LPN Medical-Surgical Nursing: Cardiovascular Disorders 1 — Questions and Answers

Question 1: A client with heart failure is prescribed furosemide (Lasix). Which assessment finding requires immediate intervention?

Urine output of 200 mL/hr
Serum potassium of 2.8 mEq/L (Correct answer)
Weight loss of 2 lb in 24 hours
Blood pressure of 118/74 mmHg

Correct answer: Serum potassium of 2.8 mEq/L

A serum potassium of 2.8 mEq/L indicates hypokalemia, a dangerous side effect of furosemide that can cause life-threatening cardiac dysrhythmias.

Furosemide (Lasix) is a loop diuretic that inhibits sodium and chloride reabsorption in the loop of Henle, also causing significant potassium loss. Normal serum potassium is 3.5–5.0 mEq/L. A level of 2.8 mEq/L is critically low and places the client at risk for cardiac dysrhythmias, including ventricular fibrillation. The LPN must notify the charge nurse or provider immediately and hold any digoxin if prescribed, as hypokalemia potentiates digoxin toxicity.

Question 2: A client with heart failure is prescribed furosemide (Lasix). Which assessment finding requires immediate intervention?

Urine output of 200 mL/hr
Serum potassium of 2.8 mEq/L (Correct answer)
Weight loss of 2 lb in 24 hours
Blood pressure of 118/74 mmHg

Correct answer: Serum potassium of 2.8 mEq/L

A serum potassium of 2.8 mEq/L indicates hypokalemia, a dangerous side effect of furosemide that can cause life-threatening cardiac dysrhythmias.

Question 3: A client is admitted with a myocardial infarction (MI). Which symptom is most commonly reported by female clients experiencing an MI?

Crushing substernal chest pain
Nausea, fatigue, and jaw pain (Correct answer)
Diaphoresis and left arm radiation
Sharp pleuritic chest pain

Correct answer: Nausea, fatigue, and jaw pain

Women more often present with atypical MI symptoms such as nausea, fatigue, indigestion, and jaw or back pain rather than classic crushing chest pain.

Myocardial infarction in women frequently presents atypically. While men commonly experience crushing substernal chest pain radiating to the left arm, women often report nausea, extreme fatigue, jaw pain, shortness of breath, and indigestion. These atypical symptoms can lead to delayed diagnosis. LPNs must recognize these differences and report any suspected cardiac symptoms promptly regardless of presentation style.

Question 4: A client is admitted with a myocardial infarction (MI). Which symptom is most commonly reported by female clients experiencing an MI?

Crushing substernal chest pain
Nausea, fatigue, and jaw pain (Correct answer)
Diaphoresis and left arm radiation
Sharp pleuritic chest pain

Correct answer: Nausea, fatigue, and jaw pain

Women more often present with atypical MI symptoms such as nausea, fatigue, indigestion, and jaw or back pain rather than classic crushing chest pain.

Question 5: A client with hypertension is being discharged. Which dietary instruction is the priority?

Increase protein intake to 1.5 g/kg/day
Limit sodium intake to 2,300 mg/day or less (Correct answer)
Avoid all caffeine permanently
Increase calcium supplements to 2,000 mg/day

Correct answer: Limit sodium intake to 2,300 mg/day or less

Reducing sodium intake to 2,300 mg/day or less is a primary dietary intervention for hypertension, helping to decrease fluid retention and vascular resistance.

The DASH (Dietary Approaches to Stop Hypertension) diet recommends limiting sodium to 2,300 mg/day, or ideally 1,500 mg/day for those with hypertension. Excess sodium causes water retention, increasing blood volume and pressure against arterial walls. LPNs should teach clients to read food labels, avoid processed and canned foods, and season food with herbs rather than salt. This is considered the most impactful single dietary modification for hypertension management.

Question 6: A client with hypertension is being discharged. Which dietary instruction is the priority?

Increase protein intake to 1.5 g/kg/day
Limit sodium intake to 2,300 mg/day or less (Correct answer)
Avoid all caffeine permanently
Increase calcium supplements to 2,000 mg/day

Correct answer: Limit sodium intake to 2,300 mg/day or less

Reducing sodium intake to 2,300 mg/day or less is a primary dietary intervention for hypertension, helping to decrease fluid retention and vascular resistance.

Question 7: A client on telemetry develops a heart rate of 180 bpm with a regular rhythm, narrow QRS complexes, and no P waves visible before each QRS. The LPN should prepare for which intervention?

Administer IV potassium chloride
Apply defibrillation pads for cardioversion
Encourage the client to perform Valsalva maneuver (Correct answer)
Administer atropine 0.5 mg IV

Correct answer: Encourage the client to perform Valsalva maneuver

The rhythm described is supraventricular tachycardia (SVT). Vagal maneuvers such as the Valsalva maneuver are a first-line non-pharmacological intervention that may terminate SVT.

Supraventricular tachycardia (SVT) is characterized by a sudden-onset rapid regular rate (150–250 bpm), narrow QRS complexes, and absent or retrograde P waves. Initial management includes vagal maneuvers (Valsalva, carotid sinus massage) which increase vagal tone and slow AV nodal conduction. If unsuccessful, adenosine is given IV. Defibrillation is used for ventricular fibrillation; atropine treats bradycardia. The LPN should anticipate the provider's order and ensure emergency equipment is nearby.

Question 8: A client on telemetry develops a heart rate of 180 bpm with a regular rhythm, narrow QRS complexes, and no P waves visible before each QRS. The LPN should prepare for which intervention?

Administer IV potassium chloride
Apply defibrillation pads for cardioversion
Encourage the client to perform Valsalva maneuver (Correct answer)
Administer atropine 0.5 mg IV

Correct answer: Encourage the client to perform Valsalva maneuver

The rhythm described is supraventricular tachycardia (SVT). Vagal maneuvers such as the Valsalva maneuver are a first-line non-pharmacological intervention that may terminate SVT.

Question 9: A client with peripheral arterial disease (PAD) reports leg pain that worsens with walking and resolves with rest. The LPN documents this as:

Dependent rubor
Venous insufficiency
Intermittent claudication (Correct answer)
Deep vein thrombosis

Correct answer: Intermittent claudication

Intermittent claudication is muscle pain caused by inadequate arterial blood flow during exercise that is relieved by rest, a hallmark symptom of peripheral arterial disease.

Intermittent claudication is the hallmark symptom of peripheral arterial disease (PAD). It occurs because atherosclerotic plaques reduce arterial blood flow, causing ischemia in the muscles during exercise. The pain, cramping, or aching is reproducible with the same amount of activity and consistently relieved within minutes of rest. DVT presents with unilateral leg swelling and warmth. Venous insufficiency causes aching that worsens with standing. Dependent rubor is a skin color change seen with severe PAD.

