Download NCLEX RN CARDIOVASCULAR EXAM 115 QUESTIONS AND ANSWERS RATED A+ UPDATE 2025/2026 and more Exams Nursing in PDF only on Docsity!
NCLEX RN CARDIOVASCULAR EXAM 115 QUESTIONS AND ANSWERS RATED
A+ UPDATE 2025/
The ambulatory care nurse is working with a client who has been diagnosed with Prinzmetal's (variant) angina. What should the nurse plan to teach the client about this type of angina?
1.It is most effectively managed by β-blocking agents.
2.It has the same risk factors as stable and unstable angina.
3.It can be controlled with a low-sodium, high-potassium diet.
4.Generally it is treated with calcium-channel-blocking agents
Prinzmetal's angina results from spasm of the coronary vessels and is treated with calcium-channel blockers. β- Blockers are contraindicated because they may actually worsen the spasm. The risk factors are unknown, and this type of angina is relatively unresponsive to nitrates. Diet therapy is not specifically indicated.
Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Client Education, Perfusion
Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse most 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
PVCs are abnormal ectopic beats originating in the ventricles. They are characterized by an absence of P waves, presence of wide and bizarre QRS complexes, and a compensatory pause that follows the ectopy.
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Subject
Priority Concepts: Clinical Judgment, Perfusion
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?
Regular insulin
Glipizide (Glucotrol)
Repaglinide (Prandin)
Metformin (Glucophage)
Metformin (Glucophage) needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system, the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before and 48 hours after cardiac catheterization.
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Planning
Content Area: Adult Health: Cardiovascular
Strategy(s): Comparable or Alike Options
Priority Concepts: Perfusion, Safety
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Subject
Priority Concepts: Clinical Judgment, Perfusion
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
Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger's disease, so stopping smoking completely is recommended. Because smoking is a form of chemical dependency, referral to a smoking-cessation program may be helpful for many clients. For many clients with Buerger's disease, symptoms are relieved or alleviated once smoking stops. A dietitian, a medical social worker, and a pain management clinic are not specifically associated with the lifestyle changes required in this disorder although they may be needed if secondary problems arise.
Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Care Coordination, Perfusion
A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem?
1.Ambulates 10 feet farther each day
2.Verbalizes the benefits of increasing activity
3.Chooses a healthy diet that meets caloric needs
4.Sleeps without awakening throughout the night
Each of the options indicates a positive outcome on the part of the client. Both options 2 and the correct one relate to the client problem of difficulty with completion of daily activities. However, the question asks about progress. The correct option is more action-oriented and therefore is the better choice. Option 3 would most likely indicate progress if the client had a problem of inadequate nutritional intake. Option 4 would be a satisfactory outcome for a client experiencing difficulty sleeping.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words
Priority Concepts: Functional Ability, Health Promotion
A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment?
1.Flat neck veins
2.Nausea and vomiting
3.Hypotension and dizziness
4.Clubbed fingertips and headache
The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output due to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
2.Wheezes
3.Crackles in the bases
4.Crackles throughout the lung fields
Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. As the client's condition improves, the amount of fluid in the alveoli decreases, which may be detected by crackles in the bases. (Clear lung sounds indicate full resolution of the episode.) Rhonchi and wheezes are not associated with pulmonary edema. Auscultation of the lungs reveals crackles throughout the lung fields.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Gas Exchange
A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding?
1.Occur in pairs
2.Appear to be multifocal
3.Fall on the second half of the T wave
4.Decrease to a frequency of less than 6 per minute
PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client's cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly dysrhythmias.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject, Strategic Words
Priority Concepts: Clinical Judgment, Perfusion
A client is admitted to the hospital with a diagnosis of aortic regurgitation. The nurse plans care for the client, knowing that the failure of the aortic valve to close completely allows blood to flow retrograde through which structures?
1.Aorta to left ventricle
2.Left ventricle to left atrium
3.Right ventricle to right atrium
4.Pulmonary artery to right ventricle
The aortic valve separates the aorta from the left ventricle. Options 2, 3, and 4 describe the mitral, tricuspid, and pulmonic valves, respectively.
Cognitive Ability: Understanding
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Planning
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Perfusion
A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures?
1.Left ventricle to aorta
2.Left atrium to left ventricle
3.Right atrium to right ventricle
4.Right ventricle to pulmonary artery
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."
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."
When a client has HF, the goal is to reduce fluid accumulation. One way that this is accomplished is through sodium reduction. Ham (and most cold cuts), cheese, and potato chips are high in sodium. Daily weighing is an appropriate intervention to help the client monitor fluid overload. Most fresh fruits and vegetables are low in sodium.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Negative Event Query
Priority Concepts: Client Education, Health Promotion
A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction?
1.Take antibiotics until the chest pain is fully resolved.
2.Take acetaminophen (Tylenol) if the chest pain worsens.
