NCLEX CARDIOVASCULAR EXAM QUESTIONS AND ANSWERS 2023-2024 GRADED A, Exams of Nursing

Download NCLEX CARDIOVASCULAR EXAM QUESTIONS AND ANSWERS 2023-2024 GRADED A and more Exams Nursing in PDF only on Docsity! 1 NCLEX CARDIOVASCULAR EXAM QUESTIONS AND ANSWERS 2023-2024 GRADED A 1. A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? 1. Glipizide 2. Metformin 3. Repaglinide 4. Regular insulin 2. A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? 1. Hypovolemia 2. Acute kidney injury 3. Glomerulonephritis 4. Urinary tract infection 2 3. The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats/minute. Which action should the nurse take? 1. Check vital signs. 2. Check laboratory test results. 3. Notify the health care provider. 4. Continue to monitor for any rhythm change. 4. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? 1. Call a code. 2. Call the health care provider. 3. Check the client's status and lead placement. 4. Press the recorder button on the electrocardiogram console. 6. The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority? 1. Anxiety level of the client and family 5 4. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning." 11. The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? 1. Flat neck veins 2. A pulse rate of 60 beats/minute 3. Muffled or distant heart sounds 4. Wheezing on auscultation of the lungs 12. The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction? 1. "I need to be sure not to go barefoot around the house." 2. "If I cut my toenails, I need to be sure that I cut them straight across." 3. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." 4. "I need to be sure that I elevate my leg above the level of my heart for at least an hour every day." 13. The nurse is providing instructions to a client with a diagnosis of hypertension 6 regarding high- sodium items to be avoided. The nurse instructs the client to avoid consuming which item? 7 1. Bananas 2. Broccoli 3. Antacids 4. Cantaloupe 14. The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client? 1. Use nail polish to protect the nail beds from injury. 2. Wear gloves for all activities involving the use of both hands. 3. Stop smoking because it causes cutaneous blood vessel spasm. 4. Always wear warm clothing, even in warm climates, to prevent vasoconstriction. 15. The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention? 1. Keep the legs aligned with the heart. 2. Elevate the legs higher than the heart. 3. Clean the skin with alcohol every hour. 4. Position the client onto the side during every shift. Rationale: In the client with a venous disorder, the legs are elevated above the level of the heart to assist with the return of venous blood to the heart. Alcohol is very irritating and drying 10 assesses the client for 11 palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. 18. The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? 1. Listening to lung sounds 2. Palpating for organomegaly 3. Assessing for jugular vein distention 4. Assessing for peripheral and sacral edema 19. The nurse is participating in a class on rhythm strip interpretation. Which statement by the nurse indicates an understanding of a PR interval of 0.20? 1. "This is a normal finding." 2. "This is indicative of atrial flutter." 3. "This is indicative of atrial fibrillation." 4. "This is indicative of impending reinfarction." 20.The nurse in the medical unit is assigned to provide discharge teaching to a client with a diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to minimize the effects of the disease process. The client continually changes the subject during the teaching session. The nurse interprets that this client's behavior is most likely related to which problem? 12 1. Anxiety related to the need to make lifestyle changes 2. Boredom resulting from having already learned the material 3. An attempt to ignore or deny the need to make lifestyle changes 4. Lack of understanding of the material provided at the teaching session and embarrassment about asking questions 21. A home care nurse is visiting a client to provide follow-up evaluation and care of a leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is pale and deep and that the surrounding tissue is cool to the touch. The nurse should document that these findings identify which type of ulcer? 1. A stage 1 ulcer 2. A vascular ulcer 3. An arterial ulcer 4. A venous stasis ulcer Rationale: Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients. A stage 1 ulcer indicates a reddened area with an intact skin surface. A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of venous congestion. 15 26. A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions? 1. "I need to cut down on cigarette smoking." 2. "I am so relieved that my heart is repaired." 3. "I need to adhere to my dietary restrictions." 