NCLEX cardiovascular, hematologic, and lymphatic

A client's serum potassium level is below the normal range. Which clinical indicators should the nurse determine are consistent with hypokalemia? Select all that apply. A. Abdominal cramping B. Tall, peaked T wave C. Irregular heart rate D. Muscular weakness E. Decreased bowel sounds F. Hyperactive deep tendon reflexes

A. Abdominal cramping C. Irregular heart rate D. Muscular weakness E. Decreased bowel sounds

A client had a pneumonectomy. For which postoperative complication specific to this type of surgery should the nurse assess this client? A. Brain attack B. Renal failure C. Internal bleeding D. Cardiac overload

D. Cardiac overload

A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding? A. Renal embolic event B. Pulmonary embolic event C. Central nervous system embolic event D. Splenic embolic event

D. Splenic embolic event

A nurse is completing the admission assessment of a client with peripheral arterial disease. Which assessments will the nurse expect to observe? Select all that apply. A. Absence of hair on the toes B. Superficial ulcer with irregular edges C. Pitting edema of the lower extremities D. Reports of pain associated with exercising E. Increased pigmentation of the medial malleolus area

A. Absence of hair on the toes D. Reports of pain associated with exercising

What is the most definitive test to confirm a diagnosis of multiple myeloma? A. Bone marrow biopsy B. Serum test for hypercalcemia C. Urine test for Bence Jones protein D. X-ray films of the ribs, spine, and skull

A. Bone marrow biopsy

Which topic is most important for the nurse to teach in a community health promotion class of middle-aged adults? A. Cessation of smoking B. Prevention of infection C. Abstinence from alcohol D. Decreasing high-density lipoproteins (HDL) levels

A. Cessation of smoking

Select-all-that-apply: What are the typical signs and symptoms of infective endocarditis? A. Hyperthermia B. S4 gallop C. Enlarged Spleen D. Hyperkalemia E. Substernal pain that radiates to the back F. Heart failure G. Cardiac Murmur

A. Hyperthermia C. Enlarged Spleen F. Heart failure G. Cardiac Murmur

A person is brought to the emergency department after prolonged exposure to cold weather. What clinical manifestations of hypothermia does the nurse expect? Select all that apply. A. Stupor B. Erythema C. Increased anxiety D. Rapid respirations E. Paresthesia in affected body parts

A. Stupor E. Paresthesia in affected body parts

A client with mild chronic heart failure is to be discharged with prescriptions for daily oral doses of an antidysrhythmic, potassium chloride 40 mEq, docusate sodium 100 mg, and furosemide 40 mg twice a day. The client reports having no family members who can help after discharge. What should the nurse help this client identify? A. Support systems that can assist the client at home B. Potential nursing homes in which the client can recuperate C. Agencies that can help the client regain activities of daily living D. Ways that the client can develop relationships with neighbors

A. Support systems that can assist the client at home

Which clinical indicator is the nurse most likely to identify when completing a history and physical assessment of a client with complete heart block? A. Syncope B. Headache C. Tachycardia D. Hemiparesis

A. Syncope

A client has a mitral valve replacement, and the nurse provides health teaching to promote optimum health. Which client statement supports the nurse's conclusion that the client needs further teaching? A. "I should wear a Medic Alert bracelet." B. "I will start a vigorous aerobic exercise program." C. "I will take antibiotics when I have my teeth repaired." D. "I should go to the doctor when I get a respiratory infection."

