NCLEX Cardiovascular, hematologic, and lymphatic

A client who has peripheral arterial disease of the lower extremities tells the nurse, "I walk so slowly that no one wants to walk with me." What is the best response by the nurse? A. "A vascular rehabilitation program may help you." B. "You should be sitting with your feet elevated, not walking." C. "Try again tomorrow because maybe you will have a better day." D. "They are not good friends if they are not willing to walk with you."

A. "A vascular rehabilitation program may help you."

A client who was in an automobile collision is now in hypovolemic shock. Why is it important for the nurse to take the client's vital signs frequently during the compensatory stage of shock? A. Arteriolar constriction occurs. B. The cardiac workload decreases. C. Contractility of the heart decreases. D. The parasympathetic nervous system is triggered.

A. Arteriolar constriction occurs.

A client, receiving a potassium infusion via a peripheral intravenous (IV) site, reports a burning sensation above the IV site. What should the nurse do first? A. Check the IV access for a blood return B. Apply warm compresses to the affected extremity C. Slow the IV infusion until the burning sensation is gone D. Request an oral supplement from the primary healthcare provider

A. Check the IV access for a blood return

Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient's symptoms? Select-all-that-apply: A. EKG B. Stress test C. Heart catheterization D. Balloon angioplasty

A. EKG B. Stress test

A low-dose intravenous dopamine hydrochloride infusion drip is prescribed for a client in acute renal failure (ARF). Which method is most appropriate for the nurse to administer this medication to the client? A. Peripherally inserted central catheter (PICC) line B. #20 angiocatheter in either antecubital area C. Large-gauge butterfly needle in hand D. Femoral line

A. Peripherally inserted central catheter (PICC) line

True or False: ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin II to Angiotensin I which causes vasodilation.

False

The client is returned to the surgical unit from the postanesthesia care unit (PACU) after a having a splenectomy. In the immediate postoperative period, the nurse specifically should monitor for which potential complications? Select all that apply. A. Shock B. Infection C. Intestinal obstruction D. Abdominal distention E. Pulmonary complications

A. Shock D. Abdominal distention E. Pulmonary complications

Laboratory results of a client's blood after chemotherapy indicate bone marrow depression. What should the nurse encourage the client to do? Select all that apply. A. Use a soft toothbrush. B. Sleep with the head of the bed elevated. C. Increase activity levels and take frequent walks. D. Drink more citrus juices and eat more citrus fruits. E. Read the ingredients in over-the-counter drugs before taking them.

A. Use a soft toothbrush. E. Read the ingredients in over-the-counter drugs before taking them.

A client with angina pectoris is scheduled for a stress echocardiogram. What should the nurse tell the client that an echocardiogram is? A. A tool used solely to determine the cause of chest pain B. A noninvasive approach to assess cardiovascular status C. A modality of minimal value in planning treatment for angina D. An invasive test that measures the body's reaction to progressive increases in exertion

B. A noninvasive approach to assess cardiovascular status

A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next? A. Take another dose of Nitroglycerin in 5 minutes. B. Call 911 immediately C. Lie down and rest to see if that helps with relieving the pain D. Take two doses of Nitroglycerin in 5 minutes

B. Call 911 immediately

A patient taking Zocor is reporting muscle pain. You are evaluating the patient's lab work and note that which of the following findings could cause muscle pain? A. Elevated potassium level B. Elevated CPK (creatine kinase level) C. Decreased potassium level D. Decreased CPK (creatine kinase level)

B. Elevated CPK (creatine kinase level)

A client with coronary artery disease is scheduled for a cardiac catheterization. What should the client be able to describe if the nurse's preoperative teaching is considered effective? A. What will occur if there is an emergency B. What will be experienced during the procedure C. The risks associated with this invasive procedure D. The importance of immediate postoperative exercises

