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NCLEX RN CARDIOVASCULAR SYSTEM EXAM 200 QUESTIONS
AND ANSWERS RATED A+ NEWEST 2025/
After administering newly prescribed captopril (Capoten) to a client with heart failure, the nurse implements interventions to decrease complications. Which priority intervention should the nurse implement for this client?
a. Provide food to decrease nausea and aid in absorption.
b. Instruct the client to ask for assistance when rising from bed.
c. Collaborate with unlicensed assistive personnel to bathe the client.
d. Monitor potassium levels and check for symptoms of hypokalemia.
b. Instruct the client to ask for assistance when rising from bed.
Administration of the first dose of angiotensin-converting enzyme (ACE) inhibitors is often associated with hypotension, usually termed first-dose effect. The nurse should instruct the client to seek assistance before arising from bed to prevent injury from postural hypotension. ACE inhibitors do not need to be taken with food. Collaboration with unlicensed assistive personnel to provide hygiene is not a priority. The client should be encouraged to complete activities of daily living as independently as possible. The nurse should monitor for hyperkalemia, not hypokalemia, especially if the client has renal insufficiency secondary to heart failure.
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching?
a. I should wear a snug-fitting shirt over the ICD.
b. I will avoid sources of strong electromagnetic fields.
c. I should participate in a strenuous exercise program.
d. Now I can discontinue my antidysrhythmic medication.
b. I will avoid sources of strong electromagnetic fields.
The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Clients should avoid tight clothing, which could cause irritation over the ICD generator. The client should be encouraged to exercise but should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately. The client should continue all prescribed medications.
After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the client's understanding. Which client statement indicates a need for additional teaching?
a. I'll be able to carry heavy loads after 6 months of rest.
b. I will have my teeth cleaned by my dentist in 2 weeks.
c. I must avoid eating foods high in vitamin K, like spinach.
d. I must use an electric razor instead of a straight razor to shave.
b. I will have my teeth cleaned by my dentist in 2 weeks.
Clients who have defective or repaired valves are at high risk for endocarditis. The client who has had valve surgery should avoid dental procedures for 6 months because of the risk for endocarditis. When undergoing a mitral valve replacement surgery, the client needs to be placed on anticoagulant therapy to prevent vegetation forming on the new valve. Clients on anticoagulant therapy should be instructed on bleeding precautions, including using an electric razor. If the client is prescribed warfarin, the client should avoid foods high in vitamin K. Clients recovering from open heart valve replacements should not carry anything heavy for 6 months while the chest incision and muscle heal.
After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, "Why is this important? How should the nurse respond?"
a. Rapid position changes can create shear and friction forces, which can tear out your internal vascular sutures.
b. Your new vascular connections are more sensitive to position changes, leading to increased intravascular pressure and dizziness.
c. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes.
d. While your heart is recovering, blood flow is diverted away from the brain, increasing the risk for stroke when you stand up.
c. Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes.
Because the new heart is denervated, the baroreceptor and other mechanisms that compensate for blood pressure drops caused by position changes do not function. This allows orthostatic hypotension to persist in the postoperative period. The other options are false statements and do not correctly address the clients question.
After teaching a client with congestive heart failure (CHF), the nurse assesses the clients understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.)
a. I'll read the nutritional labels on food items for salt content.
b. I will drink at least 3 liters of water each day.
c. Using salt in moderation will reduce the workload of my heart.
d. I will eat oatmeal for breakfast instead of ham and eggs.
a. The t-PA didnt dissolve the entire coronary clot.
b. The heparin keeps that artery from getting blocked again.
c. Heparin keeps the blood as thin as possible for a longer time.
d. The heparin prevents a stroke from occurring as the t-PA wears off.
b. The heparin keeps that artery from getting blocked again.
After the original intracoronary clot has dissolved, large amounts of thrombin are released into the bloodstream, increasing the chance of the vessel reoccluding. The other statements are not accurate. Heparin is not a blood thinner, although laypeople may refer to it as such.