Question 10: A client with peripheral arterial disease (PAD) reports leg pain that worsens with walking and resolves with rest. The LPN documents this as:

Dependent rubor
Venous insufficiency
Intermittent claudication (Correct answer)
Deep vein thrombosis

Correct answer: Intermittent claudication

Intermittent claudication is muscle pain caused by inadequate arterial blood flow during exercise that is relieved by rest, a hallmark symptom of peripheral arterial disease.

Question 11: A client is prescribed metoprolol succinate for hypertension. The LPN should hold the medication and notify the charge nurse if the client's apical heart rate is below:

50 bpm
55 bpm
60 bpm (Correct answer)
70 bpm

Correct answer: 60 bpm

Beta-blockers such as metoprolol should be held if the heart rate is below 60 bpm, as the drug slows conduction and further bradycardia could be dangerous.

Metoprolol succinate is a selective beta-1 blocker that slows heart rate by blocking catecholamine effects on the SA and AV nodes. The standard nursing guideline is to hold beta-blockers and notify the provider if the apical pulse is below 60 bpm before administration. The LPN should assess blood pressure as well, holding if systolic BP is below 90 mmHg. Documentation of the held dose and notification must be completed accurately.

Question 12: A client is prescribed metoprolol succinate for hypertension. The LPN should hold the medication and notify the charge nurse if the client's apical heart rate is below:

50 bpm
55 bpm
60 bpm (Correct answer)
70 bpm

Correct answer: 60 bpm

Beta-blockers such as metoprolol should be held if the heart rate is below 60 bpm, as the drug slows conduction and further bradycardia could be dangerous.

Question 13: A client with heart failure has crackles in the bilateral lung bases, 3+ pitting edema, and a weight gain of 5 lb in 2 days. These findings indicate:

Right-sided heart failure only
Left-sided heart failure only
Decompensated heart failure with fluid overload (Correct answer)
Normal response to cardiac medications

Correct answer: Decompensated heart failure with fluid overload

Bilateral crackles (pulmonary edema from left-sided failure), pitting edema (right-sided venous backup), and rapid weight gain together indicate decompensated heart failure with fluid overload.

Decompensated heart failure presents with signs of both left-sided and right-sided failure. Left-sided failure causes pulmonary congestion (crackles, dyspnea, orthopnea), while right-sided failure causes systemic venous congestion (pitting edema, jugular venous distension, hepatomegaly). Rapid weight gain (1 kg = ~1 liter of fluid) confirms fluid retention. The LPN should report these findings promptly, restrict fluid and sodium, and expect orders for IV diuretics and oxygen therapy.

Question 14: A client with heart failure has crackles in the bilateral lung bases, 3+ pitting edema, and a weight gain of 5 lb in 2 days. These findings indicate:

Right-sided heart failure only
Left-sided heart failure only
Decompensated heart failure with fluid overload (Correct answer)
Normal response to cardiac medications

Correct answer: Decompensated heart failure with fluid overload

Bilateral crackles (pulmonary edema from left-sided failure), pitting edema (right-sided venous backup), and rapid weight gain together indicate decompensated heart failure with fluid overload.

Question 15: When caring for a client post-cardiac catheterization via the right femoral artery, which nursing action is the priority?

Encourage ambulation within 1 hour
Keep the right leg straight and assess the puncture site (Correct answer)
Apply ice packs to the groin every 2 hours
Restrict fluids to prevent fluid overload

Correct answer: Keep the right leg straight and assess the puncture site

After femoral artery catheterization, the priority is to maintain leg immobility and frequently assess the puncture site for bleeding, hematoma, or signs of arterial compromise.

Post-cardiac catheterization care via the femoral approach requires keeping the affected leg straight (typically for 2–6 hours) to prevent arterial hemorrhage. The LPN should check the puncture site every 15 minutes for the first hour for bleeding or hematoma formation, assess pedal pulses, capillary refill, skin color, and temperature distal to the site, and monitor vital signs. IV fluids are encouraged to flush contrast dye. The client should remain on bed rest until the provider clears ambulation.

Question 16: When caring for a client post-cardiac catheterization via the right femoral artery, which nursing action is the priority?

Encourage ambulation within 1 hour
Keep the right leg straight and assess the puncture site (Correct answer)
Apply ice packs to the groin every 2 hours
Restrict fluids to prevent fluid overload

Correct answer: Keep the right leg straight and assess the puncture site

After femoral artery catheterization, the priority is to maintain leg immobility and frequently assess the puncture site for bleeding, hematoma, or signs of arterial compromise.

Question 17: A client with atrial fibrillation is prescribed warfarin. Which laboratory value monitors therapeutic anticoagulation?

aPTT (activated partial thromboplastin time)
INR (international normalized ratio) (Correct answer)
Platelet count
Fibrinogen level

Correct answer: INR (international normalized ratio)

Warfarin therapy is monitored using the INR, which reflects prothrombin time. A therapeutic INR for atrial fibrillation is typically 2.0–3.0.

Warfarin is a vitamin K antagonist that inhibits clotting factors II, VII, IX, and X. It is monitored via the INR (international normalized ratio), which standardizes prothrombin time across labs. For atrial fibrillation, the target INR is 2.0–3.0. An INR below 2.0 indicates subtherapeutic anticoagulation (clot risk); above 3.0 increases bleeding risk. aPTT monitors heparin therapy. The LPN should ensure INR is checked regularly and report values outside the therapeutic range to the provider.

Question 18: A client with atrial fibrillation is prescribed warfarin. Which laboratory value monitors therapeutic anticoagulation?

aPTT (activated partial thromboplastin time)
INR (international normalized ratio) (Correct answer)
Platelet count
Fibrinogen level

Correct answer: INR (international normalized ratio)

Warfarin therapy is monitored using the INR, which reflects prothrombin time. A therapeutic INR for atrial fibrillation is typically 2.0–3.0.

Question 19: A client with coronary artery disease is experiencing chest pain at rest rated 7/10. The LPN's first action should be:

Administer PRN nitroglycerin sublingually
Notify the charge nurse immediately
Obtain a 12-lead ECG
Assess vital signs and oxygen saturation (Correct answer)

Correct answer: Assess vital signs and oxygen saturation

The first nursing action when a client reports chest pain is a rapid assessment: vital signs, oxygen saturation, and pain characteristics to determine the urgency and inform the team.

When chest pain occurs, the LPN should immediately assess vital signs, oxygen saturation, and pain quality (OPQRST). This assessment informs subsequent actions such as applying oxygen, obtaining an ECG, or administering nitroglycerin. Administering nitroglycerin without first assessing blood pressure is dangerous (could cause hypotension). The charge RN and provider must be notified promptly. All these actions may occur in rapid sequence, but initial assessment is the first step in the nursing process.

