Nclex Cardiovascular

Front 1

A patient with a tricuspid valve disorder will have impaired blood flow between the

A. vena cava and right atrium.
B. left atrium and left ventricle.
C. right atrium and right ventricle.
D. right ventricle and pulmonary artery.

Back 1

C. right atrium and right ventricle.

Front 2

A patient with an MI of the anterior wall of the left ventricle most likely has an occlusion of then

A. right marginal artery.
B. left circumflex artery.
C. left anterior descending artery.
D. right anterior descending artery.

Back 2

C. left anterior descending artery.

Front 3

If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the

A. atria.
B. AV node.
C. ventricles.
D. bundle of His.

Back 3

C. ventricles.

Front 4

Prolonged pressure on the skin causes reddened areas at the point of contact due to

A. arterial vasodilation from smooth muscle relaxation.
B. compression of veins resulting in venous engorgement.
C. occlusion of major arteries causing infarction of the tissue.
D. tissue damage and inflammation resulting from impaired capillary blood flow.

Back 4

D. tissue damage and inflammation resulting from impaired capillary blood flow.

Front 5

When a person’s blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of

A. chemoreceptors that inhibit the sympathetic nervous system, causing vasodilation.
B. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation.
C. baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate.
D. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate.

Back 5

C. baroreceptors that inhibit the sympathetic nervous system, causing a decreased heart rate.

Front 6

When checking the capillary filling time of a patient, the color returns in 10 seconds. The nurse recognizes this finding as indicative of

A. a normal response.
B. thrombus formation in the veins.
C. lymphatic obstruction of venous return.
D. impaired arterial flow to the extremities.

Back 6

D. impaired arterial flow to the extremities.

Front 7

The auscultatory area in the left midclavicular line at the level of the fifth ICS is the

A. aortic area.
B. mitral area.
C. tricuspid area.
D. pulmonic area.

Back 7

B. mitral area.

Front 8

When assessing the patient, the nurse notes a palpable precordial thrill. This finding may be caused by

A. heart murmurs.
B. gallop rhythms.
C. pulmonary edema.
D. right ventricular hypertrophy.

Back 8

A. heart murmurs.

Front 9

When assessing the cardiovascular system of a 79-year-old patient, the nurse expects to find

A. a narrowed pulse pressure.
B. diminished carotid artery pulses.
C. difficulty in isolating the apical pulse.
D. an increased heart rate in response to stress.

Back 9

C. difficulty in isolating the apical pulse.

Front 10

An important nursing responsibility for a patient having an invasive cardiovascular diagnostic study is

A. checking the peripheral pulses and percutaneous site.
B. instructing the patient about radioactive isotope injection.
C. informing the patient that general anesthesia will be given.
D. assisting the patient to do a surgical scrub of the insertion site.

Back 10

A. checking the peripheral pulses and percutaneous site.

Front 11

A P wave on an ECG represents an impulse

A. arising at the SA node and repolarizing the atria.
B. arising at the SA node and depolarizing the atria.
C. arising at the AV node and depolarizing the atria.
D. arising at the AV node and spreading to the bundle of His.

Back 11

B. arising at the SA node and depolarizing the atria.

Front 12

If a patient has decreased cardiac output caused by fluid volume deficit and marked vasodilation, the regulatory mechanism that will increase the blood pressure by improving both of these is

A. release of antidiuretic hormone (ADH).
B. secretion of prostaglandins PGE
C. stimulation of the sympathetic nervous system.
D. activation of the renin-angiotensin-aldosterone system.

Back 12

D. activation of the renin-angiotensin-aldosterone system.Q

Front 13

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is

A. hyperlipidemia.
B. excessive alcohol intake.
C. a family history of hypertension.
D. consumption of a high-carbohydrate, high-calcium diet

Back 13

B. excessive alcohol intake.

Front 14

Target organ damage that can occur from hypertension includes

A. headache and dizziness.
B. retinopathy and diabetes.
C. hypercholesterolemia and renal dysfunction.
D. renal dysfunction and left ventricular hypertrophy.

