NCLEX Review: Cardiovascular Exam

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NCLEX Review Cardiovascular Quiz

1. The nurse is caring for an adult who has a clotting time of 20 minutes. What should the nurse do because of the lab values?
1. Observe the client carefully for thrombus formation.
2. Protect the client from sources of infection.
3. Assure the client has adequate rest.
4. Avoid giving the client injections.

2. A client who is receiving heparin asks the nurse why it cannot be given by mouth. The nurse’s reply is based on which knowledge? Heparin is given parenterally because:
1. It is destroyed by gastric secretions.
2. It irritates the gastric mucosa.
3. It irritates the intestinal lining.
4. Therapeutic levels can be achieved more quickly.

3. An adult is admitted for a cardiac catheterization. The client asks the nurse if she will be asleep during the cardiac catheterization. What is the best answer for the nurse to give?
1. “You will be given a light general anesthesia.”
2. ” You will be sedated but not asleep.”
3. “The doctor will give you an anesthetic if you are having too much pain.”
4. “Is it important for you to be asleep?”

4. An adult has just returned following a left heart catheterization. What is it essential for the nurse to do?
1. Check her peripheral pulses.
2. Maintain her NPO.
3. Apply heat to the insertion site.
4. Start range of motion exercises immediately.

5. The nurse is caring for an adult who is admitted with a history of angina pectoris. He calls the nurse and says he has just taken a nitroglycerin tablet sublingually for anginal pain. What action should the nurse take next?
1. Monitor ECG. If the pain does not subside within five minutes, place a second tablet under his tongue.
2. Assist him into bed and position him in Trendelenburg position. Record vital signs every five minutes.
3. Notify the physician immediately. Start an IV so there will be a route for cardiac medications.
4. Administer xylocaine (Lidocaine) IV. Prepare for defibrillation.

6. A low sodium, low cholesterol weight reducing diet is prescribed for an adult client. The nurse knows the client understands his diet when he chooses which of the following meals?
1. Baked chicken and mashed potatoes.
2. Stir-fried Chinese vegetables and rice.
3. Tuna fish salad with celery sticks.
4. Lean steak with carrots.

7. A 70-year-old is admitted to the intensive care unit with cardiogenic shock. The nurse prepares an infusion of dobutamine as prescribed by the physician. The nurse recognizes an essential safety measure to be taken with this drug is to
1. Obtain a 12 lead electrocardiograph.
2. Assess electrolyte levels.
3. Administer the drug through a large vein.
4. Monitor for increase in temperature.

8. A client with atrial fibrillation is receiving warfarin sodium (coumadin) daily. What is the action of this drug?
1. Inactivates protamine sulfate.
2. Prevents new clots from forming.
3. Dissolves existing clots.
4. Slows the heart rate.

9. A client is receiving enalapril (Vasotec) 5 mg po daily for hypertension. Other medications include estrogen, lithium carbonate, and lorazepam. Which complaints should alert the nurse that medication interactions are present?
1. Recent memory loss, muscle weakness, and hyperreflexia.
2. Blood pressure 140/90, reports of mood swings, and restful night sleep.
3. Slight kyphosis, occasional hot flashes, and menstrual cramps.
4. Feelings of panic and anxiety, retrograde amnesia, and sleepiness.

10. A 68-year-old is admitted with a diagnosis of right-sided congestive heart failure. What assessment findings would the nurse expect in this client?
1. Distended neck veins.
2. Slight ankle edema.
3. Hypotension.
4. Premature ventricular contractions.

11. Digoxin and Lasix (Furosemide) are ordered for an adult client. Which of the following would the nurse expect to be ordered for this client?
1. Potassium.
2. Calcium.
3. Aspirin.
4. Warfarin.

12. An adult client is receiving digoxin. One morning when the nurse goes to give the client his digoxin he says, “I think I need to see the eye doctor. Things seem to look green today.” The nurse takes his vital signs and finds them to be: B.P. 150/94; P 60; R. 28. What is the most appropriate initial action for the nurse to take at this time?
1. Record the findings on the client’s chart.
2. Withhold the digoxin and report the findings.
3. Request an appointment with the ophthalmologist.
4. Reassure the client he is experiencing a normal reaction to his medication.

13. The nurse is caring for an adult who underwent a mitral valve replacement. Following cardiac surgery, clients often experience periods of disorientation. Which of the following nursing actions may help prevent this disorientation?
1. Keep the client heavily sedated.
2. Keep the ICU well lighted 24 hours a day.
3. Restrict visitors to 5 minutes at a time.
4. Position the cardiac monitor so that it is out of the client’s view.