Question 20: A client with coronary artery disease is experiencing chest pain at rest rated 7/10. The LPN's first action should be:

Administer PRN nitroglycerin sublingually
Notify the charge nurse immediately
Obtain a 12-lead ECG
Assess vital signs and oxygen saturation (Correct answer)

Correct answer: Assess vital signs and oxygen saturation

The first nursing action when a client reports chest pain is a rapid assessment: vital signs, oxygen saturation, and pain characteristics to determine the urgency and inform the team.

Question 21: A client is prescribed atorvastatin for hyperlipidemia. The LPN should instruct the client to report which side effect immediately?

Mild headache and fatigue
Muscle pain, tenderness, or weakness (Correct answer)
Mild constipation
Increased appetite

Correct answer: Muscle pain, tenderness, or weakness

Statins like atorvastatin can cause rhabdomyolysis, a breakdown of muscle tissue that can lead to acute kidney injury. Myalgia or weakness must be reported immediately.

Rhabdomyolysis is a serious adverse effect of HMG-CoA reductase inhibitors (statins) such as atorvastatin. It involves skeletal muscle breakdown releasing myoglobin into the bloodstream, which can precipitate acute renal failure. Symptoms include unexplained muscle pain, tenderness, weakness, and dark (tea-colored) urine. CK (creatine kinase) levels will be markedly elevated. The medication should be discontinued immediately if rhabdomyolysis is suspected. LPNs should reinforce this teaching at every visit.

Question 22: A client is prescribed atorvastatin for hyperlipidemia. The LPN should instruct the client to report which side effect immediately?

Mild headache and fatigue
Muscle pain, tenderness, or weakness (Correct answer)
Mild constipation
Increased appetite

Correct answer: Muscle pain, tenderness, or weakness

Statins like atorvastatin can cause rhabdomyolysis, a breakdown of muscle tissue that can lead to acute kidney injury. Myalgia or weakness must be reported immediately.

Question 23: A client with hypertension is started on an ACE inhibitor. The client calls the clinic reporting a persistent dry cough. The LPN should:

Reassure the client it will resolve in 2 weeks
Instruct the client to take the medication with food
Document and report to the charge nurse or provider (Correct answer)
Tell the client to stop the medication immediately

Correct answer: Document and report to the charge nurse or provider

A persistent dry cough is a well-known side effect of ACE inhibitors caused by bradykinin accumulation. The provider should be notified as an ARB may be substituted.

ACE inhibitors (e.g., lisinopril, enalapril) block the conversion of angiotensin I to angiotensin II and also inhibit bradykinin degradation. Bradykinin accumulation irritates the airways, causing a persistent dry, nonproductive cough in 10–20% of clients. This is not a reason to stop the medication abruptly without provider direction. The LPN should document the symptom, report it to the charge nurse or provider, and anticipate a possible change to an angiotensin receptor blocker (ARB), which does not cause this effect.

Question 24: A client with hypertension is started on an ACE inhibitor. The client calls the clinic reporting a persistent dry cough. The LPN should:

Reassure the client it will resolve in 2 weeks
Instruct the client to take the medication with food
Document and report to the charge nurse or provider (Correct answer)
Tell the client to stop the medication immediately

Correct answer: Document and report to the charge nurse or provider

A persistent dry cough is a well-known side effect of ACE inhibitors caused by bradykinin accumulation. The provider should be notified as an ARB may be substituted.

Question 25: A client's telemetry monitor shows a regular rhythm with a rate of 42 bpm, normal P waves, and a PR interval of 0.28 seconds. The LPN should recognize this as:

Normal sinus rhythm
First-degree AV block with bradycardia (Correct answer)
Second-degree AV block type II
Complete heart block

Correct answer: First-degree AV block with bradycardia

A PR interval greater than 0.20 seconds indicates first-degree AV block; combined with a heart rate below 60, this is first-degree AV block with bradycardia.

First-degree AV block is characterized by a consistently prolonged PR interval (>0.20 seconds) with every P wave followed by a QRS. It is the mildest form of AV block and often asymptomatic. Combined with a rate of 42 bpm, the client may feel lightheaded or fatigued. The LPN should assess the client for symptoms (dizziness, syncope, hypotension), document the findings, and notify the charge nurse. Second-degree type II has intermittently dropped beats; complete heart block shows AV dissociation.

Question 26: A client's telemetry monitor shows a regular rhythm with a rate of 42 bpm, normal P waves, and a PR interval of 0.28 seconds. The LPN should recognize this as:

Normal sinus rhythm
First-degree AV block with bradycardia (Correct answer)
Second-degree AV block type II
Complete heart block

Correct answer: First-degree AV block with bradycardia

A PR interval greater than 0.20 seconds indicates first-degree AV block; combined with a heart rate below 60, this is first-degree AV block with bradycardia.

Question 27: A client with deep vein thrombosis (DVT) of the left leg is on heparin therapy. The LPN should immediately report which finding to the charge nurse?

Left calf tenderness and warmth
aPTT of 70 seconds (control 30 seconds)
Sudden onset of chest pain and dyspnea (Correct answer)
Mild bruising at the IV site

Correct answer: Sudden onset of chest pain and dyspnea

Sudden chest pain and dyspnea in a client with DVT suggest pulmonary embolism, a life-threatening emergency requiring immediate escalation.

Pulmonary embolism (PE) occurs when a DVT dislodges and travels to the pulmonary vasculature. Classic signs include sudden pleuritic chest pain, dyspnea, tachycardia, hypoxia, and anxiety. This is a medical emergency with high mortality if not treated immediately. The LPN should call for help, apply oxygen, obtain vital signs and SpO2, and stay with the client while the charge nurse contacts the provider. Calf tenderness is expected with DVT; an aPTT of 70 seconds is therapeutic (1.5–2.5x control).

Question 28: A client with deep vein thrombosis (DVT) of the left leg is on heparin therapy. The LPN should immediately report which finding to the charge nurse?

Left calf tenderness and warmth
aPTT of 70 seconds (control 30 seconds)
Sudden onset of chest pain and dyspnea (Correct answer)
Mild bruising at the IV site

Correct answer: Sudden onset of chest pain and dyspnea

Sudden chest pain and dyspnea in a client with DVT suggest pulmonary embolism, a life-threatening emergency requiring immediate escalation.

Question 29: The nurse is teaching a client about taking sublingual nitroglycerin for angina. Which instruction is most important?

Swallow the tablet with a full glass of water
If pain persists after 3 doses 5 minutes apart, call 911 (Correct answer)
Store the medication in a clear plastic container on a windowsill
Take 2 tablets at the first sign of chest pain

Correct answer: If pain persists after 3 doses 5 minutes apart, call 911

If angina is not relieved after 3 sublingual nitroglycerin doses taken 5 minutes apart, the client should call 911 as this may indicate an acute MI.