Back 14

D. renal dysfunction and left ventricular hypertrophy.

Front 15

A high-risk population that should be targeted in the primary prevention of hypertension is

A. smokers.
B. African Americans.
C. business executives.
D. middle-aged women.

Back 15

B. African Americans.

Front 16

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that

A. all patients with elevated BP require medication.
B. it is not necessary to limit salt in the diet if taking a diuretic.
C. obese persons must achieve a normal weight in order to lower BP.
D. lifestyle modifications are indicated for all persons with elevated BP.

Back 16

D. lifestyle modifications are indicated for all persons with elevated BP.

Front 17

A major consideration in the management of the older adult with hypertension is to

A. prevent pseudohypertension from converting to true hypertension.
B. recognize that the older adult is less likely to comply with the drug therapy than a younger adult.
C. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption.
D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

Back 17

D. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

Front 18

A patient with newly diagnosed hypertension has a blood pressure of 158/98 after 12 months of exercise and diet modifications. The nurse advises the patient that

A. medication may be required because the BP is still not within the normal range.
B. continued monitoring of the BP every 3 to 6 months is all that will be necessary for treatment.
C. because lifestyle modifications were not effective they do not need to be continued and drugs will be used.
D. he will have to make more vigorous changes in his lifestyle if he wants to stay off medication for his hypertension.

Back 18

A. medication may be required because the BP is still not within the normal range.

Front 19

A patient is admitted to the hospital in hypertensive crisis. The nurse recognizes that the hypertensive urgency differs from hypertensive emergency in that

A. the BP is always higher in a hypertensive emergency.
B. hypertensive emergencies are associated with evidence of target organ damage.
C. hypertensive urgency is treated with rest and tranquilizers to lower the BP.
D. hypertensive emergencies require intraarterial catheter measurement of the BP.

Back 19

B. hypertensive emergencies are associated with evidence of target organ damage.

Front 20

In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder involve

A. diffuse involvement of plaque formation in coronary veins.
B. formation of fibrous tissue around coronary artery orifices.
C. accumulation of lipid and fibrous tissue within the coronary arteries.
D. chronic vasoconstriction of coronary arteries leading to permanent vasospasm.

Back 20

C. accumulation of lipid and fibrous tissue within the coronary arteries.

Front 21

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the patient says,

A. “I would like to add weight lifting to my exercise program.”
B. “I can’t keep my blood pressure normal without medication.”
C. “I can change my diet to decrease my intake of saturated fats.”
D. “I will change my lifestyle to reduce activities that increase my stress.”

Back 21

A. “I would like to add weight lifting to my exercise program.”

Front 22

A hospitalized patient with angina tells the nurse that she is having chest pain. The nurse bases her actions on the knowledge that anginal pain

A. will be relieved by rest, nitroglycerin, or both.
B. is less severe than pain of a myocardial infarction.
C. indicates that irreversible cellular damage is occurring.
D. is frequently associated with vomiting and extreme fatigue.

Back 22

A. will be relieved by rest, nitroglycerin, or both.

Front 23

The clinical spectrum of acute coronary syndrome includes

A. unstable angina and STEMI.
B. unstable angina and NSTEMI.
C. stable angina and sudden cardiac death.
D. unstable angina, STEMI, and NSTEMI.

Back 23

D. unstable angina, STEMI, and NSTEMI.

Front 24

In planning activity for the patient recovering from an MI, the nurse recognizes that the healing heart wall is most vulnerable to stress

A. 3 weeks after the infarction.
B. 4 to 6 days after the infarction.
C. 10 to 14 days after the infarction.
D. when healing is complete at 6 to 8 weeks.

Back 24

C. 10 to 14 days after the infarction.

Front 25

A patient is admitted to the CCU with chest pain of 24 hours’ duration, ECG findings consistent with an acute MI, and occasional ventricular arrhythmias. The nurse plans care for the patient based on the expectation that the patient will be managed with

A. endotracheal intubation.
B. subcutaneous nitroglycerin.
C. continuous ECG monitoring.
D. thrombolytic therapy with tissue plasminogen activator.