14. An adult had open heart surgery today for a mitral valve replacement. He has a central venous pressure catheter. The CVP is recorded every 15 minutes. The nurse has observed a marked increase in the CVP over the last 2 hours. The latest reading is above normal. Which nursing action would be appropriate before the surgeon is called?
1. Increase the IV slightly to improve cardiac output.
2. Elevate the client’s feet to increase venous return.
3. Decrease the IV to a “keep open” rate.
4. Check the specific gravity of the urine.

15. For which of the following surgical procedures is it essential for the nurse to note the presence or absence of the dorsalis pedis and posterior tibial pulses?
1. Carotid endartarectomy.
2. Iliofemoral bypass.
3. Vein ligation.
4. Pacemaker implantation.

16. The nurse knows that the reason a client who has had a myocardial infarction is getting heparin is to:
1. Prevent extension of a thrombus.
2. Dissolve small thrombi that have lodged in the coronary arteries.
3. Enhance the action of thrombin in the bloodstream.
4. Decrease the amount of time it takes the blood to clot.

17. The nurse is caring for a client receiving heparin sodium. Which medication should the nurse have readily available because the client is receiving heparin?
1. Vitamin K.
2. Magnesium sulfate.
3. Warfarin sodium.
4. Protamine sulfate.

18. A 60-year-old client is admitted to the hospital with peripheral vascular disease of the lower extremities. He has had diabetes mellitus for 22 years. He smokes two packs of cigarettes per day and is employed in a job where he must stand for 7 or more hours each day. Which of the following would the nurse expect to elicit when assessing this client?
1. Diminished pedal pulses.
2. Warm tender calves.
3. Tremors of the feet bilaterally.
4. Difference in blood pressure when sitting and standing.

19. A 60-year-old man has several ischemic ulcers on each ankle and lower leg area. Other parts of his skin are shiny and taut with loss of hair. A primary nursing goal for this client should be to
1. Increase activity tolerance.
2. Relieve anxiety.
3. Protect from injury.
4. Help build a positive body image.

20. A 48-year-old is found on a routine physical examination to have a blood pressure of 170/98. Follow up studies confirm a diagnosis of hypertension. He is prescribed hydrochlorothiazide. What nursing instruction is it essential for him to receive?
1. Use a calcium based salt substitute.
2. Avoid hard cheeses.
3. Drink orange juice or eat a banana daily.
4. Do not take aspirin.

21. A low sodium diet has been ordered for an adult client. Which menu is the lowest in sodium?
1. Tossed salad, carrot sticks, steak.
2. Baked chicken, mashed potatoes, green beans.
3. Hot dog, roll, coleslaw.
4. Chicken noodle soup, applesauce, cottage cheese.

22. An adult client was admitted to the coronary care unit following a subendocardial myocardial infarction. A balloon-tipped pulmonary artery catheter was inserted when the client began to exhibit signs of cardiogenic shock. The nurse measures the client’s pulmonary capillary wedge pressure and finds it to be 27 mm Hg. The nurse knows that this pressure is
1. Within normal limits.
2. Elevated above normal.
3. Less than normal.
4. Life threatening.

23. An elderly client with a long history of heart disease was brought to the emergency department of a local hospital following a 30 minute episode of chest pain unrelieved by nitroglycerin. The client’s electrocardiograph has an inverted T wave. The nurse caring for the client knows this finding indicates
1. First-degree heart block.
2. Second-degree heart block.
3. Atrial flutter.
4. Myocardial ischemia.

24. A client is admitted with thrombophlebitis of the right leg. Which findings would the nurse expect when assessing this client?
1. Diminished pedal pulses.
2. Color changes in the extremities when elevated.
3. Red, shiny skin.
4. Pain when the leg is elevated.

25. Heparin via IV infusion is ordered for a client. Which of the following test results should the nurse monitor frequently?
1. Hemoglobin and hematocrit.
2. Activated Partial Thromboplastin Time (APTT)
3. Prothrombin time.
4. Platelet count.

NCLEX Review Cardiovascular Quiz Answers and Rationales

1. (4) The normal clotting is 5 to 15 minutes. A client with a clotting time of 20 minutes is prone to bleeding and should not receive injections. Choice #1 is appropriate for a client who has a decreased clotting time. Choice #2 is appropriate for a client with a low white count and choice #3 is appropriate for a client who has a low red count.

2. (1) Heparin is a protein and is destroyed by gastric secretions. IV administration achieves rapid levels of heparin. However heparin cannot be given by mouth so this is not the answer to the question.

3. (2) Persons undergoing cardiac catheterization will receive a sedative but are not put to sleep. Their cooperation is needed during the procedure. A general anesthesia is not used.

4. (3) Checking pulses is of highest priority. The complications most likely to occur are hemorrhage and obstruction of the vessel.

