Cardiovascular NCLEX Questions

Which of the following terms describes the force against which the ventricle must expel blood? a.) Afterload b.) Cardiac output c.) Overload d.) Preload

a.) Afterload Rationale: Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

Which of the following parameters should be checked before administering digoxin? a.) Apical pulse b.) Blood pressure c.) Radial pulse d.) Respiratory rate

a.) Apical pulse Rationale: An apical pulse is essential or accurately assessing the client's heart rate before administering digoxin. The apical pulse is the most accurate point in the body. Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and therefore, won't always accurately depict the heart rate. Digoxin has no effect on respiratory function.

A primary prevention for reducing a female patient's risk of developing coronary heart disease is to: a.) Avoid excessive weight gain during pregnancy. b.) Enroll in a cardiac rehabilitation program. c.) Take 81 mg of aspirin daily. d.) Take nitroglycerin at the onset of chest pain.

a.) Avoid excessive weight gain during pregnancy.

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? a.) Beta-adrenergic blockers b.) Calcium channel blockers c.) Narcotics d.) Nitrates

a.) Beta-adrenergic blockers Rationale: Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decreased anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

Which of the following symptoms is most commonly associated with left-sided heart failure? a.) Crackles b.) Arrhythmias c.) Hepatic engorgement d.) Hypotension

a.) Crackles Rationale: Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right- and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

Toxicity from which of the following medications may cause a client to see a green halo around lights? a.) Digoxin b.) Furosemide c.) Metoprolol d.) Enalapril

a.) Digoxin Rationale: One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other medications aren't associated with such an effect.

A patient who has experienced atrial fibrillation for the past 33 days is admitted to the cardiac care unit. In addition to administering an antidysrhythmia medication, the healthcare provider should anticipate which of these orders? a.) Initiate a heparin infusion b.) Give atropine IV push c.) Prepare for immediate cardioversion d.) Prepare the patient for AV node ablation

a.) Initiate a heparin infusion

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? a.) Left-sided heart failure b.) Pulmonic valve malfunction c.) Right-sided heart failure d.) Tricuspid valve malfunction

a.) Left-sided heart failure Rationale: The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure.

Which of the following complications is indicated by a third heart sound (S3)? a.) Ventricular dilation b.) Systemic hypertension c.) Aortic valve malfunction d.) Increased atrial contractions

a.) Ventricular dilation Rationale: Rapid filling of the ventricles causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result is a fourth heart sound. Aortic valve malfunction is heard as a murmur.

The cardiac/vascular nurse encourages a patient with hypertension to adopt a low sodium diet. The American Heart Association recommends limiting this patient's sodium to: a.) 1200 mg per day. b.) 1500 mg per day. c.) 1700 mg per day. d.) 2400 mg per day.

b.) 1500 mg per day.

A patient with cardiogenic shock receives a nursing diagnosis of decreased cardiac output. With the appropriate interventions, the anticipated outcome is for the patient to achieve: a.) Baseline activity level. b.) Baseline cardiac function. c.) Reduced anxiety. d.) Decreased afterload.

b.) Baseline cardiac function.

A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician's office. The nurse would plan on having which of the following medications readily available for use? a.) Diltiazem (Cardizem) b.) Digoxin (Lanoxin) c.) Propranolol (Inderal) d.) Metoprolol (Lopressor)

b.) Digoxin (Lanoxin) Rationale: Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the medication of choice to treat heart failure. Diltiazem (calcium channel blocker) and propranolol and metoprolol (beta blockers) have a negative inotropic effect and would worsen the failing heart.

When do coronary arteries primarily receive blood flow? a.) During inspiration b.) During diastole c.) During expiration d.) During systole

b.) During Diastole. Rationale: Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow

Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease? a.) Decrease anxiety b.) Enhance myocardial oxygenation c.) Administer sublignual nitroglycerin d.) Educate the client about his symptoms

b.) Enhance myocardial oxygenation Rationale: Enhancing mocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitorglycerin is administered to treat acute angina, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, nether are priorities when a client is compromised.

A patient who underwent a percutaneous, transluminal coronary angioplasty four weeks ago has a subsequent ejection fraction of 30%. The patient returns for a followup visit. Examination reveals lungs that are clear to auscultation and slight pedal edema. The patient's medications are digoxin (Lanoxin), furosemide (Lasix), enalapril maleate (Vasotec), and aspirin. The patient reports a 5 lb (2.27-kg) weight gain over the past two days. The cardiac/vascular nurse's initial action is to: a.) Document the weight, and reassess the patient at the next session. b.) Inquire about the patient's medication compliance. c.) Notify the patient's physician. d.) Review the patient's most recent nuclear scan.

b.) Inquire about the patient's medication compliance.

