Perfusion NCLEX Practice Questions With Complete Solutions 2024., Exams of Nursing

Download Perfusion NCLEX Practice Questions With Complete Solutions 2024. and more Exams Nursing in PDF only on Docsity! 1 Perfusion NCLEX Practice Questions With Complete Solutions 2024. The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive highest priority? a. BP 110/62, atrial fibrillation with HR 82, bibasilar crackles b. Confusion, urine output 15mL over the last 2 hours, orthopnea. c. SpO2 92 on 2 liters nasal cannula, respirations 20, 1+ edema of lower extremities. d. Weight gain of 1kg in 3 days, BP 130/80, mild dyspnea with exercise. - Answer b. A low urine output and confusion are signs of decreased tissue perfusion. Orthopnea is a sign of left-sided heart failure. Crackles, edema and weight gain should be monitored closely, but the levels are not as high a priority. With atrial fibrillation there is a loss of atrial kick, but the blood pressure and heart rate are stable Which of the following is an expected outcome when a client is receiving an IV administration of furosemide? a. Increased blood pressure b. Increased urine output c. Decreased pain d. Decreased premature ventricular contractions - Answer b. Furosemide is a loop diuretic that acts to increase urine output. Furosemide does not increase blood pressure, decrease pain, or decrease arrhythmias The nurse is assessing clients at a health fair. Which client is at greatest risk for coronary artery disease? a. a 32-year-old female with mitral valve prolapse who quit smoking 10 years ago. b. a 43-year-old male with a family history of CAD and cholesterol level of 158 c. A 56-year-old male with an HDL of 60 who takes atorvastatin (Lipitor) d. A 65-year-old female who is obese with an LDL of 188 - Answer d. The woman who is 65-years-old, over weight and has an elevated LDL is at greatest risk. Total cholesterol >200, LDL >100, HDL <40 in men, HDL <50 in women, men 45-years and older, women 55-years and older, smoking and obesity increase the risk of CAD. Atorvastatin is a medication to reduce LDL and decrease risk of CAD. The combination of postmenopausal, obesity and high LDL cholesterol places this client at greatest risk. A 58-year-old female with a family history of CAD is being seen for her annual physical exam. Fasting lab test results include: Total cholesterol 198; LDL cholesterol 120; HDL cholesterol 58; Triglycerides 148; Blood sugar 102; and C- reactive protein (CRP) 4.2. The health care provider informs the client that she will be started on a statin medication and aspirin. The client asks the nurse why she needs to take these medications. Which is the best response by the nurse? a. "The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a low-fat diet." b. "The triglycerides are elevated and will not return to normal without these medications." c. "The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications ordered." d. "The medications are not indicated since your lab values are all normal." - Answer c. CRP is a marker of inflammation and is elevated in the presence of cardiovascular 2 disease. The high sensitivity CRP (hs-CRP) is the blood test for greater accuracy in measuring the CRP to evaluate cardiovascular risk. The family history, post- menopausal age, LDL above optimum levels and elevated CRP place the client at risk of CAD. Statin medications can decrease LDL, whereas statins and aspirin can reduce CRP and decrease the risk of MI and stroke. An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of: a. Left ventricular atrophy b. Irregular heartbeats c. Peripheral vascular occlusion d. Pacemaker placement - Answer a. In older adults who are less active and do not exercise the heart muscle, atrophy can result. Disuse or deconditioning can lead to abnormal changes in the myocardium of the older adult. As a result, under sudden emotional or physical stress, the left ventricle is less able to respond to the increased demands on the myocardial muscle. Decreased cardiac output, cardiac hypertrophy, and heart failure are examples of the chronic conditions that may develop in response to inactivity, rather than in response to the aging process. Irregular heartbeats are generally not associated with an older sedentary adult's lifestyle. Peripheral vascular occlusion or pacemaker placement should not affect response to stress. A client with a diagnosis of cardiac dysrhythmias and a history of type I diabetes mellitus is placed on propranolol therapy. The client asks the nurse if the drug will affect insulin needs. The best response by the nurse would be that: a. The drug will have no effect on insulin needs. b. The drug might cause hypoglycemia. c. The drug could cause hyperglycemia. d. The client should ask the physician this question. - Answer b. The drug might cause hypoglycemia. There is increased incidence of hypoglycemia with type I diabetes mellitus, because propranolol can inhibit glycogenolysis. When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be: a. The client will avoid use of caffeine during therapy. b. The client will maintain heart rate below 60 beats per minute. c. The client will limit fluid intake to 1000 ml/day. d. The client will limit cigarettes to 15/day. - Answer a. The client will avoid use of caffeine during therapy. Causes of dysrhythmias include electrolyte imbalance, hyperthyroidism, anxiety, caffeine ingestion, and tobacco use. The client should be taught to avoid caffeine and tobacco. 