4. "I am so relieved that I can eat anything I want to now." 27. The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage should the nurse instruct the client to select from the menu? 1. Tea 2. Cola 3. Coffee 4. Raspberry juice 28.The nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse should immediately ask the client which question? 16 1. "Where is the pain located?" 2. "Are you having any nausea?" 3. "Are you allergic to any medications?" 4. "Do you have your nitroglycerin with you?" 29. The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions? 1. "I'll need to become a strict vegetarian." 2. "I should use polyunsaturated oils in my diet." 3. "I need to substitute eggs and whole milk for meat." 4. "I should eliminate all cholesterol and fat from my diet." 30.A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client about the dietary restrictions required with HF. Which statement by the client indicates that further teaching is needed? 1. "I'm not supposed to eat cold cuts." 2. "I can have most fresh fruits and vegetables." 17 3. "I'm going to weigh myself daily to be sure I don't gain too much fluid." 4. "I'm going to have a ham and cheese sandwich and potato chips for lunch." 31. The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL (4.9 mmol/L), and fasting blood glucose level of 184 mg/dL (10.2 mmol/L). The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)? 1. Age 2. Hypertension 3. Hyperlipidemia 4. Glucose intolerance 32. The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge? 1. "I need to start exercising more to improve my health." 2. "I will be sure to keep my appointment with the cardiologist." 20 stress test. Which instruction should the nurse plan to provide to the client about this procedure? 21 1. Eat breakfast just before the procedure. 2. Wear firm, rigid shoes, such as work boots. 3. Wear loose clothing with a shirt that buttons in front. 4. Avoid cigarettes for 30 minutes before the procedure. 37. A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? 1. Chest pain 2. Urge to cough 3. Warm, flushed feeling 4. Pressure at the insertion site 38.A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? 1. Weigh self on a daily basis. 2. Sleep with the head of the bed flat. 3. Take a double dose of the diuretic if peripheral edema is noted. 22 4. Withhold prescribed digoxin if slight respiratory distress occurs. 39. A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions? 1. "It will really hurt when the catheter is first put in." 2. "I will receive general anesthesia for the procedure." 3. "I will have to go to the operating room for this procedure." 4. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours." Rationale: It is common for the client to feel fatigued after the cardiac catheterization procedure. A local anesthetic is used, so little to no pain is experienced with catheter insertion. General anesthesia is not used. Other pre-procedure teaching points include the fact that the procedure is done in a darkened cardiac catheterization room. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection. 40.A client admitted to the hospital with coronary artery disease complains of dyspnea at rest. The nurse caring for the client uses which item as the best means to monitor respiratory status on an ongoing basis? 1. Apnea monitor 25 45. The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding? 1. The client is not experiencing dyspnea. 2. The client is not experiencing nausea or vomiting. 3. The pain has not been relieved by rest and nitroglycerin tablets. 4. The client says the pain began while she was trying to open a stuck dresser drawer. 46. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer? 1. Ad lib activities as tolerated 2. Strict bed rest for 24 hours after transfer 3. Bathroom privileges and self-care activities 4. Unsupervised hallway ambulation for distances up to 200 feet (60 meters) 47. A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding 26 should the nurse identify as an indicator that the client is experiencing complications of this therapy? 1. Tarry stools 2. Nausea and vomiting 3. Orange-colored urine 4. Decreased urine output Rationale: Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hema-test testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood. 48.The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking? 1. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer." 2. "Because most of the damage has already been done, it will be all right to cut down a little at a time." 3. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a 27 year." 30 2. Right atrium 3. Left ventricle 4. Right ventricle Rationale: Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left ventricle to fail, leading to signs and symptoms of heart failure. The remaining options are not the chambers that are primarily responsible for this disease process, although these chambers may be affected as the disease becomes more chronic. 51. The nurse has just completed education on myocardial infarction (MI) to a group of new nurses. Which statement made by one of the nurses indicates that the teaching has been effective? 