Which of the following landmarks is the correct one for obtaining an apical pulse? a.) Left intercostal space, midaxillary line b.) Left fifth intercostal space, midclavicular line c.) Left second intercostal space, midclavicular line d.) Left seventh intercostal space, midclavicular line

b.) Left fifth intercostal space, midclavicular line Rationale: The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. Normally, heart sounds aren't heard in the midaxillary line or the seventh intercostal space in the midclavicular line.

A nurse is preparing to ambulate a client on the 3rd day after cardiac surgery. The nurse would plan to do which of the following to enable the client to best tolerate the ambulation? a.) Encourage the client to cough and deep breathe b.) Premedicate the client with an analgesic c.) Provide the client with a walker d.) Remove telemetry equipment because it weighs down the hospital gown.

b.) Premedicate the client with an analgesic Rationale: The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation. Options 1 and 3 will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed.

When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority for the healthcare provider to monitor? a.) BUN and creatinine b.) Sodium, potassium, and calcium c.) Hemoglobin and hematocrit d.) PT and INR

b.) Sodium, potassium, and calcium

Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? a.) Anxiety b.) Stable angina c.) Unstable angina d.) Variant angina

b.) Stable angina Rationale: The pain of stable angina is predictable in nature, builds gradually, and quickly reaches maximum intensity. Unstable angina doesn't always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at rest—not as a result of exercise or stress.

The healthcare provider is teaching a student about the cardiac cycle and how it relates to the electrocardiogram (EKG). What will the healthcare provider tell the student about the cardiac events that occur during the QRS complex of the waveform? a.) "This represents early repolarization of right and left ventricles." b.) "The repolarization of the His Purkinje system happens here." c.) "Ventricular depolarization and atrial repolarization occur during this time." d.) "Atrial depolarization and AV node stimulation are occurring at this time."

c.) "Ventricular depolarization and atrial repolarization occur during this time."

Which of the following positions would best aid breathing for a client with acute pulmonary edema? a.) Lying flat in bed b.) Left side-lying c.) In high Fowler's position d.) In semi-Fowler's position

c.) In high Fowler's position Rationale: A high Fowler's position promotes ventilation and facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen the breathing and increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as the Fowler's position will.

Excessive alcohol use while on warfarin (Coumadin) therapy leads to: a.) Decreased anticoagulation effect. b.) Decreased international normalized ratio. c.) Increased anticoagulation effect. d.) Increased vitamin K absorption.

c.) Increased anticoagulation effect.

Prolonged occlusion of the right coronary artery produces an infarction in which of he following areas of the heart? a.) Anterior b.) Apical c.) Inferior d.) Lateral

c.) Inferior Rationale: The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion ( left ventricle ), lateral portion ( some of the left ventricle and the left atrium ), or the apical portion ( left ventricle ) of the heart.

Which of the following arteries primarily feeds the anterior wall of the heart? a.) Circumflex artery b.) Internal mammary artery c.) Left anterior descending artery d.) Right coronary artery

c.) Left anterior descending artery Rationale: The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall. The internal mammary artery supplies the mammary. The right coronary artery supplies the inferior wall of the heart.

Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? a.) Left atrium b.) Right atrium c.) Left ventricle d.) Right ventricle

c.) Left ventricle Rationale: The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is damaged, the output decreases and fluid accumulates in the interstitial and alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output or, therefore, the onset of pulmonary edema. If the right atrium and right ventricle were damaged, right-sided heart failure would result.

Which hereditary disease is most closely linked to aneurysm? a.) Cystic fibrosis b.) Lupus erythematosus c.) Marfan's syndrome d.) Myocardial infarction

c.) Marfan's syndrome Rationale: Marfan's syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasn't been linked to aneurysms. Lupus erythematosus isn't hereditary. Myocardial infarction is neither hereditary nor a disease.

A patient with negative troponins and stress test results reports recurring chest pain that is similar to the patient's pain on admission. According to the American Nurses Association's scope and standards of practice for cardiovascular nursing, the cardiac/vascular nurse's next action is to: a.) Activate the cardiac catheterization team. b.) Administer analgesics. c.) Obtain a 12-lead electrocardiogram. d.) Promote relaxation and monitor the response.

c.) Obtain a 12-lead electrocardiogram.

Which of the following symptoms might a client with right-sided heart failure exhibit? a.) Adequate urine output b.) Polyuria c.) Oliguria d.) Polydipsia

c.) Oliguria Rationale: Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren't associated with right-sided heart failure.

Medical treatment of coronary artery disease includes which of the following procedures? a.) Cardiac catheterization b.) Coronary artery bypass surgery c.) Oral medication administration d.) Percutaneous transluminal coronary angioplasty

c.) Oral medication administration Rationale: Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catheterization isn't a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)? a.) Chloride b.) Digoxin c.) Potassium d.) Sodium

c.) Potassium Rationale: Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Chloride and sodium aren't loss during diuresis. Digoxin acts to increase contractility but isn't given routinely with furosemide.