Back 25

C. continuous ECG monitoring.

Front 26

The most common pathologic finding in individuals with sudden cardiac death is

A. cardiomyopathies.
B. mitral valve disease.
C. atherosclerotic heart disease.
D. left ventricular hypertrophy.

Back 26

C. atherosclerotic heart disease.

Front 27

A compensatory mechanism involved in congestive heart failure that leads to inappropriate fluid retention and additional workload of the heart is

A. ventricular dilation.
B. ventricular hypertrophy.
C. neurohormonal response.
D. sympathetic nervous system activation.

Back 27

C. neurohormonal response.

Front 28

The drug used in the management of a patient with acute pulmonary edema that will decrease both preload and afterload and provide relief of anxiety is

A. morphine.
B. amrinone.
C. dobutamine.
D. aminophylline.

Back 28

A. morphine.

Front 29

A patient with chronic congestive heart failure and atrial fibrillation is treated with a digitalis preparation and a loop diuretic. To prevent possible complications of this combination of drugs, the nurse needs to

A. monitor serum potassium levels.
B. keep an accurate measure of intake and output.
C. teach the patient about dietary restriction of potassium.
D. withhold the digitalis and notify the health care provider if the heart rate is irregular.

Back 29

A. monitor serum potassium levels.

Front 30

The nurse plans care for the patient with dilated cardiomyopathy based on the knowledge that

A. family members may be at risk because of the infectious nature of the disease.
B. medical management of the disorder focuses on treatment of the underlying cause.
C. the prognosis of the patient is poor, and emotional support is a high priority of care.
D. the condition may be successfully treated with surgical ventriculomyotomy and myectomy.

Back 30

C. the prognosis of the patient is poor, and emotional support is a high priority of care.

Front 31

The primary causes of death in patients with heart transplants in the first year include

A. infection and rejection.
B. rejection and arrhythmias.
C. arrhythmias and infection.
D. myocardial infarction and lymphoma.

Back 31

A. infection and rejection.

Front 32

A patient with a stable blood pressure and no symptoms has the following electrocardiogram characteristics: atrial rate—74 and regular; ventricular rate—62 and irregular; P wave—normal contour; PR interval—lengthens progressively until a P wave is not conducted; QRS—normal contour. The nurse would expect that treatment would involve

A. epinephrine 1 mg IV push.
B. isoproterenol IV continuous drip.
C. immediate insertion of a temporary pacemaker.
D. careful observation for symptoms of hypotension.

Back 32

D. careful observation for symptoms of hypotension.

Front 33

The cardiac monitor of a patient in the cardiac care unit following an acute MI indicates ventricular bigeminy. The nurse anticipates

A. performing defibrillation.
B. treatment with IV lidocaine.
C. insertion of a temporary pacemaker.
D. continuing monitoring without other treatment.

Back 33

B. treatment with IV lidocaine.

Front 34

The nurse prepares a patient for electrical cardioversion knowing that cardioversion differs from defibrillation in that

A. defibrillation requires a greater dose of electrical current.
B. defibrillation is synchronized to countershock during the QRS complex.
C. cardioversion is indicated only for treatment of atrial tachyarrhythmias.
D. cardioversion may be done on a nonemergency basis with sedation of the patient.

Back 34

D. cardioversion may be done on a nonemergency basis with sedation of the patient.

Front 35

When providing discharge instructions to a patient with a new permanent pacemaker, the nurse teaches the patient to

A. take and record a daily pulse rate.
B. request special hand scanning at airport and other security gates.
C. immobilize the arm and shoulder on the side of the pacemaker insertion for 6 weeks.
D. avoid microwave ovens because they emit radio waves that alter pacemaker function.

Back 35

A. take and record a daily pulse rate.

Front 36

The nurse plans care for the patient with an implantable cardioverter-defibrillator based on the knowledge that

A. antiarrhythmia drugs can be discontinued.
B. all members of the patient’s family should learn CPR.
C. the patient should not drive until 1 month after the ICD has been implanted.
D. the patient is usually relieved to have the device implanted to prevent arrhythmias.

