NCLEX-RN PRACTICE QUESTIONS AND CORRECT ANSWERS VERIFIED LATEST 2023-2024 GRADE A +, Exams of Nursing

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NCLEX-RN PRACTICE QUESTIONS AND

CORRECT ANSWERS VERIFIED LATEST

2023 - 2024 GRADE A +

The healthcare provider is performing an assessment on a patient who is taking propranolol (Inderal) for supraventricular tachycardia. Which assessment finding is an indication the patient is experiencing an adverse effect of this drug? Please choose from one of the following options. a. Dry mouth b. Bradycardia c. Urinary retention d. Paresthesia - CORRECT ANSWER >>Bradycardia

• Propranolol is a nonselective beta-adrenergic antagonist.
• Beta-1 receptors are found in the cardiac conduction system and myocytes.
• Beta-1 blockade will slow discharge from the SA node and decrease speed through the AV node, slowing the heart rate. A patient experiencing ventricular tachycardia is given a medication which acts on the phase of the myocardial action

potential indicated by the red "X." Which class of medication will the healthcare provider administer to the patient? a. Potassium channel blocker b. Adrenergic agonist c. Sodium channel blocker d. Sympathomimetic - CORRECT ANSWER >>Potassium channel blocker

• The medication will decrease the heart rate and prolong the action potential and refractory period.
• The dysrhythmia occurs during phase 3 of the action potential.
• During phase 3 there is rapid repolarization when potassium leaves the cell, so a potassium channel blocker will be administered. A patient is being discharged after the insertion of a permanent pacemaker. Which statement made by the patient indicates an understanding regarding appropriate self-care? a. "Every morning I will perform arm and shoulder stretches." b. "Each day I'll take my pulse and record it in a log." c. "I'll have to get rid of my microwave oven."

d. "I won't be able to use my electric blanket anymore." - CORRECT ANSWER >>"Each day I'll take my pulse and record it in a log."

• Initially, patients should limit arm and shoulder activity on the operative side to prevent dislodgment of the pacing leads.
• Microwave ovens and electric blankets will not adversely affect the pacemaker.
• Tracking one's pulse can help the patient know if the pacemaker is working properly. A patient who has experienced atrial fibrillation for the past 3 days is admitted to the cardiac care unit. In addition to administering an antidysrhythmia medication, the healthcare provider should anticipate which of these orders? a. Initiate a heparin infusion b. Give atropine IV push c. Prepare for immediate cardioversion d. Prepare the patient for AV node ablation - CORRECT ANSWER >>Initiate a heparin infusion
• The antidysrhythmic will help control rhythm and rate, so atropine (an anticholinergic) is not indicated.

• Cardioversion or ablation is usually reserved for patients who have not responded to antidysrhythmic medications.
• Because blood tends to pool and clot in the fibrillating atria, patients with atrial fibrillation are at high risk for embolic stroke, so heparin will be given. The healthcare provider is caring for a patient with a diagnosis of hypomagnesemia and a QT interval of 0.500 seconds. Which of these, if noted on the cardiac monitor, is an indication the patient's condition is worsening? a. Premature ventricular contractions b. Narrow QRS complexes c. An R-R interval of 111 second d. A polymorphic ventricular tachycardia - CORRECT ANSWER

A polymorphic ventricular tachycardia

• An R-R interval of 111 second translates to a heart rate of 60 beats per minute, which is a normal finding.
• Narrow QRS complexes are associated with a variety of tachycardias, but is not expected in this situation.
• The patient's history of hypomagnesemia and prolonged QT interval puts the patient at risk of developing torsades de pointes,

a polymorphic ventricular tachycardia that can potentially degenerate into a ventricular fibrillation. A patient with a diagnosis of Wolff-Parkinson-White syndrome is undergoing a catheter ablation procedure. When caring for the patient after the procedure, which is the priority intervention? a. Assist the patient to the bathroom to void. b. Auscultate apical pulse for a full minute every hour. c. Monitor insertion site and distal pulses. d. Assess level of consciousness. - CORRECT ANSWER

Monitor insertion site and distal pulses.

• The extremity where the catheter was inserted will be immobilized initially, so the patient will not be allowed out of bed to use the bathroom.
• The patient will be on a cardiac monitor so auscultation of the apical pulse for one minute is not a priority.
• Because the catheter may cause trauma to the vessels, the healthcare provider will monitor for hematoma formation and interference of circulation distal to the insertion site. The healthcare provider is teaching a student about the cardiac cycle and how it relates to the electrocardiogram (EKG). What will

the healthcare provider tell the student about the cardiac events that occur during the waveform contained in the shaded area of the EKG? a. "This represents early repolarization of right and left ventricles." b. "The repolarization of the His Purkinje system happens here." c. "Ventricular depolarization and atrial repolarization occur during this time." d. "Atrial depolarization and AV node stimulation are occurring at this time." - CORRECT ANSWER >>"Ventricular depolarization and atrial repolarization occur during this time."