A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 0.5 mm Hg. What action by the nurse is most appropriate?
a. Level the transducer at the phlebostatic axis.
b. Lay the client in the supine position.
c. Prepare to administer diuretics.
d. Prepare to administer a fluid bolus.
d. Prepare to administer a fluid bolus.
Normal right atrial pressures are from 1 to 8 mm Hg. Lower pressures usually indicate hypovolemia, so the nurse should prepare to administer a fluid bolus. The transducer should remain leveled at the phlebostatic axis. Positioning may or may not influence readings. Diuretics would be contraindicated.
A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response?
a. Decreased intraocular pressure
b. Increased heart rate
c. Short period of asystole
d. Hypertensive crisis
c. Short period of asystole
Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain. Adenosine has no conclusive impact on intraocular pressure.
A nurse admits a client who is experiencing an exacerbation of heart failure. Which action should the nurse take first?
a. Assess the clients respiratory status.
b. Draw blood to assess the clients serum electrolytes.
c. Administer intravenous furosemide (Lasix).
d. Ask the client about current medications.
a. Assess the clients respiratory status.
Assessment of respiratory and oxygenation status is the priority nursing intervention for the prevention of complications. Monitoring electrolytes, administering diuretics, and asking about current medications are important but do not take priority over assessing respiratory status.
The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, Why do you want to know if I use cocaine? How should the nurse respond?
a. Substance abuse puts clients at risk for many health issues.
b. The hospital requires that I ask you about cocaine use.
c. Clients who use cocaine are at risk for fatal dysrhythmias.
d. We can provide services for cessation of substance abuse.
c. Clients who use cocaine are at risk for fatal dysrhythmias.
Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias. The other responses do not adequately address the clients question.
A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right- sided heart failure?
a. I sleep with four pillows at night.
b. My shoes fit really tight lately.
c. I wake up coughing every night.
d. I have trouble catching my breath.
b. My shoes fit really tight lately.
a. The client has hyperkalemia causing irregular QRS complexes.
b. Ventricular tachycardia is overriding the normal atrial rhythm.
c. The clients chest leads are not making sufficient contact with the skin.
d. Ventricular and atrial depolarizations are initiated from different sites.
d. Ventricular and atrial depolarizations are initiated from different sites.
Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization. This finding on an electrocardiograph tracing is not an indication of hyperkalemia, ventricular tachycardia, or disconnection of leads.
A nurse assesses a client who has a history of heart failure. Which question should the nurse ask to assess the extent of the clients heart failure?
a. Do you have trouble breathing or chest pain?
b. Are you able to walk upstairs without fatigue?
c. Do you awake with breathlessness during the night?
d. Do you have new-onset heaviness in your legs?
b. Are you able to walk upstairs without fatigue?
Clients with a history of heart failure generally have negative findings, such as shortness of breath. The nurse needs to determine whether the clients activity is the same or worse, or whether the client identifies a decrease in activity level. Trouble breathing, chest pain, breathlessness at night, and peripheral edema are symptoms of heart failure, but do not provide data that can determine the extent of the clients heart failure.
A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia should the nurse assess?
a. Preventricular contractions
b. Atrial fibrillation
c. Symptomatic bradycardia
d. Sinus tachycardia
b. Atrial fibrillation
Atrial fibrillation is a clinical manifestation of mitral valve regurgitation and stenosis. Preventricular contractions and bradycardia are not associated with valvular problems. These are usually identified in clients with electrolyte imbalances, myocardial infarction, and sinus node problems. Sinus tachycardia is a manifestation of aortic regurgitation due to a decrease in cardiac output.
A nurse assesses a client who is diagnosed with infective endocarditis. Which assessment findings should the nurse expect? (Select all that apply.)
a. Weight gain
b. Night sweats
c. Cardiac murmur
d. Abdominal bloating
e. Oslers nodes
b. Night sweats
c. Cardiac murmur
e. Oslers nodes
Clinical manifestations of infective endocarditis include fever with chills, night sweats, malaise and fatigue, anorexia and weight loss, cardiac murmur, and Oslers nodes on palms of the hands and soles of the feet. Abdominal bloating is a manifestation of heart transplantation rejection.
