NCLEX 2025 EXAMS WITH VERIFIED QUESTIONS AND SOLUTIONS, Exams of Nursing

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NCLEX 2025 EXAM WITH UPDATED

QUESTIONS AND ANSWERS GRADED A+

Atrial paced rhythm spike before P wave Ventricular paced rhythm Spike before the QRS complex Dual-chamber Atrioventricular (AV) pacing Two spikes one before the p wave and before the QRS Helps improve cardiac synchrony between the atria and ventricle Biventricular pacing Two pacer spikes but one may appear after the QRS complex peripheral arterial disease (PAD) Decreased blood flow from atherosclerosis plaque. -Dangling limbs is common to relieve pain, gravity maximizes blood flow. PAD sxs Int. claudication ischemic muscle pain hair loss decreased peripheral pulses Posterior tibial Dorsalis Pedis Cool, dry, shiny skin Gangrene (BAD) Thick brittle nails ulcers (on toes) PAD nursing interventions Lower extremities below the

Left heart failure Left=Lung=Pulmonary Pulmonary Congestion: -Cardiomegaly -Displaced PMI -S3 sound Pulmonary Edema: -Dyspnea -Orthopnea -PND -Crackles Crackles are heard on inspiration and indicate pulmonary congestion Right sided heart failure Systemic venous congestion:SXS -JVD -Hepatomegaly -Splenomegaly -Ascites -Edema (related to sodium and fluid retention) -Nausea/ annorexia Results from: -Pulmonary HTN -Right ventricular MI -Left side HF

Radiofrequency catheter ablation Catheter is inserted in a vein (usually femoral) and radio waves are used to destroy tissue that is hyperreactive; used typically to control cardiac arrhythmias such as SVT and Vtach. Performed near AV node can damage conduction causing AV block. After procedure the pt must stay supine with HOB less than or equal to 30 degrees and the affected extremity should be kept straight to prevent bleeding from the catheter insertion site. A small amount of bleeding is normal and expected after catheter and is appropriate to apply pressure. check pedal pulses frequently to check for perfusion (check bilat to compare). Chest pain after ablation can be d/t cardiac muscle damage but could also be caused by cardiac ischemia (Inadequate blood supply) immediately report to the HCP. 3rd Degree Heart Block (Complete Heart Block) Reg rhythm and rate Disassociation p waves and QRS complex AV heart block requires temporary or permanent pacing to restore electrical conduction and hemodynamic stability. decreased cardiac output SXS Dizziness Syncope Mental changes HF Hypotension Bradycardia Cardioversion Performed for V-Tach or SVT dysrhythmias but not heart block. NSAIDs

Absent p waves and fine, fibrillatory waves, indicating disorganized atrial electrical activity. Ventricular rate is typically irregular QRS intervals are irregular 1st degree atrioventricular block Prolonged >20 sec, regular PR interval R to R is consistent P waves always follow each QRS Sinus Bradycardia HR <60 bpm Normal rhythm P wave before every QRS (identical) PR interval is normal duration 0.12-. QRS is normal duration <0.12 normal shape DVT (deep vein thrombosis) Patients with DVT are at risk for developing a PE (resp >20 and dyspnea) DO NOT! massage or use SCD's. It could dislodge the clot. SXS: Mild fever pain swelling Nursing Intervention: It's good to walk b/c is decreases venous stasis but need medical evaluation first. Pt may be on bed rest if in pain and has edema initially. -Traumatic( immobility, or injury)