5 c. Upset stomach d. Constant, irritating cough - Answer d The nurse is teaching a client about clopidogrel (Plavix). What is important information to include? a. Constipation may occur. b. Hypotension may occur. c. Bleeding may increase when taken with aspirin. d. Normal dose is 25 mg tablet per day. - Answer C A nurse who is giving a statin(Lipitor) realizes the importance of monitoring for which serious adverse reaction? a. Pharyngitis b. Rash/pruritus c. Rhabdomyolysis d. Agranulocytosis - Answer c A client's serum lipids are cholesterol 197 mg/dl, low-density lipoprotein (LDL) 110 mg/dl, and high-density lipoprotein (HDL) 35 mg/dl. The nurse knows what about these values? a. Serum lipids are within desirable values. b. Cholesterol is within desirable value, but LDL and HDL are not. c. Cholesterol is not within desirable value, though LDL and HDL are. d. Cholesterol, LDL, and HDL are not within desirable values. - Answer b Prior to discharge from the Emergency Department, the nurse prints a rhythm strip on a patient and notices that the P wave cannot be detected and the QRS complex is 0.24 seconds. This is a change in the patient's condition. What is the best action for the nurse to take? a. Measure the PR interval. b. Prepare the patient for discharge. c. Notify the physician of this abnormal strip. d. Continue to monitor for abnormalities. - Answer c. Notify the physician of this abnormal strip. Rationale: c. is correct because notifying the physician of the abnormal rhythm would be the most appropriate response. The patient has experienced a rhythm change and requires further treatment. 6 a. is not correct for measuring the PR would not be possible as there is no P wave present. Since the QRS interval and other parameters given are abnormal, discharging the patient would not be appropriate at this point. b. is not correct as discharging the patient is not appropriate or safe practice. d. is not correct because continuing to monitor the patient without any other actions would be inappropriate as the patient has experienced a change in condition. When a patient has long-term atrial fibrillation, the nurse would expect to include which drug in the plan of care to minimize the greatest risk that is commonly associated with atrial fibrillation? a. Beta blockers b. Digitalis c. Anticoagulants d. Antiarrhythmics - Answer c. Anticoagulants Rationale: c. is correct because it reflects the greatest risk or complication of thrombi or emboli that occurs with long-term atrial fibrillation. Coumadin is often given prophylactically to prevent stroke, clots, or emboli from developing when hospitalizing a patient with long-term atrial fibrillation. The nurse should understand that which of the following treatments for Second Degree Type II AV Block would be appropriate? (Select all that apply) a. Temporary pacemaker insertion b. Close monitoring without intervention c. Atropine to increase heart rate if symptomatic d. Coronary stent placement to improve blood flow to myocardium e. An implantable defibrillator surgically implanted - Answer a. Temporary pacemaker insertion c. Atropine to increase heart rate if symptomatic d. Coronary stent placement to improve blood flow to myocardium Rationale: Rationale: a,c, and d are correct. Temporary pacing may be needed and atropine will temporarily improve heart rate cardiac output until the pacemaker can be inserted. b. is incorrect because Type II has a tendency to develop complete heart block where adequate cardiac output is not maintained and arrest is likely. Type I can be monitored and minimal treatment is needed unless unstable hemodynamics are present. e. is incorrect because a defibrillator is not called for since it is the ventricle that is trying to maintain the cardiac output from the decreased conduction between the atria and the ventricles. An implanted pacemaker may be needed permanently. 7 A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing: a. premature ventricular contractions b. ventricular tachycardia c. ventricular fibrillation d. sinus tachycardia - Answer b. ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (greater than 0.14) and a rate between 100 and 250 impulses per minute. The rhythm is usually regular. The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate the client at 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Give the client IV lidocaine. - Answer b. Check the client for a pulse. Rationale: The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit? a. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min b. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min c. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min d. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min - Answer a. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min Rationale: This client has a stable, asymptomatic dysrhythmia, which usually requires no treatment; this client can be managed by a nurse with less cardiac dysrhythmia training. For which of the following dysrhythmias is defibrillation primarily indicated? a. Ventricular fibrillation b. Third-degree AV block c. Uncontrolled atrial fibrillation d. Ventricular tachycardia with a pulse - Answer a. Ventricular fibrillation Rationale: Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.