NCLEX RN Cardiovascular Exam Questions With Answers, Exams of Nursing

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NCLEX RN Cardiovascular Exam Questions With Answers 2023/2024 Update

1. A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?
2. Glipizide
3. Metformin
4. Repaglinide
5. Regular insulin
6. A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem?
7. Hypovolemia
8. Acute kidney injury
9. Glomerulonephritis
10. Urinary tract infection
11. The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats/minute. Which action should the nurse take?
12. Check vital signs.
13. Check laboratory test results.
14. Notify the health care provider.
15. Continue to monitor for any rhythm change.
16. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action?
17. Call a code.
18. Call the health care provider.
19. Check the client's status and lead placement.
20. Press the recorder button on the electrocardiogram console. 5. The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority?
21. Blood pressure
22. Status of airway
23. Oxygen flow rate
24. Level of consciousness
25. The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority?
26. Anxiety level of the client and family

2. Presence of a Medic-Alert card for the client to carry
3. Knowledge of restrictions on post-discharge physical activity
4. Activation status of the device, heart rate cutoff, and number of shocks it is

programmed to deliver

7. A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm?
8. Sinus tachycardia
9. Sinus bradycardia
10. Sinus dysrhythmia
11. Normal sinus rhythm
12. The nurse is assessing 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. How should the nurse correctly interpret the client's neurovascular status?
13. The neurovascular status is normal because of increased blood flow through the leg.
14. The neurovascular status is moderately impaired, and the surgeon should be called.
15. The neurovascular status is slightly deteriorating and should be monitored for another hour.
16. The neurovascular status is adequate from an arterial approach, but venous complications are arising.
17. The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective?
18. Muffled heart sounds
19. A rise in blood pressure
20. Jugular venous distention
21. Client expressions of dyspnea
22. A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching?
23. "I should notify my doctor if my feet or legs start to swell."
24. "My doctor told me to call his office if my pulse rate decreases below 60."
25. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast."
26. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."
27. The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication?
28. Flat neck veins
29. A pulse rate of 60 beats/minute
30. Muffled or distant heart sounds
31. Wheezing on auscultation of the lungs

12. The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction?
13. "I need to be sure not to go barefoot around the house."
14. "If I cut my toenails, I need to be sure that I cut them straight across."
15. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes."
16. "I need to be sure that I elevate my leg above the level of my heart for at least an hour every day."
17. The nurse is providing instructions to a client with a diagnosis of hypertension regarding high- sodium items to be avoided. The nurse instructs the client to avoid consuming which item?
18. Bananas
19. Broccoli
20. Antacids
21. Cantaloupe
22. The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client?
23. Use nail polish to protect the nail beds from injury.
24. Wear gloves for all activities involving the use of both hands.
25. Stop smoking because it causes cutaneous blood vessel spasm.
26. Always wear warm clothing, even in warm climates, to prevent vasoconstriction.
27. The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention?
28. Keep the legs aligned with the heart.
29. Elevate the legs higher than the heart.
30. Clean the skin with alcohol every hour.
31. Position the client onto the side during every shift. Rationale: In the client with a venous disorder, the legs are elevated above the level of the heart to assist with the return of venous blood to the heart. Alcohol is very irritating and drying to tissues and should not be used in areas of skin breakdown. Option 4 specifies infrequent care intervals, so it is not the priority intervention.
32. The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit (ICU). The nurse notes that a cardiac troponin T assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition?
33. Heart failure
34. Atrial fibrillation
35. Myocardial infarction
36. Ventricular tachycardia
37. The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse should next assess the client for which finding?

1. Hypotension

2. Flat neck veins
3. Complaints of nausea
4. Complaints of headache Rationale: The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
5. The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function?
6. Listening to lung sounds
7. Palpating for organomegaly
8. Assessing for jugular vein distention
9. Assessing for peripheral and sacral edema
10. The nurse is participating in a class on rhythm strip interpretation. Which statement by the nurse indicates an understanding of a PR interval of 0.20?
11. "This is a normal finding."
12. "This is indicative of atrial flutter."
13. "This is indicative of atrial fibrillation."
14. "This is indicative of impending reinfarction."
15. The nurse in the medical unit is assigned to provide discharge teaching to a client with a diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to minimize the effects of the disease process. The client continually changes the subject during the teaching session. The nurse interprets that this client's behavior is most likely related to which problem?
16. Anxiety related to the need to make lifestyle changes
17. Boredom resulting from having already learned the material
18. An attempt to ignore or deny the need to make lifestyle changes
19. Lack of understanding of the material provided at the teaching session and embarrassment about asking questions
20. A home care nurse is visiting a client to provide follow-up evaluation and care of a leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is pale and deep and that the surrounding tissue is cool to the touch. The nurse should document that these findings identify which type of ulcer?
21. A stage 1 ulcer
22. A vascular ulcer
23. An arterial ulcer
24. A venous stasis ulcer Rationale: Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients. A stage 1 ulcer indicates a reddened area with an intact skin surface. A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of

