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Cardiovascular NCLEX questions
- Which of the following are most likely to be early signs of cardiac problems in older persons? (Select all that apply.) Mental status changes Agitation Frequent falls Sudden changes in GI function Correct Answer Mental status changes Agitation Frequent falls Rationale Many cardiovascular functions are complicated in that they involve many other systems. Mental status changes, agitation, and falls can be early signs of cardiac problems in the older person. Changes in function in the GI system are not typical signs of a cardiac problem.
- A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused about return of deoxygenated blood from the tissue.To clarify the confusion, which chamber of the heart receives blood from systemic circulation? Left atrium Right atrium Right ventricle Left ventricle Correct Answer Right atrium Rationale The right atrium is a thin-walled structure that receives deoxygenated blood from all the peripheral tissues by way of the superior and inferior vena cava and from the heart muscle by way of the coronary sinus.
- It is important that the nurse be knowledgeable about cardiac output in order to Correct Answer Evaluate blood flow to peripheral tissues. Determine the electrical activity of the myocardium. Provide information on the immediate need for oxygen. Implement nutritional changes. Correct Answer Evaluate blood flow to peripheral tissues. Rationale Blood flow to the tissues is measured clinically as the cardiac output, and assists to predict tissue perfusion. Electrical activity is evaluated more effectively by EKG. While the cardiac output is important for perfusion and oxygenation of tissues, the oxygen saturation would provide more valuable information. Nutritional changes would be targeted to sodium and would depend on symptoms of disease.
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Rationale Weight loss of even 10 pounds; fruits, vegetables, and whole grains; the DASH diet; and a daily exercise regimen will help reduce high blood pressure. Alcohol intake with meals should be reduced to help manage high blood pressure.
- A patient receiving the drug simvastatin (Zocor) should be taught this medication helps to prevent coronary heart disease by Correct Answer Increasing lower-density lipoprotein. Controlling lower-density lipoprotein. Increasing triglycerides. Increasing very low-density lipoprotein. Correct Answer Controlling lower-density lipoprotein. Rationale The Heart Protective Study has also shown that controlling low-density
lipoprotein (LDL) with simvastatin (Zocor) assists in the prevention of coronary heart disease by raising HDL. Responses 1, 3, and 4 are incorrect.
- Which of the following are direct causes of chronic ischemic pain? (Select all that apply.) Aortic stenosis Acid reflux Pulmonary embolus Herpes zoster (shingles) Correct Answer Aortic stenosis Acid reflux Pulmonary embolus Rationale Herpes zoster (shingles) manifests as a vesicular rash along a der- matome, not chronic ischemic pain. Integrated Process Correct Answer Nursing Process; Evaluation Cognitive Level Correct Answer Evaluation NCLEX-RN Test Plan Correct Answer Physiological Integrity; Physiological Adaptation Rationale Herpes zoster (shingles) manifests as a vesicular rash along a der- matome, not chronic ischemic pain.
- Older clients experiencing anginal pain with complaints of fatigue or weak- ness usually are medicated with which of the following types of medication? Sublingual nitroglycerin Cardiac glycosides HMG-CoA reductase inhibitors Morphine sulfate Correct Answer Sublingual nitroglycerin
Rationale CK-MB elevates 4-6 hours after tissue necrosis. Troponin levels rise 6- hours after the infarct (tissue necrosis) but also can occur with other types of tissue damage. Myoglobin also elevates, but to a lesser degree. WBC levels elevate with an inflammatory response. Troponin levels are more elevated than are the other cardiac enzymes, are more specific to cardiac tissue, and rise 6-8 hours after the infarct (tissue necrosis).
- A client with post-myocardial infarction develops acute bacterial peri- carditis.Which of the following medications would the physician most likely prescribe as the primary drug? Ticarcillin disodium (Ticar) Acetaminophen (Tylenol) Ibuprofen (Motrin) Trioxsalen (Trisoralen) Correct Answer Ticarcillin disodium (Ticar) Rationale Acute bacterial pericarditis is a complication that can occur post-my- ocardial infarction. Acute bacterial pericarditis usually requires antibiotics. NSAIDs usually are prescribed to relieve pain from the inflammatory process. If the NSAIDs do not relieve pain within 48 to 96 hours, corticosteroids are ordered. There is no mention of pain in the stem of the question. Trisoralen is used to repigment skin for persons with vitiligo.
- Which of the following diagnostic tests is preferred for evaluating heart valve function? Chest x-ray Duplex Doppler Echocardiogram
Electrocardiogram Correct Answer Echocardiogram Rationale The echocardiogram is the preferred test to evaluate heart valves, be- cause it allows the visualization of the valves as they open and close. A chest x-ray will determine the size of the heart, the duplex measures blood flow through major arteries, and an electrocardiogram identifies electrical activity.
