Cardiac NCLEX Questions
Cardiac Resychonization Surgical Manage, Valvular Disease (mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, aortic regurgitation, infective endocarditis, pericarditis, rheumatic carditis, cardiomyopathy, surgical management
Terms in this set (29)
The nurse prepares to administer digoxin to a client with heart failure and notes the following information:
Temperature: 99.8 Pulse: 48 and irregular
Respirations: 20 Potassium level: 3.2 mEq/L
What action does the nurse take?
a. Give digoxin; reassess the heart rate in 30 minutes.
b. Give the digoxin; document assessment findings in the medical record.
c. Hold the digoxin, and obtain a prescription for an additional dose of furosemide.
d. Hold the digoxin, and obtain a prescription for a potassium supplement.
Answer: Hold the digoxin, and obtain a prescription for a potassium supplement
Rationale: Digoxin causes bradycardia; hypokalemia potentiates digitalis. The nurse seeks to correct this situation through collaboration with the provider.
A client with heart failure has furosemide (Lasix). Which finding would concern the nurse with this new prescription?
a. Serum sodium level of 135 mEq/L
b. Serum potassium level of 2.8 mEq/L
c. Serum creatinine of 1.0 mg/dL
d. Serum magnesium level of 1.9 mEq/L
Answer: Serum potassium level of 2.8 mEq/L
Rationale: Clients taking loop diuretics should be monitored for potassium deficiency from diuretic therapy
In monitoring the diagnostic test of a client admitted with heart failure (HF), which finding is consistent with this diagnosis?
a. Serum potassium level of 3.2 mEq/L
b. Ejection fraction of 60%
c. B-type natriuretic peptide (BNP) of 760 ng/dL
d. Chest x-ray report showing right middle lobe consolidation
Answer: B-type natriuretic peptide (BNP) of 760 ng/dL
Rationale: BNP is produced and released by the ventricles when the client has fluid overload as a result of HF; a normal value is less than 100 pg/mL
The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure. The nurse questions the client about the use of which medication because it raises an index of suspicion as to the cause of heart failure?
a. Ibuprofen (Motrin)
b. Hydrochlorothiazide (HydroDIURIL)
c. NPH Insulin
d. Levothyroxine (Synthroid)
Answer: Ibuprofen (Motrin)
Rationale: Long-term use of NSAIDs, such as ibuprofen (Motrin), causes fluid and sodium retention
The client begins therapy with lisinopril (Prinivil, Zestril). What should the nurse consider at the start of therapy with this medication?
a. The client's ability to understand medication teaching
b. The risk for hypotension
c. The potential for bradycardia
d. Liver function tests (LFTs)
Answer: The risk for hypotension
Rationale: Angiotensin-converting enzyme (ACE) inhibitors are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.
The nurse is caring for a client with heart failure. For which symptoms should the nurse assess? Select all that apply.
a. Chest discomfort or pain
c. Expectorates thick, yellow sputum
d. Sleeps on back without a pillow
e. Shortness of breath with exertion
Answer: Chest discomfort or pain; Tachycardia; Shortness of breath with exertion
The nurse caring for a client discusses the importance of restricting sodium in the diet. Which statement made by the client indicates that he needs further teaching?
a. "I should avoid grilling hamburgers."
b. "I must cut out bacon and canned foods."
c. "I shouldn't put the salt shaker on the table anymore."
d. "I should avoid lunch meats but may cook my own turkey."
Answer: "I should avoid grilling hamburgers."
Rationale: Cutting out beef or hamburgers made at home is not necessary; however, fast food hamburgers are to be avoided owing to higher sodium content.
The nurse caring for the client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply.
b. Sinus bradycardia
d. Serum digoxin level of 1.5
Answer: Sinus bradycardia; Fatigue; Anorexia
The nurse recognizes that which medication when given in heart failure may improve morbidity and mortality?
a. Dobutamine (Dobutrex)
b. Carvedilol (Coreg)
c. Digoxin (Lanoxin)
d. Bumetamide (Bumex)
Answer: Carvedilol (Coreg)
Rationale: Beta-adrenergic blockers reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure; they improve morbidity, mortality, and quality of life
How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen?
a. Ejection fraction is 25%.
b. Client states that she is able to sleep on one pillow.
c. Client was hospitalized five times last year with pulmonary edema.
d. Client reports that she experiences palpitations.
Answer: Client states that she is able to sleep on one pillow
Rationale: Improvement in activity tolerance, less orthopnea, and improved symptoms represent a positive response to beta blockers.
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy?
a. Client ambulates around the nursing unit with a walker.
b. The nurse monitors the client's pulse and blood pressure frequently.
c. The nurse obtains a bedside commode before administering furosemide.
d. The nurse returns the client to bed when he becomes tachycardic.
Answer: The nurse obtains a bedside commode before administering furosemide.
Rationale: Limiting the need for ambulation on the first day of admission to sitting in a chair or performing basic leg exercises promotes physical rest and reduced oxygen demand.
Which intervention will best assist the client with acute pulmonary edema in reducing anxiety and dyspnea?
a. Monitor pulse oximetry and cardiac rate and rhythm.
b. Reassure the client that his distress can be relieved with proper intervention.
c. Place the client in high Fowler's position with the legs down.
d. Ask a family member to remain with the client.
Answer: Place the client in high Fowler's position with the legs down
Rationale: High Fowler's position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion.
The nurse is providing discharge teaching to the client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates understanding of the teaching?
a. "I will call the provider if I have a cough lasting 3 or more days."
b. "I will report to the provider weight loss of 2 to 3 pounds in a day."
c. "I will try walking for 1 hour each day."
d. "I should expect occasional chest pain."
Answer: "I will call the provider if I have a cough lasting 3 or more days."
Rationale: Cough, a symptom of heart failure, is indicative of intra-alveolar edema; the provider should be notified.
A client admitted for heart failure has a priority problem of Excess Fluid Volume related to compromised regulatory mechanisms. Which of these assessment data obtained the day after admission is the best indicator that the treatment has been effective?
a. The client has a diuresis of 400 mL in 24 hours.
b. The client's blood pressure is 122/84 mm Hg.
c. The client has an apical pulse of 82 beats/min.
d. The client's weight decreases by 2.5 kg.
Answer: The client's weight decreases by 2.5 kg.
Rationale: The best indicator of fluid volume loss is daily weight; because each kilogram represents approximately 1 L, this client has lost approximately 2500 mL of fluid.
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions?
a. Auscultation of crackles
b. Pedal edema
c. Weight loss of 6 pounds since the last visit
d. Reports sucking on ice chips all day for dry mouth
Answer: Weight loss of 6 pounds since the last visit
Rationale: Weight loss in this client indicates effective fluid restriction and diuretic drug therapy
The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action should the nurse take first?
a. Assess the client for peripheral edema.
b. Listen to the client's posterior breath sounds.
c. Notify the physician about the client's weight gain.
d. Remind the client about dietary sodium restrictions.
Answer: Listen to the client's posterior breath sounds.
Rationale: Because the client is at risk for pulmonary edema and hypoxemia, the first action should be to assess breath sounds.
Which of these nursing actions should the nurse delegate to a nursing assistant working on the medical unit?
a. Determine the usual alcohol intake for a client with cardiomyopathy.
b. Monitor the pain level for a client with acute pericarditis.
c. Obtain daily weights for several clients with class IV heart failure.
d. Check for peripheral edema in a client with endocarditis.
Answer: Obtain daily weights for several clients with class IV heart failure.
Rationale: Daily weight assessment is included in the role of the nursing assistant, who will report the weights to the RN.
The client who has been admitted for the third time this year for cardiac failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response?
a. Calls the family to lift the client's spirits
b. Considers further assessment for depression
c. Sedates the client to decrease myocardial oxygen demand
d. Tells the client that things will get better
Answer: Considers further assessment for depression
Rationale: This client is at risk for depression because of the diagnosis of heart failure, and further assessment should be done.
Which priority problems may be considered for the client with heart failure? Select all that apply.
a. Decreased fluid volume related to compromised regulatory mechanism
b. Impaired Physical Mobility related to limited cardiovascular endurance
c. Impaired Gas Exchange related to ventilation-perfusion imbalance
d. Potential for pulmonary edema
e. Risk for Ineffective renal Perfusion related to hypervolemia
Answer: Impaired Physical Mobility related to limited cardiovascular endurance; Impaired Gas Exchange related to ventilation-perfusion imbalance; Potential for pulmonary edema; Risk for Ineffective renal Perfusion related to hypervolemia
Although the client with cardiac failure is asymptomatic, the nurse suspects noncompliance with prescribed home therapy. Which laboratory test confirms the nurse's suspicions?
a. B-type natriuretic peptide (BNP) 90 pg/mL
b. Serum electrolytes
c. Hemoglobin and hematocrit
d. Digoxin level of 0.2 ng/dL
Answer: Digoxin level of 0.2 ng/dL
Rationale: A therapeutic digoxin level is 0.8 to 2.0 ng/dL. A level of 0.2 ng/dL indicates that the client has not been taking his digoxin as prescribed.
The nurse is caring for the client with congestive heart failure (CHF) in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client?
a. Determines the client's physical limitations
b. Encourages alternate rest and activity periods
c. Monitors and documents heart rate, rhythm, and pulses
d. Positions the client to alleviate dyspnea
Answer: Positions the client to alleviate dyspnea
Rationale: Positioning the client to alleviate dyspnea will help ease air hunger and anxiety.
The nurse is assessing the client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis?
a. Friction rub auscultated at the left lower sternal border
b. Pain aggravated by breathing, coughing, and swallowing
c. Splinter hemorrhages
d. Thickening of the endocardium
Answer: Splinter hemorrhages
Rationale: Splinter hemorrhages are indicative of infective endocarditis.
The client, a college athlete who has collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response?
a. "How does this make you feel?"
b. "This can be caused by taking performance-enhancing drugs."
c. "This may be caused by a genetic trait."
d. "Just imagine how bad it would be if you weren't in good shape."
Answer: "This may be caused by a genetic trait."
Rationale: Hypertrophic cardiomyopathy is often transmitted as a single-gene autosomal dominant trait.
After receiving change-of-shift report about these four clients, which client should the nurse assess first?
a. The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes
b. The 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94%
c. The 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths
d. The 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, rate 104
Answer: The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes
Rationale: This client's premature ventricular complexes may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity should be done and the physician notified about the dysrhythmia.
Which of these clients is best to assign to an LPN/LVN working on the telemetry unit?
a. A client with heart failure who is receiving dobutamine (Dobutrex)
b. A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea
c. A client with pericarditis who has a paradoxical pulse and distended jugular veins
d. A client with rheumatic fever who has a new systolic murmur
Answer: A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea
Rationale: This client, who needs oxygen only with exertion, is the most stable; administration of oxygen to a stable client is within the scope of LPN/LVN practice.
When caring for a client who has undergone a partial left ventriculectomy, which of these new-onset clinical manifestations indicates the need for immediate action by the nurse?
a. Chest pain with movement
b. Fatigue after ambulation
c. Muffled heart sounds
d. Bi-basilar fine crackles
Answer: Muffled heart sounds
Rationale: Muffled heart sounds may be a clinical manifestation of bleeding into the pericardial space; the nurse should assess the client for possible decreased cardiac output and should notify the surgeon.
A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply.
a. Peripheral edema
b. Crackles in both lungs
e. Lung congestion
p. 749, Physiological Integrity
Answer: Peripheral edema; Crackles in both lungs; Eng congestion
Rationale: Clients diagnosed with right-sided heart failure generally retain fluid. Assessment findings are often related to the fluid gain and include increased weight gain, peripheral edema, crackles in the lungs (indicative of fluid in the lung tissues), and shortness of breath from the fluid accumulation.
A client has been taking furosemide (Lasix) for the past 3 years. This morning, the hospital laboratory notifies the nurse that the client's serum potassium level is 2.9 mEq/L. What is the nurse's best action at this time?
a. Notify the health care provider.
b. Ask the lab to retest the potassium level.
c. Give potassium as an IV infusion.
d. Withhold this morning's Lasix dose.
p. 752, Physiological Integrity
Answer: Ask the lab to retest the potassium level
Rationale: This potassium value is at a critical level. The nurse should request that the lab confirm that this value is accurate since the client has been taking furosemide for 3 years. The lab value should be confirmed prior to contacting the health care provider for orders.
An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action?
a. Call the ED physician immediately.
b. Draw a serum digoxin level.
c. Assess for signs of hypokalemia.
d. Establish the client's airway.
p. 753, Physiological Integrity
Answer: Draw a serum digoxin level
Rationale: The client has signs and symptoms of digoxin toxicity and needs to be placed on a monitor immediately to determine the extent of effects on the heart and conduction system. Symptoms of digoxin toxicity include blurred vision or yellow or green halos around visual images, confusion, muscle weakness, and vertigo. Toxicity may be increased from furosemide-induced hypokalemia. This can lead to premature ventricular contractions (PVCs) that may lead to other life-threatening dysrhythmias and death. Clients need to be cautioned not to store both digoxin and furosemide in the same container. The most common dose of each medication is available in a small white pill (similar in appearance), increasing the chances of error.