The standard protocol for sublingual nitroglycerin is: place one tablet under the tongue at the first sign of angina; if pain is not relieved in 5 minutes, take a second tablet; if still unrelieved in another 5 minutes, take a third; if pain continues, call 911 immediately as the patient may be having an MI. Nitroglycerin should be stored in the original dark glass bottle away from heat and light. Only one tablet is taken at a time, not two. The medication should not be swallowed.

Question 30: The nurse is teaching a client about taking sublingual nitroglycerin for angina. Which instruction is most important?

Swallow the tablet with a full glass of water
If pain persists after 3 doses 5 minutes apart, call 911 (Correct answer)
Store the medication in a clear plastic container on a windowsill
Take 2 tablets at the first sign of chest pain

Correct answer: If pain persists after 3 doses 5 minutes apart, call 911

If angina is not relieved after 3 sublingual nitroglycerin doses taken 5 minutes apart, the client should call 911 as this may indicate an acute MI.

Question 31: A client with chronic heart failure is being discharged on a sodium-restricted diet. The LPN teaches the client to report which daily weight change to the provider?

Loss of 0.5 lb in one day
Gain of 1 lb over one week
Gain of 2 lb in one day or 5 lb in one week (Correct answer)
Loss of 2 lb in one week

Correct answer: Gain of 2 lb in one day or 5 lb in one week

A weight gain of 2 lb in 24 hours or 5 lb in one week indicates fluid retention and early decompensation, requiring prompt provider notification.

Daily weights are the most reliable early indicator of fluid retention in heart failure. One liter of fluid equals approximately 2.2 lb (1 kg). A sudden weight gain of 2 lb/day or 5 lb/week signals fluid accumulation and potential decompensation requiring medication adjustment (e.g., increased diuretics). Clients should weigh themselves every morning after voiding and before eating, on the same scale, in the same clothing. Early detection and reporting can prevent hospitalization.

Question 32: A client with chronic heart failure is being discharged on a sodium-restricted diet. The LPN teaches the client to report which daily weight change to the provider?

Loss of 0.5 lb in one day
Gain of 1 lb over one week
Gain of 2 lb in one day or 5 lb in one week (Correct answer)
Loss of 2 lb in one week

Correct answer: Gain of 2 lb in one day or 5 lb in one week

A weight gain of 2 lb in 24 hours or 5 lb in one week indicates fluid retention and early decompensation, requiring prompt provider notification.

Question 33: A client with a history of hypertension presents with a blood pressure of 192/114 mmHg, severe headache, and blurred vision. The LPN recognizes this as:

Hypertensive urgency requiring oral medications within 24 hours
Hypertensive emergency requiring immediate IV intervention (Correct answer)
Normal variation in a client with chronic hypertension
Orthostatic hypotension rebound

Correct answer: Hypertensive emergency requiring immediate IV intervention

Severe hypertension (>180/120 mmHg) with evidence of acute target organ damage (headache, visual changes) constitutes a hypertensive emergency requiring immediate IV treatment.

Hypertensive emergency is defined as severely elevated blood pressure (typically >180/120 mmHg) with evidence of acute end-organ damage such as hypertensive encephalopathy, retinopathy (blurred vision), acute MI, dissecting aortic aneurysm, or acute kidney injury. It requires immediate hospitalization and IV antihypertensive therapy (e.g., IV labetalol, nicardipine) to gradually reduce BP by no more than 25% in the first hour. Hypertensive urgency has no target organ damage and can be managed with oral medications over 24–48 hours.

Question 34: A client with a history of hypertension presents with a blood pressure of 192/114 mmHg, severe headache, and blurred vision. The LPN recognizes this as:

Hypertensive urgency requiring oral medications within 24 hours
Hypertensive emergency requiring immediate IV intervention (Correct answer)
Normal variation in a client with chronic hypertension
Orthostatic hypotension rebound

Correct answer: Hypertensive emergency requiring immediate IV intervention

Severe hypertension (>180/120 mmHg) with evidence of acute target organ damage (headache, visual changes) constitutes a hypertensive emergency requiring immediate IV treatment.

Question 35: Which position is best for a client in acute left-sided heart failure with severe dyspnea?

Supine with legs elevated
Semi-Fowler's (30-degree elevation)
High Fowler's (60–90 degrees) (Correct answer)
Left lateral Sims' position

Correct answer: High Fowler's (60–90 degrees)

High Fowler's position uses gravity to reduce venous return to the heart and shifts fluid away from lung bases, improving respiratory effort in acute pulmonary edema.

In left-sided heart failure with pulmonary edema, fluid accumulates in the alveoli, causing severe dyspnea. High Fowler's position (60–90 degrees) allows gravity to pool fluid in dependent areas away from the lungs, decreasing venous return (preload), and allows the diaphragm to descend fully for better ventilation. Supine position worsens pulmonary congestion. Dangling the legs over the side of the bed further reduces preload. Supplemental oxygen should accompany positioning.

Question 36: Which position is best for a client in acute left-sided heart failure with severe dyspnea?

Supine with legs elevated
Semi-Fowler's (30-degree elevation)
High Fowler's (60–90 degrees) (Correct answer)
Left lateral Sims' position

Correct answer: High Fowler's (60–90 degrees)

High Fowler's position uses gravity to reduce venous return to the heart and shifts fluid away from lung bases, improving respiratory effort in acute pulmonary edema.

Question 37: A client is receiving IV heparin. The nurse notes the aPTT is 120 seconds (control 30 seconds). What action should the LPN take?

Continue the infusion as ordered — this is therapeutic
Increase the heparin rate per protocol
Notify the charge nurse and anticipate reducing or stopping the infusion (Correct answer)
Administer vitamin K as the antidote

Correct answer: Notify the charge nurse and anticipate reducing or stopping the infusion

Therapeutic aPTT is 1.5–2.5x the control (45–75 seconds). An aPTT of 120 seconds (4x control) indicates supratherapeutic anticoagulation with high bleeding risk, requiring dose reduction.

Therapeutic heparin anticoagulation requires an aPTT of 1.5–2.5 times the control value. With a control of 30 seconds, the therapeutic range is 45–75 seconds. An aPTT of 120 seconds (4x control) indicates dangerously high anticoagulation, placing the client at risk for spontaneous bleeding. The LPN should notify the charge nurse immediately, anticipate reducing or stopping the infusion, and monitor for bleeding signs (hematuria, GI bleeding, altered mental status). Protamine sulfate is the antidote for heparin — vitamin K reverses warfarin.