A nurse assesses a client who is recovering from a heart transplant. Which assessment findings should alert the nurse to the possibility of heart transplant rejection? (Select all that apply.)
a. Shortness of breath
b. Abdominal bloating
c. New onset bradycardia
d. Increased ejection fraction
e. Hypertension
a. Shortness of breath
b. Abdominal bloating
c. New onset bradycardia
Clinical manifestations of heart transplant rejection include shortness of breath, fatigue, fluid gain, abdominal bloating, new- onset bradycardia, hypotension, atrial fibrillation or flutter, decreased activity tolerance, and decreased ejection fraction.
A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse?
a. Mid-sternal chest pain
b. Increased urine output
c. Mild orthostatic hypotension
d. P wave touching the T wave
a. Mid-sternal chest pain
Chest pain, possibly angina, indicates that tachycardia may be increasing the clients myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain. Increased urinary output and mild orthostatic hypotension are not life-threatening conditions and therefore do not require immediate intervention. The P wave touching the T wave indicates significant tachycardia and should be assessed to determine the underlying rhythm and cause; this is an important assessment but is not as critical as chest pain, which indicates cardiac cell death.
A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure?
a. A 36-year-old woman with aortic stenosis
b. A 42-year-old man with pulmonary hypertension
c. A 59-year-old woman who smokes cigarettes daily
d. A 70-year-old man who had a cerebral vascular accident
a. A 36-year-old woman with aortic stenosis
Although most people with heart failure will have failure that progresses from left to right, it is possible to have left-sided failure alone for a short period. It is also possible to have heart failure that progresses from right to left. Causes of left ventricular failure include mitral or aortic valve disease, coronary artery disease, and hypertension. Pulmonary hypertension and chronic cigarette smoking are risk factors for right ventricular failure. A cerebral vascular accident does not increase the risk of heart failure.
A nurse assesses clients on a cardiac unit. Which clients should the nurse identify as at greatest risk for the development of acute pericarditis? (Select all that apply.)
a. A 36-year-old woman with systemic lupus erythematosus (SLE)
b. A 42-year-old man recovering from coronary artery bypass graft surgery
c. A 59-year-old woman recovering from a hysterectomy
d. An 80-year-old man with a bacterial infection of the respiratory tract
e. An 88-year-old woman with a stage III sacral ulcer
a. A 36-year-old woman with systemic lupus erythematosus (SLE)
b. A 42-year-old man recovering from coronary artery bypass graft surgery
d. An 80-year-old man with a bacterial infection of the respiratory tract
Acute pericarditis is most commonly associated acute exacerbations of systemic connective tissue disease, including SLE; with Dresslers syndrome, or inflammation of the cardiac sac after cardiac surgery or a myocardial infarction; and with infective organisms, including bacterial, viral, and fungal infections. Abdominal and reproductive surgeries and pressure ulcers do not increase clients risk for acute pericarditis.
A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion?
a. Administer intravenous adenosine.
b. Turn off oxygen therapy.
c. Ensure a tongue blade is available.
d. Position the client on the left side.
b. Turn off oxygen therapy.
For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire. The other interventions are not appropriate for a cardioversion. The client should be placed in a supine position.
A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, "Why will I need to take anticoagulants for the rest of my life?" How should the nurse respond?
a. The prosthetic valve places you at greater risk for a heart attack.
b. Blood clots form more easily in artificial replacement valves.
c. The vein taken from your leg reduces circulation in the leg.
d. The surgery left a lot of small clots in your heart and lungs.
b. Blood clots form more easily in artificial replacement valves.
b. Provide the client with a sleeping pill to stimulate rest.
c. Schedule periods of exercise and rest during the day.
d. Ask unlicensed assistive personnel to help bathe the client.
c. Schedule periods of exercise and rest during the day.
Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living. The nurse should schedule periods of exercise and rest during the day to decrease fatigue. The other interventions will not assist the client with self-care activities.
