and
rhythm.
●​ C. “I haven’t noticed any swelling in my feet or
hands lately.”
10. What type of heart failure does this statement describe?
●​ D. Options B and C are correct. The ventricle is unable to properly fill with blood because it
is too stiff. Therefore, blood backs up into the lungs
●​ E. Options A and B are correct. causing the patient to experience shortness of breath.
 ●​ A. Left ventricular systolic dysfunction ●​ C. Heart failure patients should limit sodium intake
●​ B. Left ventricular ride-sided dysfunction
to 2-3 grams per day.
●​ C. Right ventricular diastolic dysfunction
●​ D. Heart failure is exacerbated by illness, too much

●​ D. Left ventricular diastolic dysfunction fluid or sodium intake, and arrhythmias.

The answer is D. This statement describes left ventricular ●​ E. Patients with heart failure should limit exercise
DIASTOLIC dysfunction. because of the risks.
The answers are B, C, and D. Option A is wrong because
11. A patient with left-sided heart failure is having heart failure patients should notify their doctor if they gain
difficulty breathing. Which of the following is the most 2-3 pounds in a day or 5 pounds in a week, and option E is
appropriate nursing intervention? wrong because exercise is important for heart failure
patients to help strengthen the heart muscle...so they should
exercise as tolerated.
●​ A. Encourage the patient to cough and deep

breathe. 14. A patient taking Digoxin is experiencing severe

bradycardia, nausea, and vomiting. A lab draw shows that
●​ B. Place the patient in Semi-Fowler's position. their Digoxin level is 4 ng/mL. What medication do you
anticipate the physician to order for this patient?
●​ C. Assist the patient into High Fowler's position.
●​ D. Perform chest percussion therapy. ●​ A. Narcan

The answer is C. Due to the patient being in fluid overload

(especially with left-sided heart failure...remember the
●​ B. Aminophylline
lungs are majorly affected in this type of heart failure), it is
most appropriate to place the patient in High Fowler's ●​ C. Digibind
position to help make breathing easier.
●​ No medication because this is a normal Digoxin
level.
12. You're providing diet discharge teaching to a patient
with a history of heart failure. Which of the following The answer is C. The patient is experiencing Digoxin
statements made by the patient represents they understood toxicity...therefore the physician will order the antidote for
the diet teaching? Digoxin which is Digibind.

●​ A. "I will limit my sodium intake to 5-6 grams a 15. Which of the following is a late sign of heart failure?
day."

●​ B. "I will be sure to incorporate canned vegetables ●​ A. Shortness of breath

and fish into my diet."
●​ B. Orthopnea
●​ C. "I'm glad I can still eat sandwiches because I
love bologna and cheese sandwiches."

●​ D. "I will limit my consumption of frozen meals." ●​ C. Edema

●​ D. Frothy-blood tinged sputum
The answer is D. Shortness of breath, orthopnea, and
The answer is D. Patients with heart failure should limit edema are EARLY signs and symptoms. Frothy-blood
sodium intake to 2 to 3 grams per day (not 5-6 grams), tinged sputum is a late sign.
avoid canned vegetable/fish, and avoid sandwich meats and
cheeses because of their high sodium content. Frozen meals
are high in sodium, therefore the patient is correct in saying 16. These drugs are used as first-line treatment of heart
they should limit their consumption of them. failure. They work by allowing more blood to flow to the
heart which decreases the work load of the heart and allows
the kidneys to secrete sodium. However, some patients can
13. Select all the correct statements about educating the develop a nagging cough with these types of drugs. This
patient with heart failure: description describes?

●​ A. It is important patients with heart failure notify ●​ A. Beta-blockers

their physician if they gain more than 6 pounds in a
●​ B. Vasodilators

day or 10 pounds in a week. ●​ C. Angiotensin II receptor blockers

●​ B. Patients with heart failure should receive an ●​ D. Angiotensin-converting-enzyme inhibitors

annual influenza vaccine and be up-to-date with

the pneumonia vaccine.

The answer is D. This is a description of ACE inhibitors
(option D).
17. A patient with heart failure is taking Losartan and ●​ A. Measure and record the urine voided.
Spironolactone. The patient is having EKG changes that
presents with tall peaked T-waves and flat p-waves. Which
●​ B. Assist the patient up slowing and gradually.
of the following lab results confirms these findings? ●​ C. Place the call light in the patient's reach while in
the bathroom.

●​ D. Provide privacy for the patient.

●​ A. Na+ 135
The answer is B. The best answer for this particular
●​ B. BNP 560 question is option B. All the options are important for the
nurse to perform. However, Hydralazine (vasodilator) and
●​ C. K+ 8.0 Isordil (nitrate) can cause orthostatic hypotension. The
patient should transfer slowly and gradually to decrease
●​ D. K+ 1.5 dizziness and the risk of falling.
The answer is C. Losartan and Spironolactone can both
cause an increased potassium level (hyperkalemia).
Losartan is an ARB and Spironolactone is a 21. A patient is taking Digoxin. Prior to administration you
potassium-sparing diuretic. Therefore, the EKG changes check the patient's apical pulse and find it to be 61 bpm.
are a sign of a high potassium level (normal potassium Morning lab values are the following: K+ 3.3 and Digoxin
level is 3.5-5.1). level of 5 ng/mL. Which of the following is the correct
nursing action?