B. What will be experienced during the procedure

The nurse is interpreting the client's rhythm strip and finds that the P and QRS waves are consistent, with a P wave preceding every QRS complex. The PR interval is 0.26 seconds long. The rate is 64 beats per minute. How should the nurse interpret this rhythm? A. Complete heart block B. Normal sinus rhythm (NSR) C. Sinus rhythm with first degree AV block D. Sinus rhythm with second degree atrioventricular (AV) block

C. Sinus rhythm with first degree AV block

A client who has had an uncomplicated myocardial infarction asks the nurse about the resumption of sexual activity. Which physical parameters should the nurse consider to determine the safe resumption of sexual activity? A. When the client and partner are not fearful of sexual intimacy B. When the client feels emotionally ready to resume sexual activity C. The point at which two flights of stairs can be climbed without dyspnea D. Laboratory data showing that enzyme results have returned to preinfarction levels

C. The point at which two flights of stairs can be climbed without dyspnea

A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. A. Age B. Height C. Weight D. Smoking E. 2Family history

C. Weight D. Smoking

A client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period? A. Hypercalcemia may result from parathyroid damage. B. Hypotension and bradycardia may result from thyroid storm. C. Tetany may result from underdosage of thyroid hormone replacement. D. Hoarseness and airway obstruction may result from laryngeal nerve damage.

D. Hoarseness and airway obstruction may result from laryngeal nerve damage.0

Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you educate the patient on how this drugs works on the body? A. Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and triglyceride levels. B. Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels. C. Lipitor increases HDL levels, total cholesterol, and triglyceride levels. D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.

D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.

A nurse is teaching a client about the use of antiembolism stockings. What instruction should the nurse include? A. Keep the stockings on 2 hours and off 2 hours. B. Wear the stockings only at bedtime when activity decreases. C. Put the stockings on before rising in the morning. D. Leave the stockings in place until the primary healthcare provider advises otherwise.

C. Put the stockings on before rising in the morning.

A client who had a myocardial infarction requests assistance to have a bowel movement. What should the nurse do? A. Place the client on a bedpan. B. Help the client into the bathroom. C. Roll the client onto a fracture pan. D. Assist the client to a bedside commode.

D. Assist the client to a bedside commode.

The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level? A. Macrocytic red blood cells (RBCs) B. Thrombocytopenia C. Decreased folate levels D. Increased total iron-binding capacity (TIBC)

D. Increased total iron-binding capacity (TIBC)

A client is in the intensive care unit. The nurse observing the telemetry monitor identifies flattening T waves and peaked P waves. What problem should the nurse consider based on these ECG changes? A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hypomagnesemia

A. Hypokalemia

A client is admitted to the hospital with a long history of hypertension. The nurse should assess the client for which complication? A. Cataracts B. Esophagitis C. Kidney failure D. Diabetes mellitus

C. Kidney failure

A client has excessive edema. Which is the most objective method a nurse can use to assess the extent of edema? A. Weighing the client B. Monitoring the intake and output C. Performing the Trendelenburg test D. Assessing the extent of pitting edema

A. Weighing the client

During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes stool from the client's rectum. Which response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate the client's bowel movements? A. Increasing pulse rate B. Slowing of the heart C. Dilating the bronchioles D. Reducing gastric acid secretions

B. Slowing of the heart

The nurse is analyzing the client's rhythm when the nurse notes multiple premature ventricular contractions (PVCs). Each PVC occurs in no particular pattern and looks like all other PVCs. How will the nurse interpret this finding? A. Multifocal B. Unifocal C. Bigeminal D. Couplet

B. Unifocal

A nurse is caring for a client 8 hours after surgery. The client's portable wound drainage device is half full of drainage. After emptying the drainage collection chamber, how will the nurse create negative pressure in the system? A. Attaching the device to a wall suction unit B. Milking the tubing toward the suction device C. Compressing the device while closing the air plug D. Keeping the device in a position lower than the site of insertion

C. Compressing the device while closing the air plug

A client who is receiving methotrexate for acute lymphocytic leukemia (ALL) develops a temperature of 101° F (38.3° C). The nurse notifies the primary healthcare provider. Aspirin 650 mg every 4 hours as needed for temperature equal to or greater than 101° F (38.3° C) is prescribed. What should the nurse do regarding this prescription? A. Express concern about the dosage prescribed. B. Request a prescription for an antacid. C. Express concern about the type of antipyretic prescribed. D. Ask if the frequency should be every 6 hours instead.

