NCLEX Cardiovascular, Hematologic, and lymphatic

A woman comes to the office of her healthcare provider reporting shortness of breath and epigastric distress that is not relieved by antacids. To which question would a woman experiencing a myocardial infarction respond differently than a man? A. "Do you have chest pain?" B. "Are you feeling anxious?" C. "Do you have any palpitations?" D. "Are you feeling short of breath?"

A. "Do you have chest pain?"

The client is in atrial fibrillation. Which information should the nurse consider about atrial fibrillation when planning care for this client? A. A loss of atrial kick B. No physiologic changes C. Increased cardiac output D. Decreased risk of pulmonary embolism

A. A loss of atrial kick

A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level? A. Losartan B. Norvasc C. Aspirin D. Cardizem

A. Losartan

The nurse is assessing a client with the diagnosis of left ventricular failure. Which assessment finding does the nurse expect to identify? A. Crushing chest pain B. Dyspnea on exertion C. Jugular vein distention D. Extensive peripheral edema

B. Dyspnea on exertion

What are the clinical manifestations of myocardial infarction in women? Select all that apply. A. Anoxia B. Indigestion C. Unusual fatigue D. Sleep disturbances E. Tightness of the chest

B. Indigestion C. Unusual fatigue D. Sleep disturbances

A client is admitted to the coronary care unit with atrial fibrillation and a rapid ventricular response. The nurse prepares for cardioversion. What nursing action is essential to prevent the potential danger of inducing ventricular fibrillation during cardioversion? A. Energy level is set at its maximum level. B. Synchronizer switch is in the "on" position. C. Skin electrodes are applied after the T wave. D. Alarm system of the cardiac monitor is functioning simultaneously.

B. Synchronizer switch is in the "on" position.

You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them? A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.

B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension.

A client has surgery to replace a prolapsed mitral valve. What should the nurse teach the client? A. The signs and symptoms of pericarditis B. The signs and symptoms of heart failure C. That cardiac surgery will have to be done eventually for the other valves D. That cardiac surgery will have to be done every six months to replace the valve

B. The signs and symptoms of heart failure

A client comes to the clinic for a physical and asks to be tested for acquired immune deficiency syndrome (AIDS). Which test should the nurse explain will be used for the initial screening for human immunodeficiency virus (HIV)? A. CD4 T cell count B. Western blot test C. Polymerase chain reaction test D. Enzyme-linked immunosorbent assay (ELISA)

D. Enzyme-linked immunosorbent assay (ELISA)

What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction

D. Left ventricular diastolic dysfunction

A patient taking Lovenox is having a severe reaction. What is the antidote for this medication? A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate

D. Protamine sulfate

Which clinical indicator should the nurse expect to identify when assessing a client with varicose veins? A. Positive Homans sign B. Pallor of the affected extremity C. Continuous edema of the lower legs D. Sensation of heaviness in calf muscles

D. Sensation of heaviness in calf muscles

A client with osteomyelitis is receiving antibiotic therapy through a central line. Trough blood levels were obtained immediately before a prescribed dose of antibiotics was administered, and peak levels were obtained 30 minutes after the infusion was completed. The laboratory results reveal that the trough level is higher than the peak level. What should the nurse conclude that this finding probably indicates? A. The dose should be increased. B. The dose is in excess of the client's needs. C. There was an adequate administration of the antibiotic. D. There was a problem with the obtaining of blood specimens.

D. There was a problem with the obtaining of blood specimens.

A nurse is developing a health teaching plan for clients with pacemakers. Which activity should the nurse teach these clients to avoid? A. Having a computed tomography (CT) scan B. Standing near a microwave C. Swimming in saltwater D. Touring a power plant

D. Touring a power plant

A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers. A. Myoglobin B. CK-MB C. CK D. Troponin

D. Troponin

A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.

E. Options A and B are correct.

True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.