1. "Chest pain is caused by tissue hypoxia in the myocardium." 2. "Chest pain is caused by tissue hypoxia in the vessels of the heart." 3. "Chest pain is caused by tissue hypoxia in the parietal pericardium." 4. "Chest pain is caused by tissue hypoxia in the visceral pericardium." 31 52. The registered nurse (RN) is educating a new nurse on mitral stenosis. Which statement by the new nurse indicates that the teaching has been effective? 1. "Left ventricle to aorta narrowing will impede flow of blood." 2. "Left atrium to left ventricle narrowing will impede flow of blood." 3. "Right atrium to right ventricle narrowing will impede flow of blood." 4. "Right ventricle to pulmonary artery narrowing will impede flow of blood." Rationale: The mitral valve separates the left atrium from the left ventricle. 53. The registered nurse (RN) is educating a new nurse about aortic regurgitation. Which statement by the new nurse indicates that the teaching has been effective? 1. "Failure of the aortic valve to close completely allows blood to flow retrograde through the aorta to the left ventricle." 2. "Failure of the aortic valve to close completely allows blood to flow retrograde through the left ventricle to the left atrium." 3. "Failure of the aortic valve to close completely allows blood to flow retrograde through the right ventricle to the right atrium." 32 4. "Failure of the aortic valve to close completely allows blood to flow retrograde through the pulmonary artery to the right ventricle." Rationale: The aortic valve separates the aorta from the left ventricle. 54. The nurse educator is teaching the new registered nurse (RN) how to care for clients with a decrease in blood pressure. Which statement by the new RN indicates the need for further instruction? 1. "Decreased contractility occurs." 2. "Decreased heart rate is not a side effect." 3. "Decreased myocardial blood flow is not a concern." 4. "Increased resistance to electrical stimulation often occurs." Rationale: The primary effect of a decrease in blood pressure is reduced blood flow to the myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase, not decrease, in response to this change. The effects of tissue ischemia lead to decreased contractility over time. 55. The nurse educator is lecturing new registered nurses (RNs) about serum calcium levels. Which statement by one of the new RNs indicates that teaching has been 35 4. "The left coronary artery supplies the right atrium and right ventricle with blood." 58. The registered nurse (RN) is orienting a new RN assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. After educating the new RN about cardiac output, which statement made by the new RN indicates the need for further instruction? 1. "A cardiac output of 2 L/min is normal." 2. "A cardiac output of 4 L/min is normal." 3. "A cardiac output of 6 L/min is normal." 4. "A cardiac output of 7 L/min is normal." Rationale: The cardiac cycle consists of contraction and relaxation of the heart muscle. In adults, the cardiac output ranges from 4 to 7 L/min. Therefore, option 1 identifies a low cardiac output. 59. The new registered nurse (RN) is orienting on the cardiac unit. Which statement by the new RN indicates an understanding of an early indication of fluid volume deficit due to blood loss? 1. "Pulse rate will increase." 2. "Blood pressure will decrease." 36 3. "Edema will be present in the legs." 37 4. "Crackles in the lungs will be present." 60.A client who has been exercising in a gymnasium stops to measure his pulse and places his fingers over both carotid arteries simultaneously. The nurse exercising nearby is correct when cautioning the client to check the pulse on only one side, primarily for which reason? 1. It is unnecessary to use both hands. 2. The client could occlude the trachea. 3. The heart rate and blood pressure could drop. 4. Feeling dual pulsations may lead to an incorrect measurement. 61. A nursing student who is researching a medication at the nurses' station asks the registered nurse (RN) what the function of an alpha-adrenergic receptor is, and where the receptors are primarily found. The RN educates the nursing student. Which statement by the nursing student indicates that teaching has been effective? 1. "The peripheral arteries and veins; when stimulated they cause vasoconstriction." 2. "Arterial and bronchial walls; when stimulated they cause vasodilation and bronchodilation." 3. "The heart; when stimulated it causes an increase in 40 64. The nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The health care provider (HCP) tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse determines that the blockage is located in which area? 1. Circumflex coronary artery 2. Right coronary artery (RCA) 3. Posterior descending coronary artery (PDA) 4. Left anterior descending coronary artery (LAD) Rationale: The LAD bifurcates from the left main coronary artery to supply the anterior wall of the left ventricle and a few other structures. The circumflex coronary artery bifurcates from the left coronary artery and supplies the left atrium and the lateral wall of the left ventricle. The RCA supplies the right side of the heart, including the right atrium and right ventricle. The PDA supplies the posterior wall of the heart. 