18. During your morning assessment of a patient with heart ●​ A. Hold this dose and administer the second dose
failure, the patient complains of sudden vision changes that at 1800.
include seeing yellowish-green halos around the lights.
Which of the following medications do you suspect is ●​ B. Administer the dose as ordered.
causing this issue?
●​ C. Hold the dose and notify the physician of the

digoxin level.
●​ A. Lisinopril
●​ D. Hold this dose until the patient’s potassium
●​ B. Losartan level is normal.
●​ C. Lasix The answer is C. The patient is Digoxin toxic. A normal
Digoxin level is <2 ng/mL. Therefore, the nurse should not
●​ D. Digoxin administer the dose but hold it and notify the doctor for
The answer is D. Yellowish-green halos/vision changes are further orders.
classic signs of Digoxin toxicity.

22. Which of the following is a common side effect of

19. Select all the correct statements about the Spironolactone?
pharmacodynamics of Beta-blockers for the treatment of
heart failure: ●​ A. Renal failure

●​ A. These drugs produce a negative inotropic effect ●​ B. Hyperkalemia

on the heart by increasing myocardial contraction. ●​ C. Hypokalemia
●​ B. A side effect of these drugs include ●​ D. Dry cough
bradycardia.
The answer is B. Spironolactone is potassium-sparing.
●​ C. These drugs are most commonly prescribed for Therefore, it can increase the potassium level
patients with heart failure who have COPD. (hyperkalemia).

23. The physician’s order says to administered Lasix 40 mg

●​ D. Beta-blockers are prescribed with ACE or IV twice a day. The patient has the following morning labs:
Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the
following is a nursing priority?
ARBs to treat heart failure.
The answers are B and D. ●​ A. Administer the Lasix as ordered
●​ B. Notify the physician of the BNP level
20. You are assisting a patient up from the bed to the ●​ C. Assess the patient for edema
bathroom. The patient has swelling in the feet and legs. The
patient is receiving treatment for heart failure and is taking ●​ D. Hold the dose and notify the physician about the
Hydralazine and Isordil. Which of the following is a potassium level
nursing priority for this patient while assisting them to the
bathroom? The answer is D. Lasix is a diuretic that wastes potassium.
A normal potassium level is 3.5-5.1. The nurse should hold
the dose and notify the physician who will order a
potassium supplement to replace the potassium deficient.
 causes inflammation. The patient's signs and symptoms are
​ classic pericarditis. To learn more about pericarditis for the
NCLEX exam:
https://www.registerednursern.com/pericarditis-nclex-revie
w/

Myocardial 4. After a myocardial infraction, at what time

1. You're educating a patient about the causes of a (approximately) do the macrophages present at the site of
myocardial infarction. Which statement by the patient injury to perform granulation of the tissue?
indicates they misunderstood your teaching and requires
you to re-educate them?
●​ A. 24 hours

●​ A. Coronary artery dissection can happen ●​ B. 2 days

spontaneously and occurs more in women.
●​ C. 10 days
●​ B. The most common cause of a myocardial
infarction is a coronary spasm from illicit drug use ●​ D. 6 hours
The answer is C.
or hypertension.

●​ C. Patients who have coronary artery disease are at 5. 24-36 hours after a myocardial infarction
high risk for developing a myocardial infarction. _____________ congregate at the site during the
inflammation phase.
●​ D. Both A and B are incorrect.
The answer is B. The most common cause of a myocardial ●​ A. Neutrophils
infarction is CORONARY ARTERY DISEASE...not
coronary spasm which is uncommon.
●​ B. Eosinophils
●​ C. Platelets
2. You note in the patient's chart that the patient recently
had a myocardial infarction due to a blockage in the left ●​ D. Macrophages
coronary artery. You know that which of the following is
true about this type of blockage? The answer is A.

●​ A. A blockage in the left coronary artery causes the

6. A patient is complaining of chest pain. You obtain a
least amount of damage to the heart muscle.
12-lead EKG and see ST elevation in leads II, III, AVF.
What area of the heart does this represent?

●​ A. Lateral
●​ B. Left coronary artery blockages can cause
anterior wall death which affects the left ventricle. ●​ B. Septal
●​ C. Left coronary artery blockage can cause ●​ C. Anterior
posterior wall death which affects the right
ventricle. ●​ D. Inferior
●​ D. The left anterior descending artery is least likely The answer is D.
to be affected by coronary artery disease.
The answer is B. The LCA (if blocked) can cause the 7. On an EKG, the lateral view of the heart is represented
MOST amount of damage to the heart muscle. It affects the with leads?
ANTERIOR part of the heart which affects the LEFT
ventricle. The left descending artery is MOST likely to be
affected by coronary artery disease. ●​ A. V1, V2, V3
●​ B. II, II, AVF
3. A patient is 36 hours status post a myocardial infarction. ●​ C. I, AVL, V5, V6
The patient is starting to complain of chest pain when they
lay flat or cough. You note on auscultation of the heart a ●​ D. V1, V2, V6
grating, harsh sound. What complication is this patient
mostly likely suffering from? The answer is C.