Question 38: A client is receiving IV heparin. The nurse notes the aPTT is 120 seconds (control 30 seconds). What action should the LPN take?

Continue the infusion as ordered — this is therapeutic
Increase the heparin rate per protocol
Notify the charge nurse and anticipate reducing or stopping the infusion (Correct answer)
Administer vitamin K as the antidote

Correct answer: Notify the charge nurse and anticipate reducing or stopping the infusion

Therapeutic aPTT is 1.5–2.5x the control (45–75 seconds). An aPTT of 120 seconds (4x control) indicates supratherapeutic anticoagulation with high bleeding risk, requiring dose reduction.

Question 39: A client is scheduled for a stress test. Which instruction should the LPN include in the teaching?

Eat a large meal before the test for sustained energy
Avoid caffeine and smoking for at least 24 hours before the test (Correct answer)
Continue taking beta-blockers as usual the morning of the test
Wear dress shoes to the test for proper support

Correct answer: Avoid caffeine and smoking for at least 24 hours before the test

Caffeine and smoking can artificially alter heart rate response, skewing test results. Both should be avoided for 24 hours before a cardiac stress test.

Pre-stress test instructions include: avoid caffeine (coffee, tea, cola, chocolate) for 24 hours as it can accelerate heart rate and falsely alter results; avoid smoking for 24 hours; eat only a light meal 2–3 hours before the test; wear comfortable, supportive athletic shoes and loose clothing; bring a list of medications. Beta-blockers and other cardiac medications may be held per provider order because they blunt the heart rate response and can produce false-negative results.

Question 40: A client is scheduled for a stress test. Which instruction should the LPN include in the teaching?

Eat a large meal before the test for sustained energy
Avoid caffeine and smoking for at least 24 hours before the test (Correct answer)
Continue taking beta-blockers as usual the morning of the test
Wear dress shoes to the test for proper support

Correct answer: Avoid caffeine and smoking for at least 24 hours before the test

Caffeine and smoking can artificially alter heart rate response, skewing test results. Both should be avoided for 24 hours before a cardiac stress test.

Question 41: A client post-coronary artery bypass graft (CABG) has a mediastinal drainage tube with output of 300 mL in the past hour. The LPN should:

Document as expected and continue monitoring
Reposition the client to increase drainage
Immediately notify the charge nurse (Correct answer)
Clamp the drainage tube

Correct answer: Immediately notify the charge nurse

Post-CABG mediastinal drainage greater than 200 mL/hr indicates excessive bleeding and potential cardiac tamponade, requiring immediate nurse notification and urgent intervention.

After cardiac surgery, mediastinal drainage is expected to average 50–200 mL/hr in the immediate postoperative period, decreasing over time. Output exceeding 200 mL/hr suggests surgical bleeding or coagulopathy and raises concern for cardiac tamponade. The LPN must immediately notify the charge nurse and surgeon. Signs of tamponade include hypotension, muffled heart sounds, jugular venous distension (Beck's triad). NEVER clamp the tube, as this would cause blood to accumulate around the heart.

Question 42: A client post-coronary artery bypass graft (CABG) has a mediastinal drainage tube with output of 300 mL in the past hour. The LPN should:

Document as expected and continue monitoring
Reposition the client to increase drainage
Immediately notify the charge nurse (Correct answer)
Clamp the drainage tube

Correct answer: Immediately notify the charge nurse

Post-CABG mediastinal drainage greater than 200 mL/hr indicates excessive bleeding and potential cardiac tamponade, requiring immediate nurse notification and urgent intervention.

Question 43: When auscultating a client's heart sounds, the LPN hears an S3 gallop. This finding is most commonly associated with:

Aortic stenosis
Heart failure and ventricular dysfunction (Correct answer)
Mitral valve prolapse
Normal aging in adults over 65

Correct answer: Heart failure and ventricular dysfunction

An S3 gallop heard after S2 indicates rapid ventricular filling in a non-compliant or volume-overloaded ventricle, a classic sign of heart failure.

The S3 heart sound (ventricular gallop) is created by turbulent blood flow during rapid ventricular filling in early diastole. In adults, an S3 is an abnormal finding suggesting ventricular dysfunction or heart failure. It has a low pitch and is best heard with the bell of the stethoscope at the apex. An S4 gallop (heard before S1) indicates a stiff, non-compliant ventricle, as in hypertensive heart disease. An S3 is normal in children and young adults but pathological in adults over 40.

Question 44: When auscultating a client's heart sounds, the LPN hears an S3 gallop. This finding is most commonly associated with:

Aortic stenosis
Heart failure and ventricular dysfunction (Correct answer)
Mitral valve prolapse
Normal aging in adults over 65

Correct answer: Heart failure and ventricular dysfunction

An S3 gallop heard after S2 indicates rapid ventricular filling in a non-compliant or volume-overloaded ventricle, a classic sign of heart failure.

Question 45: A client with stable angina asks the nurse about sexual activity. The LPN's best response is:

You should avoid sexual activity indefinitely after a cardiac diagnosis
Sexual activity is generally safe if you can climb two flights of stairs without symptoms (Correct answer)
You must complete cardiac rehab before any sexual activity
Sexual activity should only occur in the morning when energy is highest

Correct answer: Sexual activity is generally safe if you can climb two flights of stairs without symptoms

The ability to climb two flights of stairs (or achieve 5 METs on a stress test) without chest pain or dyspnea is a general guideline indicating sufficient cardiac reserve for sexual activity.

Sexual activity exerts approximately 3–5 METs of energy, equivalent to climbing 1–2 flights of stairs briskly. The general guideline is that if a cardiac patient can tolerate this level of activity without symptoms (angina, dyspnea, palpitations), sexual activity is likely safe. The provider should be consulted, especially after MI or cardiac surgery. Nitroglycerin prophylaxis before activity may be recommended. Avoid heavy meals and alcohol before sexual activity, and choose positions with less physical exertion.

Question 46: A client with stable angina asks the nurse about sexual activity. The LPN's best response is:

You should avoid sexual activity indefinitely after a cardiac diagnosis
Sexual activity is generally safe if you can climb two flights of stairs without symptoms (Correct answer)
You must complete cardiac rehab before any sexual activity
Sexual activity should only occur in the morning when energy is highest

Correct answer: Sexual activity is generally safe if you can climb two flights of stairs without symptoms

The ability to climb two flights of stairs (or achieve 5 METs on a stress test) without chest pain or dyspnea is a general guideline indicating sufficient cardiac reserve for sexual activity.

Question 47: A client with chronic atrial fibrillation has been prescribed digoxin. The therapeutic serum digoxin level is:

0.5–0.9 ng/mL
2.0–2.5 ng/mL
0.5–2.0 ng/mL (most effective below 1.0 ng/mL) (Correct answer)
3.0–4.0 ng/mL

Correct answer: 0.5–2.0 ng/mL (most effective below 1.0 ng/mL)

The therapeutic range for digoxin is 0.5–2.0 ng/mL, with current evidence suggesting levels below 1.0 ng/mL are most effective and safe for most clients.