venous congestion.

22. The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider (HCP) will most likely prescribe which option?
23. Maintain activity level as prescribed.
24. Maintain the affected leg in a dependent position.
25. Administer an opioid analgesic every 4 hours around the clock.
26. Apply cool packs to the affected leg for 20 minutes every 4 hours.
27. A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and is receiving education about the procedure from the nurse. Which statement by the client indicates that the teaching has been effective?
28. "It involves tying off the veins so that circulation is redirected in another area."
29. "It involves surgically removing the varicosity, so anesthesia will be required."
30. "It involves tying off the veins to prevent sluggishness of blood from occurring."
31. "It involves injecting an agent into the vein to damage the vein wall and close it off."
32. A client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure was performed, she has been experiencing a sensation as though the affected leg is falling asleep. The nurse should make which response to the client?
33. "Apply warm packs to the leg."
34. "Keep the leg elevated as much as possible."
35. "Your health care provider needs to be contacted to report this problem."
36. "This normally occurs after surgery and will subside when the edema goes down."
37. The registered nurse (RN) is educating a new RN about the use of oxygen for clients with angina pectoris. Which statement by the new nurse indicates that the teaching has been effective?
38. "Oxygen has a calming effect."
39. "Oxygen will prevent the development of any thrombus."
40. "The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells."
41. "Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle.

26. A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions?
27. "I need to cut down on cigarette smoking."
28. "I am so relieved that my heart is repaired."
29. "I need to adhere to my dietary restrictions."
30. "I am so relieved that I can eat anything I want to now."
31. The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage should the nurse instruct the client to select from the menu?
32. Tea
33. Cola
34. Coffee
35. Raspberry juice
36. The nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse should immediately ask the client which question?
37. "Where is the pain located?"
38. "Are you having any nausea?"
39. "Are you allergic to any medications?"
40. "Do you have your nitroglycerin with you?"
41. The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions?
42. "I'll need to become a strict vegetarian."
43. "I should use polyunsaturated oils in my diet."
44. "I need to substitute eggs and whole milk for meat."
45. "I should eliminate all cholesterol and fat from my diet."
46. A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client about the dietary restrictions required with HF. Which statement by the client indicates that further teaching is needed?

1. "I'm not supposed to eat cold cuts."

2. "I can have most fresh fruits and vegetables."
3. "I'm going to weigh myself daily to be sure I don't gain too much fluid."
4. "I'm going to have a ham and cheese sandwich and potato chips for lunch."
   31. The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL (4.9 mmol/L), and fasting blood glucose level of 184 mg/dL (10.2 mmol/L). The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)?
5. Age
6. Hypertension
7. Hyperlipidemia
8. Glucose intolerance
   32. The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge?
9. "I need to start exercising more to improve my health."
10. "I will be sure to keep my appointment with the cardiologist."
11. "I don't have anyone to help me with doing heavy housework at home."
12. "I think I have a good understanding of what all my medications are for."
    33. The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided?
13. "I will eat enough daily fiber to prevent straining at stool."
14. "I will try to exercise vigorously to strengthen my heart muscle."
15. "I will drink 3000 to 3500 mL of fluid daily to promote good kidney function."
16. "Drinking 2 to 3 oz of liquor each night will promote blood flow by enlarging blood vessels." Rationale: Standard home care instructions for a client with this problem include, among others, lifestyle changes such as decreased alcohol intake, avoiding activities that increase the demands on the heart, instituting a bowel regimen to prevent straining and constipation, and maintaining fluid and electrolyte balance. Consuming 3000 to 3500 mL of fluid and exercising vigorously will increase the cardiac workload.