B. "I will start a vigorous aerobic exercise program."

A nurse is assessing a group of clients. Which client is considered at the highest risk for a dissecting aneurysm? A. 70-year-old male with peripheral vascular disease B. 65-year-old male with uncontrolled hypertension C. 40-year-old female with controlled hypertension D. 42-year-old female with peripheral vascular disease

B. 65-year-old male with uncontrolled hypertension

A client with chronic heart failure is taking a diuretic twice a day. The healthcare provider prescribes a diet that includes the intake of foods high in dietary potassium. Which foods should the nurse instruct the client to consume? Select all that apply. A. Corn B. Bananas C. Strawberries D. Cucumber salad E. Baked potatoes with skins

B. Bananas E. Baked potatoes with skins

A nurse identifies premature ventricular complexes (PVCs) on a client's cardiac monitor. What does the nurse conclude that these complexes are a sign of? A. Atrial fibrillation B. Cardiac irritability C. Impending heart block D. Ventricular tachycardia

B. Cardiac irritability

Select-all-that-apply: Which of the following are NOT typical signs and symptoms of pericarditis? A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain

B. Increased pain when leaning forward C. ST segment depression F. Breathing in relieves the pain

You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition? A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will avoid going to the dentist due to the increased risk of developing endocarditis again." C. "I will inform my GI doctor about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats."

C. "I will inform my GI doctor about my history of endocarditis prior to any invasive procedures."

The medical-surgical nurse called the code team for a client who is unresponsive and not breathing. Cardiopulmonary resuscitation and an ambu bag have been initiated. What is the next most appropriate action for the nurse to take? A. Contact the client's primary healthcare provider. B. Move any other clients or visitors out of the room. C. Get the client's record and have it available in the room. D. Contact religious ministry.

C. Get the client's record and have it available in the room.

The family of a client with right ventricular heart failure expresses concern about the client's increasing abdominal girth. What physiologic change should the nurse consider when explaining the client's condition? A. Loss of cellular constituents in blood B. Rapid osmosis from tissue spaces to cells C. Increased pressure within the circulatory system D. Rapid diffusion of solutes and solvents into plasma

C. Increased pressure within the circulatory system

A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as? A. Janeway Lesions B. Roth Spots C. Osler's Nodes D. Trousseau's Sign

C. Osler's Nodes

You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient? A. Monitor the patient for complications of cardiac tamponade. B. Administer Ibuprofen as needed for pain. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds.

C. Place the patient in supine position to relieve pain.

A patient with endocarditis has listed in their medical history "Roth Spots". You know that this is a complication of infective endocarditis and presents as? A. Non-tender spots found on the feet and hands B. Red and tender lesions found in the eyes C. Retinal hemorrhages with white centers D. Purplish spots found on the forearms and groin

C. Retinal hemorrhages with white centers

A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient's fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis? A. Abdominal ultrasound B. Heart catheterization C. Transesophageal echocardiogram D. White blood cell count

C. Transesophageal echocardiogram

You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication? A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food

C. with a full glass of water

A nurse expects that a client with right-sided heart failure will exhibit which of these signs or symptoms? A. Oliguria B. Pallor C. Cool extremities D. Distended neck veins

D. Distended neck veins

A client with multiple myeloma is scheduled to have a chest x-ray examination and a bone scan. For this client, what is the primary responsibility of the nurses and other members of the healthcare team? A. Explain the procedure and its purpose. B. Observe the client for the presence of pallor. C. Provide for rest periods during the procedure. D. Handle the client with supportive movements.

D. Handle the client with supportive movements.

A client is returned to the surgical unit immediately after placement of a coronary artery stent that was accomplished via access through the femoral artery. What should the nurse consider the priority when assessing this client? A. Acute pain B. Impaired mobility C. Impaired swallowing D. Hematoma formation

D. Hematoma formation

A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis

D. Pericardiocentesis

A nurse witnesses a person fall. The person becomes unresponsive and pulseless. The nurse plans to use an automated external defibrillator (AED) that is available on site. What should the nurse do first? A. Remove all jewelry. B. Wash the chest area. C. Use a grounded electrical source. D. Remove medication patches on the chest.

