NCLEX RN Cardiovascular Q&As 1

NCLEX Cardiovascular Exam 2020 – Questions and

Answers

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?

1. Glipizide

2. Metformin

3. Repaglinide

4. Regular insulin

2. 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?

1. Hypovolemia

2. Acute kidney injury

3. Glomerulonephritis

4. Urinary tract infection

 NCLEX RN Cardiovascular Q&As 2

3. 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?

1. Check vital signs.

2. Check laboratory test results.

3. Notify the health care provider.

4. Continue to monitor for any rhythm change.

4. 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?

1. Call a code.

2. Call the health care provider.

3. Check the client's status and lead placement.

4. 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?

1. Blood pressure

2. Status of airway

3. Oxygen flow rate

4. Level of consciousness
 NCLEX RN Cardiovascular Q&As 3

6. 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?

1. 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?

1. Sinus tachycardia

2. Sinus bradycardia

3. Sinus dysrhythmia

4. Normal sinus rhythm

8. 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?

1. The neurovascular status is normal because of increased blood

flow through the leg.

 NCLEX RN Cardiovascular Q&As 4
2. The neurovascular status is moderately impaired, and the surgeon

should be called.

3. The neurovascular status is slightly deteriorating and should be

monitored for another hour.

4. The neurovascular status is adequate from an arterial approach,

but venous complications are arising.

9. 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?

1. Muffled heart sounds

2. A rise in blood pressure

3. Jugular venous distention

4. Client expressions of dyspnea

10. A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily.

Which statement by the client indicates theneed for further teaching?

1. "I should notify my doctor if my feet or legs start to swell."

2. "My doctor told me to call his office if my pulse rate decreases

below 60."

3. "Avoiding grapefruit juice will definitely be a challenge for me,

since I usually drink it every morning with breakfast."

 NCLEX RN Cardiovascular Q&As 5
4. "My spouse told me that since I have developed this problem, we

are going to stop walking in the mall every morning."

11. The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which

assessment finding indicates the presence of this complication?

1. Flat neck veins

2. A pulse rate of 60 beats/minute

3. Muffled or distant heart sounds

4. 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?

1. "I need to be sure not to go barefoot around the house."

2. "If I cut my toenails, I need to be sure that I cut them straight

across."

3. "It is all right to apply lanolin to my feet, but I shouldn't place it

between my toes."

4. "I need to be sure that I elevate my leg above the level of my heart

for at least an hour every day."

13. 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?
 NCLEX RN Cardiovascular Q&As 6
1. Bananas

2. Broccoli

3. Antacids

4. Cantaloupe

14. The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse

should plan to provide which instruction to the client?

1. Use nail polish to protect the nail beds from injury.

2. Wear gloves for all activities involving the use of both hands.

3. Stop smoking because it causes cutaneous blood vessel spasm.

4. Always wear warm clothing, even in warm climates, to prevent

vasoconstriction.

15. 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?

1. Keep the legs aligned with the heart.

2. Elevate the legs higher than the heart.

3. Clean the skin with alcohol every hour.

4. 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
 NCLEX RN Cardiovascular Q&As 7
used in areas of skin breakdown. Option 4 specifies infrequent care intervals, so it is not the priority

intervention.

16. 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?

1. Heart failure

2. Atrial fibrillation

3. Myocardial infarction

4. Ventricular tachycardia

17. 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
 NCLEX RN Cardiovascular Q&As 8
palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness,

syncope, shortness of breath, and distended neck veins.

18. 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?

1. Listening to lung sounds

2. Palpating for organomegaly

3. Assessing for jugular vein distention

4. Assessing for peripheral and sacral edema

19. 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?

1. "This is a normal finding."

2. "This is indicative of atrial flutter."

3. "This is indicative of atrial fibrillation."

4. "This is indicative of impending reinfarction."

20. 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?
 NCLEX RN Cardiovascular Q&As 9
1. Anxiety related to the need to make lifestyle changes

2. Boredom resulting from having already learned the material

3. An attempt to ignore or deny the need to make lifestyle changes

4. Lack of understanding of the material provided at the teaching

session and embarrassment about asking questions

21. 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?

1. A stage 1 ulcer

2. A vascular ulcer

3. An arterial ulcer

4. 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.

 NCLEX RN Cardiovascular Q&As 10
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?

1. Maintain activity level as prescribed.

2. Maintain the affected leg in a dependent position.

3. Administer an opioid analgesic every 4 hours around the clock.

4. Apply cool packs to the affected leg for 20 minutes every 4 hours.

23. 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?

1. "It involves tying off the veins so that circulation is redirected in

another area."

2. "It involves surgically removing the varicosity, so anesthesia will

be required."

3. "It involves tying off the veins to prevent sluggishness of blood

from occurring."

4. "It involves injecting an agent into the vein to damage the vein

wall and close it off."

 NCLEX RN Cardiovascular Q&As 11
24. 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?

1. "Apply warm packs to the leg."

2. "Keep the leg elevated as much as possible."

3. "Your health care provider needs to be contacted to report this

problem."

4. "This normally occurs after surgery and will subside when the

edema goes down."

25. 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?

1. "Oxygen has a calming effect."

2. "Oxygen will prevent the development of any thrombus."

3. "The pain of angina pectoris occurs because of a decreased oxygen

supply to heart cells."

4. "Oxygen dilates the blood vessels so that they can supply more

nutrients to the heart muscle.

 NCLEX RN Cardiovascular Q&As 12
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?

1. "I need to cut down on cigarette smoking."

2. "I am so relieved that my heart is repaired."

3. "I need to adhere to my dietary restrictions."

4. "I am so relieved that I can eat anything I want to now."

27. 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?

1. Tea

2. Cola

3. Coffee

4. Raspberry juice

28. 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?
 NCLEX RN Cardiovascular Q&As 13
1. "Where is the pain located?"

2. "Are you having any nausea?"

3. "Are you allergic to any medications?"

4. "Do you have your nitroglycerin with you?"

29. 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?

1. "I'll need to become a strict vegetarian."

2. "I should use polyunsaturated oils in my diet."

3. "I need to substitute eggs and whole milk for meat."

4. "I should eliminate all cholesterol and fat from my diet."

30. 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."

 NCLEX RN Cardiovascular Q&As 14
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)?

1. Age

2. Hypertension

3. Hyperlipidemia

4. 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?

1. "I need to start exercising more to improve my health."

2. "I will be sure to keep my appointment with the cardiologist."

 NCLEX RN Cardiovascular Q&As 15
3. "I don't have anyone to help me with doing heavy housework at

home."

4. "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?

1. "I will eat enough daily fiber to prevent straining at stool."

2. "I will try to exercise vigorously to strengthen my heart muscle."

3. "I will drink 3000 to 3500 mL of fluid daily to promote good

kidney function."

4. "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.
 NCLEX RN Cardiovascular Q&As 16
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?

1. Ambulates 10 feet (3 meters) farther each day

2. Verbalizes the benefits of increasing activity

3. Chooses a healthy diet that meets caloric needs

4. Sleeps without awakening throughout the night

35. 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?

1. Questions the client about allergies to iodine or shellfish

2. Has the client sign an informed consent form for an invasive

procedure

3. Tells the client that the procedure is painless and takes 30 to 60

minutes

4. Keeps the client on nothing by mouth (NPO) status for 2 hours

before the procedure

36. 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?
 NCLEX RN Cardiovascular Q&As 17
1. Eat breakfast just before the procedure.

2. Wear firm, rigid shoes, such as work boots.

3. Wear loose clothing with a shirt that buttons in front.

4. Avoid cigarettes for 30 minutes before the procedure.

37. 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?

1. Chest pain

2. Urge to cough

3. Warm, flushed feeling

4. Pressure at the insertion site

38. 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?

1. 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.

 NCLEX RN Cardiovascular Q&As 18
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?

1. "It will really hurt when the catheter is first put in."

2. "I will receive general anesthesia for the procedure."

3. "I will have to go to the operating room for this procedure."

4. "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.

40. 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?

1. Apnea monitor
 NCLEX RN Cardiovascular Q&As 19
2. Oxygen flowmeter

3. Telemetry cardiac monitor

4. 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?

1. "Stable angina is chronic."

2. "Variant angina is caused by emotional stress."

3. "Unstable angina is not a life-threatening condition."

4. "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?

1. "Presence of Q waves indicates first-degree heart block."

 NCLEX RN Cardiovascular Q&As 20
2. "Tall, peaked T waves indicate first-degree heart block."

3. "Widened QRS complexes indicate first-degree heart block."

4. "Prolonged, equal PR intervals indicates first-degree heart block."

43. 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?

1. "I will avoid using table salt with meals."

2. "It is best to exercise once a week for 1 hour."

3. "I will take nitroglycerin whenever chest discomfort begins."

4. "I will use muscle relaxation to cope with stressful situations."

44. 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?

1. It is most effectively managed by beta-blocking agents.

2. It has the same risk factors as stable and unstable angina.

3. It can be controlled with a low-sodium, high-potassium diet.

4. Generally, it is treated with calcium channel–blocking agents.

 NCLEX RN Cardiovascular Q&As 21
45. 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?

1. The client is not experiencing dyspnea.

2. The client is not experiencing nausea or vomiting.

3. The pain has not been relieved by rest and nitroglycerin tablets.

4. The client says the pain began while she was trying to open a stuck

dresser drawer.

46. 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?

1. 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
 NCLEX RN Cardiovascular Q&As 22
should the nurse identify as an indicator that the client is experiencing complications of this

therapy?

1. Tarry stools

2. Nausea and vomiting

3. Orange-colored urine

4. 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.

48. 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?

1. "None of the cardiovascular effects are reversible, but quitting

might prevent lung cancer."

2. "Because most of the damage has already been done, it will be all

right to cut down a little at a time."

3. "If you totally quit smoking right now, you can cut your

cardiovascular risk to zero within a year."

 NCLEX RN Cardiovascular Q&As 23
4. "If you quit now, your risk of cardiovascular disease will decrease

to that of a nonsmoker in 3 to 4 years."

49. 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?

1. Rhonchi

2. Wheezes

3. Crackles in the bases

4. 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?

1. Left atrium
 NCLEX RN Cardiovascular Q&As 24
2. Right atrium

3. Left ventricle

4. 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.

51. 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?

1. "Chest pain is caused by tissue hypoxia in the myocardium."

2. "Chest pain is caused by tissue hypoxia in the vessels of the heart."

3. "Chest pain is caused by tissue hypoxia in the parietal

pericardium."

4. "Chest pain is caused by tissue hypoxia in the visceral

pericardium."
 NCLEX RN Cardiovascular Q&As 25
52. 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?

1. "Left ventricle to aorta narrowing will impede flow of blood."

2. "Left atrium to left ventricle narrowing will impede flow of blood."

3. "Right atrium to right ventricle narrowing will impede flow of

blood."

4. "Right ventricle to pulmonary artery narrowing will impede flow of

blood."

Rationale:

The mitral valve separates the left atrium from the left ventricle.

53. 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?

1. "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."

 NCLEX RN Cardiovascular Q&As 26
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.

54. 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?

1. "Decreased contractility occurs."

2. "Decreased heart rate is not a side effect."

3. "Decreased myocardial blood flow is not a concern."

4. "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.

55. 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?

1. "Calcium has no effect on the risk for stroke."

 NCLEX RN Cardiovascular Q&As 27
2. "Low calcium levels can lead to cardiac arrest."

3. "Low calcium levels cause high blood pressure."

4. "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?

1. Bundle of His

2. Purkinje fibers

3. Sinoatrial (SA) node

4. 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?

1. "The coronary arteries branch from the aorta."

2. "The coronary arteries supply the heart muscle with blood."

3. "The left coronary artery provides blood for the left atrium and the

left ventricle."
 NCLEX RN Cardiovascular Q&As 28
4. "The left coronary artery supplies the right atrium and right

ventricle with blood."

58. 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?

1. "A cardiac output of 2 L/min is normal."

2. "A cardiac output of 4 L/min is normal."

3. "A cardiac output of 6 L/min is normal."

4. "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.

59. 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?

1. "Pulse rate will increase."

2. "Blood pressure will decrease."

3. "Edema will be present in the legs."

 NCLEX RN Cardiovascular Q&As 29
4. "Crackles in the lungs will be present."

60. 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?

1. It is unnecessary to use both hands.

2. The client could occlude the trachea.

3. The heart rate and blood pressure could drop.

4. 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?

1. "The peripheral arteries and veins; when stimulated they cause

vasoconstriction."

2. "Arterial and bronchial walls; when stimulated they cause

vasodilation and bronchodilation."

3. "The heart; when stimulated it causes an increase in heart rate,

atrioventricular node conduction, and contractility."

 NCLEX RN Cardiovascular Q&As 30
4. "Several tissues; when stimulated they cause contraction of

smooth muscle, inhibition of lipolysis, and promotion of platelet

aggregation."

62. 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?

1. Normal, because of the client's age

2. Abnormal, requiring further assessment

3. Normal, as a result of the effects of digoxin

4. Normal, because this is the reason the client is receiving digoxin

63. 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?

1. Pulse rate is not a reflection of cardiac response.

2. Cardiac index is the mechanism that allows blood to flow better.

3. Cardiac output is the body's attempt to meet metabolic demands.

4. Stroke volume is an artificial number used to determine the

adequacy of cardiac output.

 NCLEX RN Cardiovascular Q&As 31

64. 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?

1. Circumflex coronary artery

2. Right coronary artery (RCA)

3. Posterior descending coronary artery (PDA)

4. 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?

1. Increased heart rate and increased blood pressure

2. Increased heart rate and decreased blood pressure

 NCLEX RN Cardiovascular Q&As 32
3. Decreased heart rate and increased blood pressure

4. 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.

66. 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?

1. Vagus nerve stimulation causes a decrease in heart rate and

cardiac contractility.

2. Vagus nerve stimulation causes an increase in heart rate and

cardiac contractility.

3. Sympathetic nerve stimulation causes a decrease in heart rate and

cardiac contractility.

4. Sympathetic nerve stimulation causes an increase in heart rate and

cardiac contractility.

67. A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The

nurse should respond with which statement?

 NCLEX RN Cardiovascular Q&As 33
1. "The work of breathing is increased when the client is anemic."

2. "Blood flows more slowly when the hemoglobin or hematocrit is

low."

3. "The body has to work harder to fight infection in the presence of

anemia."

4. "Adequate amounts of hemoglobin are needed to carry oxygen for

tissue metabolism."

68. Which laboratory test results may be associated with peaked or tall, tented T waves on a client's

electrocardiogram (ECG)?

1. 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?

1. Oxygen saturation decreased from 96% to 91%.

 NCLEX RN Cardiovascular Q&As 34
2. Pulse rate increased from 80 to 104 beats per minute.

3. Blood pressure decreased from 140/86 to 112/72 mm Hg.

4. 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.

70. A client is being discharged from the hospital after being treated for infective endocarditis. The

nurse should provide the client with which discharge instruction?

1. Take acetaminophen if the chest pain worsens.

2. Take antibiotics until the chest pain is fully resolved.

3. Use a firm-bristle toothbrush and floss vigorously to prevent

cavities.

4. Notify all health care providers (HCPs) of the history of infective

endocarditis before any invasive procedures.

71. 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?
 NCLEX RN Cardiovascular Q&As 35
1. Use the knee gatch on the bed.

2. Cover the legs lightly when sitting in a chair.

3. Encourage the client to cross the legs when sitting in a chair.

4. 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?

1. Driving is permitted as long as the lap and shoulder seat belts are

worn.

2. Lifting should be restricted to objects that do not weigh more than

25 pounds (11.3 kg).

3. Use the arms for balance, not weight support, when getting out of

bed or a chair.
 NCLEX RN Cardiovascular Q&As 36
4. Activities that involve straining may be resumed as long as they do

not cause pain.

73. 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?

1. Sinus bradycardia

2. Sick sinus syndrome

3. Normal sinus rhythm

4. 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.

74. 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?

1. Sinus tachycardia
 NCLEX RN Cardiovascular Q&As 37
2. Sinus bradycardia

3. Sinus dysrhythmia

4. Normal sinus rhythm

75. 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?

1. "Ventricular fibrillation appears as irregular beats within a

rhythm."

2. "Ventricular fibrillation does not have P waves or QRS complexes."

3. "Ventricular fibrillation is a regular pattern of wide QRS

complexes."

4. "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?

1. Digoxin

2. Verapamil
 NCLEX RN Cardiovascular Q&As 38
3. Acebutolol

4. Amiodarone

77. 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?

1. They occur in pairs.

2. They appear to be multifocal.

3. They fall on the second half of the T wave.

4. They decrease to a frequency of less than 6 per minute.

78. The nurse is assessing the client's condition after cardioversion. Which observation should be

of highest priority to the nurse?

1. Heart rate

2. Skin color

3. Status of airway

4. Peripheral pulse strength

 NCLEX RN Cardiovascular Q&As 39
79. 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?

1. "If I feel an internal defibrillator shock, I should sit down."

2. "I won't be able to have a magnetic resonance imaging test (MRI)."

3. "My wife knows how to call the emergency medical services (EMS)

if I need it."

4. "I can stop taking my antidysrhythmic medicine now because I

have a pacemaker."

80.A client with a complete heart block has had a permanent demand ventricular pacemaker

inserted. The nurse assesses for proper pacemaker function by examining the

electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point?

1. Before each P wave

2. Just after each P wave

3. Just after each T wave

4. Before each QRS complex

 NCLEX RN Cardiovascular Q&As 40
81. A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse

should next assess the client for which finding?

1. Bilateral edema

2. Increased calf circumference

3. Diminished distal peripheral pulses

4. Coolness and pallor of the affected limb

Rationale:

The client with thrombophlebitis, also known as deep vein thrombosis, exhibits redness or warmth of

the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema

distal to the obstruction, and increased calf circumference in the affected extremity. Peripheral pulses

are unchanged from baseline because this is a venous, not an arterial, problem. Often

thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms

unless pulmonary embolism occurs as a complication.

82. The nurse is planning care for a client with deep vein thrombosis of the right leg. Which

interventions would the nurse plan, based on the health care provider's (HCP's)

prescriptions? Select all that apply.

1. Elevation of the right leg

2. Administration of acetaminophen

3. Application of moist heat to the right leg

 NCLEX RN Cardiovascular Q&As 41
4. Monitoring for signs of pulmonary embolism

5. Ambulation in around the nursing unit every hour

Rationale:

Standard management of the client with deep vein thrombosis includes possible bed rest for 5 to 7

days or as prescribed; limb elevation; relief of discomfort with warm, moist heat and analgesics as

needed; anticoagulant therapy; and monitoring for signs of pulmonary embolism. Although the health

care provider may allow ambulation, hourly ambulation around the nursing unit is not encouraged

because it increases the likelihood of dislodgement of the tail of the thrombus, which could travel to

the lungs as a pulmonary embolism.

83. A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is

identifying measures to help the client cope with lifestyle changes needed to control the disease

process. The nurse plans to refer the client to which member of the health care team?

1. Dietitian

2. Medical social worker

3. Pain management clinic

4. Smoking cessation program

Rationale:

Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins.
 NCLEX RN Cardiovascular Q&As 42
Smoking is highly detrimental to the client with Buerger's disease, so stopping smoking completely is

recommended. Because smoking is a form of chemical dependency, referral to a smoking cessation

program may be helpful for many clients. For many clients with Buerger's disease, symptoms are

relieved or alleviated once smoking stops. A dietitian, a medical social worker, and a pain

management clinic are not specifically associated with the lifestyle changes required in this disorder,

although they may be needed if secondary problems arise.

84. The home health nurse is visiting a client who has had a mechanical valve replacement for

severe mitral valve stenosis. Which statement by the client reflects an understanding of specific

postoperative care after this surgery?

1. "I need to count my pulse every day."

2. "I have to do deep-breathing exercises every 2 hours."

3. "I need to throw away my straight razor and buy an electric razor."

4. "I have to go to the bathroom frequently because of my

medication."

Rationale:

Mechanical valves require long-term anticoagulation to prevent clots from forming on the "foreign"

object implanted in the client's body. Anticoagulation therapy requires clients to avoid any trauma or

potential means of causing bleeding, such as the use of straight razors.

 NCLEX RN Cardiovascular Q&As 43
85. The nurse is planning to teach a client with peripheral arterial disease about measures to limit

disease progression. Which items should the nurse include on a list of suggestions for the

client? Select all that apply.

1. Soak the feet in hot water daily.

2. Be careful not to injure the legs or feet.

3. Use a heating pad on the legs to aid vasodilation.

4. Walk each day to increase circulation to the legs.

5. Cut down on the amount of fats consumed in the diet.

86. The home health nurse visits a client recovering after an episode of cardiogenic shock

secondary to an anterior myocardial infarction (MI) and provides home care instructions to the

client. Which statement by the client indicates an understanding of these home care measures?

1. "I exercise every day after breakfast."

2. "I've gained 8 pounds (3.6 kg) since discharge."

3. "I take an antacid when I experience epigastric pain."

4. "I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily."

87. A client who had coronary artery bypass surgery states to the home health nurse, "I get so

frustrated. I can't even do my gardening." The nurse then assesses the client for activity level

since the surgery. Which client statement indicates a need for further teaching?
 NCLEX RN Cardiovascular Q&As 44
1. "I pace my activities throughout the day."

2. "I plan regular rest periods during the day."

3. "I avoid outdoor physical activity during the heat of the day."

4. "I try to walk immediately after lunch, after I've finished my

morning housecleaning."

88. The nurse notes that a client's cardiac rhythm shows absent P waves, no PR interval, and an

irregular rhythm. How should the nurse interpret this rhythm?

1. Bradycardia

2. Tachycardia

3. Atrial fibrillation

4. Normal sinus rhythm (NSR)

89. The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving

intravenous doses of furosemide. The client is attached to cardiac telemetry, and the nurse is

monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has

changed to this pattern. The nurse determines that the most likely cause of this cardiac

rhythm in the client is which problem? Refer to Figure.

View Figure
 NCLEX RN Cardiovascular Q&As 45
1. Pacemaker dysfunction

2. The presence of hypokalemia

3. The effectiveness of the furosemide

4. An impending myocardial infarction (MI)

Rationale:

This cardiac rhythm is normal sinus rhythm with unifocal premature ventricular complexes (PVCs).

PVCs may be insignificant, or they may occur with myocardial ischemia or MI; heart failure;

hypokalemia; hypomagnesemia; medications; stress; nicotine, caffeine, or alcohol intake; infection;

trauma; or surgery. This client is receiving furosemide, a diuretic that causes the excretion of

potassium. The most likely cause of the PVCs in this client is hypokalemia. Option 3 is an incorrect

interpretation. The question presents no data indicating that this client has a pacemaker or has signs

or symptoms of an impending MI.

90. A client is attached to a cardiac monitor, and the nurse notes the presence of this cardiac

rhythm on the monitor. The nurse quickly assesses the client, knowing that this rhythm is

indicative of which rhythm? Refer to Figure.

View Figure

1. Atrial fibrillation

2. Ventricular fibrillation (VF)

 NCLEX RN Cardiovascular Q&As 46
3. Ventricular tachycardia (VT)

4. Premature ventricular complexes

91. The nurse is assessing a client's legs for the presence of edema. The nurse notes that the client

has mild pitting with slight indentation and no perceptible swelling of the leg. How should the

nurse define and document this finding?

1. 1+ edema

2. 2+ edema

3. 3+ edema

4. 4+ edema

92. The post–myocardial infarction client is scheduled for a technetium-99m ventriculography

(multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before

the procedure?

1. A urinary catheter

2. Signed informed consent

3. A central venous pressure (CVP) line

4. Notation of allergies to iodine or shellfish

 NCLEX RN Cardiovascular Q&As 47
93. The nurse is teaching a client with cardiomyopathy about home care safety measures. The

nurse should address with the client which most important measure to ensure client safety?

1. Assessing pain

2. Administering vasodilators

3. Avoiding over-the-counter (OTC) medications

4. Moving slowly from a sitting to a standing position

94. A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus

tachycardia. Which nursing action should be included in the client's plan of care?

1. Limiting oral and intravenous fluids

2. Measuring the client's pulse each shift

3. Providing the client with short, frequent walks

4. Eliminating sources of caffeine from meal trays

95. A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation.

Which finding indicates that further preparation is needed for the procedure?
 NCLEX RN Cardiovascular Q&As 48
1. The client's digoxin has been withheld for the last 48 hours.

2. The client is wearing a nasal cannula delivering oxygen at 2 L/min.

3. The defibrillator has the synchronizer turned on and is set at 120

joules (J).

4. The client has received an intravenous dose of a conscious

sedation medication.

Rationale:

During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and

a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before

cardioversion because it increases ventricular irritability and may cause ventricular dysrhythmias

after the countershock. The defibrillator is switched to synchronizer mode to time the delivery of the

electrical impulse to coincide with the QRS and avoid the T wave, which could cause ventricular

fibrillation. Energy level typically is set at 120 to 200 J for a biphasic machine. The client typically

receives a dose of an intravenous sedative or antianxiety agent.

96. The nurse is assisting in the care of a client scheduled for cardioversion. The nurse plans to set

the defibrillator to which starting energy range level, depending on the specific health care

provider (HCP) prescription?

1. 120 joules

2. 200 joules

3. 250 joules
 NCLEX RN Cardiovascular Q&As 49
4. 350 joules

97. A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min.

What manifestation should the nurse observe for when performing the client's focused

assessment?

1. Flat neck veins

2. Nausea and vomiting

3. Hypotension and dizziness

4. Clubbed fingertips and headache

Rationale:

The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at

risk for low cardiac output due to 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.

98. The nurse has provided self-care activity instructions to a client after insertion of an implanted

cardioverter-defibrillator (ICD). The nurse determines that further instruction is needed if

the client makes which statement?

1. "I need to avoid doing anything that could involve rough contact

with the ICD insertion site."

 NCLEX RN Cardiovascular Q&As 50
2. "I can perform activities such as swimming, driving, or operating

heavy equipment as I need to."

3. "I should try to avoid doing strenuous things that would make my

heart rate go up to or above the rate cutoff on the ICD."

4. "I should keep away from electromagnetic sources such as

transformers, large electrical generators, and metal detectors, and

I shouldn't lean over running motors."

Rationale:

Post-discharge instructions typically include avoiding tight clothing or belts over the ICD insertion

sites; rough contact with the ICD insertion site; and electromagnetic fields such as with electrical

transformers, radio/TV/radar transmitters, metal detectors, and running motors of cars or boats.

Clients also must alert health care providers (HCPs) or dentists to the presence of the device because

certain procedures such as diathermy, electrocautery, and magnetic resonance imaging may need to

be avoided to prevent device malfunction. Clients should follow the specific advice of a HCP regarding

activities that are potentially hazardous to self or others, such as swimming, driving, or operating

heavy equipment.

99. A client with a history of hypertension has been prescribed triamterene. The nurse determines

that the client understands the effect of this medication on the diet if the client states to avoid

which fruit?

1. Pears

2. Apples
 NCLEX RN Cardiovascular Q&As 51
3. Bananas

4. Cranberries

100. A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should

assess the client for which manifestation that differentiates pericarditis from other

cardiopulmonary problems?

1. Anterior chest pain

2. Pericardial friction rub

3. Weakness and irritability

4. Chest pain that worsens on inspiration

101. Cardiac monitoring leads are placed on a client who is at risk for premature ventricular

contractions (PVCs). Which heart rhythm will the nurse anticipate in this client if PVCs are

occurring?

1. A P wave preceding every QRS complex

2. QRS complexes that are short and narrow

3. Inverted P waves before the QRS complexes

4. Premature beats followed by a compensatory pause

 NCLEX RN Cardiovascular Q&As 52

102. The nurse is developing a plan of care for a client recovering from pulmonary edema.

The nurse establishes a goal to have the client participate in activities that reduce cardiac

workload. The nurse should identify which client action as contributing to this goal?

1. Using a bedside commode

2. Sleeping in the supine position

3. Elevating the legs when in bed

4. Using seasonings to improve the taste of food

Rationale:

Using a bedside commode decreases the work of getting to the bathroom or struggling to use the

bedpan. The supine position increases respiratory effort and decreases oxygenation. Elevating the

client's legs increases venous return to the heart thus increasing cardiac workload. Seasonings may be

high in sodium and promote further fluid retention.

103. The nurse is performing an admission assessment on a client with a diagnosis of

Raynaud's disease. How should the nurse assess for this disease?

1. Checking for a rash on the digits

2. Observing for softening of the nails or nail beds

3. Palpating for a rapid or irregular peripheral pulse

4. Palpating for diminished or absent peripheral pulses

 NCLEX RN Cardiovascular Q&As 53

104. The health care provider (HCP) prescribes limited activity (bed rest and bathroom only)

for a client who developed deep vein thrombosis (DVT) after surgery. What interventions

should the nurse plan to include in the client's plan of care? Select all that apply.

1. Encourage coughing with deep breathing.

2. Place in high Fowler's position for eating.

3. Encourage increased oral intake of water daily.

4. Place thigh-length elastic stockings on the client.

5. Place sequential compression boots on the client.

6. Encourage the intake of dark green, leafy vegetables.

Rationale:

The client with DVT may require bed rest to prevent embolization of the thrombus resulting from

skeletal muscle action, anticoagulation to prevent thrombus extension and allow for thrombus

autodigestion, fluids for hemodilution and to decrease blood viscosity, and elastic stockings to reduce

peripheral edema and promote venous return. While the client is on bed rest, the nurse prevents

complications of immobility by encouraging coughing and deep breathing. Venous return is

important to maintain because it is a contributing factor in DVT, so the nurse maintains venous

return from the lower extremities by avoiding hip flexion, which occurs with high Fowler's position.

The nurse avoids providing foods rich in vitamin K, such as dark green, leafy vegetables, because this

vitamin can interfere with anticoagulation, thereby increasing the risk of additional thrombi and

emboli. The nurse also would not include use of sequential compression boots for an existing
 NCLEX RN Cardiovascular Q&As 54
thrombus. They are used only to prevent DVT, because they mimic skeletal muscle action and can

disrupt an existing thrombus, leading to pulmonary embolism.

105. Spironolactone is prescribed for a client with heart failure. In providing dietary

instructions to the client, the nurse identifies the need to avoid foods that are high in which

electrolyte?

1. Calcium

2. Potassium

3. Magnesium

4. Phosphorus

106. A client is seen in the emergency department for complaints of chest pain that began 3

hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value

comes back elevated?

1. Myoglobin

2. Troponin

3. C-reactive protein

4. Creatine kinase (CK)

 NCLEX RN Cardiovascular Q&As 55
107. The nurse is giving discharge instructions to a client who has just undergone vein

ligation and stripping. The nurse evaluates that the client understands activity and positioning

limitations if the client states that which action is appropriate to do?

1. Walk for as long as possible each day.

2. Cross the legs at the ankle only, not at the knee.

3. Sit in a chair 3 times a day for 3 hours at a time.

4. Lie down with the legs elevated and avoid sitting.

108. A client with no history of cardiovascular disease comes to the ambulatory clinic with

flulike symptoms. The client suddenly complains of chest pain. Which question

should best help the nurse discriminate pain caused by a noncardiac problem?

1. "Can you describe the pain to me?"

2. "Have you ever had this pain before?"

3. "Does the pain get worse when you breathe in?"

4. "Can you rate the pain on a scale of 1 to 10, with 10 being the

worst?"

109. Endovenous laser treatment (EVLT) is done on a client with varicose veins. Which

interventions should the nurse include in the post-procedure plan of care?

 NCLEX RN Cardiovascular Q&As 56
1. Inform the client that the EVLT procedure ensures closure of the

treated vein.

2. Assess color and temperature of the affected limb to determine

vascular status.

3. Teach the client the importance of using graduated compression

stockings (GCSs) during the day.

4. Inform the client that circulation impairment and nerve damage is

expected to occur following the procedure.

110. The nurse is conducting a health history of a client with a primary diagnosis of heart

failure. Which conditions reported by the client could play a role in exacerbating the heart

failure? Select all that apply.

1. Emotional stress

2. Atrial fibrillation

3. Nutritional anemia

4. Peptic ulcer disease

5. Recent upper respiratory infection

111. The registered nurse (RN) is listening to a lecture on pulmonary edema. Which

statement by the RN indicates that the teaching has been effective?

 NCLEX RN Cardiovascular Q&As 57
1. "The client may have mild anxiety."

2. "The client will not experience anxiety."

3. "The client will experience extreme anxiety."

4. "The client will only experience anxiety in a stressful

environment."

112. A client with pulmonary edema has been receiving diuretic therapy. The client has a

prescription for additional furosemide in the amount of 40 mg intravenous push. Knowing that

the client will also be started on digoxin, which laboratory result should the nurse review as

the priority?

1. Sodium level

2. Digoxin level

3. Creatinine level

4. Potassium level

113. A client is at risk for vasovagal attacks that cause brady dysrhythmias. The nurse would

tell the client to avoid which actions to prevent this occurrence? Select all that apply.

1. Applying pressure on the eyes

2. Raising the arms above the head

 NCLEX RN Cardiovascular Q&As 58
3. Taking stool softeners on a daily basis

4. Bearing down during a bowel movement

5. Simulating a gag reflex when brushing the teeth

114. The nurse employed in a cardiac unit determines that which client is the least likely to

have an implanted cardioverter-defibrillator (ICD) inserted?

1. A client with syncopal episodes related to ventricular tachycardia

2. A client with ventricular dysrhythmias despite medication therapy

3. A client with an episode of cardiac arrest related to myocardial

infarction

4. A client with 3 episodes of cardiac arrest unrelated to myocardial

infarction

115. The nurse is caring for a client immediately after insertion of a permanent demand

pacemaker via the right subclavian vein. Which activity will assist with preventing

dislodgement of the pacing catheter?

1. Limiting both movement and abduction of the left arm

2. Limiting both movement and abduction of the right arm

3. Assisting the client to get out of bed and ambulate with a walker
 NCLEX RN Cardiovascular Q&As 59
4. Having the physical therapist do active range-of-motion exercises

to the right arm

116. A client seeks treatment in a health care provider's office for unsightly varicose veins,

and radiofrequency ablation (RFA) is recommended. Before leaving the examining room, the

client says to the nurse, "Can you tell me again how this is done?" Which statement should the

nurse make?

1. "The varicosity is surgically removed."

2. "A heating element is used to occlude the vein."

3. "The vein is tied off at the upper end to prevent stasis from

occurring."

4. "The vein is tied off at the lower end to prevent stasis from

occurring."

117. A client is having a follow-up health care provider (HCP) office visit after vein ligation

and stripping. The client describes a sensation of "pins and needles" in the affected leg. Which

would be an appropriate action by the nurse based on evaluation of the client's comment?

1. Report the complaint to the HCP.

2. Instruct the client to apply warm packs.

3. Reassure the client that this is only temporary.

 NCLEX RN Cardiovascular Q&As 60
4. Advise the client to take acetaminophen until it is gone.

118. A client is scheduled for a cardiac catheterization using an iodineagent. Which

assessment is mostcritical before the procedure?

1. Intake and output

2. Height and weight

3. Baseline peripheral pulse rates

4. Previous allergy to contrast agents

119. The nurse is assessing a client with an abdominal aortic aneurysm. Which assessment

finding by the nurse is unrelated to the aneurysm?

1. Pulsatile abdominal mass

2. Hyperactive bowel sounds in the area

3. Systolic bruit over the area of the mass

4. Subjective sensation of "heart beating" in the abdomen

120. The nurse is providing postoperative care for a client who had a percutaneous insertion

of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should

be most concerned about monitoring for which potential complications?

 NCLEX RN Cardiovascular Q&As 61
1. Bleeding and infection

2. Thrombosis and infection

3. Bleeding and wound dehiscence

4. Wound dehiscence and evisceration

121. The nurse is listening to a lecture on Advanced Cardiac Life Support (ACLS). The

instructor is discussing electrocardiographic (ECG) changes caused by myocardial ischemia.

Which statement by the nurse indicates that teaching has been effective?

1. "Tall, peaked T waves can indicate ischemia."

2. "Prolonged PR interval can indicate ischemia."

3. "Widened QRS complex can indicate ischemia."

4. "ST segment elevation or depression can indicate ischemia."

Rationale:

An ECG taken during a chest pain episode captures ischemic changes, which include ST segment

elevation or depression. Tall, peaked T waves may indicate hyperkalemia. A prolonged PR interval

indicates first-degree heart block. A widened QRS complex indicates delay in intraventricular

conduction, such as a bundle branch block.

122. The nurse is preparing to ambulate a client on the third day after cardiac surgery. What

should the nurse plan to do to enable the client to best tolerate the ambulation?
 NCLEX RN Cardiovascular Q&As 62
1. Remove telemetry equipment.

2. Provide the client with a walker.

3. Premedicate the client with an analgesic.

4. Encourage the client to cough and breathe deeply.

123. A client with rapid-rate atrial fibrillation asks the nurse why the health care provider

(HCP) is going to perform carotid sinus massage. The nurse educates the client about the

treatment. Which statement by the client indicates that the teaching has been effective?

1. "The vagus nerve slows the heart rate."

2. "The diaphragmatic nerve slows the heart rate."

3. "The diaphragmatic nerve overdrives the rhythm."

4. "The vagus nerve increases the heart rate, overdriving the

rhythm."

124. The nurse assesses the sternotomy incision of a client on the third day after cardiac

surgery. The incision shows some slight puffiness along the edges and is non-reddened, with

no apparent drainage. The client's temperature is 99°F (37.2°C) orally. The white blood cell

count is 7500 mm3 (7.5 × 109/L). How should the nurse interpret these findings?

1. Incision is slightly edematous but shows no active signs of

infection.
 NCLEX RN Cardiovascular Q&As 63
2. Incision shows early signs of infection, although the temperature

is nearly normal.

3. Incision shows no sign of infection, although the white blood cell

count is elevated.

4. Incision shows early signs of infection, supported by an elevated

white blood cell count.

Rationale:

Sternotomy incision sites are assessed for signs and symptoms of infection, such as redness, swelling,

induration, and drainage. An elevated temperature and white blood cell count 3 to 4 days

postoperatively usually indicate infection. Therefore, the option indicating that there is slight edema

and no active signs of infection is correct.

125. The nurse notes bilateral 2+ edema in the lower extremities of a client with myocardial

infarction who was admitted 2 days ago. Based on this observation, what should the nurse plan

to do first?

1. Review intake and output records for the last 2 days.

2. Prescribe daily weights starting on the following morning.

3. Change the time of diuretic administration from morning to

evening.

4. Request a sodium restriction of 1 g/day from the health care

provider (HCP).
 NCLEX RN Cardiovascular Q&As 64

126. The nurse is evaluating a client's cardiac rhythm strip to determine if there is proper

function of the VVI mode pacemaker. Which denotes proper functioning?

1. Spikes precede all P waves and QRS complexes.

2. There are consistent spikes before each P wave.

3. Spikes occur before QRS complexes when intrinsic ventricular

beats do not occur.

4. Spikes occur before all QRS complexes regardless of intrinsic

ventricular activity.

127. The nurse determines that a client requires further teaching after permanent

pacemaker insertion if which statement is made?

1. "My pulse rate should be less than what my pacemaker is set at."

2. "I'll need to call my health care provider if I feel tired or dizzy."

3. "I'll have to avoid carrying the grocery bags into the house for the

next 6 weeks."

4. "It's safe to use my microwave as long it is properly grounded and

well shielded."
 NCLEX RN Cardiovascular Q&As 65

128. The nurse is reviewing the procedure for performance of an electrocardiogram (ECG).

Which action by the nurse indicates understanding of the correct position for the V1lead when

performing a 12-lead electrocardiogram?

1. "The lead should be placed on the fourth intercostal space left

sternal border."

2. "The lead should be placed on the fourth intercostal space right

sternal border."

3. "The lead should be placed on the fifth intercostal space left

midaxillary line."

4. "The lead should be placed on the fifth intercostal space left

midclavicular line."

129. After instruction on the application of antiembolism stockings, the nurse determines

that the client requires further teaching if which of these actions is performed?

1. The client puts on the stockings before getting out of bed.

2. The client bunches up the stockings for easier application.

3. The client ensures that stockings are pulled up all the way.
 NCLEX RN Cardiovascular Q&As 66
4. The client ensures that the rough seams of the stockings are on the

outside.

130. The nurse is assessing a client newly diagnosed with mild hypertension. Which

assessment finding should the nurse expect?

1. Asymptomatic

2. Shortness of breath

3. Visual disturbances

4. Frequent nosebleeds

131. The nurse monitors the client for which condition as a complication of polycythemia

vera?

1. Thrombosis

2. Hypotension

3. Cardiomyopathy

4. Pulmonary edema

Rationale:

Polycythemia vera is a disorder of the bone marrow. It results in excessive production of white blood

cells, red blood cells, and platelets. Clients with polycythemia vera are also more likely to form blood

clots that can cause thrombi, strokes, myocardial infarctions, and abnormal bleeding. Clients with
 NCLEX RN Cardiovascular Q&As 67
polycythemia vera are hypertensive; therefore, hypotension is incorrect. Cardiomyopathy and

pulmonary edema are not concerns with this disorder.

132. A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's

cardiac monitor. Which is the nurse's first action?

1. Check the blood pressure.

2. Call the health care provider (HCP).

3. Check the client and the chest leads.

4. Initiate cardiopulmonary resuscitation (CPR).

133. Which is the priority assessment in the care of a client who is newly admitted to the

hospital for acute arterial insufficiency of the left leg and moderate chronic arterial

insufficiency of the right leg?

1. Monitor oxygen saturation with pulse oximetry.

2. Assess activity tolerance before and after exercise.

3. Observe the client's cardiac rhythm with telemetry.

4. Assess peripheral pulses with an ultrasonic Doppler device.

 NCLEX RN Cardiovascular Q&As 68
134. A client's electrocardiogram shows that the ventricular rhythm is irregular and there are

no discernible P waves. The nurse recognizes that this pattern is associated with which

condition?

1. Atrial flutter

2. Atrial fibrillation

3. Third-degree atrioventricular (AV) block

4. First-degree AV block

135. The nurse is caring for a client after an above-the-knee amputation. The nurse assesses

the residual (remaining) limb and expects to note which finding?

1. Pink color to the skin flap

2. Hot feeling on palpation of the skin flap

3. Serous fluid leaking from the skin flap incision

4. Absent pulse at the proximal pulse point site closest to the skin

flap

136. An emergency room nurse is performing a cardiovascular assessment on a client. During

auscultation of the heart sounds, the nurse hears these abnormal sounds.

The nurse suspects that the client has which condition?

 NCLEX RN Cardiovascular Q&As 69
Stop Sound

1. Atrial fibrillation

2. Ventricular fibrillation

3. Ventricular hypertrophy

4. Left bundle branch block

137. The nurse is caring for a postoperative client who has lost a significant amount of blood

because of complications during a surgical procedure. Which assessment finding would be

indicative of further fluid volume deficit?

1. 4+ edema noted in lower extremities

2. Crackles auscultated from lung bases to apices

3. Blood pressure rises from 116/68 to 118/74 mm Hg

4. Pulse rate increases from 100 beats/min to 136 beats/min

138. The nurse reading the operative record of a client who had cardiac surgery notes that the

client's cardiac output immediately after surgery was 3.2 L/min. Evaluation of the cardiac

output results leads the nurse to make which conclusion?

1. The cardiac output is above the normal range.

 NCLEX RN Cardiovascular Q&As 70
2. The cardiac output is below the normal range.

3. The cardiac output is in the low-normal range.

4. The cardiac output is in the high-normal range.

Rationale:

The normal cardiac output for the adult can range from 4 to 7 L/min. Therefore, a cardiac output of

3.2 L/min is below normal range.

139. The nurse is auscultating a 56-year-old adult client's apical heart rate before giving

digoxin and notes that the heart rate is 48 beats/minute. Which action should the nurse take?

1. Withhold the digoxin and re-evaluate the heart rate in 4 hours.

2. Administer half of the prescribed dose to avoid a further decrease

in heart rate.

3. Withhold the digoxin and assess for signs of decreased cardiac

output and digoxin toxicity.

4. Administer the digoxin; the heart rate would be considered normal

because of the client's age.

140. A new registered nurse (RN) is assisting the RN in admitting a client who has a

diagnosis of hypothermia. The RN provides education to the new RN on anticipated vital signs

in the client with hypothermia. Which statement by the new RN indicates that the teaching has

been effective?
 NCLEX RN Cardiovascular Q&As 71
1. "The client will likely exhibit increased heart rate and increased

blood pressure."

2. "The client will likely exhibit increased heart rate and decreased

blood pressure."

3. "The client will likely exhibit decreased heart rate and increased

blood pressure."

4. "The client will likely exhibit decreased heart rate and decreased

blood pressure."

141. A client has been admitted with left-sided heart failure. When planning care for the

client, interventions should be focused on reduction of which specific problem associated with

this type of heart failure?

1. Ascites

2. Pedal edema

3. Bilateral lung crackles

4. Jugular vein distention

142. The nurse is educating the client about variant angina. Which statement by the client

indicates that the teaching has been effective?

1. "Variant angina is induced by exercise."

 NCLEX RN Cardiovascular Q&As 72
2. "Variant angina occurs at the same time each day."

3. "Variant angina occurs at lower levels of activity."

4. "Variant angina is less predictable and a precursor of myocardial

infarction."

Rationale:

Variant angina, or Prinz metal's angina, is prolonged and severe and occurs at the same time each

day, usually in the morning. Stable angina is induced by exercise and relieved by rest or nitroglycerin

tablets. Unstable angina occurs at lower levels of activity than those that previously precipitated the

angina. Unstable angina also occurs at rest, is less predictable, and is often a precursor of myocardial

infarction.

143. A client's total cholesterol level is 344 mg/dL (8.6 mmol/L), low-density lipoprotein

cholesterol (LDL-C) level is 164 mg/dL (4.25 mmol/L), and high-density lipoprotein

cholesterol (HDL-C) level is 30 mg/dL (1.2 mmol/L). Based on analysis of the data, how should

the nurse direct client teaching?

1. The client should maintain the current dietary regimen but

increase activity level.

2. Results are inconclusive unless the triglyceride level is also

screened, so teaching is not indicated at this time.

3. The client is at high risk for cardiovascular disease, and measures

to modify all identified risk factors should be taught.

 NCLEX RN Cardiovascular Q&As 73
4. The client is at low risk for cardiovascular disease, so the client

should be encouraged to continue to follow the current regimen.

Rationale:

In the absence of documented cardiovascular disease, the desired goal is to have the total cholesterol

level lower than 200 mg/dL (<5 mmol/L). A desired LDL-C level for all individuals is lower than 100

mg/dL (<2.59 mmol/L), and a desirable HDL-C level is higher than 40 mg/dL (>1.55 mmol/L).

Because the client's levels are outside the range to a significant degree for all three values, the client is

at high risk for developing cardiovascular disease and requires teaching on risk factor reduction.

144. An ambulatory care nurse measures the blood pressure of a client and finds it to be

156/94 mm Hg. Which statement indicates that the client needs additional education?

1. "It is important that I limit protein intake."

2. "I need to maintain a regular exercise program."

3. "I understand that I need to avoid adding salt to foods."

4. "It is important that I begin reducing and then maintaining

weight."

145. The nurse identifies that a client is having occasional premature ventricular contractions

(PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and

determines that which result would be consistent with the observation?

1. Serum chloride level of 98 mEq/L (98 mmol/L)

 NCLEX RN Cardiovascular Q&As 74
2. Serum sodium level of 145 mEq/L (145 mmol/L)

3. Serum calcium level of 10.5 mg/dL (2.75 mmol/L)

4. Serum potassium level of 2.8 mEq/L (2.8 mmol/L)

146. The nurse is performing a cardiovascular assessment on a client. Which parameter

would the nurse assess to gain the best information about the client's left-sided heart

function?

1. Breath sounds

2. Peripheral edema

3. Hepatojugular reflux

4. Jugular vein distention