34. A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem?
35. Ambulates 10 feet (3 meters) farther each day
36. Verbalizes the benefits of increasing activity
37. Chooses a healthy diet that meets caloric needs
38. Sleeps without awakening throughout the night
39. The health care provider (HCP) has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure?
40. Questions the client about allergies to iodine or shellfish
41. Has the client sign an informed consent form for an invasive procedure
42. Tells the client that the procedure is painless and takes 30 to 60 minutes
43. Keeps the client on nothing by mouth (NPO) status for 2 hours before the procedure
44. A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure?
45. Eat breakfast just before the procedure.
46. Wear firm, rigid shoes, such as work boots.
47. Wear loose clothing with a shirt that buttons in front.
48. Avoid cigarettes for 30 minutes before the procedure.
49. A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure?
50. Chest pain
51. Urge to cough
52. Warm, flushed feeling
53. Pressure at the insertion site
54. A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge?
55. Weigh self on a daily basis.

2. Sleep with the head of the bed flat.
3. Take a double dose of the diuretic if peripheral edema is noted.
4. Withhold prescribed digoxin if slight respiratory distress occurs.
   39. A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions?
5. "It will really hurt when the catheter is first put in."
6. "I will receive general anesthesia for the procedure."
7. "I will have to go to the operating room for this procedure."
8. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours." Rationale: It is common for the client to feel fatigued after the cardiac catheterization procedure. A local anesthetic is used, so little to no pain is experienced with catheter insertion. General anesthesia is not used. Other pre- procedure teaching points include the fact that the procedure is done in a darkened cardiac catheterization room. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection.
9. A client admitted to the hospital with coronary artery disease complains of dyspnea at rest. The nurse caring for the client uses which item as the best means to monitor respiratory status on an ongoing basis?
10. Apnea monitor
11. Oxygen flowmeter
12. Telemetry cardiac monitor
13. Oxygen saturation monitor
    41. The nurse is listening to a lecture about angina. Which statement by the nurse indicates that the teaching has been effective?
14. "Stable angina is chronic."
15. "Variant angina is caused by emotional stress."
16. "Unstable angina is not a life-threatening condition."
17. "Intractable angina rarely limits the client's lifestyle." Rationale: Stable angina is triggered by a predictable amount of effort or emotion and is a chronic condition. Variant angina is triggered by coronary artery spasm; the attacks are of longer duration than in classic angina and tend to occur early in the day and at rest. 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. Intractable angina is chronic and incapacitating and is refractory to medical therapy.

42. The nurse has completed an educational course covering first-degree heart block. Which statement by the nurse indicates that teaching has been effective?
43. "Presence of Q waves indicates first-degree heart block."
44. "Tall, peaked T waves indicate first-degree heart block."
45. "Widened QRS complexes indicate first-degree heart block."
46. "Prolonged, equal PR intervals indicates first-degree heart block."
47. The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary to control disease progression. Which statement by the client indicates a need for further teaching?
48. "I will avoid using table salt with meals."
49. "It is best to exercise once a week for 1 hour."
50. "I will take nitroglycerin whenever chest discomfort begins."
51. "I will use muscle relaxation to cope with stressful situations."
52. The ambulatory care nurse is working with a client who has been diagnosed with Prinz metal’s (variant) angina. What should the nurse plan to teach the client about this type of angina?
53. It is most effectively managed by beta-blocking agents.
54. It has the same risk factors as stable and unstable angina.
55. It can be controlled with a low-sodium, high-potassium diet.
56. Generally, it is treated with calcium channel–blocking agents.
57. The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding?
58. The client is not experiencing dyspnea.
59. The client is not experiencing nausea or vomiting.
60. The pain has not been relieved by rest and nitroglycerin tablets.
61. The client says the pain began while she was trying to open a stuck dresser drawer.
62. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer?
63. Ad lib activities as tolerated

2. Strict bed rest for 24 hours after transfer
3. Bathroom privileges and self-care activities
4. Unsupervised hallway ambulation for distances up to 200 feet (60 meters)
   47. A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as an indicator that the client is experiencing complications of this therapy?
5. Tarry stools
6. Nausea and vomiting
7. Orange-colored urine
8. Decreased urine output Rationale: Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hema-test testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood.
9. The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking?
10. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer."
11. "Because most of the damage has already been done, it will be all right to cut down a little at a time."
12. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year."
13. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."
14. A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted?
15. Rhonchi
16. Wheezes
17. Crackles in the bases
18. Crackles throughout the lung fields Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink- tinged sputum. As the client's condition improves, the amount of fluid in the alveoli decreases, which may be detected by

crackles in the bases. (Clear lung sounds indicate full resolution of the episode.) Rhonchi and wheezes are not associated with pulmonary edema. Auscultation of the lungs reveals crackles throughout the lung fields.