65. A new registered nurse (RN) is assigned to the care of a client hospitalized with a diagnosis of hypothermia. After consulting with an experienced RN, which statement by the new RN indicates understanding of likely assessment findings for this client? 1. Increased heart rate and increased blood pressure 41 2. Increased heart rate and decreased blood pressure 42 3. Decreased heart rate and increased blood pressure 4. Decreased heart rate and decreased blood pressure Rationale: Hypothermia decreases the heart rate and the blood pressure because the metabolic needs of the body are reduced in this condition. With fewer metabolic needs, the workload of the heart decreases, resulting in decreased heart rate and blood pressure. 66. A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse provides education to the client based on which physiological concept? 1. Vagus nerve stimulation causes a decrease in heart rate and cardiac contractility. 2. Vagus nerve stimulation causes an increase in heart rate and cardiac contractility. 3. Sympathetic nerve stimulation causes a decrease in heart rate and cardiac contractility. 4. Sympathetic nerve stimulation causes an increase in heart rate and cardiac contractility. 67. A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement? 45 71. The nurse is concerned about the adequacy of peripheral tissue perfusion in the post–cardiac surgery client. Which action should the nurse include within the plan of care for this client? 46 1. Use the knee gatch on the bed. 2. Cover the legs lightly when sitting in a chair. 3. Encourage the client to cross the legs when sitting in a chair. 4. Provide pillows for the client to place under the knees as desired. Rationale: Covering the legs with a light blanket during sitting promotes warmth and vasodilation of the leg vessels. The nurse plans postoperative measures to prevent venous stasis. These include applying elastic stockings or leg wraps, use of pneumatic compression boots, and discouraging crossing of the legs. Clients should be encouraged to perform passive and active range-of-motion exercises. The knee gatch on the bed and pillows under the knees should be avoided because they place pressure on the blood vessels in the popliteal area, impeding venous return. 72. The nurse is instructing the post–cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse should include which item in the instructions? 1. Driving is permitted as long as the lap and shoulder seat belts are worn. 2. Lifting should be restricted to objects that do not weigh more than 25 pounds (11.3 kg). 3. Use the arms for balance, not weight support, when getting out of bed or a chair. 47 4. Activities that involve straining may be resumed as long as they do not cause pain. 73. The nurse is assessing an electrocardiogram (ECG) rhythm strip for a client. The PP and RR intervals are regular. The PR interval is 0.14 second, and the QRS complexes measure 0.08 second. The overall heart rate is 82 beats/min. The nurse should report the cardiac rhythm to be which rhythm? 1. Sinus bradycardia 2. Sick sinus syndrome 3. Normal sinus rhythm 4. First-degree heart block Rationale: Normal sinus rhythm is defined as a regular rhythm with an overall rate of 60 to 100 beats/min. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively. 74. A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/minute. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse report this rhythm? 1. Sinus tachycardia 50 79. The home health nurse makes a home visit to a client who has an implanted cardioverter- defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary? 1. "If I feel an internal defibrillator shock, I should sit down." 2. "I won't be able to have a magnetic resonance imaging test (MRI)." 3. "My wife knows how to call the emergency medical services (EMS) if I need it." 4. "I can stop taking my antidysrhythmic medicine now because I have a pacemaker." 80.A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point? 1. Before each P wave 2. Just after each P wave 3. Just after each T wave 4. Before each QRS complex 51 81. A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding? 1. Bilateral edema 2. Increased calf circumference 3. Diminished distal peripheral pulses 4. Coolness and pallor of the affected limb Rationale: The client with thrombophlebitis, also known as deep vein thrombosis, exhibits redness or warmth of the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema distal to the obstruction, and increased calf circumference in the affected extremity. Peripheral pulses are unchanged from baseline because this is a venous, not an arterial, problem. Often thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms unless pulmonary embolism occurs as a complication. 