True

Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

A client with heart failure has anxiety. Which effect of anxiety makes it particularly important for the nurse to reduce the anxiety of this client? A. Increases the cardiac workload B. Interferes with usual respirations C. Produces an elevation in temperature D. Decreases the amount of oxygen used

A. Increases the cardiac workload

A client with a suspected dysrhythmia is to wear a Holter monitor for 24 hours at home. What should the nurse instruct the client to do? A. Keep a record of the day's activities. B. Avoid going through laser-activated doors. C. Record the pulse and blood pressure every 4 hours. D. Delay taking prescribed medications until the monitor is removed.

A. Keep a record of the day's activities.

24-36 hours after a myocardial infarction _____________ congregate at the site during the inflammation phase. A. Neutrophils B. Eosinophils C. Platelets D. Macrophages

A. Neutrophils

A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status: A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time

A. Obtain a 12-lead EKG D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula

A nurse reviews the plan of care for a client who is recovering from the acute phase of left ventricular failure. Which dietary restriction will the nurse expect to be included in the plan? A. Sodium B. Calcium C. Potassium D. Magnesium

A. Sodium

Serum cardiac marker studies are prescribed for a client after a myocardial infarction. Which laboratory test is most important for the nurse to monitor? A. Troponin B. Myoglobin C. Homocysteine D. Creatine kinase (CK)

A. Troponin

A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time? A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Last consumption of caffeine D. CK result and when the next CK level is due to be collected

A. Troponin result and when the next troponin level is due to be collected

A nurse is providing dietary instruction to a client with cardiovascular disease. Which dietary selection by the client indicates that the nurse needs to reeducate the client? A. Whole milk with oatmeal B. Garden salad with olive oil C. Tuna fish with a small apple D. Soluble fiber cereal with yogurt

A. Whole milk with oatmeal

After teaching a client about a low-fat diet, what is most important for the nurse to document? A. Client's weight loss goals B. Client's ability to plan a low-fat meal C. Client's receptiveness to the education D. Education of family members/significant others as well as the client

B. Client's ability to plan a low-fat meal

The nurse is caring for a client who is admitted with the diagnosis of mild heart failure. Which type of lung sounds should the nurse expect to hear? A. Stridor B. Crackles C. Wheezes D. Friction rubs

B. Crackles

You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage? A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease.

B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle.

A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect? A. Losartan B. Lisinopril C. Cardizem D. Lipitor

B. Lisinopril

Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea

B. Persistent cough D. Crackles F. Orthopnea

Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY: A. Lengthening p-waves B. ST-segment elevation C. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression

B. ST-segment elevation C. T-wave inversion D. Tall t-waves F. ST-segment depression

A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug? A. "I will take this medication at night." B. "I will take this medication as needed." C. "I will monitor my heart rate and blood pressure while taking this medication." D. "I will take this medication in the morning with grapefruit juice."

C. "I will monitor my heart rate and blood pressure while taking this medication."

After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue? A. 24 hours B. 2 days C. 10 days D. 6 hours

C. 10 days

A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.

C. Assist the patient into High Fowler's position.

A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind D. No medication because this is a normal Digoxin level.

C. Digibind

On an EKG, the lateral view of the heart is represented with leads? A. V1, V2, V3 B. II, II, AVF C. I, AVL, V5, V6 D. V1, V2, V6

C. I, AVL, V5, V6

A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this? A. Coreg B. Cardizem C. Lovenox D. Lipitor

C. Lovenox

The laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco2 of 50 mm Hg, HCO3 of 58 mEq/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L). The nurse concludes that the findings support what diagnosis? A. Hypocapnia B. Hyperkalemia C. Metabolic alkalosis D. Respiratory acidosis

C. Metabolic alkalosis

In addition to atrial fibrillation, which cardiac dysrhythmia exhibited by a client does the nurse determine may be converted to sinus rhythm by cardioversion? A. Cardiac standstill B. First degree heart block C. Supraventricular tachycardia D. Frequent premature complexes

C. Supraventricular tachycardia

Which nursing action should be included in the plan of care for a client who has a permanent fixed (asynchronous) pacemaker inserted? A. Instruct the client that it is better to sleep on two pillows B. Encourage the client to reduce activity from former levels C. Teach the client to keep daily accurate records of the pulse D. Inform the client that the pacemaker functions when the heart rate drops below a preset rate

C. Teach the client to keep daily accurate records of the pulse

During a routine physical examination, an abdominal aortic aneurysm is diagnosed. The client immediately is admitted to the hospital, and surgery is scheduled for the next morning. Which clinical finding should the nurse expect when performing an assessment of this client? A. Severe radiating abdominal pain B. Pattern of visible peristaltic waves C. Visible pulsating abdominal mass D. Cyanosis with other symptoms of shock

C. Visible pulsating abdominal mass

You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."