50. A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily responsible for the symptoms?
51. Left atrium
52. Right atrium
53. Left ventricle
54. Right ventricle Rationale: Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left ventricle to fail, leading to signs and symptoms of heart failure. The remaining options are not the chambers that are primarily responsible for this disease process, although these chambers may be affected as the disease becomes more chronic.
55. The nurse has just completed education on myocardial infarction (MI) to a group of new nurses. Which statement made by one of the nurses indicates that the teaching has been effective?
56. "Chest pain is caused by tissue hypoxia in the myocardium."
57. "Chest pain is caused by tissue hypoxia in the vessels of the heart."
58. "Chest pain is caused by tissue hypoxia in the parietal pericardium."
59. "Chest pain is caused by tissue hypoxia in the visceral pericardium."
60. The registered nurse (RN) is educating a new nurse on mitral stenosis. Which statement by the new nurse indicates that the teaching has been effective?
61. "Left ventricle to aorta narrowing will impede flow of blood."
62. "Left atrium to left ventricle narrowing will impede flow of blood."
63. "Right atrium to right ventricle narrowing will impede flow of blood."
64. "Right ventricle to pulmonary artery narrowing will impede flow of blood." Rationale: The mitral valve separates the left atrium from the left ventricle.
65. The registered nurse (RN) is educating a new nurse about aortic regurgitation. Which statement by the new nurse indicates that the teaching has been effective?
66. "Failure of the aortic valve to close completely allows blood to flow retrograde through the aorta to the left ventricle."

2. "Failure of the aortic valve to close completely allows blood to flow retrograde

through the left ventricle to the left atrium."

3. "Failure of the aortic valve to close completely allows blood to flow retrograde through the right ventricle to the right atrium."
4. "Failure of the aortic valve to close completely allows blood to flow retrograde through the pulmonary artery to the right ventricle." Rationale: The aortic valve separates the aorta from the left ventricle.
5. The nurse educator is teaching the new registered nurse (RN) how to care for clients with a decrease in blood pressure. Which statement by the new RN indicates the need for further instruction?
6. "Decreased contractility occurs."
7. "Decreased heart rate is not a side effect."
8. "Decreased myocardial blood flow is not a concern."
9. "Increased resistance to electrical stimulation often occurs." Rationale: The primary effect of a decrease in blood pressure is reduced blood flow to the myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or irritable in the presence of hypoxia. Correspondingly, the heart rate is likely to increase, not decrease, in response to this change. The effects of tissue ischemia lead to decreased contractility over time.
10. The nurse educator is lecturing new registered nurses (RNs) about serum calcium levels. Which statement by one of the new RNs indicates that teaching has been effective?
11. "Calcium has no effect on the risk for stroke."
12. "Low calcium levels can lead to cardiac arrest."
13. "Low calcium levels cause high blood pressure."
14. "Calcium has no effect on urinary stone formation."
    56. The nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site?
15. Bundle of His
16. Purkinje fibers
17. Sinoatrial (SA) node
18. Atrioventricular (AV) node

57. A nursing instructor asks a nursing student to describe the structure and function of the coronary arteries. Which response by the student indicates a need for further teaching on the anatomy and physiology of the heart?
58. "The coronary arteries branch from the aorta."
59. "The coronary arteries supply the heart muscle with blood."
60. "The left coronary artery provides blood for the left atrium and the left ventricle."
61. "The left coronary artery supplies the right atrium and right ventricle with blood."
62. The registered nurse (RN) is orienting a new RN assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. After educating the new RN about cardiac output, which statement made by the new RN indicates the need for further instruction?
63. "A cardiac output of 2 L/min is normal."
64. "A cardiac output of 4 L/min is normal."
65. "A cardiac output of 6 L/min is normal."
66. "A cardiac output of 7 L/min is normal." Rationale: The cardiac cycle consists of contraction and relaxation of the heart muscle. In adults, the cardiac output ranges from 4 to 7 L/min. Therefore, option 1 identifies a low cardiac output.
67. The new registered nurse (RN) is orienting on the cardiac unit. Which statement by the new RN indicates an understanding of an early indication of fluid volume deficit due to blood loss?
68. "Pulse rate will increase."
69. "Blood pressure will decrease."
70. "Edema will be present in the legs."
71. "Crackles in the lungs will be present."
72. A client who has been exercising in a gymnasium stops to measure his pulse and places his fingers over both carotid arteries simultaneously. The nurse exercising nearby is correct when cautioning the client to check the pulse on only one side, primarily for which reason?
73. It is unnecessary to use both hands.
74. The client could occlude the trachea.
75. The heart rate and blood pressure could drop.
76. Feeling dual pulsations may lead to an incorrect measurement.

