NCLEX 3500: Cardiac Exam Questions With 100% Correct Answers 2024/2025
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NCLEX 3500
NCLEX 3500: Cardiac Exam Questions With 100% Correct Answers 2024/2025
Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's:
1. electro...
NCLEX 3500: Cardiac Exam Questions With
100% Correct Answers 2024/2025
Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion
of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the
client's:
1. electrocardiogram (ECG).
2. urine output.
3. creatine kinase (CK) and troponin levels.
4. blood pressure and heart rate.
Correct Answer: 1
RATIONALES: Lidocaine is an antiarrhythmic and is given for the treatment of cardiac irritability and
ventricular arrhythmias. The best indicator of its effectiveness is a reduction in or disappearance of
ventricular arrhythmias as seen on an ECG. Urine output is an indicator of pump effectiveness; CK and
troponin levels monitor myocardial damage. Blood pressure and heart rate measurements are too
nonspecific to help determine the effectiveness of parenteral lidocaine.
A client is admitted to the emergency department after complaining of acute chest pain radiating
down his left arm. Which laboratory studies would be indicated?
1. Hemoglobin and hematocrit
2. Serum glucose
3. Creatinine phosphokinase (CPK)
4. Troponin T and troponin I
5. Myoglobin
6. Blood urea nitrogen (BUN)
Correct Answer: 3,4,5
RATIONALES: Levels of CPK, troponin T, and troponin I elevate because of cellular damage. Myoglobin
elevation is an early indicator of myocardial damage. Hemoglobin, hematocrit, serum glucose, and
BUN levels don't provide information related to myocardial ischemia.
A client is admitted to an acute care facility with pneumonia. When auscultating heart sounds, the
nurse notes a fixed split of the second heart sound (S2) — a pathological split that doesn't vary with
respirations. A fixed S2 split is the hallmark of:
1. right bundle-branch block.
2. left bundle-branch block.
3. atrial septal defect.
4. aortic stenosis.
Correct Answer: 3
RATIONALES: A fixed S2 split is the hallmark of atrial septal defect. This split, which is continuous and
doesn't vary with respirations, results from prolonged emptying of the right ventricle. A right bundle-
branch block causes a wide S2 split that is louder on inspiration than on expiration; this split results
from delayed depolarization of the right ventricle and late pulmonic valve closure. Left bundle-branch
block, aortic stenosis, and patent ductus arteriosus cause a paradoxical S2 split. Heard only on
expiration, a paradoxical S2 split results from delayed aortic valve closure.
A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous I.V.
infusion. Which statement by the client indicates that this drug is producing its therapeutic effect?
1. "I have a bad headache."
2. "My chest pain is decreasing."
3. "I feel a tingling sensation around my mouth."
4. "My blood pressure must be up because my vision is blurred."
Correct Answer: 2
RATIONALES: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the
myocardium, thus producing its intended effect: relief of chest pain. Headache is an adverse effect of
,nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not
raise, blood pressure.
A client with refractory angina is scheduled for a percutaneous transluminal coronary angioplasty
(PTCA). The cardiologist orders an infusion of abciximab (ReoPro). Before beginning the infusion, the
nurse should ensure the client has:
1. negative history of tonic-clonic seizures.
2. ampule of naloxone (Narcan) at the bedside.
3. continuous electrocardiogram (ECG) monitoring.
4. up-to-date partial thromboplastin time (PTT) result in his record.
Correct Answer: 4
RATIONALES: Clients undergoing PTCA receive abciximab because it inhibits platelet aggregation and,
thereby, reduces cardiac ischemic complications. Before abciximab is administered, the client should
have an up-to-date PTT result available. The drug isn't contraindicated in clients with a seizure history.
Abciximab isn't an opioid; therefore, an opioid antagonist doesn't need to be at the bedside. Any
client with refractory angina should be on continuous ECG monitoring; however, monitoring isn't a
requirement for administering abciximab.