●​ A. Cardiac dissection
8. A patient is admitted with chest pain to the ER. The
patient has been in the ER for 5 hours and is being admitted
to your unit for overnight observation. From the options
●​ B. Ventricular septum rupture below, what is the most IMPORTANT information to know
about this patient at this time?
●​ C. Mitral valve prolapse
●​ D. Pericarditis ●​ A. Troponin result and when the next troponin
level is due to be collected
The answer is D. A complication of a myocardial infarction
is PERICARDITIS, especially 24-36 hours post MI. This is ●​ B. Diet status
because of neutrophils being present at the site which
 ●​ C. Last consumption of caffeine ●​ B. Administer Morphine IV and place the patient
in reverse Trendelenburg position.
●​ D. CK result and when the next CK level is due to
be collected ●​ C. Administer Nitroglycerin and monitor the
patient’s blood pressure.
The answer is A. The key words in this question are "chest
pain" and "been in the ER for 5 hours". The patient should ●​ D. All the options are incorrect.
have already had one troponin level drawn since it starts to
elevate 2-4 hours after injury and has been in the ER for 5 The answer is A. Nitroglycerin can cause hypotension,
hours. Therefore, it is essential you know what the level is however, if there is a significant drop in blood pressure
and when the next level is due. If the patient's chest pain is with SBP <90, further doses of Nitroglycerin should be
caused by a myocardial event the troponin levels will trend held. The doctor should be notified for further orders,
upward. Troponin levels are usually ordered every 6 hours especially since the patient is still having chest pain and
x 3. CK results are not as specific as a troponin levels. This t-wave inversion. Morphine should NOT be given because
question wanted to know the MOST important, and the it can cause hypotension.
troponin level for this patient/when it is drawn next is
MOST important. Diet status and last consumption of
caffeine are things the nurse needs to know but not the 12. A patient recovering from a myocardial infarction is
MOST important. complaining of the taste of blood in their mouth. On
assessment, you note there is bleeding on the anterior
gums. Which medication can cause this?
9. A doctor has ordered cardiac enzymes on a patient being
admitted with chest pain. You know that _____________ ●​ A. Coreg
levels elevate 2-4 hours after injury to the heart and is the
most regarded marker by providers. ●​ B. Cardizem
●​ C. Lovenox
●​ A. Myoglobin
●​ D. Lipitor
●​ B. CK-MB
The answer is C. Lovenox is an antithrombotic. An adverse
●​ C. CK side effect of this medication is bleeding. Coreg
●​ D. Troponin (beta-blocker), Cardizem (calcium channel blocker), and
Lipitor (statin) do NOT cause excessive bleeding.
The answer is D.

13. A patient is on a Heparin drip post myocardial

10. A patient is complaining of chest pain. On the bedside infarction. The patient has been on the drip for 4 days. You
cardiac monitor you observe pronounce T-wave inversion. are assessing the patient's morning lab work. Which of the
You obtain the patient's vital signs and find the following: following findings in the patient's lab work is a potential
Blood pressure 190/98, HR 110, oxygen saturation 96% on life-threatening complication of Heparin therapy and
room air, and respiratory rate 20. Select-all-that-apply in requires intervention?
regards to the MOST IMPORTANT nursing interventions
you will provide based on the patient’s current status: ●​ A. K+ 3.7
●​ B. PTT 65 seconds

●​ A. Obtain a 12-lead EKG ●​ C. Hgb 14.5

●​ B. Place the patient in supine position ●​ D. Platelets 135,000

●​ C. Assess urinary output The answer is D. Platelet value of <150,000 indicates

thrombocytopenia and is found in patients with
●​ D. Administer Nitroglycerin sublingual as ordered Heparin-Induced Thrombocytopenia. The potassium and
per protocol hemoglobin level are normal. The PTT level is therapeutic
(60-80 seconds) for Heparin and isn't a cause for concern.
●​ E. Collect cardiac enzymes as ordered per protocol
●​ F. Encourage patient to cough and deep breath 14. A patient is experiencing Heparin-Induced
Thrombocytopenia from Heparin therapy. The doctor
●​ G. Administer Morphine IV as ordered per orders Heparin to be discontinued. The patient will most
protocol likely be placed on what other medication?
●​ H. Place patient on oxygen via nasal cannula
●​ I. No interventions are needed at this time
●​ A. Argatroban
The answers are A, D, E, G, and H.
●​ B. Lovenox

11. In regards to the patient in the previous question, after ●​ C. Levophed

administering the first dose of Nitroglycerin sublingual the
patient's blood pressure is now 68/48. The patient is still ●​ D. Tridil
having chest pain and T-wave inversion on the cardiac The answer is A. Argatroban or Angiomax may be
monitor. What is your next nursing intervention? prescribed in place of Heparin for a patient experiencing
HIT (heparin-induced thrombocytopenia).
●​ A. Hold further doses of Nitroglycerin and notify
the doctor immediately for further orders.
15. A patient taking Lovenox is having a severe reaction.
What is the antidote for this medication? 19. Which of the following EKG changes are abnormal
findings that may indicate ischemia or injury to the cardiac
muscle found on a 12-lead EKG?
●​ A. Activated Charcoal
SELECT-ALL-THAT-APPLY:
●​ B. Acetylcysteine
●​ A. Lengthening p-waves
●​ C. Narcan
●​ B. ST-segment elevation
●​ D. Protamine sulfate
●​ C. T-wave inversion
The answer is D.
●​ D. Tall t-waves
16. A patient is being discharged home after receiving ●​ E. QT interval narrowing
treatment for a myocardial infarction. The patient will be
taking Coreg. What statement by the patient demonstrates ●​ F. ST-segment depression
they understood your education material about this drug?
The answers are B, C, D, and F.

●​ A. "I will take this medication at night."