61. A nursing student who is researching a medication at the nurses' station asks the registered nurse (RN) what the function of an alpha-adrenergic receptor is, and where the receptors are primarily found. The RN educates the nursing student. Which statement by the nursing student indicates that teaching has been effective?
62. "The peripheral arteries and veins; when stimulated they cause vasoconstriction."
63. "Arterial and bronchial walls; when stimulated they cause vasodilation and bronchodilation."
64. "The heart; when stimulated it causes an increase in heart rate, atrioventricular node conduction, and contractility."
65. "Several tissues; when stimulated they cause contraction of smooth muscle, inhibition of lipolysis, and promotion of platelet aggregation."
66. The nurse who is auscultating a 56-year-old client's apical heart rate before administering digoxin notes that the heart rate is 52 beats/min. The nurse should make which interpretation of this information?
67. Normal, because of the client's age
68. Abnormal, requiring further assessment
69. Normal, as a result of the effects of digoxin
70. Normal, because this is the reason the client is receiving digoxin
71. The client who is beginning an exercise program asks the nurse why his heart "feels like it's pounding" when he is exercising vigorously. The nurse provides education to the client about increased cardiac response based on which physiological concept?
72. Pulse rate is not a reflection of cardiac response.
73. Cardiac index is the mechanism that allows blood to flow better.
74. Cardiac output is the body's attempt to meet metabolic demands.
75. Stroke volume is an artificial number used to determine the adequacy of cardiac output.
76. The nurse is listening to a cardiologist explain the results of a cardiac catheterization to a client and family. The health care provider (HCP) tells the client that a blockage is present in the large blood vessel that supplies the anterior wall of the left ventricle. The nurse determines that the blockage is located in which area?
77. Circumflex coronary artery
78. Right coronary artery (RCA)
79. Posterior descending coronary artery (PDA)
80. Left anterior descending coronary artery (LAD)

Rationale: The LAD bifurcates from the left main coronary artery to supply the anterior wall of the left ventricle and a few other

structures. The circumflex coronary artery bifurcates from the left coronary artery and supplies the left atrium and the lateral wall of the left ventricle. The RCA supplies the right side of the heart, including the right atrium and right ventricle. The PDA supplies the posterior wall of the heart.

65. A new registered nurse (RN) is assigned to the care of a client hospitalized with a diagnosis of hypothermia. After consulting with an experienced RN, which statement by the new RN indicates understanding of likely assessment findings for this client?
66. Increased heart rate and increased blood pressure
67. Increased heart rate and decreased blood pressure
68. Decreased heart rate and increased blood pressure
69. Decreased heart rate and decreased blood pressure Rationale: Hypothermia decreases the heart rate and the blood pressure because the metabolic needs of the body are reduced in this condition. With fewer metabolic needs, the workload of the heart decreases, resulting in decreased heart rate and blood pressure.
70. A client who has had a myocardial infarction asks the nurse why she should not bear down or strain to ensure having a bowel movement. The nurse provides education to the client based on which physiological concept?
71. Vagus nerve stimulation causes a decrease in heart rate and cardiac contractility.
72. Vagus nerve stimulation causes an increase in heart rate and cardiac contractility.
73. Sympathetic nerve stimulation causes a decrease in heart rate and cardiac contractility.
74. Sympathetic nerve stimulation causes an increase in heart rate and cardiac contractility.
75. A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement?
76. "The work of breathing is increased when the client is anemic."
77. "Blood flows more slowly when the hemoglobin or hematocrit is low."
78. "The body has to work harder to fight infection in the presence of anemia."
79. "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."
80. Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)?
81. Chloride level of 98 mEq/L (98 mmol/L)