82.The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse plan, based on the health care provider's (HCP's) prescriptions? Select all that apply. 1. Elevation of the right leg 2. Administration of acetaminophen 3. Application of moist heat to the right leg 52 4. Monitoring for signs of pulmonary embolism 5. Ambulation in around the nursing unit every hour Rationale: Standard management of the client with deep vein thrombosis includes possible bed rest for 5 to 7 days or as prescribed; limb elevation; relief of discomfort with warm, moist heat and analgesics as needed; anticoagulant therapy; and monitoring for signs of pulmonary embolism. Although the health care provider may allow ambulation, hourly ambulation around the nursing unit is not encouraged because it increases the likelihood of dislodgement of the tail of the thrombus, which could travel to the lungs as a pulmonary embolism. 83.A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? 1. Dietitian 2. Medical social worker 3. Pain management clinic 4. Smoking cessation program Rationale: 55 85. The nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. Which items should the nurse include on a list of suggestions for the client? Select all that apply. 1. Soak the feet in hot water daily. 2. Be careful not to injure the legs or feet. 3. Use a heating pad on the legs to aid vasodilation. 4. Walk each day to increase circulation to the legs. 5. Cut down on the amount of fats consumed in the diet. 86.The home health nurse visits a client recovering after an episode of cardiogenic shock secondary to an anterior myocardial infarction (MI) and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? 1. "I exercise every day after breakfast." 2. "I've gained 8 pounds (3.6 kg) since discharge." 3. "I take an antacid when I experience epigastric pain." 4. "I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily." 87. A client who had coronary artery bypass surgery states to the home health nurse, "I get so frustrated. I can't even do my gardening." The nurse then assesses the 56 client for activity level since the surgery. Which client statement indicates a need for further teaching? 57 1. "I pace my activities throughout the day." 2. "I plan regular rest periods during the day." 3. "I avoid outdoor physical activity during the heat of the day." 4. "I try to walk immediately after lunch, after I've finished my morning housecleaning." 88.The nurse notes that a client's cardiac rhythm shows absent P waves, no PR interval, and an irregular rhythm. How should the nurse interpret this rhythm? 1. Bradycardia 2. Tachycardia 3. Atrial fibrillation 4. Normal sinus rhythm (NSR) 89.The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving intravenous doses of furosemide. The client is attached to cardiac telemetry, and the nurse is monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has changed to this pattern. The nurse determines that the most likely cause of this cardiac rhythm in the client is which problem? Refer to Figure. View Figure NCLEX RN Cardiovascular Q&As 47 93. The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? 1. Assessing pain 2. Administering vasodilators 3. Avoiding over-the-counter (OTC) medications 4. Moving slowly from a sitting to a standing position 94. A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. Which nursing action should be included in the client's plan of care? 1. Limiting oral and intravenous fluids 2. Measuring the client's pulse each shift 3. Providing the client with short, frequent walks 4. Eliminating sources of caffeine from meal trays 95. A client is scheduled for elective cardioversion to treat chronic high-rate atrial NCLEX RN Cardiovascular Q&As 48 fibrillation. Which finding indicates that further preparation is needed for the procedure? NCLEX RN Cardiovascular Q&As 49 1. The client's digoxin has been withheld for the last 48 hours. 2. The client is wearing a nasal cannula delivering oxygen at 2 L/min. 3. The defibrillator has the synchronizer turned on and is set at 120 joules (J). 4. The client has received an intravenous dose of a conscious sedation medication. Rationale: During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before cardioversion because it increases ventricular irritability and may cause ventricular dysrhythmias after the countershock. The defibrillator is switched to synchronizer mode to time the delivery of the electrical impulse to coincide with the QRS and avoid the T wave, which could cause ventricular fibrillation. Energy level typically is set at 120 to 200 J for a biphasic machine. The client typically receives a dose of an intravenous sedative or antianxiety agent. 96. The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set the defibrillator to which starting energy range level, depending on the specific health care provider (HCP) prescription? 1. 120 joules 2. 