D. Remove medication patches on the chest.

On physical assessment of a patient with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub

D. pericardial friction rub

A nurse is teaching a group of clients about risk factors for heart disease. Which factors will the nurse include that increase a client's risk for a myocardial infarction (MI)? Select all that apply. A. Obesity B. Hypertension C. Diabetes insipidus D. Asian-American ancestry E. Increased high-density lipoprotein (HDL)

A. Obesity B. Hypertension

A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis? A. Pericardial effusion B. Acute pericarditis C. Constrictive pericarditis D. Effusion-Constrictive pericarditis

C. Constrictive pericarditis

How should the nurse make the bed of a client who is in the acute phase after a myocardial infarction? A. Replace the top linen and only the necessary bottom linen. B. Lift the client from side to side while changing the bed linen. C. Change the linen from top to bottom without lowering the head of the bed. D. Slide the client onto a stretcher to remake the bed and then slide the client back to the bed.

A. Replace the top linen and only the necessary bottom linen.

A client is admitted after a motor vehicle crash. The primary healthcare provider has diagnosed the presence of pelvic fractures and bilateral femur fractures. The client's blood pressure has fallen from 120/76 to 60/40, and the heart rate has risen from 82 to 121. Which does the nurse recognize as the most likely reason for the assessment findings? A. Cardiogenic shock B. Hypervolemic shock C. Hemorrhagic shock D. Septic shock

C. Hemorrhagic shock

A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient's symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What is type of infective endocarditis this classified as based on the information listed? A. Acute Infective Endocarditis B. Subacute Infective Endocarditis C. Non-infective Endocarditis D. Pericarditis

A. Acute Infective Endocarditis

A hospitalized client puts the call light on and reports a sudden onset of chest pain that feels like a pressure or weight on the chest. The client also states, "I feel nauseated and very weak." Which action should the nurse take? A. Call the rapid response team. B. Perform a nutritional assessment. C. Discuss possible sources of stress for the panic attack. D. Provide reassurance while helping the client to deep breathe.

A. Call the rapid response team.

A nurse is caring for a client who just had coronary artery bypass graft surgery. For which complication should the nurse monitor the client in the immediate postoperative period? A. Dysrhythmias, especially atrial fibrillation B. Postpericardiotomy syndrome with fever and friction rub C. Mediastinitis with boggy sternum and increased white blood cell count D. Increased hemoglobin and hematocrit levels with a risk for embolization

A. Dysrhythmias, especially atrial fibrillation

A nurse is caring for a client with first degree atrioventricular (AV) block. Which information will the nurse consider when planning care? A. Every P wave is conducted to the ventricles. B. Some P waves are conducted to the ventricles. C. There are no P waves visible on the rhythm strip. D. None of the P waves are conducted to the ventricles.

A. Every P wave is conducted to the ventricles.

Which of the following patients are MOST at risk for developing endocarditis? Select-all-that-apply: A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. C. A 63 year old female who is newly diagnosed with hyperparathyroidism and is taking Aspirin. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.

A nurse identifies that a client who had a myocardial infarction is struggling with an alteration in self-concept. The nurse intervenes to promote client autonomy. Which behavior by the client demonstrates an increase in client autonomy? A. Active participation in providing self-care B. Verbalizing realistic expectations of caregivers C. Discussing necessary lifestyle changes with family members D. Listing the indicators of recovery after a myocardial infarction

A. Active participation in providing self-care

Findings on a client's cardiac monitor indicate a need for an intravenous infusion that contains potassium for a client with hypokalemia. The nurse concludes that what finding on the monitor indicated a need for potassium replacement? A. Lowering of the T wave B. Elevation of the ST segment C. Shortening of the QRS complex D. Increased deflection of the Q wave

A. Lowering of the T wave

A primary healthcare provider decides to omit a treatment that was part of a course of chemotherapy for a client because the client demonstrates myelosuppression. What information would be appropriate for the nurse to give to the client regarding myelosuppression? A. Calcium carbonate and vitamin D must be increased in the diet because of the effects of myelosuppression. B. Eating a balanced diet, resting, and trying to prevent bleeding and infections are appropriate at this time. C. The development of myelosuppression explains why the client has nausea, vomiting, anorexia, and alopecia. D. Frequent testing for restlessness, muscle control, and pupillary response is necessary because the meninges may be irritable.