Digoxin is a cardiac glycoside used to slow ventricular rate in atrial fibrillation and improve contractility in heart failure. Its therapeutic range is narrow: 0.5–2.0 ng/mL. Modern guidelines favor the lower end (<1.0 ng/mL) for reduced toxicity risk. Signs of digoxin toxicity include bradycardia, visual disturbances (yellow-green halos), nausea, vomiting, and dysrhythmias. Hypokalemia potentiates toxicity. The LPN must ensure potassium levels are normal and report any signs of toxicity promptly.

Question 48: A client with chronic atrial fibrillation has been prescribed digoxin. The therapeutic serum digoxin level is:

0.5–0.9 ng/mL
2.0–2.5 ng/mL
0.5–2.0 ng/mL (most effective below 1.0 ng/mL) (Correct answer)
3.0–4.0 ng/mL

Correct answer: 0.5–2.0 ng/mL (most effective below 1.0 ng/mL)

The therapeutic range for digoxin is 0.5–2.0 ng/mL, with current evidence suggesting levels below 1.0 ng/mL are most effective and safe for most clients.

Question 49: A client with a recent MI is started on carvedilol. The LPN knows this medication is used to:

Increase heart rate and contractility after MI
Reduce myocardial oxygen demand and prevent ventricular remodeling (Correct answer)
Prevent blood clots in the coronary arteries
Treat pulmonary edema by reducing preload

Correct answer: Reduce myocardial oxygen demand and prevent ventricular remodeling

Carvedilol is a non-selective beta-blocker used post-MI to reduce myocardial oxygen demand, lower heart rate, decrease cardiac workload, and prevent maladaptive ventricular remodeling.

Carvedilol is a non-selective alpha- and beta-adrenergic blocker indicated post-MI and in heart failure. By blocking beta-1 receptors, it decreases heart rate, contractility, and myocardial oxygen consumption. It also reduces neurohormonal activation that drives ventricular remodeling (hypertrophy and dilation) after MI. Carvedilol has been shown to reduce mortality in post-MI clients with left ventricular dysfunction. It should be started at low doses and titrated up; the LPN should monitor for bradycardia, hypotension, and bronchospasm.

Question 50: A client with a recent MI is started on carvedilol. The LPN knows this medication is used to:

Increase heart rate and contractility after MI
Reduce myocardial oxygen demand and prevent ventricular remodeling (Correct answer)
Prevent blood clots in the coronary arteries
Treat pulmonary edema by reducing preload

Correct answer: Reduce myocardial oxygen demand and prevent ventricular remodeling

Carvedilol is a non-selective beta-blocker used post-MI to reduce myocardial oxygen demand, lower heart rate, decrease cardiac workload, and prevent maladaptive ventricular remodeling.

Question 51: A client with hypertension is taught the DASH diet. Which meal selection indicates the client understands the teaching?

Canned chicken noodle soup with white bread and butter
Grilled salmon, steamed broccoli, brown rice, and low-fat milk (Correct answer)
Pepperoni pizza with a diet soda
Deli turkey sandwich on white bread with regular chips

Correct answer: Grilled salmon, steamed broccoli, brown rice, and low-fat milk

The DASH diet emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy while limiting sodium, saturated fat, and processed foods.

The DASH (Dietary Approaches to Stop Hypertension) diet recommends: fruits and vegetables (8–10 servings/day), whole grains, low-fat dairy, lean proteins such as fish and poultry, nuts and legumes, and limited sodium (<2,300 mg/day), red meat, sweets, and sugary beverages. Option B (grilled salmon, broccoli, brown rice, low-fat milk) exemplifies DASH principles: omega-3 rich fish, vegetables, whole grain, and low-fat dairy. Canned soups, deli meats, pizza, and chips are high in sodium and processed ingredients.

Question 52: A client with hypertension is taught the DASH diet. Which meal selection indicates the client understands the teaching?

Canned chicken noodle soup with white bread and butter
Grilled salmon, steamed broccoli, brown rice, and low-fat milk (Correct answer)
Pepperoni pizza with a diet soda
Deli turkey sandwich on white bread with regular chips

Correct answer: Grilled salmon, steamed broccoli, brown rice, and low-fat milk

The DASH diet emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy while limiting sodium, saturated fat, and processed foods.

Question 53: The LPN is preparing to administer an IV dose of adenosine for SVT. What is critical to know about this medication?

It must be administered slowly over 30 minutes
It is given as a rapid IV push followed immediately by a saline flush (Correct answer)
It requires cardiac monitoring for at least 2 hours after administration
The dose should be doubled if the first dose is ineffective

Correct answer: It is given as a rapid IV push followed immediately by a saline flush

Adenosine has a half-life of 10 seconds and must be given as a very rapid IV push (1–2 seconds) into a large peripheral or central vein, followed immediately by a rapid saline flush.

Adenosine temporarily blocks AV nodal conduction to terminate SVT. Due to its 5–10 second half-life, it must be administered as a rapid IV bolus (1–2 seconds) directly into a proximal or central IV site, immediately followed by a rapid 20 mL saline flush to ensure the drug reaches systemic circulation before being metabolized. Slow administration renders it ineffective. The client should be warned about transient chest discomfort, flushing, and a brief sensation of 'heart stopping.' Continuous cardiac monitoring is maintained throughout.

Question 54: The LPN is preparing to administer an IV dose of adenosine for SVT. What is critical to know about this medication?

It must be administered slowly over 30 minutes
It is given as a rapid IV push followed immediately by a saline flush (Correct answer)
It requires cardiac monitoring for at least 2 hours after administration
The dose should be doubled if the first dose is ineffective

Correct answer: It is given as a rapid IV push followed immediately by a saline flush

Adenosine has a half-life of 10 seconds and must be given as a very rapid IV push (1–2 seconds) into a large peripheral or central vein, followed immediately by a rapid saline flush.

Question 55: A client with heart failure develops sudden-onset dyspnea, pink frothy sputum, and severe anxiety. The priority nursing intervention is:

Obtain a stat 12-lead ECG
Place the client in high Fowler's position and apply oxygen (Correct answer)
Prepare for immediate intubation
Administer oral furosemide as prescribed

Correct answer: Place the client in high Fowler's position and apply oxygen

Pink frothy sputum and sudden dyspnea indicate acute pulmonary edema. The immediate priority is positioning to reduce venous return and applying high-flow oxygen to treat hypoxia.