Myocardial oxygen consumption increases as which of the following parameters increase? a.) Preload, afterload, and cerebral blood flow b.) Preload, afterload, and renal blood flow c.) Preload, afterload, contractility, and heart rate d.) Preload, afterload, cerebral blood flow, and heart rate

c.) Preload, afterload, contractility, and heart rate Rationale: Myocardial oxygen consumption increases as preload, afterload, renal contractility, and heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption.

A 55-year-old patient who is diagnosed with an evolving myocardial infarction (MI) insists on going home. The cardiac/vascular nurse encourages the patient to be admitted, because the greatest risk within the first 24 hours of sustaining an MI is: a.) Heart failure. b.) Pulmonary embolism. c.) Sudden death. d.) Ventricular aneurysm.

c.) Sudden death.

What is the most common complication of a myocardial infarction? a.) Cardiogenic shock b.) Heart failure c.) Arrhythmias d.) Pericarditis

c.) arrhythmias Rationale: Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial of viral infection but may occur after MI.

The nurse coming on duty receives the report from the nurse going off duty. Which of the following clients should the on-duty nurse assess first? a.) The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a respiratory rate of 21 breaths a minute. b.) The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order. c.) The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV heparin. d.) A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV diltiazem (Cardizem).

d.) A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving IV diltiazem (Cardizem). Rationale: The client with A-fib has the greatest potential to become unstable and is on IV medication that requires close monitoring. After assessing this client, the nurse should assess the client with thrombophlebitis who is receiving a heparin infusion, and then go to the 58-year-old client admitted 2-days ago with heart failure (her s/s are resolving and don't require immediate attention). The lowest priority is the 89-year-old with end stage right-sided heart failure, who requires time consuming supportive measures.

A client who had cardiac surgery 24 hours ago has a urine output averaging 19 ml/hr for 2 hours. The client received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is at risk for: a.) Hypovolemia b.) UTI c.) Glomerulonephritis d.) Acute renal failure

d.) Acute renal failure Rationale: The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal insult is signaled by decreased urine output, and increased BUN and creatinine levels. The client may need medications such as dopamine (Intropin) to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis.

Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? a.) Cardiac catheterization b.) Cardiac enzymes c.) Echocardiogram d.) Electrocardiogram

d.) Electrocardiogram Rationale: The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can't determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately.

Which of the following cardiac conditions does a fourth heart sound (S4) indicate? a.) Dilated aorta b.) Normally functioning heart c.) Decreased myocardial contractility d.) Failure of the ventricle to eject all the blood during systole

d.) Failure of the ventricle to eject all the blood during systole Rationale: An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decrease compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An s4 isn't heard in a normally functioning heart.

Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions? a.) Pericarditis b.) Hypertension c.) MI d.) Heart failure

d.) Heart failure Rationale: These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. MI causes heart failure but isn't related to these symptoms.

Which of the following is a compensatory response to decreased cardiac output? a.) Decreased BP b.) Alteration in LOC c.) Decreased BP and diuresis d.) Increased BP and fluid retention

d.) Increased BP and fluid retention Rationale: The body compensates for a decrease in cardiac output with a rise in BP, due to the stimulation of the sympathetic NS and an increase in blood volume as the kidneys retain sodium and water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists.

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: a.) It is uncomfortable for the client, giving a sense of impending doom. b.) It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. c.) It is almost impossible to convert to a normal sinus rhythm. d.) It can develop into ventricular fibrillation at any time.

d.) It can develop into ventricular fibrillation at any time. Rationale: Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.

After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes are these? a.) Electrophysiologic b.) Hematologic c.) Mechanical d.) Metabolic

d.) Metabolic Rationale: Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Mechanical changes are those that affect the pumping action of the heart, and electro physiologic changes affect conduction. Hematologic changes would affect the blood.

Which is the primary consideration when preparing to administer thrombolytic therapy to a patient who is experiencing an acute myocardial infarction (MI)? a.) History of heart disease. b.) Sensitivity to aspirin. c.) Size and location of the MI. d.) Time since onset of symptoms.

d.) Time since onset of symptoms.

What is the primary reason for administering morphine to a client with myocardial infarction? a.) To sedate the client b.) To decrease the client's pain c.) To decrease the client's anxiety d.) To decrease oxygen demand on the client's heart

d.) To decrease oxygen demand on the client's heart Rationale: Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but isn't primarily given for those reasons.

Which of the following types of angina is most closely related with an impending MI? a.) Angina decubitus b.) Chronic stable angina c.) Noctural angina d.) Unstable angina

d.) Unstable angina Rationale: Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.