• The arrow is pointing to a waveform called the QRS complex.
• Atrial depolarization is represented by the P wave.
• Ventricular depolarization follows atrial depolarization. Atrial repolarization occurs simultaneously and is masked by the QRS complex. The healthcare provider is examining the electrocardiogram (EKG) of a patient and notes the PR interval is 6 small boxes in length. What is the significance of this finding? Please choose from one of the following options. a. Stress is causing increased sympathetic stimulation. b. This should be documented as an expected finding.

c. There may be some scar tissue in one of the ventricles. d. There may be a delay in the conduction through the AV node. - CORRECT ANSWER >>There may be a delay in the conduction through the AV node.

• The PR interval reflects the time it takes for the atria to depolarize and for the action potential to travel through the AV node and to His-Purkinje system.
• Each small box on the EKG graph paper equals 0.040 seconds.
• The normal PR interval is 0.120 - 0.200 seconds, which is 3 to 5 small boxes. When caring for a patient with a cardiac dysrhythmia, which laboratory value is a priority for the healthcare provider to monitor? a. BUN and creatinine b. Sodium, potassium, and calcium c. Hemoglobin and hematocrit d. PT and INR - CORRECT ANSWER >>Sodium, potassium, and calcium
• BUN and creatinine levels are always important to monitor when giving any drug, not only antidysrhythmia drugs.

• The PT and INR will be important for patients who are on warfarin (Coumadin).
• Because abnormalities in sodium, potassium and calcium levels are likely to affect depolarization and repolarization of cardiac cells, it is most important for the healthcare provider to monitor these laboratory values. Risks and benefits are balanced when giving an antidysrhythmic drug to a treat a cardiac dysrhythmia. When does the need for the drug outweigh the risks? a. When there is impairment in cardiac output. b. When the dysrhythmia becomes chronic. c. If the heart rate is 50 to 60 beats per minute. d. After the heart rate reaches a rate faster than 100 beats per minute - CORRECT ANSWER >>When there is impairment in cardiac output.
• A heart rate less than 60 beats per minute is usually well tolerated in an otherwise healthy adult.
• Because antidysrhythmic medications can cause new dysrhythmias or worsen existing dysrhythmias, chronicity of a dysrhythmia is not the only consideration when weighing risks and benefits.

• If ventricular pumping is impaired so that cardiac output is decreased, the benefits of an antidysrhythmic mediation often outweigh the risks. While caring for a patient who is experiencing a postoperative hemorrhage, the healthcare provider notes the rhythm observed on the electrocardiogram (EKG) does not produce a pulse. Which initial action(s) is/are most likely to resolve this patient's problem? Select all that apply. a. Defibrillation b. Administration of vasoconstrictors c. Administration of IV crystalloid d. Cardiopulmonary resuscitation (CPR) e. Synchronized cardioversion - CORRECT ANSWER >>b. Administration of vasoconstrictors c. Administration of IV crystalloid d. Cardiopulmonary resuscitation (CPR)
• The patient is experiencing pulseless electrical activity (PEA).
• PEA is not a shockable rhythm.
• An important treatment for PEA is to address the underlying cause.

• The underlying cause of PEA in this patient is hypovolemia, which can be treated with IV crystalloid (type of IV fluids) and vasoconstrictors, along with CPR. A patient who has a diagnosis of atrial fibrillation has a heart rate of 152 beats per minute. The healthcare provider should assess for which of these problems related to the dysrhythmia? Select all that apply. a. Hypotension b. Dizziness c. Headache d. Pulse deficit e. Chest pain - CORRECT ANSWER >>a. Hypotension b. Dizziness d. Pulse deficit e. Chest pain
• In atrial fibrillation, there is disorganized atrial electrical activity.
• The atria quiver (fibrillate) instead of contracting in an organized way, decreasing pumping effectiveness.
• Coronary arteries receive most of their blood supply during diastole.