1. True or False: The left anterior descending coronary
●​ B. "I will take this medication as needed." artery provides blood supply to the left ventricle, front of
the septum and part of the right ventricle.
●​ C. "I will monitor my heart rate and blood pressure
while taking this medication." ●​ True
●​ D. "I will take this medication in the morning with ●​ False
grapefruit juice."
Answer: True...the LAD (left anterior descending artery)
The answer is C. It is the only correct option that reflects provides blood supply to the left ventricle, front of the
Coreg. This medication doesn't have to be taken at night, septum and collateral circulation to the right ventricle.
preferably in the morning. It is taken daily (not as needed),
and must be avoided with grapefruit juice because it slow
down the absorption of Coreg. 2. Which coronary artery provides blood to the left atrium
and left ventricle:
17. A patient is complaining of a nagging cough that is
continuous. Which medication below can cause this side ●​ A. Right marginal artery
effect?
●​ B. Posterior descending artery
●​ A. Losartan ●​ C. Left circumflex artery
●​ B. Lisinopril ●​ D. Right coronary artery
●​ C. Cardizem Answer: C. The LCA provides blood to the left atrium and
left ventricle.
●​ D. Lipitor
The answer is B. ACE inhibitors, such as Lisinopril, can 3. Which patient(s) are most at risk for developing coronary
cause a nagging cough that is continuous. The patient may artery disease? Select-all-that-apply:
be switched to an ARB (angiotensin receptor blocker) if the
cough is troublesome.
●​ A. A 25 year old patient who exercises 3 times per
week for 30 minutes a day and has a history of
18. A patient's morning lab work shows a potassium level cervical cancer.
of 6.3. The patient’s potassium level yesterday was 4.0 The
patient was recently started on new medications for ●​ B. A 35 year old male with a BMI of 30 and
treatment of myocardial infarction. What medication below reports smoking 2 packs of cigarettes a day.
can cause an increased potassium level?
●​ C. A 45 year old female that reports her father died
at the age of 42 from a myocardial infraction.

●​ A. Losartan
●​ B. Norvasc ●​ D. A 29 year old that has type I diabetes.
●​ C. Aspirin Answers: B,C, D. Remember risk factors for developing
CAD include: smoking, family history, diabetes, being
●​ D. Cardizem overweight or obese, and high cholesterol.
The answer is A. Losartan is an ARB. ARBs (angiotensin
receptor blockers) and ACE inhibitors (angiotension
4. A patient reports during a routine check-up that he is
converting enzyme inhibitors) can cause an INCREASE
experiencing chest pain and shortness of breath while
potassium level because of it affects of decreasing
performing activities. He states the pain goes away when he
aldosterone. A normal potassium level is 3.5-5.1.
rests. This is known as:
 ●​ A. Unstable angina 8. A patient is receiving treatment for stable coronary artery
disease. The doctor prescribes the patient Plavix. What
●​ B. Variant angina important information will you include in the patient's
teaching? Select-all-that-apply:
●​ C. Stable angina
●​ D. Prinzmetal angina ●​ A. If you are scheduled for any planned surgical
procedures, let your doctor know you are taking
Answer: C. Stable angina occurs during activities but goes Plavix because this medication will need to be
away when the patient rests. Variant and Prinzmetal angina discontinued 5-7 days prior to the procedure.
are the same and occur at rest during cycles. Unstable
angina is chest pain felt during rest and is more severe.

5. Keeping the patient in question 4 in mind: What type of ●​ B. A normal side effect of this medication is a dry
diagnostic tests will the physician most likely order (at cough.
first) for this patient to evaluate the cause of the patient’s
●​ C. Avoid green leafy vegetables while taking
symptoms? Select-all-that-apply:
Plavix.

●​ A. EKG ●​ D. Notify the doctor, immediately, if you develop

bruising, problems urinating, or fever.
●​ B. Stress test
Answers: A and D. Patients on Plavix should let their
●​ C. Heart catheterization doctor know that they are taking Plavix because it should
be discontinued 5 to 7 days before a surgical procedure due
●​ D. Balloon angioplasty to increased risk of bleeding. Also, option D represents
signs and symptoms of Thrombotic Thrombocytopenic
Answers: A and B. If the patient is experiencing STABLE Purpura a clotting disorder where clots form in the vessels
angina (which in question 4 the patient's symptoms are of the body which is a complication of Plavix.
stable) an EKG or stress test would be ordered to
investigate if there are any EKG changes (ST depression)
during exercise. These tests are usually ordered first and 9. A patient calls the cardiac clinic you are working at and
then the doctor may proceed with a heart catheterization. A reports that they have taken 3 sublingual doses of
balloon angioplasty is sometimes performed during a heart Nitroglycerin as prescribed for chest pain, but the chest
cath. pain is not relieved. What do you educate the patient to do
next?
6. You're providing education to a patient who will be
undergoing a heart catheterization. Which statement by the ●​ A. Take another dose of Nitroglycerin in 5 minutes.
patient requires you to re-educate the patient about this
procedure? ●​ B. Call 911 immediately
●​ C. Lie down and rest to see if that helps with
●​ A. “The brachial artery is most commonly used for relieving the pain
this procedure.”
●​ D. Take two doses of Nitroglycerin in 5 minutes
●​ B. “A dye is injected into the coronary arteries to
assess for blockages." Answer: B. If a patient's chest pain is not relieved with 3
doses of Nitroglycerin, taken 5 minutes apart, they should
●​ C. “Not all patients who have a heart call 911 immediately. The patient should never exceed
catheterization will need a stent placement.” more than 3 doses of Nitroglycerin or take 2 doses at one
time.
●​ D. “I will not be completely asleep and will be able
to breathe on my own during the procedure.”
10. Lipitor is prescribed for a patient with a high
Answers: A. The femoral or radial artery is used during a cholesterol level. As the nurse, how do you educate the
heart cath...not the brachial. patient on how this drugs works on the body?