B. Eating a balanced diet, resting, and trying to prevent bleeding and infections are appropriate at this time.

To manage heart failure a client has been taking several medications, including furosemide 40 mg by mouth twice a day. The client develops severe muscle cramps and fatigue, and laboratory tests confirm the presence of hypokalemia. Potassium chloride intravenously (IV) and ECG monitoring have been prescribed. Which ECG change associated with hypokalemia should the nurse expect to observe? A. Inverted P waves B. Flattened T waves C. Absence of U waves D. Elevated ST segment

B. Flattened T waves

Although the nurse is unable to identify any obvious signs or symptoms of bleeding, a client repeatedly has tested positive for occult blood in the stool. Which laboratory result is a concern considering this client's history? A. Iron level 100 mcg/dL (22 mcmol/L) B. Hemoglobin level 8.5 g/dL (85 mmol/L) C. Platelet count 160,000/mm3 (160 × 109/L) D. Transferrin level 300 mg/dL (3 g/L)

B. Hemoglobin level 8.5 g/dL (85 mmol/L)

A client has an open reduction and internal fixation of a fractured hip. To prevent the most common complication after this type of surgery, what does the nurse expect the client's postoperative plan of care to include? A. Routinely turning the client from side to side B. Sequential compression stockings C. Isometric exercises to the extremities D. Passive range of motion (ROM) to the affected extremity

B. Sequential compression stockings

A thallium scan is scheduled for a client who had a myocardial infarction. What should the nurse explain to the client regarding the reason the scan has been prescribed? A. That it will monitor the mitral and aortic valves B. That it establishes the viability of myocardial muscle C. That it can visualize the ventricular systole and diastole D. That it will determine the adequacy of electrical conductivity

B. That it establishes the viability of myocardial muscle

The primary healthcare provider prescribes warm intravenous fluids for a client with a body temperature of 28 °C. During administration of the fluids, it is important for the nurse to continuously monitor what? A. The client's liver function B. The client's cardiac function C. The client's red blood cell count D. The client's blood platelet count

B. The client's cardiac function

A client with an inferior myocardial infarction has a heart rate of 120 beats per minute. Which goal achievements are priority? A. Increase left ventricular filling and improve cardiac output B. Decrease oxygen needs of the vital organs and prevent cardiac dysrhythmias C. Decrease the workload on the heart and promote maximum coronary artery filling D. Increase venous return to the right atrium and increase pulmonary arterial blood flow

C. Decrease the workload on the heart and promote maximum coronary artery filling

A client with a history of hypertension has a blood pressure of 180/102 mm Hg. When the nurse asks whether the client has been taking any medications, the client replies, "I took the blood pressure pills the healthcare provider prescribed for a few weeks, but I didn't feel any different, so I decided I'd only take them when I feel sick." What is the best initial response by the nurse? A. "You must be quite frightened about having high blood pressure." B. "I'm glad to hear you have felt well enough to stop the medication." C. "It is important to take your medications daily to achieve optimal results." D. "You will need to document daily whether you took your medication or not."

C. "It is important to take your medications daily to achieve optimal results."

You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicates the patient did NOT understand the education you provided? A. "I can take this medication with or without food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take all my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."

C. "I like to take all my medications in the morning with grapefruit juice."

A client is admitted with stage 2 hypertension. What diastolic pressure does the nurse consider to be consistent with this diagnosis? A. 80 to 89 mm Hg B. 90 to 99 mm Hg C. Less than 79 mm Hg D. More than 100 mm Hg

D. More than 100 mm Hg

True or False: Endocarditis only affects the atrioventricular and semi-lunar valves in the heart.

False (Endocarditis can affect not only the heart valves but the interventricular septum and chordae tendineae as well.)

True or False: The pericardium layer consists of a fibrous layer that is made up of two layers called the parietal and visceral layers.

False (The pericardium layer consists of a fibrous layer and SEROUS layer that is made up of two layers called that parietal and visceral layers.)