A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations should the nurse assess? (Select all that apply.)
a. Decrease in cardiac output
b. Increase in cardiac output
c. Decrease in blood pressure
d. Increase in blood pressure e. Decrease in urine output
f. Increase in urine output
a. Decrease in cardiac output
d. Increase in blood pressure e. Decrease in urine output
Elevated heart rates in a healthy client initially cause blood pressure and cardiac output to increase. However, in a client who has congestive heart failure or a client with long-term tachycardia, ventricular filling time, cardiac output, and blood pressure eventually decrease. As cardiac output and blood pressure decrease, urine output will fall.
A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, I know a transplant is my last chance, but I dont want to become a vegetable. How should the nurse respond?
a. Would you like to speak with a priest or chaplain?
b. I will arrange for a psychiatrist to speak with you.
c. Do you want to come off the transplant list?
d. Would you like information about advance directives?
d. Would you like information about advance directives?
The client is verbalizing a real concern or fear about negative outcomes of the surgery. This anxiety itself can have a negative effect on the outcome of the surgery because of sympathetic stimulation. The best action is to allow the client to verbalize the
concern and work toward a positive outcome without making the client feel as though he or she is crazy. The client needs to feel that he or she has some control over the future. The nurse personally provides care to address the clients concerns instead of pushing the clients issues off on a chaplain or psychiatrist. The nurse should not jump to conclusions and suggest taking the client off the transplant list, which is the best treatment option.
A nurse cares for a client with infective endocarditis. Which infection control precautions should the nurse use?
a. Standard Precautions
b. Bleeding precautions
c. Reverse isolation
d. Contact isolation
a. Standard Precautions
The client with infective endocarditis does not pose any specific threat of transmitting the causative organism. Standard Precautions should be used. Bleeding precautions or reverse or contact isolation is not necessary.
A nurse cares for a client with right-sided heart failure. The client asks, Why do I need to weigh myself every day? How should the nurse respond?
a. Weight is the best indication that you are gaining or losing fluid.
b. Daily weights will help us make sure that you're eating properly.
c. The hospital requires that all inpatients be weighed daily.
d. You need to lose weight to decrease the incidence of heart failure.
a. Weight is the best indication that you are gaining or losing fluid.
Daily weights are needed to document fluid retention or fluid loss. One liter of fluid equals 2.2 pounds. The other responses do not address the importance of monitoring fluid retention or loss.
A nurse cares for an older adult client with heart failure. The client states, "I don't know what to do. I don't want to be a burden to my daughter, but I cant do it alone. Maybe I should die." How should the nurse respond?
a. Would you like to talk more about this?
b. You are lucky to have such a devoted daughter.
c. It is normal to feel as though you are a burden.
e. Proteinuria
f. Microalbuminuria
A hematocrit of 32.8% is low (should be 42.6%), indicating a dilutional ratio of red blood cells to fluid. A serum sodium of 130 mEq/L is low because of hemodilution. Microalbuminuria and proteinuria are present, indicating a decrease in renal filtration. These are early warning signs of decreased compliance of the heart. The potassium level is on the high side of normal and the serum creatinine level is normal.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this clients medication administration record to prevent a common complication of this condition?
a. Sotalol (Betapace)
b. Warfarin (Coumadin)
c. Atropine (Sal-Tropine)
d. Lidocaine (Xylocaine)
b. Warfarin (Coumadin)
Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.
A nurse is assessing a client with left-sided heart failure. For which clinical manifestations should the nurse assess? (Select all that apply.)
a. Pulmonary crackles
b. Confusion, restlessness
c. Pulmonary hypertension
d. Dependent edema
e. Cough that worsens at night
a. Pulmonary crackles
b. Confusion, restlessness
e. Cough that worsens at night
Left-sided heart failure occurs with a decrease in contractility of the heart or an increase in afterload. Most of the signs will be noted in the respiratory system. Right-sided heart failure occurs with problems from the pulmonary vasculature onward including pulmonary hypertension. Signs will be noted before the right atrium or ventricle including dependent edema.
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation?
a. A 45-year-old who takes an aspirin daily
b. A 50-year-old who is post coronary artery bypass graft surgery
c. A 78-year-old who had a carotid endarterectomy
d. An 80-year-old with chronic obstructive pulmonary disease
b. A 50-year-old who is post coronary artery bypass graft surgery
Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery. The other conditions do not place these clients at higher risk for atrial fibrillation.