7. A patient reports having crushing chest pain that radiates ●​ A. Lipitor increases LDL levels and decreases
to the jaw. You administer sublingual nitroglycerin and HDL levels, total cholesterol, and triglyceride
obtain a 12 lead EKG. Which of the following EKG levels.
findings confirms your suspicion of a possible myocardial
infraction? ●​ B. Lipitor decreases LDL, HDL levels, total

●​ A. absent Q wave cholesterol, and triglyceride levels.

●​ B. QRS widening ●​ C. Lipitor increases HDL levels, total cholesterol,

and triglyceride levels.
●​ C. absent P-wave
●​ D. Lipitor increases HDL levels and decreases
●​ D. ST segment elevation LDL, total cholesterol, and triglyceride levels.
Answer: D This is a common finding on an EKG when a Answer: D. Lipitor is a common "statin" medication used
patient is having a myocardial infraction due to muscle to lower cholesterol in CAD. It works by increasing HDL
damage. levels (the "good" cholesterol") and decreases LDL (the
"bad" cholesterol"), total cholesterol, and triglyceride
levels.
 2. Which of the following patients are MOST at risk for
developing endocarditis? Select-all-that-apply:
11. A patient taking Zocor is reporting muscle pain. You
are evaluating the patient’s lab work and note that which of
●​ A. A 25 year old male who reports using
the following findings could cause muscle pain?

●​ A. Elevated potassium level intravenous drugs on a daily basis.

●​ B. Elevated CPK (creatine kinase level) ●​ B. A 55 year old male who is post-opt from aortic

●​ C. Decreased potassium level

valve replacement.
●​ D. Decreased CPK (creatine kinase level)
●​ C. A 63 year old female who is newly diagnosed
Answer: B. Zocor (a statin medication used for lowering with hyperparathyroidism and is taking Aspirin.
cholestorl) can cause increased CPK levels which will lead
to a patient experiencing muscle pain. Therefore, CPK
levels must be monitored while a patient is taking this
medication. ●​ D. A 66 year old female who recently had an
invasive dental procedure performed 1 month ago
12. A patient who has diabetes will be started on
Metoprolol for medical management of coronary artery
disease. Which of the following will you include in your and is having a fever.
discharge teaching about this medication?
Options A, B, and D are all risks for developing
endocarditis. Remember that any thing that allows entry of
●​ A. Check your heart rate regularly because bacteria into the system can potentially cause endocarditis.
Metoprolol can cause an irregular heart rate. Option C is not relevant.
●​ B. Check your glucose regularly because this
medication can cause hyperglycemia.
3. A patient is receiving treatment for infective
●​ C. Check your blood pressure regularly because endocarditis. The patient has a history of intravenous drug
this medication can cause hypertension. use and underwent mitral valve replacement a year ago.
The patient is scheduled for a transesophageal
●​ D. Check your glucose regularly because this echocardiogram tomorrow. On assessment, you find tender,
medication can mask the typical signs and red lesions on the patient's hands and feet. You know that
this is a common finding in patients with infective
endocarditis and is known as?
symptoms of hypoglycemia.
Answer: D. This patient needs to be educated to check their ●​ A. Janeway Lesions
glucose levels regularly because this medication can mask
the typical signs and symptoms of hypoglycemia. This is ●​ B. Roth Spots
very important since the patient is diabetic.

●​ C. Osler's Nodes
13. True or False: ACE inhibitors work to decrease the
workload on the heart by blocking the conversion of ●​ D. Trousseau’s Sign
Angiotensin II to Angiotensin I which causes vasodilation.
Answer is C...Osler's Nodes. They are TENDER, red
lesions on the hands and feet. Don't get this confused with
●​ True Janeway Lesions which are NON-TENDER, red lesions on
the PALMS of the hands and SOLES of the feet. Roth spots
●​ False
are retinal hemorrhages with white centers and Trousseau's
Answer: False. ACE inhibitors work to decrease the Sign is found in hypocalcemia.
workload on the heart by blocking the conversion of
Angiotensin I to Angiotensin II (not Angiotensin II to ​
Angiotensin I as stated in the question) which causes
vasodilation. 4. A 30 year old female is being treated for infective
endocarditis with IV antibiotics. At the beginning of the
hospitalization, the patient’s symptoms were severe and
sudden with a high fever but are now controlled. She has no
Endocarditis significant health history other than 2 cesarean sections in
1. True or False: Endocarditis only affects the the past. She is being prepped for a central line placement
atrioventricular and semi-lunar valves in the heart. so she can be discharged home with home health to
continue the 4 week antibiotic regime. What is type of
infective endocarditis this classified as based on the
information listed?
●​ True
●​ A. Acute Infective Endocarditis
●​ False
●​ B. Subacute Infective Endocarditis
This statement is FALSE. Endocarditis can affect not only
the heart valves but the interventricular septum and chordae
tendineae as well.
●​ C. Non-infective Endocarditis
●​ D. Pericarditis
The answer is A. This is acute infective endocarditis. The ●​ D. "I will avoid eating fish and organ meats."
key clues in this question are patient has no significant
health history and signs and symptoms were sudden/severe. The answer is C. Patients should finish all antibiotics doses
In subacute infective endocarditis, the patient will have a and never stop taking them in the middle of treatment
pre-existing condition that caused them to develop the IE because this increases antibiotic resistances. Also, the
and the symptoms are gradual and subtle. patient should maintain good oral hygiene and should go to
the dentist regularly for cleanings. However, it is very
important the patient inform all other healthcare
5. A patient is admitted with sepsis. The patient has a practitioners about their history of endocarditis because
temperature of 104.2 'F and is experiencing chills. On they will need prophylactic antibiotics therapy prior to any
assessment, you note a mitral murmur which the patient invasive procedures to prevent acquiring endocarditis
states they've never had before, and dark, small lines on the again. Option D is incorrect.
patient’s fingernails. The patient has a history of IV drug
use in the past. However, the patient states they are no
longer using drugs. The physician suspects possible 8. A patient being treated for infective endocarditis is
infective endocarditis. What diagnostic test do you expect complaining of very sharp radiating abdominal pain that
the physician to order in order to confirm the presence of goes to the left shoulder and back. As the nurse familiar
infective endocarditis? with complications of infective endocarditis, what do you
suspect is the cause of this patient finding?