200 joules 3. 250 joules NCLEX RN Cardiovascular Q&As 52 2. Apples NCLEX RN Cardiovascular Q&As 53 3. Bananas 4. Cranberries 100. A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? 1. Anterior chest pain 2. Pericardial friction rub 3. Weakness and irritability 4. Chest pain that worsens on inspiration 101. Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse anticipate in this client if PVCs are occurring? 1. A P wave preceding every QRS complex 2. QRS complexes that are short and narrow 3. Inverted P waves before the QRS complexes 4. Premature beats followed by a compensatory pause NCLEX RN Cardiovascular Q&As 54 102. The nurse is developing a plan of care for a client recovering from pulmonary edema. The nurse establishes a goal to have the client participate in activities that reduce cardiac workload. The nurse should identify which client action as contributing to this goal? 1. Using a bedside commode 2. Sleeping in the supine position 3. Elevating the legs when in bed 4. Using seasonings to improve the taste of food Rationale: Using a bedside commode decreases the work of getting to the bathroom or struggling to use the bedpan. The supine position increases respiratory effort and decreases oxygenation. Elevating the client's legs increases venous return to the heart thus increasing cardiac workload. Seasonings may be high in sodium and promote further fluid retention. 103. The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease? 1. Checking for a rash on the digits 2. Observing for softening of the nails or nail beds NCLEX RN Cardiovascular Q&As 57 the risk of additional thrombi and emboli. The nurse also would not include use of sequential compression boots for an existing NCLEX RN Cardiovascular Q&As 58 thrombus. They are used only to prevent DVT, because they mimic skeletal muscle action and can disrupt an existing thrombus, leading to pulmonary embolism. 105. Spironolactone is prescribed for a client with heart failure. In providing dietary instructions to the client, the nurse identifies the need to avoid foods that are high in which electrolyte? 1. Calcium 2. Potassium 3. Magnesium 4. Phosphorus 106. A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value comes back elevated? 1. Myoglobin 2. Troponin 3. C-reactive protein 4. Creatine kinase (CK) NCLEX RN Cardiovascular Q&As 59 107. The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do? 1. Walk for as long as possible each day. 2. Cross the legs at the ankle only, not at the knee. 3. Sit in a chair 3 times a day for 3 hours at a time. 4. Lie down with the legs elevated and avoid sitting. 108. A client with no history of cardiovascular disease comes to the ambulatory clinic with flulike symptoms. The client suddenly complains of chest pain. Which question should best help the nurse discriminate pain caused by a noncardiac problem? 1. "Can you describe the pain to me?" 2. "Have you ever had this pain before?" 3. "Does the pain get worse when you breathe in?" 4. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?" 109. Endovenous laser treatment (EVLT) is done on a client with varicose veins. Which interventions should the nurse include in the post-procedure NCLEX RN Cardiovascular Q&As 62 1. "The client may have mild anxiety." 2. "The client will not experience anxiety." 3. "The client will experience extreme anxiety." 4. "The client will only experience anxiety in a stressful environment." 112. A client with pulmonary edema has been receiving diuretic therapy. The client has a prescription for additional furosemide in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin, which laboratory result should the nurse review as the priority? 1. Sodium level 2. Digoxin level 3. Creatinine level 4. Potassium level 113. A client is at risk for vasovagal attacks that cause brady dysrhythmias. The nurse would tell the client to avoid which actions to prevent this occurrence? Select all that apply. 1. Applying pressure on the eyes NCLEX RN Cardiovascular Q&As 63 2. Raising the arms above the head NCLEX RN Cardiovascular Q&As 64 3. Taking stool softeners on a daily basis 4. Bearing down during a bowel movement 5. Simulating a gag reflex when brushing the teeth 114. The nurse employed in a cardiac unit determines that which client is the least likely to have an implanted cardioverter-defibrillator (ICD) inserted? 1. A client with syncopal episodes related to ventricular tachycardia 2. A client with ventricular dysrhythmias despite medication therapy 3. A client with an episode of cardiac arrest related to myocardial infarction 4. A client with 3 episodes of cardiac arrest unrelated to myocardial infarction 115. The nurse is caring for a client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. Which activity will assist with preventing dislodgement of the pacing catheter? 