The telemetry unit nurse is caring for a client who was just transferred from the coronary care unit
(CCU). The client is anxious because he fears he won't be monitored as closely as he was in the CCU.
How can the nurse allay his fears?
1. Assign the same nurse to the client when possible.
2. Allow the client uninterrupted periods of rest as much as possible.
3. Limit the client's visitors to coincide with CCU visiting policy.
4. Move the client to a room far from the nurses' station to reduce his exposure to noise.
Correct Answer: 1
RATIONALES: Assigning the same nurse to the client when possible provides continuity of care and
stability, thereby reducing his anxiety. The client needs uninterrupted periods of rest; however,
providing as much rest as possible may leave the client feeling isolated. Feelings of isolation can
increase the client's anxiety, and having visitors can help distract the client. A room close to nurses'
station would provide this client with a sense of security because the nurses are close by in the event
of an emergency.
Before administering digoxin (Lanoxin), a nurse reviews information about the drug. She learns that
after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the:
1. lungs.
2. kidneys.
3. feces.
4. skin.
Correct Answer: 2
RATIONALES: After digoxin is metabolized, the kidneys eliminate remaining digoxin as unchanged
drug. Therefore, a
client with renal dysfunction will require a decreased digoxin dosage. Although some drugs may be
eliminated by other routes, digoxin isn't known to be eliminated by way of the lungs, feces, or skin.
The nurse determines that a hockey player hospitalized with bilateral leg fractures is
hemodynamically stable and observes the following pattern on the electrocardiogram (ECG) monitor.
Which nursing intervention is most appropriate at this time?
1. None; this arrhythmia is benign
2. Administering atropine sulfate, 0.5 mg, as prescribed, to increase the heart rate
3. Continuing to monitor for lengthening PR intervals
4. Evaluating the client's recent serum electrolyte studies
Correct Answer: 1
,RATIONALES: This ECG shows sinus arrhythmia with a rate of 70 beats/minute. In this benign
arrhythmia, the rhythm is irregular; the impulse originates in the sinoatrial node and travels down the
conduction system normally. The P-P interval is irregular; a P wave precedes every QRS complex; and
the R-R interval is irregular, increasing with inspiration and decreasing with expiration. Sinus
arrhythmia commonly is associated with vagal inhibition caused by respiration. It seldom causes
symptoms and doesn't call for atropine or other treatment. Continuing to monitor for lengthening PR
intervals isn't necessary because the PR interval doesn't increase with sinus arrhythmia. Because this
arrhythmia isn't caused by an electrolyte imbalance, evaluating serum electrolyte studies isn't
warranted.
The nurse would advise the client with an axillofemoral bypass graft to avoid:
1. standing for prolonged periods.
2. tight belts.
3. reclining and instead sit in a chair for prolonged periods.
4. upper-extremity exercises.
Correct Answer: 2
RATIONALES: Tight belts around the waist can occlude the axillofemoral bypass; the client should use
suspenders instead. Prolonged sitting can kink the femoral portion of the graft. Prolonged standing
and upper-extremity exercises need not be avoided.
The nurse administers basic cardiac life support to a client in cardiac arrest. Which action does the
nurse perform?
1. Assessing the patency of the airway
2. Administering I.V. medications
3. Administering a countershock of 200 joules
4. Breathing for the client after inserting an endotracheal (ET) tube
Correct Answer: 1
RATIONALES: A nurse certified in basic cardiac life support can assess airway patency. I.V. medications
given to maintain blood pressure, correct acidosis, or restore a cardiac rhythm are administered by a
provider of advanced cardiac life support. Administering a countershock of 200 joules and breathing
for the client after inserting an ET tube are measures carried out during advanced life support.
The nurse is caring for a cardiac client who requires various cardiac medications. When the nurse
helps the client out of bed for breakfast, the client becomes dizzy and asks to lie down. The nurse
helps the client lie down, puts up the side rails, and obtains the client's blood pressure, which is 84/50
mm Hg. It's time for the nurse to administer the client's medications: nitroglycerin, metoprolol
(Lopressor), and furosemide (Lasix). Which action is best taken by the nurse?