●​ A. Renal embolic event

●​ A. Abdominal ultrasound
●​ B. Pulmonary embolic event
●​ B. Heart catheterization
●​ C. Central nervous system embolic event
●​ C. Transesophageal echocardiogram
●​ D. White blood cell count
●​ D. Splenic embolic event
The answer is C. Transesophageal echocardiogram (TEE)
is an ultrasound performed to look at the back side of the The answer is D. These are classic signs and symptoms of a
heart and assesses the valve structure. It is a test used to splenic embolic event. The patient with endocarditis is at
diagnose vegetations found on the valves. All the other risk for renal, pulmonary, central nervous system, or spleen
options do not confirm endocarditis. emboli. Renal emboli would present with flank pain with
pus or blood in the urine. Pulmonary emboli would present
with dyspnea, chest pain, or shortness of breath, and CNS
6. Select-all-that-apply: What are the typical signs and emboli would present with confusion or difficulty speaking.
symptoms of infective endocarditis?

9. A patient with endocarditis has listed in their medical

history “Roth Spots”. You know that this is a complication
●​ A. Hyperthermia of infective endocarditis and presents as?

●​ B. S4 gallop ●​ A. Non-tender spots found on the feet and hands

●​ C. Enlarged Spleen
●​ D. Hyperkalemia ●​ B. Red and tender lesions found in the eyes

●​ E. Substernal pain that radiates to the back ●​ C. Retinal hemorrhages with white centers
●​ D. Purplish spots found on the forearms and groin

●​ F. Heart failure The answer is C. Roth spots are found in the eyes as retinal
hemorrhages with white centers.

●​ G. Cardiac Murmur Pericarditis

The answer is A, C, F, and G. These are classic signs and
1. True or False: The pericardium layer consists of a fibrous
symptoms of IE.
layer that is made up of two layers called the parietal and
visceral layers.
7. You’re providing discharge teaching to a patient being
treated for endocarditis. Which statement by the patient
demonstrated they understood your teaching about this
condition? ●​ True
●​ False
●​ A. "I will stop taking the antibiotics once my fever
is gone in order to prevent antibiotic resistance." False: The pericardium layer consists of a fibrous layer and
SEROUS layer that is made up of two layers called that
●​ B. "I will only wash my hands with soap and parietal and visceral layers.
water."
2. A patient is hospitalized with chronic pericarditis. On
●​ C. "I will inform my dentist about my history of assessment, you note the patient has pitting edema in lower
endocarditis prior to any invasive procedures." extremities, crackles in lungs, and dyspnea on excretion.
The patient's echocardiogram shows thickening of the ●​ A. “I can take this medication with or without
pericardium. This is known as what type of pericarditis? food.”

●​ B. “I will notify the doctor immediately if I start

●​ A. Pericardial effusion
experiencing nausea, vomiting, or stomach pain
●​ B. Acute pericarditis while taking this medication.”

●​ C. “I like to take all my medications in the morning

with grapefruit juice.”
●​ C. Constrictive pericarditis
●​ D. “This medication is also used to treat patients
●​ D. Effusion-Constrictive pericarditis with gout.”
The answer is C. This describes constrictive pericarditis. The answer is C. Patients should not take Colchicine with
The key words in this question are: the patient's signs and grapefruit juice because it increases the amount of
symptoms which indicate heart failure (a common finding Colchicine the body absorbs (causing an increased chance
with patients who have constrictive pericarditis) and that of Colchicine toxicity). This medication can be taken
the echo showed "thickening" of the pericardium. WITH or WITHOUT food.

3. Select-all-that-apply: Which of the following are NOT 6. A patient with severe pericarditis has developed a large
typical signs and symptoms of pericarditis? pericardial effusion. The patient is symptomatic. The
physician orders what type of procedure to help treat this
●​ A. Fever condition?

●​ A. Pericardiectomy
●​ B. Increased pain when leaning forward ●​ B. Heart catheterization
●​ C. Thoracotomy
●​ C. ST segment depression
●​ D. Pericardiocentesis
●​ D. Pericardial friction rub
The answer is D. The physician will probably order a
●​ E. Radiating substernal pain felt in the left pericardiocentesis. This is a procedure to remove excessive
fluid from the pericardial sac.

shoulder 7. You are providing care to a patient experiencing chest

pain when coughing or breathing in. The patient has
pericarditis. The physician has ordered the patient to take
Ibuprofen for treatment. How will you administer this
●​ F. Breathing in relieves the pain medication?
The answers are B, C, and F. These are findings NOT
found in pericarditis. B is wrong because leaning forward ●​ A. strictly without food
actually helps relieve pain felt in pericarditis (supine
position makes it worst). C is wrong because ST segment ●​ B. with a full glass of juice
ELEVATION is seen not depression. F is wrong because
inspiration (breathing in) increases the pain felt with ●​ C. with a full glass of water
pericarditis.