1. Limiting both movement and abduction of the left arm 2. Limiting both movement and abduction of the right arm 3. Assisting the client to get out of bed and ambulate with a walker NCLEX RN Cardiovascular Q&As 67 1. Bleeding and infection 2. Thrombosis and infection 3. Bleeding and wound dehiscence 4. Wound dehiscence and evisceration 121. The nurse is listening to a lecture on Advanced Cardiac Life Support (ACLS). The instructor is discussing electrocardiographic (ECG) changes caused by myocardial ischemia. Which statement by the nurse indicates that teaching has been effective? 1. "Tall, peaked T waves can indicate ischemia." 2. "Prolonged PR interval can indicate ischemia." 3. "Widened QRS complex can indicate ischemia." 4. "ST segment elevation or depression can indicate ischemia." Rationale: An ECG taken during a chest pain episode captures ischemic changes, which include ST segment elevation or depression. Tall, peaked T waves may indicate hyperkalemia. A prolonged PR interval indicates first-degree heart block. A widened QRS complex indicates delay in intraventricular conduction, such as a bundle branch block. 122. The nurse is preparing to ambulate a client on the third day after cardiac NCLEX RN Cardiovascular Q&As 68 surgery. What should the nurse plan to do to enable the client to best tolerate the ambulation? NCLEX RN Cardiovascular Q&As 69 1. Remove telemetry equipment. 2. Provide the client with a walker. 3. Premedicate the client with an analgesic. 4. Encourage the client to cough and breathe deeply. 123. A client with rapid-rate atrial fibrillation asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective? 1. "The vagus nerve slows the heart rate." 2. "The diaphragmatic nerve slows the heart rate." 3. "The diaphragmatic nerve overdrives the rhythm." 4. "The vagus nerve increases the heart rate, overdriving the rhythm." 124. The nurse assesses the sternotomy incision of a client on the third day after cardiac surgery. The incision shows some slight puffiness along the edges and is non-reddened, with no apparent drainage. The client's temperature is 99°F (37.2°C) orally. The white blood cell count is 7500 mm3 (7.5 × 109/L). How should the nurse interpret these findings? 1. Incision is slightly edematous but shows no active NCLEX RN Cardiovascular Q&As 72 126. The nurse is evaluating a client's cardiac rhythm strip to determine if there is proper function of the VVI mode pacemaker. Which denotes proper functioning? 1. Spikes precede all P waves and QRS complexes. 2. There are consistent spikes before each P wave. 3. Spikes occur before QRS complexes when intrinsic ventricular beats do not occur. 4. Spikes occur before all QRS complexes regardless of intrinsic ventricular activity. 127. The nurse determines that a client requires further teaching after permanent pacemaker insertion if which statement is made? 1. "My pulse rate should be less than what my pacemaker is set at." 2. "I'll need to call my health care provider if I feel tired or dizzy." 3. "I'll have to avoid carrying the grocery bags into the house for the next 6 weeks." 4. "It's safe to use my microwave as long it is properly grounded and well shielded." NCLEX RN Cardiovascular Q&As 73 128. The nurse is reviewing the procedure for performance of an electrocardiogram (ECG). Which action by the nurse indicates understanding of the correct position for the V1lead when performing a 12-lead electrocardiogram? 1. "The lead should be placed on the fourth intercostal space left sternal border." 2. "The lead should be placed on the fourth intercostal space right sternal border." 3. "The lead should be placed on the fifth intercostal space left midaxillary line." 4. "The lead should be placed on the fifth intercostal space left midclavicular line." 129. After instruction on the application of antiembolism stockings, the nurse determines that the client requires further teaching if which of these actions is performed? 1. The client puts on the stockings before getting out of bed. 2. The client bunches up the stockings for easier application. 3. The client ensures that stockings are pulled up all the way. NCLEX RN Cardiovascular Q&As 74 4. The client ensures that the rough seams of the stockings are on the outside. 130. The nurse is assessing a client newly diagnosed with mild hypertension. Which assessment finding should the nurse expect? 1. Asymptomatic 2. Shortness of breath 3. Visual disturbances 4. Frequent nosebleeds 131. The nurse monitors the client for which condition as a complication of polycythemia vera? 1. Thrombosis 2. Hypotension 3. Cardiomyopathy 4. Pulmonary edema Rationale: Polycythemia vera is a disorder of the bone marrow. It results in excessive production of white blood cells, red blood cells, and platelets. Clients with polycythemia vera are also more likely to form blood clots that can cause thrombi, strokes, myocardial NCLEX RN Cardiovascular Q&As 77 134. A client's electrocardiogram shows that the ventricular rhythm is irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition? 