1. Withhold the medications and notify the physician.
2. Administer the medications immediately.
3. Encourage the client to sit up and eat breakfast.
4. Administer the nitroglycerin and metoprolol and withhold the furosemide.
Correct Answer: 1
RATIONALES: The nurse should withhold the three medications and notify the physician. Each of these
medications has the potential to lower the client's blood pressure. Administering them together when
the client is already hypotensive may severely lower the client's blood pressure. The client may
continue to experience dizziness when sitting up so breakfast should be held until his blood pressure
stabilizes.
A client with a permanent pacemaker and a long history of cardiac disease is admitted to the coronary
care unit for evaluation for heart failure. The nurse observes the following electrocardiogram (ECG)
pattern. What does this pattern indicate?
1. Use of a DDD pacemaker with a rate of 78 beats/minute
2. Use of a VVI pacemaker with a rate of 72 beats/minute
, 3. Use of an AVI pacemaker with a rate of 76 beats/minute
4. Use of an AAI pacemaker with a rate of 80 beats/minute
Correct Answer: 2
RATIONALES: In the pacemaker identification code, the first letter stands for the heart chamber being
paced (atrium, ventricle, or both [D]); the second letter stands for the chamber being sensed (atrium,
ventricle, both, or none [O]); and the third letter stands for the pacemaker's response to the sensed
event (inhibited, triggered, both, or none). This ECG indicates use of a VVI pacemaker, which paces
and senses the ventricle and is inhibited by a sensed event (a spontaneous QRS complex). A spike
precedes every QRS complex stimulated by the pacemaker. Sensing that the client's intrinsic rate is
below 72 beats/minute, the pacemaker triggers a ventricular impulse. The other options give
incorrect rates; also, if the atrium were being paced, a spike would precede each P wave, indicating
atrial contraction.
During digoxin (Lanoxin) therapy, the nurse should closely monitor the client's:
1. serum potassium and magnesium levels.
2. urine glucose and ketones.
3. serum potassium and creatine kinase (CK) levels.
4. urine potassium and CK levels.
Correct Answer: 1
RATIONALES: During digoxin therapy, the nurse should closely monitor the client's serum potassium
and magnesium levels. This is because hypokalemia or hypomagnesemia can predispose the client to
digitalis toxicity. Glucose and ketones aren't usually in the urine except in a client with uncontrolled
diabetes, and digoxin isn't known to affect these levels in the diabetic. CK levels may be elevated if
digoxin is administered I.M., but this route of administration isn't recommended.
A client is participating in a cardiac research study in which his physician is directly involved. Which
statement by the client indicates a lack of understanding about his rights as a research study
participant?
1. "I can withdraw from the study at anytime."
2. "My confidentiality will not be compromised by this study."
3. "I will have to find a new physician if I do not complete this study."
4. "I understand the risks associated with this study."
Correct Answer: 3
RATIONALE: The client's participation in this study should not influence the relationship with his
physician. The client has the right to withdraw from a study at any time without penalty. All
information provided by the client will be kept confidential and used only by members of the study
team for scientific purposes. The client must be informed of all risks associated with study
participation.
A client with chest pain receives nitroglycerin on the way to the acute care facility. Based on an
electrocardiogram obtained on admission, the physician suspects a myocardial infarction (MI) and
prescribes I.V. morphine to relieve continuing pain. A primary goal of nursing care for this client is to
recognize life-threatening complications of an MI. The major cause of death after an MI is:
1. cardiogenic shock.
2. cardiac arrhythmia.
3. heart failure.
4. pulmonary embolism.
Correct Answer: 2
RATIONALES: Cardiac arrhythmias cause roughly 40% to 50% of deaths after MI. Heart failure, in
contrast, accounts for 33% and cardiogenic shock for 9% of post-MI deaths. Pulmonary embolism,
another potential complication of an MI, is less common.
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