nclex questions cardio

A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. The nurse would first:

1. Call a code blue. 2. Call the health care provider. 3. Check the client status and lead placement. 4. Press the recorder button on the ECG console. ANSWER : 3

A nurse has completed counseling about smoking cessation with a client with coronary artery disease. The nurse determines that the client has understood the material best if the client states that:

1. "A smoker has twice the risk of having a heart attack than a nonsmoker." 2. "I may try just cutting down first, because the damage has already been done." 3. "I'm never going to start again, because I can cut my risk of cardiovascular disease to zero within a year." 4. "I don't think I want to quit because none of the effects are reversible anyway." ANSWER : 1

A nurse has reinforced dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions?

1. "I need to substitute eggs and milk for meat." 2. "I will eliminate all cholesterol and fat from my diet." 3. "I should routinely use polyunsaturated oils in my diet." 4. "I need to seriously consider becoming a strict vegetarian." ANSWER: 3 Rationale: The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hyperlipidemia. It is not necessary to eliminate all cholesterol and fat from the diet. It is not necessary to become a strict vegetarian.

A nurse determines that a client with coronary artery disease (CAD) understands disease management if the client makes which of the following statements?

1. "I will walk for one-half hour daily." 2. "As long as I exercise I can eat anything I wish." 3. "My weight has nothing to do with this disease." 4. "It doesn't matter if my father had high cholesterol." ANSWER: option 1

A nurse is assisting in the care of a client with myocardial infarction who should reduce intake of saturated fat and cholesterol. The nurse should help the client comply with diet therapy by selecting which of the following food items from the dietary menu?

1. Cheeseburger, pan-fried potatoes, whole kernel corn, sherbet 2. Baked haddock, steamed broccoli, herbed rice, sliced strawberries 3. Spaghetti and sweet sausage in tomato sauce, vanilla pudding (with 4% milk) 4. Pork chop, baked potato, cauliflower in cheese sauce, ice cream ANSWER: 2

A client with heart failure is scheduled to be discharged to home with digoxin (Lanoxin) and furosemide (Lasix) as ongoing prescribed medications. The nurse teaches the client to report which sign that indicates that the medications are not having the intended effect?

1. Decrease in pedal edema 2. High urine output during the day 3. Weight gain of 2 to 3 pounds in a few days 4. Cough accompanied by other signs of respiratory infection ANSWER : 3 Rationale: Clients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia. An increase in daytime voiding is expected while on diuretic therapy (Lasix). A cough as a result of respiratory infection does not necessarily indicate that heart failure is exacerbating. Test-Taking Strategy: Use the process of elimination. Note the strategic words, "not having the intended effect." Eliminate option 4 first because it is related to respiratory infection and does not indicate impending heart failure. Options 1 and 2 are eliminated next because they are positive signs. Sudden weight gain would accompany fluid retention and should be reported. Review home care instructions for the client with heart failure if you had difficulty with this question.

A client is receiving a continuous intravenous (IV) infusion of heparin in the treatment of deep vein thrombosis. The nurse is told that the client's activated partial thromboplastin time (aPTT) level is 65 seconds and that the client's baseline before the initiation of therapy was 30 seconds. The nurse identifies these results as:

1. Low 2. Elevated 3. Within the therapeutic range 4. Abnormal ANSWER: 3 Rationale: The normal aPTT varies between 20 and 36 seconds, depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 and 2.5 times normal. Thus the client's aPTT is within the therapeutic range, and the dose should remain unchanged.

A nurse is checking the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is:

1. Moderately impaired, and the surgeon should be called 2. Normal, caused by increased blood flow through the leg 3. Slightly deteriorating, and should be monitored for another hour 4. Adequate from an arterial approach, but venous complications are arising ANSWER : 2 Rationale: An expected outcome of surgery is warmth, redness, and edema in the surgical extremity cause by increased blood flow. Options 1, 3, and 4 are incorrect.

A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath, and the client is visibly anxious. The nurse understands that a life-threatening complication of this condition is:

1. Pneumonia 2. Pulmonary edema 3. Pulmonary embolism 4. Myocardial infarction ANSWER : 3 Rationale: Pulmonary embolism is a life-threatening complication of deep vein thrombosis and thrombophlebitis. Chest pain is the most common symptom, which is sudden in onset and may be aggravated by breathing. Other signs and symptoms include dyspnea, cough, diaphoresis, and apprehension

A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often in the morning. On further data collection, the nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as:

1. Stable angina 2. Variant angina 3. Unstable angina 4. Nonanginal pain ANSWER: option 2 :variant angina Rationale: Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often in the morning. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower and lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction. The data in the question is characteristic of a type of angina pain and therefore option 4 is incorrect.