1. Atrial flutter 2. Atrial fibrillation 3. Third-degree atrioventricular (AV) block 4. First-degree AV block 135. The nurse is caring for a client after an above-the-knee amputation. The nurse assesses the residual (remaining) limb and expects to note which finding? 1. Pink color to the skin flap 2. Hot feeling on palpation of the skin flap 3. Serous fluid leaking from the skin flap incision 4. Absent pulse at the proximal pulse point site closest to the skin flap 136. An emergency room nurse is performing a cardiovascular assessment on a client. During auscultation of the heart sounds, the nurse hears these abnormal sounds. The nurse suspects that the client has which condition? NCLEX RN Cardiovascular Q&As 78 Stop Sound 1. Atrial fibrillation 2. Ventricular fibrillation 3. Ventricular hypertrophy 4. Left bundle branch block 137. The nurse is caring for a postoperative client who has lost a significant amount of blood because of complications during a surgical procedure. Which assessment finding would be indicative of further fluid volume deficit? 1. 4+ edema noted in lower extremities 2. Crackles auscultated from lung bases to apices 3. Blood pressure rises from 116/68 to 118/74 mm Hg 4. Pulse rate increases from 100 beats/min to 136 beats/min 138. The nurse reading the operative record of a client who had cardiac surgery notes that the client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac output results leads the nurse to make which conclusion? 1. The cardiac output is above the normal range. NCLEX RN Cardiovascular Q&As 79 2. The cardiac output is below the normal range. 3. The cardiac output is in the low-normal range. 4. The cardiac output is in the high-normal range. Rationale: The normal cardiac output for the adult can range from 4 to 7 L/min. Therefore, a cardiac output of 3.2 L/min is below normal range. 139. The nurse is auscultating a 56-year-old adult client's apical heart rate before giving digoxin and notes that the heart rate is 48 beats/minute. Which action should the nurse take? 1. Withhold the digoxin and re-evaluate the heart rate in 4 hours. 2. Administer half of the prescribed dose to avoid a further decrease in heart rate. 3. Withhold the digoxin and assess for signs of decreased cardiac output and digoxin toxicity. 4. Administer the digoxin; the heart rate would be considered normal because of the client's age. 140. A new registered nurse (RN) is assisting the RN in admitting a client who has a diagnosis of hypothermia. The RN provides education to the new RN on anticipated vital signs in the client with hypothermia. Which statement by the NCLEX RN Cardiovascular Q&As 82 2. "Variant angina occurs at the same time each day." 3. "Variant angina occurs at lower levels of activity." 4. "Variant angina is less predictable and a precursor of myocardial infarction." Rationale: Variant angina, or Prinz metal's angina, is prolonged and severe and occurs at the same time each day, usually in the morning. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower levels of activity than those that previously precipitated the angina. Unstable angina also occurs at rest, is less predictable, and is often a precursor of myocardial infarction. 143. A client's total cholesterol level is 344 mg/dL (8.6 mmol/L), low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL (4.25 mmol/L), and high- density lipoprotein cholesterol (HDL-C) level is 30 mg/dL (1.2 mmol/L). Based on analysis of the data, how should the nurse direct client teaching? 1. The client should maintain the current dietary regimen but increase activity level. 2. Results are inconclusive unless the triglyceride level is also screened, so teaching is not indicated at this time. 3. The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught. NCLEX RN Cardiovascular Q&As 83 4. The client is at low risk for cardiovascular disease, so the client should be encouraged to continue to follow the current regimen. Rationale: In the absence of documented cardiovascular disease, the desired goal is to have the total cholesterol level lower than 200 mg/dL (<5 mmol/L). A desired LDL-C level for all individuals is lower than 100 mg/dL (<2.59 mmol/L), and a desirable HDL-C level is higher than 40 mg/dL (>1.55 mmol/L). Because the client's levels are outside the range to a significant degree for all three values, the client is at high risk for developing cardiovascular disease and requires teaching on risk factor reduction. 144. An ambulatory care nurse measures the blood pressure of a client and finds it to be 156/94 mm Hg. Which statement indicates that the client needs additional education? 1. "It is important that I limit protein intake." 2. "I need to maintain a regular exercise program." 3. "I understand that I need to avoid adding salt to foods." 4. "It is important that I begin reducing and then maintaining weight." 145. The nurse identifies that a client is having occasional premature ventricular NCLEX RN Cardiovascular Q&As 84 contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1. Serum chloride level of 98 mEq/L (98 mmol/L)