3.Use a firm-bristle toothbrush and floss vigorously to prevent cavities.
4.Notify all health care providers (HCP) of the history of infective endocarditis before any invasive procedures.
The client should alert any HCP about the history of infective endocarditis before any procedure that involves instrumentation. The HCP should place the client on prophylactic antibiotics if an invasive procedure is needed. Antibiotics should be taken for the full course of therapy. The client should notify the HCP if chest pain worsens or if dyspnea or other symptoms occur. The client should use a soft toothbrush and floss carefully to avoid any trauma to the gums, which could provide a portal of entry for bacterial infection.
Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Client Education, Infection
A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item?
1.Sensation of palpitations
2.Causative factors, such as caffeine
3.Precipitating factors, such as infection
4.Blood pressure and oxygen saturation
Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol.
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, ABCs—Airway, Breathing, Circulation
Priority Concepts: Clinical Judgment, Perfusion
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Comparable or Alike Options
Priority Concepts: Client Education, Perfusion
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 came back elevated?
1.Myoglobin
2.Cardiac troponin
3.C-reactive protein
4.Creatine kinase (CK)
Cardiac troponin elevations indicate myocardial injury or infarction. Although the remaining options may also rise, they are not definitive enough to draw a conclusive diagnosis.
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Perfusion
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse?
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.
Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.
Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Implementation
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Steps of the Nursing Process
A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise?
1.Oxygen saturation decreased from 96% to 91%.
2.Pulse rate increased from 80 to 104 beats per minute.
3.Blood pressure decreased from 140/86 to 112/72 mm Hg.
4.Respiratory rate increased from 16 to 19 breaths per minute.
Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. Additionally, it reflects a minimal increase. A pulse rate increase to a rate over 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Subject
Priority Concepts: Mobility, Perfusion
Sinus dysrhythmia has all of the characteristics of normal sinus rhythm except for the presence of an irregular PP interval. This irregular rhythm occurs because of phasic changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration. Cardiac output is not affected.
Cognitive Ability: Understanding
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Perfusion
A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0. second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?
1.Sinus dysrhythmia
2.Sinus tachycardia
3.Sinus bradycardia
4.Normal sinus rhythm
Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Perfusion
A client who had coronary artery bypass surgery states to the home health nurse: "get so frustrated. I can't even do my gardening." The nurse then assesses the client for activity level since the surgery. Which client statement indicates a need for further teaching?
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."
Exercise is an integral part of the rehabilitation program. It is necessary for optimal physiological functioning and psychological well-being. Postoperative physical rehabilitation must be progressive with planned periods of rest. Exercise tolerance is judged by the client's response, such as heart rate and endurance. Planning regular rest periods, pacing activities, and avoiding outdoor activities during the heat of the day are appropriate client activities. The correct option lacks planned periods of rest, and the client has grouped too many activities in a brief period of time, which will decrease endurance. Also, exercise after meals can decrease the client's tolerance because of shunting of blood to the gastrointestinal tract for digestion.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Negative Event Query, Comparable or Alike Options
Priority Concepts: Client Education, Perfusion
A client who has been exercising in a gymnasium stops to measure his pulse and places his fingers over both carotid arteries simultaneously. A nurse exercising nearby is correct when the nurse cautions him 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.
A client who is beginning an exercise program asks the nurse why his heart "feels like it's pounding" when he is exercising vigorously. In formulating a response, the nurse understands that this effect occurs because of the client's primary need for which increased cardiac response?
1.Pulse rate
2.Cardiac index
3.Cardiac output
4.Stroke volume
The client's symptoms are the direct result of the body's attempt to meet the metabolic demands generated during exercise. An adequate cardiac output is needed to maintain perfusion to the vital organs of the body. With exercise, these demands increase, and the heart must beat faster (increased heart rate) and harder (increased stroke volume) to meet them. Cardiac index is an artificial number used to determine the adequacy of the cardiac output for a given individual. It is calculated by adjusting the cardiac output for body surface area.
Cognitive Ability: Understanding
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Adult Health: Cardiovascular
Strategy(s): Strategic Words, Subject, Umbrella Option
Priority Concepts: Client Education, Perfusion
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
If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted. A demand pacemaker fires only when needed and should therefore discharge only when no electrical activity is occurring in the client's own heart.
Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Assessment
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Clinical Judgment, Perfusion
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."
After angioplasty, the client needs to be instructed regarding the specific dietary restrictions that must be followed. Making the recommended dietary and lifestyle changes will assist in preventing further atherosclerosis. Abrupt closure of the artery can occur if the dietary and lifestyle recommendations are not followed. Cigarette smoking needs to be stopped. An angioplasty does not repair the heart.
Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process: Evaluation
Content Area: Adult Health: Cardiovascular
Strategy(s): Subject
Priority Concepts: Client Education, Perfusion