5. (1) Nitroglycerine can be given at 5 minute intervals for up to 3 doses if the pain is not relieved. Monitor ECG is appropriate for a hospitalized patient. Trendelenburg position is contraindicated in someone who has angina. It would increase cardiac work load. There is no need to start an IV immediately for angina. Most hospitalized patients will have an IV access already in place. There is no data to support administering xylocaine. Defibrillation is for cardiac arrest.

6. (1) Baked chicken is low in sodium. Chinese food is high in sodium. Tuna fish is high in sodium; so is celery. Steak is high in sodium; so are carrots.

7. (3) Dobutamine is a vasoconstrictor and must be administered through a large vein to prevent extravasation. The nurse should also assess the client’s vital signs, lung sounds, urine output, and ECG. There is no need for a 12 lead ECG. Electrolyte levels are not related to dobutamine. Dobutamine does not cause a change in temperature.

8. (2) Clients with atrial fibrillation are subject to clot formation. Warfarin sodium (Coumadin) is given to prevent new clots from forming and existing clots from enlarging. Coumadin interrupts clotting by depressing hepatic synthesis of vitamin K dependent coagulation factor. Thrombolytic agents such as streptokinase or tPA dissolve existing clots. Protamine sulfate is the antidote for heparin. Warfarin does not slow the heart rate.

9. (1) Recent memory loss, muscle weakness, and hyperreflexia are adverse side effects associated with lithium carbonate toxicity. Enalapril (Vasotec), an antihypertensive drug, increases lithium levels when they are taken together. The other symptoms do not indicate medication interaction.

10. (1) Right sided heart failure is characterized by venous symptoms such as distended neck veins, hepatomegaly and pitting peripheral edema. Slight ankle edema might be seen with left sided heart failure. Blood pressure usually rises with heart failure. Premature ventricular contractions are not a major symptom with right sided heart failure.

11. (1) Lasix is a potassium depleting diuretic. Digoxin toxicity occurs more quickly in the presence of a low serum potassium.

12. (2) Disturbance in green and yellow vision is a sign of digitalis toxicity. A pulse of 62 is borderline for toxicity.

13. (4) Positioning the cardiac monitor so it is out of the client’s view will make the ICU less machine oriented and more people oriented. It may be anxiety producing for the client. The other choices are clearly incorrect since none of them will prevent disorientation. Sedation may cause disorientation. Keeping the room well lighted 24 hours a day causes abnormal sleep and waking patterns. Sleep deprivation may cause disorientation. Restricting visitors limits the emotional support a potentially disoriented person may need from significant others in his life.

14. (3) High CVP is indicative of circulatory overload. The IV should be decreased not increased. Elevation of the client’s feet would increase circulating volume. Check specific gravity of urine would be appropriate if the CVP were low and the nurse was concerned about dehydration. Note that choice #1 and #3 are opposites.

15. (2) Palpable pulses in the feet indicate that the bypass is patent. Following a carotid endartarectomy the carotid and temporal pulse s are most essential. A vein ligation would not compromise arterial circulation in the feet. Apical pulse is appropriate after pacemaker insertion.

16. (1) Heparin prevents formation of new thrombi. It does not dissolve those already present. Heparin blocks the action of thrombin. It does not enhance it. Heparin makes it take longer for blood to clot.

17. (4) Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin sodium (Coumadin). Magnesium sulfate is a central nervous system depressant given to treat preeclampsia.

18. (1) Arterial disease will cause decreased pulses in the lower extremities. Warm tender calves are typical with thrombophlebitis.

19. (3) He has decreased arterial circulation and will not heal well if injured. Important physical and safety needs take precedence over emotional needs.

20. (3) Hydrochlorothiazide is a potassium depleting diuretic. Orange juice and bananas are good sources of potassium. The person who is taking a potassium depleting diuretic should take a potassium based salt substitute if he is to take one. Hard cheeses should be avoided by persons taking the powerful monamine oxidase inhibitor antidepressants. Aspirin has an anticoagulant effect and is not contraindicated when taking a thiazide diuretic.

21. (2) Chicken is low in sodium, as are mashed potatoes and green beans. Carrot sticks, steak, hot dog, soup and cottage cheese are all high in sodium.

22. (4) The normal pulmonary capillary wedge pressure (PCWP) is 5 to 12 mm Hg. The higher the pressure, the more severe the heart failure. Pressures that exceed 25 to 30 mm Hg can be associated with pulmonary edema, which is life threatening.

23. (4) An inverted T wave is characteristic of myocardial ischemia.

24. (3) Red, shiny skin suggests inflammation. Diminished pedal pulses suggest arterial insufficiency. Color changes when the extremities are elevated would suggest arterial insufficiency or varicose veins. Thrombophlebitis should not cause pain when the leg is elevated.

25. (2) APTT is the blood test used to monitor the effectiveness of heparin. Prothrombin time is used to monitor coumadin therapy.

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