Back 36

B. all members of the patient’s family should learn CPR.

Front 37

A 62-year-old woman weighs 92 kg and has a history of daily alcohol intake, smoking, high blood pressure, high sodium intake, and sedentary lifestyle. The nurse identifies the risk factors most highly related to peripheral arterial disease in this patient as

A. sex and age.
B. weight and alcohol intake.
C. cigarette smoking and hypertension.
D. sedentary lifestyle and high sodium intake.

Back 37

C. cigarette smoking and hypertension.

Front 38

Significant risk factors for peripheral arterial disease include

A. sedentary lifestyle, stress, obesity.
B. advanced age, female gender, familial tendency.
C. cigarette smoking, hyperlipidemia, hypertension.
D. protein S deficiency, protein C deficiency, factor V Leiden mutation.

Back 38

C. cigarette smoking, hyperlipidemia, hypertension.

Front 39

Rest pain is a manifestation of peripheral arterial disease that occurs as a result of

A. the beginning of a venous leg ulcer.
B. inadequate blood flow to the nerves of the feet.
C. inadequate blood flow to the muscles during exercise.
D. inadequate blood flow to the skin after application of the heat.

Back 39

B. inadequate blood flow to the nerves of the feet.

Front 40

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse’s initial action should be to

A. notify the physician.
B. elevate the leg to promote venous return.
C. wrap the leg in a blanket to provide warmth.
D. perform passive range of motion to stimulate circulation to the leg.

Back 40

A. notify the physician.

Front 41

The patient who is most likely to have the highest risk for deep vein thrombosis is a

A. 25-year-old obese woman who is 3 days postpartum.
B. 40-year-old woman who smokes and uses oral contraceptives.
C. 62-year-old man who has had a stroke with left-sided hemiparesis.
D. 72-year-old man who had a suprapubic prostatectomy for cancer of the prostate.

Back 41

B. 40-year-old woman who smokes and uses oral contraceptives.

Front 42

The nurse suspects the presence of a deep vein thrombosis based on the findings of

A. paresthesia and coolness of the leg.
B. pain in the calf that occurs with exercise.
C. generalized edema of the involved extremity.
D. pallor and cyanosis of the involved extremity.

Back 42

C. generalized edema of the involved extremity.

Front 43

Nursing interventions indicated in the plan of care for the patient with acute lower extremity deep vein thrombosis include

A. applying elastic compression stockings.
B. administering anticoagulants as ordered.
C. positioning the leg dependently to promote arterial circulation.
D. encouraging walking and leg exercises to promote venous return.

Back 43

B. administering anticoagulants as ordered.

Front 44

The nurse instructs the patient discharged on anticoagulant therapy to

A. limit intake of vitamin C.
B. report symptoms of nausea to the physician.
C. have blood drawn routinely to check electrolytes.
D. be aware of and report signs or symptoms of bleeding.

Back 44

D. be aware of and report signs or symptoms of bleeding.

Front 45

A patient with a deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest pain. Initially the most appropriate action by the nurse is to

A. auscultate for abnormal lung sounds.
B. administer oxygen and notify the physician.
C. ask the patient to cough and deep breathe to clear the airways.
D. elevate the head of the bed 30 to 45 degrees to facilitate breathing.

Back 45

D. elevate the head of the bed 30 to 45 degrees to facilitate breathing.

Front 46

A person who starts smoking in adolescence and continues to smoke into middle age:

A. Has an increased risk for alcoholism
B. Has an increased risk for obesity and diabetes
C. Has an increased risk for stress-related illnesses
D. Has an increased risk for cardiopulmonary disease and lung cancer

Back 46

D. Has an increased risk for cardiopulmonary disease and lung cancer

The risk of lung cancer is 10 times greater for a person who smokes than for a nonsmoker. Cigarette smoking worsens peripheral vascular and coronary artery disease. Inhaled nicotine causes vasoconstriction of peripheral and coronary blood vessels, increasing blood pressure and decreasing blood flow to peripheral vessels.

Front 47

Conditions such as shock and severe dehydration resulting from extracellular fluid loss cause:

A. Hypoxia
B. Hypovolemia
C. Hypervolemia
D. Uncontrolled bleeding

Back 47

B. Hypovolemia

Conditions such as shock and severe dehydration cause extracellular fluid loss and reduced circulating blood volume (hypovolemia).