Acute pulmonary edema is a medical emergency characterized by rapid accumulation of fluid in the alveoli. Pink frothy sputum is diagnostic. Immediate interventions: (1) High Fowler's or legs-dangling position to reduce preload, (2) High-flow oxygen (non-rebreather mask) or CPAP/BiPAP, (3) IV morphine and furosemide per order, (4) notify charge nurse and provider immediately. IV (not oral) diuretics are needed for rapid effect. Intubation may follow if oxygenation fails, but positioning and oxygen are the first nursing actions.

Question 56: A client with heart failure develops sudden-onset dyspnea, pink frothy sputum, and severe anxiety. The priority nursing intervention is:

Obtain a stat 12-lead ECG
Place the client in high Fowler's position and apply oxygen (Correct answer)
Prepare for immediate intubation
Administer oral furosemide as prescribed

Correct answer: Place the client in high Fowler's position and apply oxygen

Pink frothy sputum and sudden dyspnea indicate acute pulmonary edema. The immediate priority is positioning to reduce venous return and applying high-flow oxygen to treat hypoxia.

Question 57: A client with a permanent pacemaker is being discharged. Which instruction should the LPN include?

Avoid using a microwave oven and electric blankets
Carry a pacemaker ID card and report any pulse below the set rate (Correct answer)
Refrain from all physical activity for 6 months
Avoid all metal objects including silverware and coins

Correct answer: Carry a pacemaker ID card and report any pulse below the set rate

Clients with pacemakers should carry an ID card at all times and know their pacemaker's set rate. A pulse below the set rate may indicate pacemaker malfunction requiring evaluation.

Pacemaker discharge teaching includes: carry a pacemaker ID card listing the device type, settings, and manufacturer; check pulse daily and report rates below the set rate; avoid strong magnetic fields (MRI, large industrial motors); notify all healthcare providers and airport security; avoid direct contact over the pacemaker site; call the provider if experiencing dizziness, syncope, or palpitations. Modern pacemakers are shielded from household appliances including microwaves. Activity restrictions are temporary and individualized.

Question 58: A client with a permanent pacemaker is being discharged. Which instruction should the LPN include?

Avoid using a microwave oven and electric blankets
Carry a pacemaker ID card and report any pulse below the set rate (Correct answer)
Refrain from all physical activity for 6 months
Avoid all metal objects including silverware and coins

Correct answer: Carry a pacemaker ID card and report any pulse below the set rate

Clients with pacemakers should carry an ID card at all times and know their pacemaker's set rate. A pulse below the set rate may indicate pacemaker malfunction requiring evaluation.

Question 59: Which finding in a client taking spironolactone for heart failure requires immediate reporting?

Urinary frequency
Serum potassium of 5.8 mEq/L (Correct answer)
Blood pressure of 122/78 mmHg
Mild ankle edema

Correct answer: Serum potassium of 5.8 mEq/L

Spironolactone is a potassium-sparing diuretic. A serum potassium of 5.8 mEq/L indicates hyperkalemia, which can cause life-threatening cardiac dysrhythmias.

Spironolactone is an aldosterone antagonist that blocks potassium excretion. Unlike loop diuretics, it causes potassium retention. Hyperkalemia (K+ > 5.0 mEq/L) can produce peaked T waves, wide QRS, and fatal ventricular dysrhythmias. At 5.8 mEq/L, the risk is significant. The LPN should notify the charge nurse immediately, anticipate holding the medication, and prepare for interventions (calcium gluconate, sodium bicarbonate, or insulin with glucose). Clients should be cautioned about high-potassium foods and salt substitutes.

Question 60: Which finding in a client taking spironolactone for heart failure requires immediate reporting?

Urinary frequency
Serum potassium of 5.8 mEq/L (Correct answer)
Blood pressure of 122/78 mmHg
Mild ankle edema

Correct answer: Serum potassium of 5.8 mEq/L

Spironolactone is a potassium-sparing diuretic. A serum potassium of 5.8 mEq/L indicates hyperkalemia, which can cause life-threatening cardiac dysrhythmias.

Question 61: A client with MI has returned from the cardiac catheterization lab with a radial access site. What is the priority assessment?

Monitor for access site bleeding and assess radial pulse and capillary refill (Correct answer)
Keep the arm elevated above heart level for 6 hours
Apply warm compresses to the wrist to promote healing
Restrict arm movement for 24 hours by applying an arm sling

Correct answer: Monitor for access site bleeding and assess radial pulse and capillary refill

After radial artery access, the priority is assessing for bleeding at the compression band site and monitoring neurovascular status (radial pulse, capillary refill, sensation, color) in the affected hand.

Radial artery catheterization uses a compression device (TR Band) over the puncture site to achieve hemostasis. The LPN must assess: bleeding at the site, radial pulse strength and equality bilaterally, capillary refill time (<2 seconds), skin color and temperature of the hand, and patient-reported numbness or tingling. Loss of radial pulse or signs of ischemia in the hand require immediate notification. The hand should be kept at heart level. The compression band is gradually deflated per protocol (typically over 2–3 hours).

Question 62: A client with MI has returned from the cardiac catheterization lab with a radial access site. What is the priority assessment?

Monitor for access site bleeding and assess radial pulse and capillary refill (Correct answer)
Keep the arm elevated above heart level for 6 hours
Apply warm compresses to the wrist to promote healing
Restrict arm movement for 24 hours by applying an arm sling

Correct answer: Monitor for access site bleeding and assess radial pulse and capillary refill

Question 63: A client with hyperlipidemia asks about foods to reduce LDL cholesterol. The LPN should recommend:

Red meat and full-fat dairy for protein
Oatmeal, nuts, olive oil, and fatty fish (Correct answer)
White bread and refined carbohydrates
Tropical oils such as coconut and palm oil

Correct answer: Oatmeal, nuts, olive oil, and fatty fish

Oatmeal (soluble fiber), nuts (healthy fats), olive oil (monounsaturated fat), and fatty fish (omega-3s) are evidence-based foods that help reduce LDL cholesterol levels.

To reduce LDL cholesterol, the LPN should recommend: soluble fiber (oatmeal, barley, beans, apples) which binds bile acids; nuts (walnuts, almonds) rich in unsaturated fats; olive oil (monounsaturated fat replaces saturated fat); fatty fish (salmon, mackerel) high in omega-3 fatty acids; plant sterols/stanols. Avoid: saturated fats (red meat, full-fat dairy, tropical oils) and trans fats (partially hydrogenated oils). Refined carbohydrates raise triglycerides. These dietary changes can reduce LDL by 5–10%.