A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side of the neck. Which nonpharmacologic comfort measure should the nurse implement?
a. Apply an ice pack to the clients chest.
b. Provide a neck rub, especially on the left side.
c. Allow the client to lie in bed with the lights down.
d. Sit the client up with a pillow to lean forward on.
d. Sit the client up with a pillow to lean forward on.
Pain from acute pericarditis may worsen when the client lays supine. The nurse should position the client in a comfortable position, which usually is upright and leaning slightly forward. Pain is decreased by using gravity to take pressure off the heart muscle. An ice pack and neck rub will not relieve this pain.
A nurse is teaching a client with heart failure who has been prescribed enalapril (Vasotec). Which statement should the nurse include in this clients teaching?
a. Avoid using salt substitutes.
b. Take your medication with food.
c. Avoid using aspirin-containing products.
d. Check your pulse daily.
A nurse prepares to discharge a client who has heart failure. Based on the Heart Failure Core Measure Set, which actions should the nurse complete prior to discharging this client? (Select all that apply.)
a. Teach the client about dietary restrictions.
b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor.
c. Encourage the client to take a baby aspirin each day.
d. Confirm that an echocardiogram has been completed.
e. Consult a social worker for additional resources.
a. Teach the client about dietary restrictions.
b. Ensure the client is prescribed an angiotensin-converting enzyme (ACE) inhibitor.
d. Confirm that an echocardiogram has been completed.
The Heart Failure Core Measure Set includes discharge instructions on diet, activity, medications, weight monitoring and plan for worsening symptoms, evaluation of left ventricular systolic function (usually with an echocardiogram), and prescribing an ACE inhibitor or angiotensin receptor blocker. Aspirin is not part of the Heart Failure Core Measure Set and is usually prescribed for clients who experience a myocardial infarction. Although the nurse may consult the social worker or case manager for additional resources, this is not part of the Core Measures.
A nurse prepares to discharge a client who has heart failure. Which questions should the nurse ask to ensure this clients safety prior to discharging home? (Select all that apply.)
a. Are your bedroom and bathroom on the first floor?
b. What social support do you have at home?
c. Will you be able to afford your oxygen therapy?
d. What spiritual beliefs may impact your recovery?
e. Are you able to accurately weigh yourself at home?
a. Are your bedroom and bathroom on the first floor?
b. What social support do you have at home?
d. What spiritual beliefs may impact your recovery?
To ensure safety upon discharge, the nurse should assess for structural barriers to functional ability, such as stairs. The nurse should also assess the clients available social support, which may include family, friends, and home health services. The clients ability to adhere to medication and treatments, including daily weights, should also be reviewed. The other questions do not address the clients safety upon discharge.
A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge?
a. Medication reconciliation
b. Immunization history
c. Religious beliefs
d. Nutrition preferences
a. Medication reconciliation
The home health nurse needs to know current medications the client is taking to ensure assessment, evaluation, and further education related to these medications. The other information will not assist the nurse to develop a plan of care for the client.
A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure?
a. Clean the skin and clip hairs if needed.
b. Add gel to the electrodes prior to applying them.
c. Place the electrodes on the posterior chest.
d. Turn off oxygen prior to monitoring the client.
To ensure the best signal transmission, the skin should be clean and hairs clipped. Electrodes should be placed on the anterior chest, and no additional gel is needed. Oxygen has no impact on electrocardiographic monitoring.
A nurse teaches a client recovering from a heart transplant who is prescribed cyclosporine (Sandimmune). Which statement should the nurse include in this clients discharge teaching?
a. Use a soft-bristled toothbrush and avoid flossing.
b. Avoid large crowds and people who are sick.
c. Change positions slowly to avoid hypotension.
d. Check your heart rate before taking the medication.
b. Avoid large crowds and people who are sick.
These agents cause immune suppression, leaving the client more vulnerable to infection. The medication does not place the client at risk for bleeding, orthostatic hypotension, or a change in heart rate.