2. Sodium level of 135 mEq/L (135 mmol/L)
3. Potassium level of 6.8 mEq/L 6.8 mmol/L)
4. Magnesium level of 1.6 mEq/L (0.8 mmol/L)
   69. A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise?
5. Oxygen saturation decreased from 96% to 91%.
6. Pulse rate increased from 80 to 104 beats per minute.
7. Blood pressure decreased from 140/86 to 112/72 mm Hg.
8. Respiratory rate increased from 16 to 19 breaths per minute. Rationale: Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. In addition, it reflects a minimal increase. A pulse rate increase to a rate more than 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity.
9. A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction?
10. Take acetaminophen if the chest pain worsens.
11. Take antibiotics until the chest pain is fully resolved.
12. Use a firm-bristle toothbrush and floss vigorously to prevent cavities.
13. Notify all health care providers (HCPs) of the history of infective endocarditis before any invasive procedures.
14. The nurse is concerned about the adequacy of peripheral tissue perfusion in the post–cardiac surgery client. Which action should the nurse include within the plan of care for this client?
15. Use the knee gatch on the bed.
16. Cover the legs lightly when sitting in a chair.
17. Encourage the client to cross the legs when sitting in a chair.
18. Provide pillows for the client to place under the knees as desired. Rationale: Covering the legs with a light blanket during sitting promotes warmth and vasodilation of the leg vessels. The nurse plans postoperative measures to prevent venous stasis. These include applying elastic stockings or leg wraps, use of pneumatic compression boots, and discouraging crossing of the legs. Clients should be encouraged to perform passive and active range-of-motion exercises. The knee gatch on the bed and pillows under the knees should be avoided because they place pressure on the blood vessels in the popliteal area, impeding venous return.

72. The nurse is instructing the post–cardiac surgery client about activity limitations for the first 6 weeks after hospital discharge. The nurse should include which item in the instructions?
73. Driving is permitted as long as the lap and shoulder seat belts are worn.
74. Lifting should be restricted to objects that do not weigh more than 25 pounds (11.3 kg).
75. Use the arms for balance, not weight support, when getting out of bed or a chair.
76. Activities that involve straining may be resumed as long as they do not cause pain.
77. The nurse is assessing an electrocardiogram (ECG) rhythm strip for a client. The PP and RR intervals are regular. The PR interval is 0.14 second, and the QRS complexes measure 0.08 second. The overall heart rate is 82 beats/min. The nurse should report the cardiac rhythm to be which rhythm?
78. Sinus bradycardia
79. Sick sinus syndrome
80. Normal sinus rhythm
81. First-degree heart block Rationale: Normal sinus rhythm is defined as a regular rhythm with an overall rate of 60 to 100 beats/min. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively.
82. A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/minute. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse report this rhythm?
83. Sinus tachycardia
84. Sinus bradycardia
85. Sinus dysrhythmia
86. Normal sinus rhythm
87. The new registered nurse (RN) is reviewing cardiac rhythms with a mentor. Which statement by the new RN indicates that teaching about ventricular fibrillation has been effective?
88. "Ventricular fibrillation appears as irregular beats within a rhythm."
89. "Ventricular fibrillation does not have P waves or QRS complexes."
90. "Ventricular fibrillation is a regular pattern of wide QRS complexes."
91. "Ventricular fibrillation has recognizable P waves, QRS complexes, and T waves."

76. A client with myocardial infarction is experiencing new, multiform premature ventricular contractions and short runs of ventricular tachycardia. The nurse plans to have which medication available for immediate use to treat the ventricular tachycardia?
77. Digoxin
78. Verapamil
79. Acebutolol
80. Amiodarone
81. A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if which finding is noted with regard to the PVCs?
82. They occur in pairs.
83. They appear to be multifocal.
84. They fall on the second half of the T wave.
85. They decrease to a frequency of less than 6 per minute.
86. The nurse is assessing the client's condition after cardioversion. Which observation should be of highest priority to the nurse?
87. Heart rate
88. Skin color
89. Status of airway
90. Peripheral pulse strength
91. The home health nurse makes a home visit to a client who has an implanted cardioverter- defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary?
92. "If I feel an internal defibrillator shock, I should sit down."
93. "I won't be able to have a magnetic resonance imaging test (MRI)."
94. "My wife knows how to call the emergency medical services (EMS) if I need it."
95. "I can stop taking my antidysrhythmic medicine now because I have a pacemaker."