-Major surgery (injury or immobility) -Prolonged immobilization (stroke, long travels) -Pregnancy (pressure on inferior vena cava) -Birth Control (estrogen is thrombotic) -Underlying malignancy(cancer cells release procoagulants). -Smoking (inflammation) -Old age -Obesity. varicose veins -Myeloproliferative disorders (increase blood viscosity- thickness) Inferior vena cava filter Inserted in femoral artery. The filter traps blood clots from the lower extremity vessels prevents them from traveling to the lungs and causing a PE. Prescribed for clients with recurrent emboli or when anticoagulation is contraindicated. Physical activity is promoted and client should avoid crossing legs. If PT has leg pain, numbness, or swelling it could be impaired neurovascular status distal to the insertion site and should be reported IMMEDIATELY. Pt should report only chest pain, SOB, impaired lower extremity (Pain, numbness, and notify health care team prior to MRI. All filters and coils need to be told to MRI team / HC team. IVC filters should stop a PE Immunosuppressive Therapy Mycophenolate, tacrolimus, and corticosteroids The drugs above are important for use after organ transplant to prevent acute and chronic rejection.

-Avoid changing eating habits (dramatically increasing Vit. K+ such as kale, spinach, broccoli, and greens)

• Do NOT take vit K+ supplements -Ask Dr. before starting and stopping meds and herbal supplements. -Ginkgo and ginseng effect blood clotting and can cause bleeding risk -wear a medical alert bracelet indicating what coagulants are being taken -Wash incision with soap and water only and pat dry ( do not use lotions or oils until the incision site is fully healed) Aortic valve replacement Temp and antibiotics Monitor the pt and stick with med plan. Urine output Normal 30 ml/hr Congestive HF URGENT failure of heart to work as a pump to meet the metabolic demands of the body. Heart is unable to eject all the blood coming to it. Causes a drop in CO and increase in the congestion in the systemic and pulmonary circulation Weight gain crackles new onset of edema Aortic Stenosis Narrowing of left ventricle and aorta.

-asymptomatic until exertion. The left ventricle can't pump enough blood to meet body's demands. Due to aortic obstruction (stenosis) SXS: -dyspnea -angina -syncope (in severe cases reduced blood flow to the brain) If the patient has already experienced syncope, and angina the pt is at high risk for sudden death with exertion. The client should restrict activity- you dont want to strain the heart while waiting on surgery Discharge instructions recovering from GABG Explain importance of smoking cessation, weight reduction, healthy diet, and increase activity levels. Wash in shower not bath b/c microorganisms wash incision with mild soap, water, and pat dry. DO NOT SOAK or have lotions or creams applied d/t possible infection. Light housekeeping in 2 weeks is okay but no lifting >5 lbs without being cleared by HCP. Pt can gradually increase activity after 6 weeks and cleared by HCP. No driving for 4-6 weeks unless HCP approves. If client can walk one block or climb 2 flights of stairs without chest pain, SOB, fatigue, and then it is usually safe to resume sexual activity. Notify HCP if: -Chest pain or SOB does not subside with rest. -Fever >101F (38.3c) -Redness drainage or swelling @ incision site

-Peripheral edema -acute, rapid weight gain -s3 heart sound in adults -Increase urine output that is dilute -JVD -Tachypnea, dyspnea, crackles Fluid volume deficit/dehydration Dry mucous membranes, and hypotension Implantable cardioverter defibrillator (ICD) Can sense and defib life threatening dysrhythmias. It can also overdrive pace for rapid heart rhythms or back up pace for bradycardias -> that occur after defib. Device is placed in endocardium via subclavian vein. The pulse generator is implanted subcutaneously over the pectoral muscle. Post op care is similar to pacemaker implantation: -Client should not raise the affected arm above the shoulder until HCP says it's ok bc it can cause dislodgement of the lead wire in endocardium. -ICD firing may be painful. -Driving may occur after healing and HCP signs off -Travel is NOT restricted -ICD will set off metal detectors and metal detector wand should not be held over it. -Carry ICD identification card and list of meds hypovolemic shock