C. Express concern about the type of antipyretic prescribed.

A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action? A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.

C. Hold the dose and notify the physician of the digoxin level.

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5

C. K+ 8.0

Which coronary artery provides blood to the left atrium and left ventricle: A. Right marginal artery B. Posterior descending artery C. Left circumflex artery D. Right coronary artery

C. Left circumflex artery

A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as: A. Unstable angina B. Variant angina C. Stable angina D. Prinzmetal angina

C. Stable angina

A client receiving a blood transfusion that was just initiated reports urticaria and difficulty breathing. The heart rate has increased, the blood pressure is falling, and the client is becoming extremely apprehensive. Which type of shock does the nurse suspect the client is experiencing? A. Septic shock B. Cardiogenic shock C. Neurogenic shock D. Anaphylactic shock

D. Anaphylactic shock

These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors

D. Angiotensin-converting-enzyme inhibitors

You're providing education to a patient who will be undergoing a heart catheterization. Which statement by the patient requires you to re-educate the patient about this procedure? A. "The brachial artery is most commonly used for this procedure." B. "A dye is injected into the coronary arteries to assess for blockages." C. "Not all patients who have a heart catheterization will need a stent placement." D. "I will not be completely asleep and will be able to breathe on my own during the procedure."

A. "The brachial artery is most commonly used for this procedure."

The nurse is completing an assessment on a couple seeking genetic counseling for sickle cell anemia. Both prospective parents carry sickle cell traits. The nurse recognizes that the couple has what chance of having a child who develops the disease? A. 25% B. 50% C. 75% D. 100%

A. 25%

Following a client's cardiac catheterization, the nurse identifies that the client's urinary output is three times the client's intake amount. The client is stable otherwise. The nurse concludes that what is the cause of the increase in the client's urinary output? A. An expected effect of the dye used with the procedure B. Increased cardiac output as a result of the procedure C. An improvement of urinary functioning after the catheterization D. A physiologic effect of the prescribed intravenous (IV) rate of 50 mL/hr

A. An expected effect of the dye used with the procedure

A 78-year-old client comes to the health clinic presenting with fatigue. The client's laboratory results indicate a hematocrit of 32.1% and a hemoglobin of 10.5 g/dL (105 mmol/L). Which is the most appropriate nursing intervention in response to these laboratory results? A. Conduct a complete nutritional assessment of the client B. Nothing, because these are expected values for this client's age C. Advise the client to come back to the clinic to have the test repeated in three months D. Investigate the cause of the anemia while understanding that mild anemia is an expected response to the aging process

A. Conduct a complete nutritional assessment of the client

A client presents to the emergency department with weakness and dizziness. The blood pressure is 90/60 mm Hg, pulse is 92 and weak, and body weight reflects a 3-pound (1.4 kilogram) loss in two days. The weather has been hot. Which condition should the nurse conclude is the priority for this client? A. Deficient fluid volume B. Impaired skin integrity C. Inadequate nutritional intake D. Decreased participation in activities

A. Deficient fluid volume

A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix. What important information will you include in the patient's teaching? Select-all-that-apply: A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure. B. A normal side effect of this medication is a dry cough. C. Avoid green leafy vegetables while taking Plavix. D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.

A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure. D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.

A home healthcare nurse is assessing a client with cardiac insufficiency. The nurse identifies that the client's pulse rate increases from 70 to 135 beats per minute while climbing the stairs. What instruction should the nurse give to the client? A. "Continue climbing." B. "Stand still and rest." C. "Walk down the stairs." D. "Climb but at a slower rate."

B. "Stand still and rest."

Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply: A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer. B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes.

B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction. D. A 29 year old that has type I diabetes.

Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

B. A side effect of these drugs include bradycardia. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

A nurse is auscultating a client's heart. Where should the nurse listen to hear S1 the loudest? A. Base of the heart B. Apex of the heart C. Left lateral border D. Right lateral border

B. Apex of the heart

You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.

B. Assist the patient up slowing and gradually.

A prescribed blood transfusion of packed red blood cells was started five minutes ago. Now the client is complaining of chest pain, flank pain, difficulty breathing, and chills. The blood pressure has dropped from 140/88 to 110/60 mm Hg, temperature is 100.8° F (38.2° C), and the client seems less alert. What should the nurse suspect? A. Urticarial reaction B. Hemolytic reaction C. Circulatory overload D. Anaphylactic reaction

B. Hemolytic reaction

Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough

B. Hyperkalemia

A client who lives with the parents is diagnosed with stage III Hodgkin disease with a grossly involved spleen and is scheduled for a splenectomy. After the nurse performs preoperative teaching, the client appears anxious. What is the best approach for the nurse to use at this time? A. Allow the client to regress at this time and rest quietly. B. State that that the client seems anxious and ask whether the client would like to talk for a while. C. Consider the reaction an unconscious response and inquire about the client's relationship with the parents. Incorrect D. Understand that anxiety prevented the client from comprehending and repeat the information in simpler terms.

B. State that the client seems anxious and ask whether the client would like to talk for a while.

A client is admitted to the emergency department after vomiting bright red blood. After the vomiting ceases and the vital signs are stabilized, the client is transferred to a medical-surgical unit. To assess for bleeding, what should the nurse on the medical-surgical unit should monitor the client for? A. Lethargy B. Tachycardia C. Deep breathing D. Abdominal pain

B. Tachycardia

The primary healthcare provider prescribes "bathroom privileges only" for a client with pulmonary edema. The client becomes irritable and asks the nurse whether it is really necessary to stay in bed so much. What would be the best reply by the nurse? A. "Why do you want to be out of bed?" B. "Bed rest plays a role in most therapy." C. "Rest helps your body direct energy toward healing." D. "Would you like me to ask your primary healthcare provider to change the prescription?"

C. "Rest helps your body direct energy toward healing."

The nurse is monitoring a client's hemoglobin level. The nurse recalls that the amount of hemoglobin in the blood has what effect on oxygenation status? A. Except with rare blood disorders, hemoglobin seldom affects oxygenation status. B. There are many other factors that affect oxygenation status more than hemoglobin does. C. A low hemoglobin level causes reduced oxygen-carrying capacity. D. Hemoglobin reflects the body's clotting ability and may or may not affect oxygenation status.

C. A low hemoglobin level causes reduced oxygen-carrying capacity.

An unresponsive older adult is admitted to the emergency department on a hot, humid day. The initial nursing assessment reveals hot, dry skin, a respiratory rate of 36 breaths/min, and a heart rate of 128 beats/min. What is the initial nursing action? A. Offer cool fluids. B. Suction the airway. C. Remove the clothing. D. Prepare for intubation.

C. Remove the clothing.

A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication? A. Check your heart rate regularly because Metoprolol can cause an irregular heart rate. B. Check your glucose regularly because this medication can cause hyperglycemia. C. Check your blood pressure regularly because this medication can cause hypertension. D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.

D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.

During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin

D. Digoxin

A client's blood pressure increases dramatically six hours after a femoral-popliteal bypass graft. Which priority concern motivates the nurse to inform the primary healthcare provider? A. Hypertension may cause the graft to occlude. B. Hypervolemia may be the cause of the hypertension. C. Extremely high blood pressure may cause a brain attack. D. Rapidly increasing blood pressure may rupture the graft.

D. Rapidly increasing blood pressure may rupture the graft.

A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction? A. absent Q wave B. QRS widening C. absent P-wave D. ST segment elevation

D. ST segment elevation

True or False: The left anterior descending coronary artery provides blood supply to the left ventricle, front of the septum and part of the right ventricle.

True