Front 48

Left-sided heart failure is characterized by:

A. Increased cardiac output
B. Lowered cardiac pressures
C. Decreased functioning of the left atrium
D. Decreased functioning of the left ventricle

Back 48

D. Decreased functioning of the left ventricle

Left-sided heart failure is an abnormal condition characterized by decreased functioning of the left ventricle. If left ventricular failure is significant, the amount of blood ejected from the left ventricle drops greatly, which results in decreased cardiac output.

Front 49

The nurse is concerned when a client's heart rate, which is normally 95 beats per minute, rises to 220 beats per minute, because a rate this high will:

A. Exhaust the client
B. Decrease metabolic rate
C. Reduce coronary artery perfusion
D. Provide too much blood flow to major organs

Back 49

C. Reduce coronary artery perfusion

Coronary arteries fill and perfuse the myocardium (heart muscle) during diastole. When the heart rate is elevated, more time is spent in systole and less in diastole; hence, the myocardium may not be perfused adequately. The client may be exhausted, but the primary concern is myocardial perfusion. Major organs will adjust to increased blood flow. This is usually not a problem. With a heart rate this high, metabolic rate will be increased, not decreased.

Front 50

The nurse is caring for a client who has undergone cardiac catheterization. The client says to the nurse, "The doctor said my cardiac output was 5.5 L/min. What is normal cardiac output?" Which of the following is the nurse's best response?

A. "It is best to ask your doctor."
B. "Did the test make you feel upset?"
C. "The normal cardiac output for an adult is 4 to 6 L/min."
D. "Are you able to explain why are you asking this question?"

Back 50

C. "The normal cardiac output for an adult is 4 to 6 L/min."

Front 51

A client asks why smoking is a major risk factor for heart disease. In formulating a response, the nurse incorporates the understanding that nicotine:

A. Causes vasodilation
B. Causes vasoconstriction
C. Increases the level of high-density lipoproteins
D. Increases the oxygen-carrying capacity of hemoglobin

Back 51

B. Causes vasoconstriction

Front 52

The nurse suspects left-sided heart failure in a newly admitted client when the nurse notes which of the following symptoms? (Select all that apply.)

A. Distended neck veins
B. Bilateral crackles in the lungs
C. Weight gain of 2 lb in past 2 days
D. Shortness of breath, especially at night

Back 52

B. Bilateral crackles in the lungs
D. Shortness of breath, especially at night

Left-sided heart failure results in ineffective ejection of blood from the left ventricle. This causes a backup of blood into the lungs. Thus, symptoms of left-sided heart failure are usually related to the lungs.

Front 53

A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include:

a. CT scan
B. angiography
c. echocardiography
d. ultrasound

Back 53

a. CT scan

Front 54

A patient with a small abdominal aneurysm is not a good surgical candidate. The nurse teaches the patient that one of the best ways to prevent expansion of the lesion is to:

Back 54

control hypertension with prescribed therapy.

Front 55

During preoperative prep of patient scheduled for an abdominal aortic aneurysm the nurse establishes basline data for the patient knowing that

a. postop all pphysiologic processes will be altered
b. The cause of the aneurysm is a systemic vasuclar disease
c. surgery will be canceled if any function is not normal
d. blood pressure and HR will be maintained below normal levels during surgery

Back 55

b. The cause of the aneurysm is a systemic vascular disease

Front 56

During the patient's acute postop period following repair of an aneurysm, the nurse should ensure that:

a. hypothermia is maintained to decrease 02 need
b. the blood pressure and all peripheral pulses are evaluated at least every hour
c. IV fluids are admin at a rate to keep urine at 100 ml / hr
d. patient's bp is kept lower than baseline

Back 56

b. the blood pressure and all peripheral pulses are evaluated at least every hour

Front 57

Following an ascending aortic aneurysm repair, the nurse monitors for and immediately reports:

a. shallow resp and poor coughing
b. decreased drainaged from chest tubes
c. change in level of consciousness and ability to speak
d. lower extremity pulses that are decreased from preop baseline

Back 57

c. change in level of consciousness and ability to speak