The client's B-type natriuretic peptide (BNP) level is 691 pg/mL. Which of the following should the nurse institute when providing care for the client?

1. Take daily weights and monitor trends. 2. Encourage fluids to improve hydration. 3. Elevate the legs above the level of the heart. 4. Position supine with the head of the bed at 30 degrees. ANSWER : 1 Rationale: BNP levels greater than 500 pg/mL indicate that heart failure is probable. Nursing measures are geared toward decreasing intravascular volume, decreasing preload, and decreasing afterload. Option 2 increases intravascular volume, and options 3 and 4 increase preload.

A sublingual nitroglycerin (Nitrostat) tablet administered to a client for chest pain has relieved the pain. The nurse ensures that the client has which important item within easy reach before leaving the room?

1. Tissues 2. Call bell 3. Telephone 4. Cool cloth for the forehead ANSWER : 2

A client with a diagnosis of rapid rate atrial fibrillation asks the nurse why the health care provider is going to perform carotid massage. The nurse responds that this procedure may stimulate the:

1. Vagus nerve to slow the heart rate 2. Vagus nerve to increase the heart rate 3. Diaphragmatic nerve to slow the heart rate 4. Diaphragmatic nerve to increase the heart rate ANSWER: 1 Rationale: Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. The other maneuvers are the Valsalva maneuver of inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm.

A client is admitted to the hospital with possible rheumatic endocarditis. The nurse would check the client for signs and symptoms of concurrent:

1. Viral infection 2. Yeast infection 3. Streptococcal infection 4. Staphylococcal infection ANSWER : 3 Rationale: Rheumatic endocarditis, also called rheumatic carditis, is a major indicator of rheumatic fever, which is a complication of infection with group A β-hemolytic streptococcal infections. It is frequently triggered by streptococcal pharyngitis. Options 1, 2, and 4 are incorrect.

A nurse is planning to teach a client with peripheral arterial disease about measures to limit disease progression. The nurse should include which items on a list of suggestions to be given to the client? Select all that apply.

Cut down on the amount of fats consumed in the diet. Use a heating pad on the legs to aid vasodilation. Walk each day to increase circulation to the legs. Be careful not to injure the legs or feet. Eat a well-balanced diet every day. *** ANSWER : all of them except using a heating pad on the legs to aid vasodilation.

A client is admitted to the hospital with a venous stasis leg ulcer. The nurse inspects the ulcer, expecting to note that the ulcer:

Has a brownish or "brawny" appearance

Acetylsalicylic acid (Aspirin) is prescribed for a client before a percutaneous transluminal coronary angioplasty (PTCA). When the nurse takes the aspirin to the client, the client asks the nurse about its purpose. The nurse informs the client that the aspirin will:

prevents clot formation

A client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. The nurse interprets that the client is experiencing which of the following types of angina?

stable Rationale: Stable angina, also known as exertional angina, is triggered by a predictable amount of effort or emotion. Unstable angina is triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Variant angina is triggered by coronary artery spasm; the attacks are of longer duration than classic angina and tend to occur early in the day and at rest. Intractable angina is chronic and incapacitating, and is refractory to medical therapy.

A hospitalized client with a history of angina pectoris is ambulating in the corridor. The client suddenly complains of severe substernal chest pain. The nurse should take which action first?

1. Administer sublingual nitroglycerin. 2. Assist the client to sit or lie down. 3. Apply nasal oxygen at a rate of 2 L/min. 4. Check the client's vital signs. ANSWER : 2

A nurse assisting in caring for a client hospitalized with acute pericarditis is monitoring the client for signs of cardiac tamponade. The nurse determines that which finding is unrelated to possible cardiac tamponade?

1. Distended jugular neck veins 2. Pulse rate of 58 beats per minute 3. Muffled and distant heart sounds 4. Systolic blood pressure of 110 mm Hg, dropping to 94 mm Hg on inspiration ANSWER : 2

A nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse would expect to note which specific characteristic of this condition?

1. Dyspnea 2. Hacking cough 3. Dependent edema 4. Crackles on lung auscultation ANSWER : 3