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NCLEX cardiac questions and answers
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The nurse in the telemetry unit explains two nonpharmacological treatments such as ___________, or ___________, can be used to treat dysrhythmias.
A) ECG; pacemaker
B) Cardioversion; defibrillation
C) Aspirin; Plavix
D) Exercise; stress test โโB) Cardioversion; defibrillation
The more serious types of dysrhythmias are corrected through electrical shock of the heart, a treatment called elective cardioversion, or defibrillation.
The client is scheduled for implantable cardioverter defibrillators (ICD) for treatment of a dysrhythmia. The nurse explains that the action of this procedure is to:
A) Trigger electrical impulses to the heart.
B) Take over SA node function.
C) Block AV node transmission of impulses.
D) Increase ventricular conduction. โโA) Trigger electrical impulses to the heart.
The nurse recognizes the action of beta blockers for treatment of dysrhythmias is:
A) Positive inotropic effect.
B) Negative inotropic effect.
C) Positive chronotropic effect.
D) Negative chronotropic effect. โโD) Negative chronotropic effect.
Beta blockers slow the heart rate (negative chronotropic effect) and decrease conduction velocity through the AV node.
A client with a diagnosis of cardiac dysrhythmias and a history of type I diabetes mellitus is placed on propranolol therapy. The client asks the nurse if the drug will affect insulin needs. The best response by the nurse would be that:
A) The drug will have no effect on insulin needs.
B) The drug might cause hypoglycemia.
C) The drug could cause hyperglycemia.
A) Heart rate.
B) Blood pressure.
D) Glucose.
C) Potassium. โโA) Heart rate.
Rationale: Studies show lack of drug-metabolizing enzyme (mephenytoin hydroxylase) causes Asians to metabolize propranolol more quickly than do Caucasians. The nurse should assess for high early buildup and overdose.
When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be:
A) The client will avoid use of caffeine during therapy.
B) The client will maintain heart rate below 60 beats per minute.
C) The client will limit fluid intake to 1000 ml/day.
D) The client will limit cigarettes to 15/day. โโA) The client will avoid use of caffeine during
therapy.
Rationale: Causes of dysrhythmias include electrolyte imbalance, hyperthyroidism, anxiety, caffeine ingestion, and tobacco use. The client should be taught to avoid caffeine and tobacco.
Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A) Abdominal pain.
B) Absent pedal pulses.
C) Chest pain.
D) Lower back pain. โโD) Lower back pain.
What is the most common cause of abdominal aortic aneurysm?
A) Atherosclerosis
B) DM
C) HPN
D) Syphili โโA) Atherosclerosis
n which of the following areas is an abdominal aortic aneurysm most commonly located?
D) Upper back pain โโA) Abdominal pain
Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A) Abdominal pain
B) Absent pedal pulses
C) Angina
D) Lower back pain โโD) Lower back pain
What is the definitive test used to diagnose an abdominal aortic aneurysm?
A) Abdominal X-ray
B) Arteriogram
C) CT scan
D) Ultrasound โโB) Arteriogram
Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
A) HPN
B) Aneurysm rupture
C) Cardiac arrythmias
D) Diminished pedal pulses โโB) Aneurysm rupture
When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
A) Right upper quadrant
B) Directly over the umbilicus
C) Middle lower abdomen to the left of the midline
D) Midline lower abdomen to the right of the midline โโC) Middle lower abdomen to the left
of the midline
Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
C) Severe lower back pain, decreased BP, decreased RBC, decreased WBC
D) Intermittent lower back pain, decreased BP, decreased RBC, increased WBC โโB) Severe
lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased - not increase. The WBC count increases as cells migrate to the site of injury.
A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:
A) Loss of sensation in the lower extremities
B) Back pain that lessens when standing
C) Decreased urinary output
D) Pulsations in the periumbilical area โโD) Pulsations in the periumbilical area
Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be :
A) Placing her in a trendeleburg position
B) Putting several warm blankets on her
C) Monitoring her hourly urine output
D) Assessing her VS especially her RR โโD) Assessing her VS especially her RR
A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?
A) The patient will be admitted to the medicine unit for observation and medication.
B) The patient will be admitted to the day surgery unit for sclerotherapy.
C) The patient will be admitted to the surgical unit and resection will be scheduled.
D) The patient will be discharged home to follow-up with his cardiologist in 24 hours. โโC)
The patient will be admitted to the surgical unit and resection will be scheduled.
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." โโ3."I need to adhere to my dietary
restrictions."
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 โโ4.Raspberry juice
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?
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?" โโ1."Where is the pain located?"
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." โโ2."I should use polyunsaturated
oils in my diet."
The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hypercholesterolemia.
The health care provider has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure?
1.Questions the client about allergies to iodine or shellfish
2.Has the client sign an informed consent form for an invasive procedure
3.Tells the client that the procedure is painless and takes 30 to 60 minutes
4.Keeps the client on nothing-by-mouth (NPO) status for 2 hours before the procedure โโ3.Tells the client that the procedure is painless and takes 30 to 60 minutes
A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure?
1.Eat breakfast just before the procedure.
2.Wear firm, rigid shoes, such as workboots.
3.Wear loose clothing with a shirt that buttons in front.
4.Avoid cigarettes for 30 minutes before the procedure. โโ3.Wear loose clothing with a shirt
that buttons in front.
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 โโ1.Chest pain
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."
โโ4."I probably will feel tired after the test from lying on a hard x-ray table for a few hours."
A client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. What type of angina should the nurse determine that the client is experiencing?
1.Stable
2.Variant
3.Unstable
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. โโ3.The pain has not been relieved by rest and nitroglycerin tablets.
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 โโ3.Bathroom privileges and
self-care activities
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
should the nurse identify as the most likely 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 โโ1.Tarry stools
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 Hematest testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood.
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 year."