- An elderly client is being monitored for evidence of congestive heart failure.To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient? Observe electrocardiogram readings and report deviations to the nurse.
impulse conduction through the AV node, all of which slows the progression of the disease process. Carvedilol (Coreg) is another beta-adrenergic blocker used to treat heart failure.
- A common arrhythmia found in some older clients is chronic atrial fibrilla- tion. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered? Aspirin (acetylsalicylic acid) Warfarin sodium (Coumadin) Simvastatin (Zocor) Vinorelbine tartrate (Navelbine) Correct Answer Warfarin sodium (Coumadin) Rationale Chronic atrial fibrillation places a patient at high risk for clot formation. Warfarin sodium frequently is ordered as an anti-coagulant. Aspirin will not prevent
clots associated with atrial fibrillation. Zocor is used to lower LDL and increase HDL. Navelbine is an anti-neoplastic.
- Which of the following assessments would be an important finding for a patient with arterial disease? Intermittent claudication with exercise Brownish discoloration around the ankles Non-pitting edema on the lower extremities Altered sensation to touch Correct Answer Intermittent claudication with exercise Rationale Intermittent claudication is a common finding in persons with arterial dis- ease, usually due to progression of atherosclerosis and alteration of tissue perfusion to the extremities. In venous disease, valves of the veins in the extremities become incompetent, resulting in higher pressures than normal in the veins. The pressure is transmitted to the capillaries of the lower extremities, resulting in thickening and non-pitting edema of tissues around the ankles. Prolonged thickening results in the red blood cells' being pressed outside the capillaries. The cells eventually break down, resulting in collection of hemosiderin deposits being collected in the area. Altered sensation to touch would be due to neuropathic changes commonly found with diabetes mellitus.
- 1) A client is scheduled for a cardiac catherization using a radiopaque dye. Which of the following assessments is most critical before the procedure? Intake and output Baseline peripheral pulse rates Height and weight
Chest pain is assessed by using the standard pain assessment parameters. Options 1, 2, and 4 may or may not help discriminate the origin of pain. Pain of pleuropul- monary origin usually worsens on inspiration.
- 3) A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities? Strict bed rest for 24 hours after transfer Bathroom privileges and self-care activities Unsupervised hallway ambulation with distances under 200 feet Ad lib activities because the client is monitored. Correct Answer 2. On transfer from the CCU, the client is allowed self-care activities and bathroom privileges. Supervised ambulation for brief distances are encouraged, with distances gradually increased (50, 100, 200 feet).
- 4) A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? Review the intake and output records for the last 2 days Change the time of diuretic administration from morning to evening Request a sodium restriction of 1 g/day from the physician. Order daily weights starting the following morning. Correct Answer 1. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
- 5) A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to Correct Answer Check the client status and lead placement Press the recorder button on the electrocardiogram console. Call the physician Call a code blue Correct Answer 1. Sudden loss of electrocardiogram complexes indicates ventricular asystole or pos- sible electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention.
- 6) A nurse is assessing the blood pressure of a client diagnosed with primary hypertension.The nurse ensures accurate measurement by avoiding
- 8) A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin).The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is Correct Answer The same as the client's own baseline level Lower than the needed therapeutic level Within the therapeutic range Higher than the therapeutic range Correct Answer 3. The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.
- 9) A client who has been receiving heparin therapy also is started on warfarin.The client asks a nurse why both medications are being adminis- tered. In formulating a response, the nurse incorporates the understanding that warfarin Correct Answer Stimulates the breakdown of specific clotting factors by the liver, and it takes 2- 3 days for this to exert an anticoagulant effect. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an anticoagulant effect. Stimulates production of the body's own thrombolytic substances,but it takes 2- 4 days for this to begin. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to be therapeutic. Correct Answer 2. Warfarin works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.
- 10) A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2mg of morphine given intravenously. The nurse should first Correct Answer Administer the morphine Obtain a 12-lead ECG Obtain the lab work Order the chest x-ray
Reflects electrical impulse beginning at the SA node Indicated electrical impulse beginning at the AV node Reflects atrial muscle depolarization Identifies ventricular muscle depolarization Has duration of normally 0.11 seconds or less. Correct Answer 1, 3, 5. In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
- 13) A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion.The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to Correct Answer Call for the doctor Start an intravenous line Obtain a portable chest radiograph Draw blood for laboratory studies Correct Answer 2. Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.
- 14) The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? Cancer Hypertension Liver disease Myocardial infarction Correct Answer 4. Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within 4 to 6 hours after infarction (Remember, less than 90 mg/L is normal).
- 15) When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochlo-