• Atrial kick is lost and cardiac output is diminished. The result is less blood supplying the brain (dizziness), hypotension, less blood perfusing the coronary arteries, chest pain, and a pulse deficit because the stroke volume is not sufficient to produce a palpable peripheral pulse. The CORRECT ANSWER is then chest pain, dizziness, pulse deficit, and hypotension. The healthcare provider is caring for a patient on a telemetry unit. The patient loses consciousness, and the healthcare provider notes this waveform on the patient's cardiac monitor. Which intervention should the healthcare provider do first? a. Administer 100% oxygen via face mask at 8 liters/minute. b. Document the findings and continue to monitor. c. Ask the unit secretary to call the cardiologist. d. Begin cardiopulmonary resuscitation (CPR) and call for a defibrillator. - CORRECT ANSWER >>Begin cardiopulmonary resuscitation (CPR) and call for a defibrillator.
• The heart rhythm is irregular.
• There are no P waves and the PR interval is not measurable.
• Instead of QRS complexes, there are irregular undulating waves.

• Because the ventricles are fibrillating, treatment will include immediate defibrillation along with CPR. What criteria will the healthcare provider use to identify atrial flutter for a patient on a cardiac monitor? Select all that apply. a. Presence of saw-tooth wave pattern b. Irregular R-R interval c. QRS complex is normal d. PR interval is not measurable e. P:QRS ratio is 1:1 - CORRECT ANSWER >>a. Presence of saw-tooth wave pattern c. QRS complex is normal d. PR interval is not measurable
• Atrial flutter is caused by irritable ectopic depolarization in the atria.
• Usually the ventricular rate is regular, so R-R interval will be normal.
• The atrial rate (250 to 400 beats per minute) is so fast the AV node can't conduct all the atrial impulses to the ventricle, so the ventricular rate is usually 75 to 150 beats per minute.

• The PR interval is not measurable because it gets buried in the multiple flutter waves.
• The characteristic pattern in atrial flutter is saw-toothed flutter waves, normal QRS complexes, regular R-R interval, with a P:QRS ratio of 2:1, 3:1, or possibly 4:1. The healthcare provider is teaching a patient who has a diagnosis of Wolff-Parkinson-White syndrome how to manage an occasional occurrence of atrioventricular reentrant tachycardia (AVRT). Which of these maneuvers will the healthcare provider recommend? Select all that apply. a. Bearing down (as if having a bowel movement) b. Taking a brisk walk for a couple of blocks c. Breath-holding for several seconds d. Applying firm bilateral carotid pressure e. Coughing vigorously - CORRECT ANSWER >>a. Bearing down (as if having a bowel movement) c. Breath-holding for several seconds e. Coughing vigorously

• The patient will be instructed to perform maneuvers that stimulate the baroreceptors located in the aortic arch and carotid arteries.
• Although massage of one carotid artery is sometimes used, bilateral carotid massage is contraindicated as it may cause the patient to faint.
• Coughing, bearing down (Valsalva maneuver), and breath- holding are all vagal maneuvers which stimulate the Vagus nerve and can slow the conduction through the AV node and interfere with the circular loop of AVRT. An infant is being prepared for surgical repair of a ventricular septal defect (VSD). Which of the following problems will be prevented by closing the defect? Please choose from one of the following options. a. Failure to thrive b. Ventricular dysrhythmias c. Heart block d. Respiratory alkalosis - CORRECT ANSWER >>Failure to thrive
• Infants with a ventricular septal defect usually have normal arterial blood gasses.

• Although cardiac dysrhythmias may occur post-procedure, the electrocardiogram of an infant with ventricular septal defect is normal.
• A ventricular septal defect may cause an increase in pulmonary circulation.
• Infants with congenital heart disease are challenging to feed when pulmonary circulation is increased because it makes it harder for them to coordinate sucking, swallowing, and breathing. They also have increased metabolic needs. Both these factors increase the likelihood of inadequate weight gain and possible failure to thrive. The healthcare provider is preparing to administer indomethacin to an infant with a persistent patent ductus arteriosus (PDA). The mother of the baby asks why the medication is being given to her baby. What is the healthcare provider's best response? Please choose from one of the following options. a. "Your baby needs help clearing the extra fluid from the lungs." b. "Your baby needs this drug because it interferes with substances that keep the PDA open." c. "This drug will help your baby's heart contract with a stronger force."

d. "This drug is a non-steroidal anti-inflammatory drug, so it will help control your baby's pain." - CORRECT ANSWER >>"Your baby needs this drug because it interferes with substances that keep the PDA open."

• It is true that indomethacin is a nonsteroidal anti-inflammatory drug, but it is not given for pain management.
• Nonsteroidal anti-inflammatory drugs interfere with the production of prostaglandins.
• Prostaglandins help keep the ductus arteriosus open and functional while the baby is in utero, so inhibiting prostaglandins will help the ductus to close after birth.