4. You are providing care to a patient with pericarditis. ●​ D. with or without food
Which of the following is NOT a proper nursing
intervention for this patient? The answer is C. Ibuprofen should be taken with a full
glass of water to prevent GI problems, such as ulcers or
●​ A. Monitor the patient for complications of cardiac bleeding.
tamponade.
8. On physical assessment of a patient with pericarditis,
●​ B. Administer Ibuprofen as scheduled. you may hear what type of heart sound?

●​ C. Place the patient in supine position to relieve ●​ A. S3 or S4

pain.
●​ B. mitral murmur
●​ D. Monitor the patient for pulsus paradoxus and
●​ C. pleural friction rub
muffled heart sounds. ●​ D. pericardial friction rub
The answer is C. Placing the patient in supine position is The answer is D. A common sign of pericarditis is being
not a proper nursing intervention for a patient experiencing able to auscultate a pericardial friction rub.
pericarditis because this increases pain. The high Fowler's
position or leaning forward is the best position for a patient
with pericarditis. Myocarditis
1. You're educating a patient about the causes of a
5. You are providing discharge teaching to a patient being myocardial infarction. Which statement by the patient
discharged home after hospitalization with pericarditis. The indicates they misunderstood your teaching and requires
physician has ordered the patient to take Colchicine. Which you to re-educate them?
of the following statements indicates the patient did NOT
understand the education you provided?
 ●​ A. Coronary artery dissection can happen ●​ B. 2 days
spontaneously and occurs more in women.

●​ B. The most common cause of a myocardial

infarction is a coronary spasm from illicit drug use ●​ C. 10 days
●​ D. 6 hours
or hypertension.
The answer is C.
●​ C. Patients who have coronary artery disease are at
high risk for developing a myocardial infarction.
5. 24-36 hours after a myocardial infarction
●​ D. Both A and B are incorrect. _____________ congregate at the site during the
inflammation phase.
The answer is B. The most common cause of a myocardial
infarction is CORONARY ARTERY DISEASE...not
coronary spasm which is uncommon.
●​ A. Neutrophils

2. You note in the patient's chart that the patient recently ●​ B. Eosinophils
had a myocardial infarction due to a blockage in the left
coronary artery. You know that which of the following is ●​ C. Platelets
true about this type of blockage?
●​ D. Macrophages
●​ A. A blockage in the left coronary artery causes the The answer is A.
least amount of damage to the heart muscle.

●​ B. Left coronary artery blockages can cause 6. A patient is complaining of chest pain. You obtain a
anterior wall death which affects the left ventricle. 12-lead EKG and see ST elevation in leads II, III, AVF.
What area of the heart does this represent?
●​ C. Left coronary artery blockage can cause
posterior wall death which affects the right
●​ A. Lateral

ventricle. ●​ B. Septal

●​ D. The left anterior descending artery is least likely

to be affected by coronary artery disease.
●​ C. Anterior
The answer is B. The LCA (if blocked) can cause the
MOST amount of damage to the heart muscle. It affects the
●​ D. Inferior
ANTERIOR part of the heart which affects the LEFT The answer is D.
ventricle. The left descending artery is MOST likely to be
affected by coronary artery disease.
7. On an EKG, the lateral view of the heart is represented
with leads?
3. A patient is 36 hours status post a myocardial infarction.
The patient is starting to complain of chest pain when they
lay flat or cough. You note on auscultation of the heart a ●​ A. V1, V2, V3
grating, harsh sound. What complication is this patient
mostly likely suffering from? ●​ B. II, II, AVF
●​ C. I, AVL, V5, V6
●​ A. Cardiac dissection
●​ B. Ventricular septum rupture
●​ D. V1, V2, V6
The answer is C.
●​ C. Mitral valve prolapse
●​ D. Pericarditis 8. A patient is admitted with chest pain to the ER. The
patient has been in the ER for 5 hours and is being admitted
The answer is D. A complication of a myocardial infarction to your unit for overnight observation. From the options
is PERICARDITIS, especially 24-36 hours post MI. This is below, what is the most IMPORTANT information to know
because of neutrophils being present at the site which about this patient at this time?
causes inflammation. The patient's signs and symptoms are
classic pericarditis. To learn more about pericarditis for the
NCLEX exam: ●​ A. Troponin result and when the next troponin
https://www.registerednursern.com/pericarditis-nclex-revie
w/
level is due to be collected

●​ B. Diet status
4. After a myocardial infraction, at what time
(approximately) do the macrophages present at the site of ●​ C. Last consumption of caffeine
injury to perform granulation of the tissue?
●​ D. CK result and when the next CK level is due to
be collected
●​ A. 24 hours
The answer is A. The key words in this question are "chest 11. In regards to the patient in the previous question, after
pain" and "been in the ER for 5 hours". The patient should administering the first dose of Nitroglycerin sublingual the
have already had one troponin level drawn since it starts to patient's blood pressure is now 68/48. The patient is still
elevate 2-4 hours after injury and has been in the ER for 5 having chest pain and T-wave inversion on the cardiac
hours. Therefore, it is essential you know what the level is monitor. What is your next nursing intervention?
and when the next level is due. If the patient's chest pain is
caused by a myocardial event the troponin levels will trend
●​ A. Hold further doses of Nitroglycerin and notify
upward. Troponin levels are usually ordered every 6 hours
the doctor immediately for further orders.
x 3. CK results are not as specific as a troponin levels. This
question wanted to know the MOST important, and the ●​ B. Administer Morphine IV and place the patient
troponin level for this patient/when it is drawn next is in reverse Trendelenburg position.
MOST important. Diet status and last consumption of
caffeine are things the nurse needs to know but not the ●​ C. Administer Nitroglycerin and monitor the
MOST important. patient’s blood pressure.