Narrowing pulse pressure (systolic vs diastolic) Hypovolemia Vitals show: -Tachycardia -Hypotension Rehydration -Cap refill <3 sec -Urine output is one of the best signs of rehydration -Normal urine specific gravity: 1.003-1. orthostatic hypotension When a client stands vasoconstriction occurs to maintain blood pressure. If pt the is dehydrated the body has already vasoconstricted and no compensatory mechanism left to compensate the position change. -Start with client in the lying position for at least 5 mins. -Measure BP and HR -Have client stand -Repeat BP and HR after standing 1 and 3 min intervals Abnormal drop in systolic BP of greater than or equal to 20mmHg, Diastolic BP of greater than or equal to 10mmHg Abnormal SXS: Lightheadedness, and dizziness Endovascular abdominal aortic aneurysm repair

If chest tube volume is decreased the nurse should assess for cardiac tamponade Keep chest tubes free of dependent loops and kinks. It helps with fluid drainage and prevents accumulating backflow into mediastinum. DO NOT STRIP OR MILK unless the dr prescribes it. It can cause excessively high neg pressure and traumatized tissue in mediastinum. If there are no signs of tamponade then the nurse should troubleshoot the symptoms and situation before calling the HCP. PVC Early conduction of QRS complex. PVC's are wide and distorted. PVC's can be associated with stimulants (caffeine), medication, (digoxin), heart disease, electrolyte imbalances, hypoxia, and emotional stress. PVC's are not usually harmful in pts with a healthy heart. If pt has MI a PVC can indicate ventricular irritability and increase the risk for the rhythm to deteriorate into life threatening dysrhythmias (v tach, v fib) Nurse should assess the client's physiological response and apical pulse. Rhythm is irregular, QRS of PVCs is wide and distorted, T-wave is large and inverted. Consecutive run of greater than or equal to 3 PVC's is considered ventricular tach. Atrial Flutter Recurring, regular, sawtooth shape flutter waves that originate from single ectopic focus in the atria. (atrial rate 250)

Pre Atrial Contractions (PACs) Irregular, p wave shape is different from SA node and generated p wave. ventricular tachycardia -MED OF CHOICE: Lidocaine -Ventricular rate of 150-250/min -originates from foci firing repeatedly in the ventricle -Regular rhythm -Wide QRS (>0.12 sec or >3 small squares) Infective Endocarditis (IE) In IE vegetation over the valve can break off and embolize to various organs. Organs resulting in life threatening conditions and complications. May cause muscle damage or tiny clots that damage the small capillaries. Not as critical emboli. -Stroke(paralysis on one side) -Spinal cord ischemia(paralysis in both legs) -ischemia to the extremities(pain, pallor, and cold foot or arm) -intestinal infarction (abd pain) -splenic infarction (LUQ pain) -septic pulmonary emboli The nurse or client at home should contact HCP immediately . -kidney infarction -hematuria -splinter hemorrhage -petechiae -osler nodes -gangrene

-Urine output -Peripheral sensation -Extremity temp Virchow's triad 3 common theories: Behind the pathophysiology of venous emboli (DVT, PE) -Venous stasis -Endothelial damage -Hypercoagulability of blood Coronary arteriogram (angiogram) Diagnostic test of coronary arteries, heart chamber, and function of the heart. The client should have IV line started for sedation meds. Femoral or radial artery will be accessed. -Dont eat or drink for 6-12 hrs prior to procedure -Client may feel warm or flushed during contrast dye. -Compression on insertion site, have to lay flat for hours. angiography -a radiographic study of the blood vessels after the injection of a contrast medium. (Cardiac Cath) -If the test is just a diagnostic test then the pt often goes home the same day. -Angioplasty may require 1-3 days hospitalization or if stent is placed. -General anesthesia is not given for angiography sedation meds are used. Supraventricular tachycardia

MED CHOICE: Adenosine and adenocard Asytole MED CHOICE: Atropine Chronic Heart Failure (CHF) MED CHOICE: Ace inhibitor Pts with chronic HF are at risk for acute decompensation HF and also pulmonary edema. anaphalactic shock MED CHOICE: Epinephrine Status epilepticus MED CHOICE: Valium Bipolar disorder MED CHOICE: Lithium Hyperkalemia

5.0 mEq/L DANGEROUS: