NCLEX Cardiovascular, Hematologic and Lymphatic

When a Schilling test is prescribed for a client suspected of having cobalamin deficiency because of pernicious anemia, what should the nurse plan to do? A. Give medications on time B. Prescribe foods low in vitamin B12 C. Keep an accurate intake and output D. Collect a 24-hour to 48-hour urine specimen

D. Collect a 24-hour to 48-hour urine specimen

A nurse is determining a client's heart rate on an ECG strip. Which action should the nurse take? A. Count the P waves B. Count the T waves C. Count the PR interval D. Count the QRS complexes

D. Count the QRS complexes

A client with the diagnosis of myocardial infarction is admitted to the intensive care unit, and a pulmonary artery catheter is inserted for hemodynamic monitoring. Therapy is administered to maintain the pulmonary artery wedge pressure at 16 to 20 mm Hg to optimize stroke volume. The client's pulmonary artery wedge pressure increases to 24 mm Hg. What does the nurse consider as the most likely reason for this change? A. Decreased afterload B. Decreased heart rate C. Increased stroke volume D. Increased intravascular volume

D. Increased intravascular volume

A patient, with a history of gastric bypass surgery 6 months ago, reports feeling very fatigued and is having food cravings for clay and dirt. On assessment, you note the patient has nail changes that look "spoon-shaped". This spoon-shaped appearance of the nails is called? A. Terry's Nails B. Onychoschizia C. Koilonychias D. Leukonychia

C. Koilonychias

A client had a ventricular demand pacemaker inserted. What is the priority nursing intervention immediately after the procedure? A. Encourage fluids. B. Assess the implant site. C. Monitor the heart rate and rhythm. D. Encourage turning and deep breathing.

C. Monitor the heart rate and rhythm.

A client with a distal femoral shaft fracture is at risk for developing a fat embolus. The nurse knows to watch for what distinguishing sign that is unique to a fat embolus? A. Oliguria B. Dyspnea C. Petechiae D. Confusion

C. Petechiae

A client diagnosed with multiple myeloma has been given a poor prognosis. After discharge, the client plans to travel on an airplane and attend sporting events with friends and family. The nurse prepares a discharge teaching plan for this client. What should the plan include? A. Eliminating travel plans to combat anemia-related fatigue B. Reinforcing a positive mental attitude to improve prognosis C. Preventing infection; the client is at risk for leukopenia D. Restricting fluid intake; the client is at risk for congestive heart failure

C. Preventing infection; the client is at risk for leukopenia

The nurse is assessing the pulse of a client who has a demand pacemaker. If the client's demand pacemaker is functioning effectively, the nurse would identify which assessment finding? A. Pulse regular rhythm B. Pulse palpable at all sites C. Pulse rate at least at the preset rate D. Pulse equal to the pacemaker setting

C. Pulse rate at least at the preset rate

A patient is admitted with iron- deficiency anemia and has been receiving iron supplementation. The patient voices concern about how their stool is dark black. As the nurse, you would? A. Notify the doctor B. Hold the next dose of iron C. Reassure the patient this is a normal side effect of iron supplementation D. None of the options are correct

C. Reassure the patient this is a normal side effect of iron supplementation

Metoprolol is prescribed for a client. Which condition in the client's electronic medical record will cause the nurse to question the prescription? A. Hypertension B. Angina pectoris C. Sinus bradycardia D. Myocardial infarction

C. Sinus bradycardia

A nurse is teaching a client about the normal pathway followed during the cardiac cycle. In which sequence should the nurse list the structures, beginning with the first? 1. Bundle of His 2. Sinoatrial node 3. Purkinje fibers 4. Bundle branches 5. Atrioventricular node

2. Sinoatrial node 5. Atrioventricular node 1. Bundle of His 4. Bundle branches 3. Purkinje fibers

A nurse is providing postprocedure care to a client who had a cardiac catheterization via a brachial artery. For the first hour after the procedure, what is the priority nursing intervention? A. Monitor the vital signs every 15 minutes B. Maintain the client in the supine position C. Keep the client's lower extremities in extension D. Administer the prescribed oxygen at 4 L/min via nasal cannula

A. Monitor the vital signs every 15 minutes

A client with peripheral arterial insufficiency is scheduled for surgery. On admission, the client complains of discomfort and aches in the legs and feet. How should the nurse position the client's feet and legs? A. Place them dependent to the torso. B. Position them dependent by using a fully extended knee gatch. C. Raise them to a two-pillow height above the buttocks. D. Elevate them by raising the foot of the bed on blocks.

A. Place them dependent to the torso.

The student nurse demonstrates correct understanding of anemia related to chronic disease with which statement? A. "Red blood cells appear normal in size and color; however, there is a decreased amount produced." B. "The red blood cells have an increased life span with a decrease in normal functioning." C. "Administration of vitamins B12 and folate will help to treat this type of long-term anemia." D. "This is the mildest form of anemia and is easily corrected through administration of blood products."

A. "Red blood cells appear normal in size and color; however, there is a decreased amount produced."

The client is admitted with sinus tachycardia. To treat the dysrhythmia, the nurse will look for potential causes. Which causes will the nurse look for in this client? Select all that apply. A. Anxiety B. Caffeine C. Exercise D. Anemia E. Hypothermia

A. Anxiety B. Caffeine C. Exercise D. Anemia

A client with multiple myeloma asks how the disease and therapy progresses. What would be appropriate to include in the client's teaching? A. Blood transfusions may be necessary. B. Frequent urinary tract infections may result. C. Intravenous (IV) fluid therapy may be administered in the home. D. The disease is exacerbated by exposure to ultraviolet rays.

A. Blood transfusions may be necessary.

A client is admitted to the emergency department with the diagnosis of a possible spinal cord injury. The nurse should monitor the client for what clinical manifestations of spinal shock? Select all that apply. A. Bradycardia B. Hypotension C. Spastic paralysis D. Bladder dysfunction E. Increased pulse pressure

A. Bradycardia B. Hypotension D. Bladder dysfunction

Which symptoms indicate to the nurse that the client has an inadequate fluid volume? Select all that apply. A. Decreased urine B. Hypotension C. Dyspnea D. Dry mucous membranes E. Pulmonary edema F. Poor skin turgor

A. Decreased urine B. Hypotension D. Dry mucous membranes F. Poor skin turgor

Immediately after receiving spinal anesthesia a client develops hypotension. To what physiologic change does the nurse attribute the decreased blood pressure? A. Dilation of blood vessels B. Decreased response of chemoreceptors C. Decreased strength of cardiac contractions D. Disruption of cardiac accelerator pathways

A. Dilation of blood vessels

Which clinical indicators is the nurse most likely to identify when taking the admission history of a client with right ventricular failure? Select all that apply. A. Edema B. Vertigo C. Polyuria D. Ascites E. Palpitations

A. Edema D. Ascites

A client develops iron-deficiency anemia. Which of the client's laboratory test results should the nurse expect to be decreased? A. Ferritin level B. Platelet count C. White blood cell count D. Total iron-binding capacity

A. Ferritin level

A postoperative client returned from the postanesthesia care unit (PACU) this morning with a patient-controlled analgesia (PCA) pump running with a basal rate of hydromorphone. The nurse assesses the client's vital signs as blood pressure 90/60 mm Hg, heart rate 96 beats per min, and respiratory rate of 10 breaths per min. Which action should the nurse take next? A. Give naloxone intravenous push med (IVP) per protocol. B. Assess the client's pain level on a 10-point scale. C. Document the findings and reassess in 2 hours. D. Call the rapid response team.

A. Give naloxone intravenous push med (IVP) per protocol.

A nurse is caring for a client with varicose veins. Which clinical manifestations should the nurse expect with this diagnosis? Select all that apply. A. Presence of ankle edema B. Increased muscle fatigue C. Diminished peripheral pulses D. Report of leg fullness and pruritus E. Leg pain with activity that diminishes with rest

A. Presence of ankle edema B. Increased muscle fatigue D. Report of leg fullness and pruritus

After sustaining multiple internal injuries when hit by a motor vehicle, a client has a sudden drop in blood pressure to 80/60 mm Hg. What does the nurse determine probably caused this response? A. Reduction in circulating blood volume B. Diminished vasomotor stimulation to arterial walls C. Vasodilation resulting from diminished vasoconstrictor tone D. Cardiac decompensation resulting from electrolyte imbalance

A. Reduction in circulating blood volume

A client is admitted to the hospital with chest pain and a diagnosis of myocardial infarction. How would the nurse expect the client to describe the chest pain? A. Severe, intense B. Burning and of short duration C. Mild, radiating toward the abdomen D. Squeezing, relieved by nitroglycerin

A. Severe, intense

The client's heart monitor shows a regular rhythm made up of wide and bizarre-looking QRS complexes and no P waves. The rate is 40 beats per minute. How should the nurse interpret these findings? A. Sinoatrial (SA) and atrioventricular (AV) nodes fail to initiate an impulse. B. Purkinje fibers are suppressed. C. SA node is stimulated. D. AV node is stimulated.

A. Sinoatrial (SA) and atrioventricular (AV) nodes fail to initiate an impulse.

A client in the emergency department is diagnosed with atrial fibrillation. Initially the primary healthcare provider instructs the client to perform the Valsalva maneuver by holding the breath and bearing down. What should the nurse include in an explanation of how this may convert atrial fibrillation to a normal sinus rhythm? A. The vagus nerve is stimulated. B. The glottis closes momentarily. C. Thoracic pressure decreases. D. Respiratory pattern is interrupted.

A. The vagus nerve is stimulated.

You're providing education to a patient about how to take their prescribed iron supplement. Which statement by the patient requires you to re-educate the patient on how to take this supplement? A. "I will take this medication on an empty stomach." B. "I will avoid taking this medication with orange juice." C. "I will wait and take my calcium supplements 2 hours after I take my iron supplement." D. "This medication can cause constipation. So, I will drink plenty of fluids and take a stool softer as needed."

B. "I will avoid taking this medication with orange juice."

A client with dehydration suddenly becomes diaphoretic, clammy, and pale. The client's blood pressure falls to 50/30 mm Hg. In which position will the nurse place the client? A. Prone B. High-Fowler C. Feet elevated with head at 20-degree angle D. Whatever position is most comfortable for the client

C. Feet elevated with head at 20-degree angle

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime? A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime."

The nurse is caring for a client after the client's open heart surgery (coronary artery bypass grafting [CABG]). Serosanguineous fluid drains from the client's chest tube. The nurse expects what volume of drainage from the tube during the first 24 hours after the surgery? A. 100 to 300 mL B. 400 to 500 mL C. 750 to 900 mL D. 800 to 1000 mL

B. 400 to 500 mL

Select all the patients who are at MOST risk for iron-deficiency anemia: A. A 55 year old male who reports taking Ferrous Sulfate regularly. B. A 25 year old female who was recently diagnosed with Celiac Disease. C. A 35 year old female who is 36 weeks pregnant that reports craving ice. D. A 67 year old female with a Hemoglobin level of 14.

B. A 25 year old female who was recently diagnosed with Celiac Disease. C. A 35 year old female who is 36 weeks pregnant that reports craving ice.

An electrocardiogram (ECG) is performed before a client is to have a cardiac catheterization, and hypokalemia is suspected. What does the nurse expect the primary healthcare provider to prescribe to confirm the presence of hypokalemia? A. A complete blood count B. A serum electrolyte level C. An arterial blood gas panel D. An x-ray film of long bones

B. A serum electrolyte level

When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first? A. Interview the client for a health history. B. Assess the client's heart and lung sounds. C. Monitor the client's pulse and temperature. D. Obtain the client's blood specimen for electrolytes.

B. Assess the client's heart and lung sounds.

The nurse is caring for a client who is receiving a thiazide diuretic for hypertension. Which food selection by the client indicates to the nurse that dietary teaching about thiazide diuretics is successful? A. Apples B. Broccoli C. Cherries D. Cauliflower

B. Broccoli

A nurse is caring for a client who was admitted to the hospital with the diagnosis of tertiary syphilis. Which system of the body should the nurse assess most closely in this stage of the disease? A. Reproductive B. Cardiovascular C. Lower respiratory D. Lower gastrointestinal

B. Cardiovascular

A Foley catheter was placed with an urimeter for a client with heart failure receiving furosemide. The output is 45 mL/hour, cloudy, and has sediment. How should the nurse interpret these findings? A. The furosemide is causing dehydration. B. Cloudy urine may be indicative of infection. C. The client has inadequate hourly urine output. D. All of the indications are within normal findings.

B. Cloudy urine may be indicative of infection.

A client is experiencing a myocardial infarction. What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion? A. Arterial spasm B. Heart muscle ischemia C. Blocking of the coronary veins D. Irritation of nerve endings in the cardiac plexus

B. Heart muscle ischemia

The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia? A. Hyperchromic and macrocytic B. Hypochromic and microcytic C. Hyperchromic and macrocytic D. Hypochromic and macrocytic

B. Hypochromic and microcytic

A nurse is caring for two clients; one has polycythemia and the other has prolonged anemia. What do these clients have in common? A. Increased urinary output B. Increased cardiac workload C. Decreased oxygen saturation D. Decreased arterial blood pressure

B. Increased cardiac workload

After abdominal surgery a client suddenly reports numbness in the right leg and a "funny feeling" in the toes. What should the nurse do first? A. Tell the client to drink more fluids. B. Instruct the client to remain in bed. C. Gently rub the client's legs for circulation. D. Tell the client about the dangers of prolonged bed rest.

B. Instruct the client to remain in bed.

An older client with hypertension is admitted to the hospital. Which data from the client's history and diagnostic workup represent risk factors for hypertension? Select all that apply. A. Taking an aspirin a day B. Occasional cocaine use C. Reduced hemoglobin level D. African-American heritage E. Increased high-density lipoprotein (HDL)

B. Occasional cocaine use D. African-American heritage

An older adult with peripheral vascular disease has stopped smoking, and the client's children want to make the home environment safe. What should the home healthcare nurse emphasize when providing instructions? A. Observe for evidence of blurred vision B. Use measures that can prevent thermal injuries C. Reduce fluid intake to prevent peripheral edema D. Limit activities to reduce the workload on the heart

B. Use measures that can prevent thermal injuries

A client's laboratory report indicates hyperkalemia. Which responses should the nurse expect the client to exhibit? Select all that apply. A. Anorexia B. Vomiting C. Constipation D. Muscle weakness E. Irregular heart rate

B. Vomiting D. Muscle weakness E. Irregular heart rate

The nurse is watching the technician obtain a 12-lead ECG. In which area should the nurse make sure the technician places the V1 lead? A. Halfway between V2 and V4 B. Fourth intercostal space, left sternal border C. Fourth intercostal space, right sternal border D. Fifth intercostal space, left midclavicular line

C. Fourth intercostal space, right sternal border

A client is admitted to the hospital with multiple signs and symptoms associated with a cardiac problem. What clinical finding alerts the nurse that the primary healthcare provider probably will insert a pacemaker? A. Angina B. Chest pain C. Heart block D. Tachycardia

C. Heart block

A client who is diagnosed as having a myocardial infarction is admitted to the coronary care unit with prescriptions for bed rest and medication for chest pain. Within an hour after admission, the nurse finds the client walking around the unit. What is the nurse's best initial response? A. "Tell me what you are doing out of bed." B. "It must be frustrating to be confined in bed." C. "You need to rest. You should get back into bed." D. "Please get back into bed immediately. The primary healthcare provider wants you to rest."

C. "You need to rest. You should get back into bed."

Which client should a nurse consider the greatest risk for developing hypernatremia? A. A 52-year-old who is receiving 0.45% NaCl intravenously B. A 76-year-old who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a result of head trauma C. A 63-year-old who has had watery diarrhea since traveling abroad D. A 48-year-old who is admitted with a diagnosis of Addison disease

C. A 63-year-old who has had watery diarrhea since traveling abroad

A nurse in the emergency department is assigned to care for four clients. Which client should the nurse see first? A. A client with a head injury B. A client with a fractured femur C. A client with ventricular fibrillation D. A client with a penetrating abdominal wound

C. A client with ventricular fibrillation

A nurse is taking blood pressures at a health fair. Which finding should cause the nurse to advise the client to have the blood pressure checked by a primary healthcare provider? A. A loud Korotkoff sound B. An irregular pulse of 92 beats per minute C. A diastolic blood pressure that remains greater than 90 mm Hg D. A throbbing headache over the left eye when arising in the morning

C. A diastolic blood pressure that remains greater than 90 mm Hg

A client is admitted to the emergency department with a possible myocardial infarction. Three hours after admission, the client experiences a new onset of severe chest pain. The client is diaphoretic with a pulse rate of 110 beats per minute. Which action should the nurse take immediately? A. Decrease the oxygen amount B. Obtain an electrocardiogram (ECG) C. Administer the prescribed morphine D. Offer acetaminophen until the pain subsides

C. Administer the prescribed morphine

A client reports a history of bilateral blanching and pain in the fingers on exposure to cold. When rewarmed, the fingers become bright red and "tingly" with a slow return to their usual color. The client smokes one to two packs of cigarettes per day. Which sign or symptom leads the nurse to determine that the client has Raynaud disease and not Raynaud phenomenon? A. Tingling sensation B. Skin color changes C. Bilateral involvement D. Changes in skin temperature

C. Bilateral involvement

A client returns from a cardiac catheterization procedure and is to remain in the supine position for 4 hours with the affected leg straight. What are these measures intended to prevent? A. Orthostatic hypotension B. Headache with disorientation C. Bleeding at the arterial puncture site D. Infiltration of radiopaque dye into tissue

C. Bleeding at the arterial puncture site

A nurse discovers lower extremity pitting edema in a client with right ventricular heart failure. Which information should the nurse consider when planning care? A. Client has decreased plasma colloid osmotic pressure. B. Client has increased tissue colloid osmotic pressure. C. Client has increased plasma hydrostatic pressure. D. Client has decreased tissue hydrostatic pressure.

C. Client has increased plasma hydrostatic pressure.

After undergoing a cardiac catheterization, the client complains of tingling sensations in the affected leg. What should the nurse do to determine the cause of the tingling? A. Assess for bleeding at the puncture site. B. Evaluate the affected leg for signs of inflammation. C. Compare femoral, popliteal, and pedal pulses in both legs. D. Obtain the temperature, pulse, respirations, and blood pressure.

C. Compare femoral, popliteal, and pedal pulses in both legs.

A client with a history of occasional pain in the left foot when walking now has pain at rest. The left foot is cyanotic, numb, and painful. The suspected cause is arteriosclerosis. Which information will the nurse share with the client to help decrease the pain? A. Keep the left foot cool B. Cross legs with the left one on top C. Comply with the prescribed exercise program D. Keep the foot elevated at a 30-degree angle

C. Comply with the prescribed exercise program

You are providing diet teaching to a patient with low iron levels. Which foods would you encourage the patient to eat regularly? A. Herbal tea, apples, and watermelon B. Sweet potatoes, artichokes, and packaged meat C. Egg yolks, beef, and legumes D. Chocolate, cornbread, and cabbage

C. Egg yolks, beef, and legumes

A client with a history of angina is scheduled for a cardiac catheterization. Catheter entry will be through the femoral artery. What should the nurse tell the client to expect? A. Remain fully alert during the procedure B. Ambulate shortly after the procedure C. Experience a feeling of warmth during the procedure D. Be placed in a semi-Fowler position for 12 hours after the procedure

C. Experience a feeling of warmth during the procedure

The client's underlying heart rhythm is sinus rhythm, but the rhythm is irregular because of occasional early beats. The configuration of the P waves is normal, except the P wave of the early beat does not look the same as the others. The morphology of the QRS complex is the same for all beats. The heart rate is 66 beats per min, and the blood pressure is normal. How should the nurse interpret this finding? A. Sinus tachycardia B. Normal sinus rhythm C. Sinus rhythm with premature atrial contractions (PACs) D. Sinus bradycardia with premature ventricular contractions (PVCs)

C. Sinus rhythm with premature atrial contractions (PACs)

A client who is scheduled for a modified radical mastectomy decides to have family members donate blood in the event it is needed. The client has type A negative blood. Which blood types can be used? A. Type O positive B. Type AB positive C. Type A or O negative D. Type A or AB negative

C. Type A or O negative

A client with type 1 diabetes asks what causes the several brown spots on the skin. What would be the best response by the nurse? A. "The brown spots reflect the accumulation of blood fats in the skin; they should disappear." B. "Those spots indicate a high glucose content in the skin that may get infected if left untreated." C. "They are the result of diseased small vessels in the shins and may spread if not treated soon." D. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."

D. "Those brown spots result from small blood vessel damage; the blood contains iron, which leaves a brown spot."

Thrombus formation is a danger for postoperative clients. Which independent interventions should the nurse perform to prevent this complication? Select all that apply. A. Increase the client's intravenous (IV) flow rate. B. Massage the client's extremities with lotion. C. Place the client's legs in pneumatic sequential stockings. D. Instruct the client to avoid crossing the legs. E. Instruct the client to dorsiflex the feet routinely.

D. Instruct the client to avoid crossing the legs. E. Instruct the client to dorsiflex the feet routinely.

A client who recently was diagnosed as having myelocytic leukemia discusses the diagnosis by referring to statistics, facts, and figures. The nurse determines that the client is using which defense mechanism? A. Projection B. Sublimation C. Identification D. Intellectualization

D. Intellectualization

An older client tells the nurse, "My legs begin to hurt after walking the dog for several blocks. The pain goes away when I stop walking, but it comes back again when I resume walking." Which condition does the nurse consider as the most likely cause of the client's pain? A. Spinal stenosis B. Buerger disease C. Rheumatoid arthritis D. Intermittent claudication

D. Intermittent claudication

A primary healthcare provider prescribes an antihypertensive medication. Which over-the-counter medication should the nurse teach the client to avoid because it has the potential to counteract the effect of the antihypertensive? A. Omeprazole B. Acetaminophen C. Docusate sodium D. Pseudoephedrine

D. Pseudoephedrine

A nurse is caring for a client with a myocardial infarction. What is most important for the nurse to assess that has a direct relationship to the action potential of the heart? A. Heart rate B. Refractory period C. Pulmonary pressure D. Strength of contractions

D. Strength of contractions

A client has contrast medium injected into the brachial artery so that a cerebral angiogram can be performed. What nursing assessment is most essential immediately after the procedure? A. Stability of gait B. Presence of a gag reflex C. Blood pressure in both arms D. Symmetry of the radial pulses

D. Symmetry of the radial pulses

A nurse determines that the client's apical pulse rate is higher than the radial pulse and documents the pulse deficit. What does the nurse consider is the primary reason for the pulse deficit? A. The client's heart may be beating faster temporarily. B. The nurse may not know how to take an accurate pulse. C. The radial pulse site may be surrounded by too much subcutaneous fat. D. The client may have atrial fibrillation.

D. The client may have atrial fibrillation.

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 121/78 to 62/44 mm Hg and the heart rate has risen from 78 to 128 beats/min. The nurse knows that which parenteral replacement fluids is the most appropriate for this client? A. 5% Dextrose and lactated Ringer solution B. 0.9% normal saline solution C. Total parenteral nutrition D. Whole blood products

D. Whole blood products

True or False: High levels of iron lead to the body producing fewer red blood cells.

False

True or False: The body uses hemoglobin to make iron.

False

True or False: The least common type of anemia is iron-deficiency anemia.

False

True or False: Early signs and symptoms of iron-deficiency anemia are vague.

True