D. "I will limit my consumption of frozen meals."

Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum

D. Frothy-blood tinged sputum

Which of the following tests/procedures are NOT used to diagnose heart failure? A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring

D. Holter monitoring

A nurse is obtaining an admission history for a client who is scheduled for surgery to repair a ruptured abdominal aneurysm. Which type of shock should the nurse monitor for in this client? A. Obstructive B. Neurogenic C. Cardiogenic D. Hypovolemic

D. Hypovolemic

The nurse is caring for a client who is receiving therapy for vitamin B12 deficiency. Which finding indicates that the therapy is having the desired effect? A. Normal serum electrolyte levels B. Healthy skin integrity C. Resolution of peripheral edema D. Improved hemoglobin and hematocrit levels

D. Improved hemoglobin and hematocrit levels

A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III, AVF. What area of the heart does this represent? A. Lateral B. Septal C. Anterior D. Inferior

D. Inferior

A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from? A. Cardiac dissection B. Ventricular septum rupture C. Mitral valve prolapse D. Pericarditis

D. Pericarditis

A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of Heparin therapy and requires intervention? A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000

D. Platelets 135,000 (Platelet value of <150,000 indicates thrombocytopenia and is found in patients with Heparin-Induced Thrombocytopenia. The potassium and hemoglobin level are normal. The PTT level is therapeutic (60-80 seconds) for Heparin and isn't a cause for concern.)

A client is receiving warfarin. The nurse explains the need for careful regulation of dietary intake of vitamin K. What is the rationale for the nurse's teaching? A. Vitamin K promotes platelet aggregation. B. Vitamin K promotes ionization of blood calcium. C. Vitamin K promotes fibrinogen formation by the liver. D. Vitamin K promotes prothrombin formation by the liver.

D. Vitamin K promotes prothrombin formation by the liver.

A nurse is assessing a client's ECG reading. The client's atrial and ventricular heart rates are equal at 88 beats per min. The PR interval is 0.14 seconds, and the QRS width is 0.10 seconds. Rhythm is regular with normal P waves and QRS complexes. How will the nurse interpret this rhythm? A. Normal sinus rhythm B. Sinus tachycardia C. Sinus bradycardia D. Sinus arrhythmia

A. Normal sinus rhythm

A nurse identifies that a client may be dehydrated. Which clinical manifestations would the client exhibit? Select all that apply. A. Oliguria B. Dyspnea C. Hypotension D. Pulmonary crackles E. Tenting tissue turgor

A. Oliguria C. Hypotension E. Tenting tissue turgor

A patient is experiencing Heparin-Induced Thrombocytopenia from Heparin therapy. The doctor orders Heparin to be discontinued. The patient will most likely be placed on what other medication? A. Argatroban B. Lovenox C. Levophed D. Tridil

A. Argatroban

In regards to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention? A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders. B. Administer Morphine IV and place the patient in reverse Trendelenburg position. C. Administer Nitroglycerin and monitor the patient's blood pressure. D. All the options are incorrect.

A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders.

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02

B. BNP 820

A client is admitted with chest pain unrelieved by nitroglycerin, an elevated temperature, decreased blood pressure, and diaphoresis. A myocardial infarction is diagnosed. Which should the nurse consider as a valid reason for one of this client's physiologic responses? A. Parasympathetic reflexes from the infarcted myocardium cause diaphoresis. B. Inflammation in the myocardium causes a rise in the systemic body temperature. C. Catecholamines released at the site of the infarction cause intermittent localized pain. D. Constriction of central and peripheral blood vessels causes a decrease in blood pressure.

B. Inflammation in the myocardium causes a rise in the systemic body temperature.

Select all the correct statements about educating the patient with heart failure: A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.

B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.

A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."