9. A doctor has ordered cardiac enzymes on a patient being

admitted with chest pain. You know that _____________ ●​ D. All the options are incorrect.
levels elevate 2-4 hours after injury to the heart and is the The answer is A. Nitroglycerin can cause hypotension,
most regarded marker by providers. however, if there is a significant drop in blood pressure
with SBP <90, further doses of Nitroglycerin should be
●​ A. Myoglobin held. The doctor should be notified for further orders,
especially since the patient is still having chest pain and
t-wave inversion. Morphine should NOT be given because
it can cause hypotension.
●​ B. CK-MB
●​ C. CK
12. A patient recovering from a myocardial infarction is
●​ D. Troponin complaining of the taste of blood in their mouth. On
assessment, you note there is bleeding on the anterior
The answer is D. gums. Which medication can cause this?

●​ A. Coreg
10. A patient is complaining of chest pain. On the bedside
cardiac monitor you observe pronounce T-wave inversion. ●​ B. Cardizem
You obtain the patient's vital signs and find the following:
Blood pressure 190/98, HR 110, oxygen saturation 96% on ●​ C. Lovenox
room air, and respiratory rate 20. Select-all-that-apply in
regards to the MOST IMPORTANT nursing interventions
you will provide based on the patient’s current status:
●​ D. Lipitor
The answer is C. Lovenox is an antithrombotic. An adverse
side effect of this medication is bleeding. Coreg
●​ A. Obtain a 12-lead EKG (beta-blocker), Cardizem (calcium channel blocker), and
Lipitor (statin) do NOT cause excessive bleeding.
●​ B. Place the patient in supine position
●​ C. Assess urinary output
13. A patient is on a Heparin drip post myocardial
●​ D. Administer Nitroglycerin sublingual as ordered infarction. The patient has been on the drip for 4 days. You
are assessing the patient's morning lab work. Which of the
following findings in the patient's lab work is a potential
per protocol life-threatening complication of Heparin therapy and
requires intervention?
●​ E. Collect cardiac enzymes as ordered per protocol
●​ A. K+ 3.7
●​ B. PTT 65 seconds
●​ F. Encourage patient to cough and deep breath
●​ C. Hgb 14.5

●​ G. Administer Morphine IV as ordered per ●​ D. Platelets 135,000

The answer is D. Platelet value of <150,000 indicates
protocol thrombocytopenia and is found in patients with
Heparin-Induced Thrombocytopenia. The potassium and
●​ H. Place patient on oxygen via nasal cannula hemoglobin level are normal. The PTT level is therapeutic
(60-80 seconds) for Heparin and isn't a cause for concern.

14. A patient is experiencing Heparin-Induced

●​ I. No interventions are needed at this time Thrombocytopenia from Heparin therapy. The doctor
orders Heparin to be discontinued. The patient will most
The answers are A, D, E, G, and H.
likely be placed on what other medication?
 ●​ A. Argatroban treatment of myocardial infarction. What medication below
can cause an increased potassium level?
●​ B. Lovenox

●​ C. Levophed ●​ A. Losartan

●​ D. Tridil ●​ B. Norvasc

The answer is A. Argatroban or Angiomax may be ●​ C. Aspirin

prescribed in place of Heparin for a patient experiencing
HIT (heparin-induced thrombocytopenia). ●​ D. Cardizem
The answer is A. Losartan is an ARB. ARBs (angiotensin
receptor blockers) and ACE inhibitors (angiotension
15. A patient taking Lovenox is having a severe reaction. converting enzyme inhibitors) can cause an INCREASE
What is the antidote for this medication? potassium level because of it affects of decreasing
aldosterone. A normal potassium level is 3.5-5.1.
●​ A. Activated Charcoal
●​ B. Acetylcysteine 19. Which of the following EKG changes are abnormal
findings that may indicate ischemia or injury to the cardiac
●​ C. Narcan muscle found on a 12-lead EKG?
SELECT-ALL-THAT-APPLY:

●​ D. Protamine sulfate ●​ A. Lengthening p-waves

The answer is D. ●​ B. ST-segment elevation

16. A patient is being discharged home after receiving

treatment for a myocardial infarction. The patient will be ●​ C. T-wave inversion
taking Coreg. What statement by the patient demonstrates
they understood your education material about this drug?
●​ D. Tall t-waves

●​ A. "I will take this medication at night."

●​ E. QT interval narrowing
●​ B. "I will take this medication as needed."
●​ C. "I will monitor my heart rate and blood pressure ●​ F. ST-segment depression
while taking this medication."
The answers are B, C, D, and F.
●​ D. "I will take this medication in the morning with
grapefruit juice."
The answer is C. It is the only correct option that reflects
Coreg. This medication doesn't have to be taken at night,
preferably in the morning. It is taken daily (not as needed),
and must be avoided with grapefruit juice because it slow
down the absorption of Coreg.

17. A patient is complaining of a nagging cough that is

continuous. Which medication below can cause this side
effect?

●​ A. Losartan
●​ B. Lisinopril
●​ C. Cardizem

●​ D. Lipitor
The answer is B. ACE inhibitors, such as Lisinopril, can
cause a nagging cough that is continuous. The patient may
be switched to an ARB (angiotensin receptor blocker) if the
cough is troublesome.

18. A patient's morning lab work shows a potassium level

of 6.3. The patient’s potassium level yesterday was 4.0 The
patient was recently started on new medications for