Question 64: A client with hyperlipidemia asks about foods to reduce LDL cholesterol. The LPN should recommend:

Red meat and full-fat dairy for protein
Oatmeal, nuts, olive oil, and fatty fish (Correct answer)
White bread and refined carbohydrates
Tropical oils such as coconut and palm oil

Correct answer: Oatmeal, nuts, olive oil, and fatty fish

Oatmeal (soluble fiber), nuts (healthy fats), olive oil (monounsaturated fat), and fatty fish (omega-3s) are evidence-based foods that help reduce LDL cholesterol levels.

Question 65: A client is admitted with chest pain and troponin I is elevated at 2.8 ng/mL (normal <0.04 ng/mL). The LPN understands this result indicates:

Musculoskeletal chest pain
Myocardial injury or infarction (Correct answer)
Pulmonary embolism
Normal variation with strenuous exercise

Correct answer: Myocardial injury or infarction

Troponin I is a highly specific biomarker of myocardial injury. A significantly elevated level strongly indicates myocardial cell death consistent with acute MI.

Cardiac troponins (I and T) are proteins released from damaged myocardial cells. Troponin I is highly specific for cardiac muscle injury. Normal levels are <0.04 ng/mL; levels begin rising 3–6 hours after MI onset, peak at 18–24 hours, and remain elevated 7–10 days. An elevated troponin in the context of chest pain confirms acute MI. Serial troponin measurements every 3–6 hours are standard protocol. The LPN should report elevated values immediately, restrict activity, apply continuous monitoring, and prepare for urgent intervention.

Question 66: A client is admitted with chest pain and troponin I is elevated at 2.8 ng/mL (normal <0.04 ng/mL). The LPN understands this result indicates:

Musculoskeletal chest pain
Myocardial injury or infarction (Correct answer)
Pulmonary embolism
Normal variation with strenuous exercise

Correct answer: Myocardial injury or infarction

Troponin I is a highly specific biomarker of myocardial injury. A significantly elevated level strongly indicates myocardial cell death consistent with acute MI.

Question 67: A client with severe mitral valve regurgitation is awaiting valve surgery. Which symptom requires immediate intervention?

Mild fatigue with exertion
Sudden worsening of dyspnea and hypotension (Correct answer)
Occasional palpitations at rest
Mild lower extremity edema

Correct answer: Sudden worsening of dyspnea and hypotension

Sudden worsening dyspnea with hypotension in a client with mitral regurgitation suggests acute decompensation or rupture of chordae tendineae, requiring emergency intervention.

Mitral valve regurgitation allows blood to flow backward from the left ventricle into the left atrium, causing volume overload. While chronic MR may be compensated, acute decompensation presents with sudden severe dyspnea, pulmonary edema, and hypotension — signs of cardiogenic shock. This can occur with chordae tendineae rupture, papillary muscle dysfunction post-MI, or endocarditis. The LPN should call for immediate help, position the client upright, apply oxygen, obtain IV access, and notify the charge nurse and provider stat.

Question 68: A client with severe mitral valve regurgitation is awaiting valve surgery. Which symptom requires immediate intervention?

Mild fatigue with exertion
Sudden worsening of dyspnea and hypotension (Correct answer)
Occasional palpitations at rest
Mild lower extremity edema

Correct answer: Sudden worsening of dyspnea and hypotension

Sudden worsening dyspnea with hypotension in a client with mitral regurgitation suggests acute decompensation or rupture of chordae tendineae, requiring emergency intervention.

Question 69: A client on lisinopril for hypertension develops sudden facial, lip, and tongue swelling. The LPN recognizes this as:

An expected side effect that will resolve
Angioedema — a medical emergency requiring immediate action (Correct answer)
A sign of fluid overload from the medication
A mild allergic reaction treatable with antihistamines

Correct answer: Angioedema — a medical emergency requiring immediate action

Angioedema is a rare but life-threatening adverse effect of ACE inhibitors caused by bradykinin excess. Airway swelling can progress rapidly to complete obstruction.

ACE inhibitor-induced angioedema occurs in 0.1–0.5% of patients and involves bradykinin-mediated swelling of the face, lips, tongue, throat, and larynx. It can develop at any time during therapy and is NOT dose-dependent. Airway obstruction can occur within minutes. The LPN must: call for help immediately, keep the client upright, administer epinephrine if ordered, prepare for possible intubation or emergency airway management, discontinue the ACE inhibitor, and document. This is a medical emergency with potential for rapid fatality.

Question 70: A client on lisinopril for hypertension develops sudden facial, lip, and tongue swelling. The LPN recognizes this as:

An expected side effect that will resolve
Angioedema — a medical emergency requiring immediate action (Correct answer)
A sign of fluid overload from the medication
A mild allergic reaction treatable with antihistamines

Correct answer: Angioedema — a medical emergency requiring immediate action

Angioedema is a rare but life-threatening adverse effect of ACE inhibitors caused by bradykinin excess. Airway swelling can progress rapidly to complete obstruction.

Question 71: A client with coronary artery disease is scheduled for discharge. The LPN reinforces teaching about recognizing the difference between stable and unstable angina. Unstable angina is characterized by:

Chest pain relieved by rest and one nitroglycerin tablet
Predictable chest pain that occurs only with strenuous exercise
New-onset chest pain at rest or pain that is more severe, frequent, or prolonged than usual (Correct answer)
Chest pain lasting less than 2 minutes

Correct answer: New-onset chest pain at rest or pain that is more severe, frequent, or prolonged than usual

Unstable angina occurs at rest, is new-onset, or represents a change from a stable pattern — more frequent, severe, or prolonged. It signals impending MI and requires immediate evaluation.

Stable angina is predictable, occurs with exertion, is relieved by rest and nitroglycerin, and follows a consistent pattern. Unstable angina (ACS) is characterized by: rest pain, new-onset angina with minimal exertion, or a change from stable pattern (increased frequency, severity, or duration). It reflects vulnerable plaque with partial thrombus and is a medical emergency. The LPN should teach clients to call 911 immediately for any rest pain or change in angina pattern rather than waiting to see if it resolves.

Question 72: A client with coronary artery disease is scheduled for discharge. The LPN reinforces teaching about recognizing the difference between stable and unstable angina. Unstable angina is characterized by:

Chest pain relieved by rest and one nitroglycerin tablet
Predictable chest pain that occurs only with strenuous exercise
New-onset chest pain at rest or pain that is more severe, frequent, or prolonged than usual (Correct answer)
Chest pain lasting less than 2 minutes

Correct answer: New-onset chest pain at rest or pain that is more severe, frequent, or prolonged than usual

Unstable angina occurs at rest, is new-onset, or represents a change from a stable pattern — more frequent, severe, or prolonged. It signals impending MI and requires immediate evaluation.

LPN Medical-Surgical Nursing: Cardiovascular Disorders 1

A client with heart failure is prescribed furosemide (Lasix).
Which assessment finding requires immediate intervention?

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